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Heeeeeeere's Obamacare!

Ziggurat said:
This "statistic" is wrong. Not a little bit wrong, but wildly wrong. So wrong, and so obviously wrong, that I'm left wondering not where this lie came from, but how you ever believed it.
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The ACA requires health insurance companies to spend at least 80% of premiums collected on medical services. For companies over a certain size, that figure is 85%. The remaining 20% or 15% can be used for overhead and profit.

By contrast, over 95% of all Medicare spending goes to pay for medical services.

Yes, it is incorrect to say the 20% is all profit. But it is correct to say that private insurance companies are roughly 10% less efficient at paying for medical care than the government.
 
Grizzly Bear said:
I find it absolutely incredible if not unsurprising that everyone wants to think that criticism of the ACA is always based on politics. Yep I get to see a doctor and I have my dental insurance back, probably cheaper than I can get elsewhere. I also pay the price for being forced to buy it at a point in time when my own finances are running thin, now I have to hope that rates remain relatively stable... maybe if the politics weren't a factor between ACA supporters and Repubs... something would get done properly.
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My republican controlled state requires the purchase of car insurance and yet i've not heard so much as a peep about it from them. Maybe that whole hubbub about forced insurance is 10% legitimate criticism and 90% partisan BS.
 
xjx388 said:
Even if 30 million signed up this year, is that really a win? That would still leave 20 million or so without insurance. Isn't that still pretty bad?
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If 30 Million uninsured signed up this year, that would be a massive win.

Some of those 50 million will never buy insurance. There are many reasons... but consider that at least some of them are homeless, some are philosophically opposed to it for whatever reason, and some believe they don't need it (regardless of whether that is rational or not). At the end of the day, you cannot please all of the people, and some of them will not purchase no matter how tasty your carrot nor how big your stick.

The second thing to consider is that uptake isn't immediate. Even if there had NOT been concerted anti-campaigning... there will still be some skeptics who are going to take a "wait and see" approach. They don't want to jump in right away, they want to wait and see how it works out in the first few years - let the system work out the bugs. Whether that realistically makes any sense or not is beside the point; that personality type exists, and they will delay enrollment for 2 to 3 years.

All told, when MA launched their exchange several years ago, they only got about 5% uptake form the uninsured in their first year IIRC. At 5 years they were up to about 25%, I think. I'm working from memory, so I could be wrong by a few percent or years :p. They did not have expanded Medicaid to pair with it... which increases the penetration for ACA, but still.

At the end of the day, if ACA actually reduces the number of uninsured by 60%, I'll be astonished, and I'll consider it an earth-shaking success.
 
Ziggurat said:
This "statistic" is wrong. Not a little bit wrong, but wildly wrong. So wrong, and so obviously wrong, that I'm left wondering not where this lie came from, but how you ever believed it.
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It's the health-care sector as a whole that was taking over 20% profit at least in 2011. The insurance industry has a lot lower profits.
 
Unabogie said:
You want more doctors in network? Lose a little "freedom" and require all hospitals to accept all plans (including Medicare and Medicaid) as a condition of their licenses.
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Will you also require Medicaid and Medicare and those Insurers to pay the hospitals enough to ensure that they don't go bankrupt, or do you just require that they operate at a loss? And do you require that all doctors who operate outside of hospitals (which is most of them) to follow those same rules? Do you grant insurance carriers license to dictate whatever ridiculously low payment rate they want, since the doctors and hospitals are now required by law to accept all payers?

Unabogie said:
You want lower deductibles? Outlaw deductibles and bake the price into the premiums.
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And will you increase subsidies so that families who can't afford the cash-flow burden of those increased premiums can afford it? How will you fund those increased subsidies when everbody's premiums increase by 15% to 50%?

Unabogie said:
You want lower premiums? Cut out insurance companies who are legally taking 20% as profit off the top.
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He he he he... find me these magical insurance companies who are taking 20% profit.

Unabogie said:
You want lower hospital costs? Mandate price controls.
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Will you mandate price controls for the supplies and drugs as well? Or will you force hospitals to operate at a loss because they can no longer charge enough to cover their costs?

Unabogie said:
In fact, the more problems you discover, the more that the single payer solution, which other countries use, will let us pay half as much and get the same quality of care.

The ACA was the compromise that incorporated all of the conservative ideas into the patchwork you see now.
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Yes, ACA is a horrible crazy-quilt of ideas stitched together by an insane person, that somehow manages to work relatively well. It's like the most inane Rube Goldberg contraption ever enacted by our pet congresscritters. But simply parrotting "single payer" as a solution isn't really an answer. It's a LOT more complicated than you appear to give consideration to. It's one thing to develop a single payer solution organically as the industry evolves - it's quite another to have to remove a fully developed private system and replace it with single payer.

