Heeeeeeere's Obamacare!

[Emily's Cat]

What would you say would comprise (in terms of care used) a reasonable amount to expect and budget for in a year... for example, how many ER visits, how many check up visits, etc? Not the dollars yet--just what care to expect to need.

I can answer this.

An average adult should budget for 3 doctor's office visits, one ER visit with one follow-up, and 3 to 5 prescriptions.

Costs vary by region, but on average we're talking $100 per office visit, $3000 per ER visit, $250 for followup, and about $50 for Rx. So... $3600 per individual stuffed in the bank for an average health care experience.

Actually, this is higher than strictly average, because the average person has 1 ER visit about every 4 years.

If you started contributing to a savings plan specifically for health care when you were fairly young, a reasonable person could save $5000 in just a few years, even with a modest income. Once that base is built up, you only need an insurance plan that will cover hospital and facility expenses that are higher than $5000... which didn't used to be all that expensive. Then the insurance acts as it ought - as financial security.

Of course, this hinges on people's willingness to forego instant gratification in preference to long-term security. Humans aren't very good at that.

 

[Emily's Cat]

For people who cannot afford insurance under ACA there is an exception to allow them to purchase catastrophic insurance

No there's not. For people who are under age 30, they can purchase a catastrophic plan... but the cat plans aren't much cheaper or much different in design than a Bronze plan. It has nothing to do with what they can afford.

 

[DavidJames]

They're not really solving any new or interesting technical problems, they've had plenty of time, and it really isn't that complicated. I've worked on many much more complicated rollouts in the private sector.

People couldn't even create accounts and log in. That is basic stuff.

Considering how much technical information has been provided (none) regarding the solution you have no information to reach such a conclusion.

In other words you are blowing smoke, making stuff up.

 

[Emily's Cat]

$400 million and 3 years, 8 months wasn't enough time and resources to get a website operational?

To be fair, they didn't have 3 years, 8 months. The ACA as written left a whole lot of stuff to be figured out, including how the interaction between states and the fed would work, who is responsible for validating which pieces of information, and a lot of other bits that would be vital to the foundational design of the web site. I don't have an exact date... but I'd guess they realistically had only about a year and a half.

Some of the rules weren't finalized until December last year. A few of them weren't finalized until March of this year. And those are only the ones I know about, that directly affected my job; I don't know how many open questions there were for the website.

 

[xjx388]

Of course, this hinges on people's willingness to forego instant gratification in preference to long-term security. Humans aren't very good at that.

This is the big issue, isn't it?

My biggest problem is the idea that those who DO consider their long-term security and fit their lives and budget around that, somehow have an additional burden to make sure the people that don't do that are protected.

 

[Emily's Cat]

That number you keep throwing out doesn't seem reasonable. Obviously, the money was used on more than the website. There are dozens of data sources that needed interfaces. From what I've read, old legacy databases, like those needed in order to connect up users, IRS data, health insurance companies, and state regulations, all required different teams.



Under what criteria is a health exchange that covers 36 states, each with their own laws and regulations, each with their own set of insurance companies, ALL of whom are run by people who are hostile to the process (or else they'd have set up their own exchange) "simple"?

These are very good points.

 

[Emily's Cat]

This is the big issue, isn't it?

WEll, it's one of them

My biggest problem is the idea that those who DO consider their long-term security and fit their lives and budget around that, somehow have an additional burden to make sure the people that don't do that are protected.

Oh I get that, completely. For me, though, this is where the philosophic and the pragmatic come into conflict. I mean, from a philosophical point of view, I object to any approach that sytematically rewards ability and good judgment with ever increasing burdens, and opposes inability and poor judgement with an easier time of it.

But pragmatically, it's not that simple - there are many forces that affect one's ability, and not all of them are within the control of that individual. Poor childhood nutrition, constant insecurity, exposure to violence, drugs, etc. all play a very significant role in how a child views the world... and sets the standard for what is accepted as "normal" as an adult. Privilege, even if subconscious, has a significant impact on the probability of future success. And while I don't approve of rewarding bad decision-making... I also don't approve of punishing people for the effect of dynamics that are outside of their control.

So when it comes to reality, I tend to seek solutions that address root causes. I don't particularly like a socialized solution... but at the same time, I don't think that a fully privatized health care market can have a material effect on the system. Adequate health care for children, especially, is something that can have a significant impact on the future success of those children. I feel the same way about education.

My personal goal is to find a way to address the root causes, and change the underlying dynamic. If that is accomplished, then the entire society will find a new equilibrium, and is less likely to actually need intervention from the government.

 

[sir drinks-a-lot]

Considering how much technical information has been provided (none) regarding the solution you have no information to reach such a conclusion.