Unabogie said:
As a conservative, I suggest you contact your conservative representatives and tell them that you support single payer, and that Medicare should be available to all Americans.
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Sure... Medicare should be available to everyone. I agree with that. But just to be contrarian... you do realize that Medicare doesn't do most of the things you listed above, right?
  • Hospitals and doctors are not required to accept Medicare.
  • Medicare has deductibles, which can be catastrophic if you're admitted as an inpatient.
  • MA carriers can make whatever profit level their bid lets them make... although realistically that's never as high as 20% (a bit of a red herring though, since insurers don't make 20% profits anyway). Med Supp carriers can make whatever profit they can get away with.
  • Medicare uses a fee schedule for hospitals and doctors - that's the only item from your list above that Medicare does... and the only reason it can do that is because those low costs are subsidized by private insurance paying higher costs to keep the hospitals in business.
 
Kestrel said:
The ACA requires health insurance companies to spend at least 80% of premiums collected on medical services. For companies over a certain size, that figure is 85%. The remaining 20% or 15% can be used for overhead and profit.

By contrast, over 95% of all Medicare spending goes to pay for medical services.

Yes, it is incorrect to say the 20% is all profit. But it is correct to say that private insurance companies are roughly 10% less efficient at paying for medical care than the government.
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Oy. Okay folks, buckle your seat belts, this is going to be a long one.

1) The denominator matters. The average medical cost for Medicare is on the order of $900 per person per month (pmpm). The average medical cost for commercial insurance is on the order of $350 pmpm. Let's assume that both Medicare and commercial insurers spend about $50 on administrative costs and claims adjudication - just because it makes the math easier and this is for illustrative purposes. So the Gross Cost (Medical plus Admin) is $950 for Medicare and $400 for Commercial. When you turn it into a percentage, you're looking at just over 5% admin rate for Medicare versus a 12.5% admin rate for commercial. But the fact is that the cost of operating a business and adjudicating claims is the same on a per-person basis for both concerns - which is perfectly reasonable. The only thing different is that older people have higher medical claims. Simply because their medical costs are higher, Medicare reaps the benefit of magical math and looks like they have a much better administrative rate, when in reality their costs are not actually much different from a cost of doing business perspective.

2) When insurers count up their administrative costs, they have to actually count all of their costs - you know, the salaries of all the people who work for them, in all capacities, the costs paid to all of their vendors, all that sort of thing. Medicare doesn't. Several of the people who do work for Medicare are counted under other parts of the government's budget, so the true administrative cost of Medicare is understated.

3) Commercial insurers provide disease management and usually lots of other tools and services in addition to merely access to care. Those costs are part of that administrative cost. Many of those elements serve to make people healthier, and hence to reduce the overall cost of medical care, resulting a net lower cost. Medicare does none of this.

4) Insurers are charged state premium taxes on the order of 2% to 4% (depending on the state) as well as income tax which comes out of that administrative portion. Medicare does not pay tax.

5) And somehow commercial insurers still manage to pay commissions to brokers and insurance agents, as well as a 2% to 3% profit margin.

So... for about the same actual dollar amount per person, commercial insurers do significantly more than Medicare does, as well as providing more value to their consumers.

Are you sure you want to talk about efficiency?
 
Emily's Cat said:
Will you also require Medicaid and Medicare and those Insurers to pay the hospitals enough to ensure that they don't go bankrupt, or do you just require that they operate at a loss? And do you require that all doctors who operate outside of hospitals (which is most of them) to follow those same rules? Do you grant insurance carriers license to dictate whatever ridiculously low payment rate they want, since the doctors and hospitals are now required by law to accept all payers?
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I'd actually put you guys out of business. But yes, I'd require all doctors to follow the same rules.

And will you increase subsidies so that families who can't afford the cash-flow burden of those increased premiums can afford it? How will you fund those increased subsidies when everbody's premiums increase by 15% to 50%?
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Through taxes and an end to the ridiculous military spending we seem stuck on?

He he he he... find me these magical insurance companies who are taking 20% profit.
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Well, I should have called it overhead. Again, I'd simply put in a single payer and bypass all of that.

Will you mandate price controls for the supplies and drugs as well? Or will you force hospitals to operate at a loss because they can no longer charge enough to cover their costs?
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Somehow the rest of the world manages to spend half as much as we do. I'd probably just do what they do to control costs.