In other words you are blowing smoke, making stuff up.

I don't need any technical information regarding the solution . First off, it wasn't much of a solution, and secondly, there are a limited number of ways you would implement it, none of which are reinventing the wheel.

 

[DGM]

I just heard a few kids (laborers) talking about the new plans. They're saying "screw it, pay the fine. it's cheaper".

I asked them about it and apparently the fine is around $100 going up to a max of $700. I'm no math genius but, to someone young and invincible, this is a no brainier

I did ask them if they worried about getting hurt. I was not surprised when the said "you have workmans comp, right"

BTW: My comp coverage is going up too.

 

[DavidJames]

I don't need any technical information regarding the solution . First off, it wasn't much of a solution, and secondly, there are a limited number of ways you would implement it, none of which are reinventing the wheel.

lol - thanks. That explains a lot about your knowledge of such things.

 

[WildCat]

So there was an actual intercept of a simulated missile that didn't broadcast a homing beacon for the incoming anti-missile?

Interesting. Is there a link to that event?

http://en.wikipedia.org/wiki/Aegis_Ballistic_Missile_Defense_System

 

[sir drinks-a-lot]

lol - thanks. That explains a lot about your knowledge of such things.

Huh? Since I don't know the technical details of how to build a non-functioning website?

 

[Unabogie]

Huh? Since I don't know the technical details of how to build a non-functioning website?

I think it's more that since you don't know what you're talking about, either about writing software or the specifics of this system, calling the task "simple" was grossly ignorant.

 

[sir drinks-a-lot]

I think it's more that since you don't know what you're talking about, either about writing software or the specifics of this system, calling the task "simple" was grossly ignorant.

Er, uh, well, I do know quite a bit about writing software and architecting systems that work. And the requirements for this system were not that technically groundbreaking. How they did it, I do not know - there are many different approaches that would have worked. They didn't chose any of them, so who knows what kind of Rube Goldberg system they have.

 

[DavidJames]

Er, uh, well, I do know quite a bit about writing software and architecting systems that work. And the requirements for this system were not that technically groundbreaking. How they did it, I do not know - there are many different approaches that would have worked. They didn't chose any of them, so who knows what kind of Rube Goldberg system they have.

Keep digging sparky. Read what I put in bold, grab your boots and shovel and dig yourself even deeper and make yourself a poster child for Dunning-Kruger

 

[Emily's Cat]

Er, uh, well, I do know quite a bit about writing software and architecting systems that work. And the requirements for this system were not that technically groundbreaking. How they did it, I do not know - there are many different approaches that would have worked. They didn't chose any of them, so who knows what kind of Rube Goldberg system they have.

Okay, I'll bite. I know nothing of software design or systems architecture aside from being able to spell them.

What is it that you perceive the system was designed to do, and how it was to function? What aspects of it, in your opinion, do you find to be not technically challenging?

 

[boooeee]

No there's not. For people who are under age 30, they can purchase a catastrophic plan... but the cat plans aren't much cheaper or much different in design than a Bronze plan. It has nothing to do with what they can afford.

There actually is a hardship provision in the catastrophic plan regulations. The vast majority of those eligible for the plan will be the under 30, but there is a rule that says you're eligible for catastrophic if the premiums available to you exceed some fixed percent of your income (can't remember how much).

 

[Emily's Cat]

There actually is a hardship provision in the catastrophic plan regulations. The vast majority of those eligible for the plan will be the under 30, but there is a rule that says you're eligible for catastrophic if the premiums available to you exceed some fixed percent of your income (can't remember how much).

Can you point me to your information on this? Without that piece of info, I suspect that you are confusing the catastrophic plan with the premium subsidies. Subsidies are income-linked. My understanding (which isn't small, since I work with this info on a daily basis ) is that the cat plan is only for people under 30, and that there is no provision for financial hardship for people over 30 to purchase it. It's always possible I've missed something... but I'm skeptical of this, since it would be a pretty large oversight that my entire department missed.

 

[xjx388]

Can you point me to your information on this? Without that piece of info, I suspect that you are confusing the catastrophic plan with the premium subsidies. Subsidies are income-linked. My understanding (which isn't small, since I work with this info on a daily basis ) is that the cat plan is only for people under 30, and that there is no provision for financial hardship for people over 30 to purchase it. It's always possible I've missed something... but I'm skeptical of this, since it would be a pretty large oversight that my entire department missed.

You can apply for a hardship exemption if you are over 30.

But their definition of "catastrophic plan" isn't the same as mine.

 

[Emily's Cat]

You can apply for a hardship exemption if you are over 30.

But their definition of "catastrophic plan" isn't the same as mine.

Well I'll be damned. Alrighty then.