Yes, ACA is a horrible crazy-quilt of ideas stitched together by an insane person, that somehow manages to work relatively well. It's like the most inane Rube Goldberg contraption ever enacted by our pet congresscritters. But simply parrotting "single payer" as a solution isn't really an answer. It's a LOT more complicated than you appear to give consideration to. It's one thing to develop a single payer solution organically as the industry evolves - it's quite another to have to remove a fully developed private system and replace it with single payer.
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Agreed. I'd phase it in over time. My preferred method would be to allow a Medicare buy-in, with the end result being all of it paid for by taxes and no premiums.

Sure... Medicare should be available to everyone. I agree with that. But just to be contrarian... you do realize that Medicare doesn't do most of the things you listed above, right?
  • Hospitals and doctors are not required to accept Medicare.
  • Medicare has deductibles, which can be catastrophic if you're admitted as an inpatient.
  • MA carriers can make whatever profit level their bid lets them make... although realistically that's never as high as 20% (a bit of a red herring though, since insurers don't make 20% profits anyway). Med Supp carriers can make whatever profit they can get away with.
  • Medicare uses a fee schedule for hospitals and doctors - that's the only item from your list above that Medicare does... and the only reason it can do that is because those low costs are subsidized by private insurance paying higher costs to keep the hospitals in business.
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Yes, but I'd change that. We're talking magic wand, right?
 
Honestly, I end up arguing a LOT with people who are gung-ho for single payer or other UHC solutions. Not because I'm against it... but because their arguments are so naive and well... I really chafe at blind dogma. Personally, I fully agree that a universal coverage solution would be preferable. If I were the queen of the world, we'd have had something worlds different from what we've got now. But reality exists, and we do have something... and changing it means disruption... and disruption means that people end up unemployed, they lose their homes and their livelihood, they go bankrupt, and they end up all around screwed all because someone is trying to do something for the greater good, and that greater good didn't include them :(.

The health insurance industry that we have, in all its glorious mess, is a tenacious weed that accounts for more than 15% of our GDP. I don't even know how many people are employed in the health sector - hundreds of thousands? When the rest of the developed world looked around and said "Gee, I think we ought to share the burden among ourselves for this one", we took a different path. Part of it is our national contrariness, sure... but some of it was responses to the pressures of the times - hiring freezes and economic pressures that prompted employers to find creative ways to compete for employees led to the integration of medical insurance into employee benefits. That more than anything has led to our current situation. Hindsight is 20/20 of course, but if medical insurance had never become an employee benefit, then I doubt the private industry would ever have grown as large as it has - the cost to the consumer would have been more apparent and immediate, the bankruptcies would have been more abundant, and our government would have responded before the industry had grown so many roots.

As it is, we have an industry that is fully intertwined. It's like a giant Jenga tower, carefully balanced. You can't just yank out the block marked "Private Insurance" without toppling many others. In some states, private insurers provide the entirety of the medicaid services through managed medicaid programs. There are immediate impacts to the employees of those insurance companies, of course, but also to insurance agents and brokers, as well as consultants, and insurance regulators. There are impacts to drug companies, hospitals, pharmacies, physical therapists. It's a mess.

So while I'm philosophically and principally supportive of a single payer approach, I'm hesitant to rush forward too quickly. And I'm particularly skeptical of anyone who approaches the topic with torches and pitchforks raised - I look askance at anyone who seems to say "I want single payer, and I don't care how many people I have to kill to get it!". That seems to be entirely too contradictory to me.
 
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Unabogie said:
So would I, if anyone ever said that in the history of humanity.

;)
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Well not literally, sheesh! :p. Thus the "seems to say"

I have run across some people who are so vociferously adamant about it that I'm pretty sure they're not too far from that viewpoint. I have actually had people say something akin to they don't care how many people are put out of a job or lose their homes as long as we get single payer - they don't care how many people they hurt along the way, the ends justify the means for them. Which is a stance I can't abide.
 
Emily's Cat said:
Well not literally, sheesh! :p. Thus the "seems to say"

I have run across some people who are so vociferously adamant about it that I'm pretty sure they're not too far from that viewpoint. I have actually had people say something akin to they don't care how many people are put out of a job or lose their homes as long as we get single payer - they don't care how many people they hurt along the way, the ends justify the means for them. Which is a stance I can't abide.
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Well, all innovations mean some people are hurt. The car put all the horse and buggy people out of work. Robotics are putting factory workers out of work. If we want to have a sane health system, we need to move away from private health insurance.
 
Unabogie said:
Well, all innovations mean some people are hurt. The car put all the horse and buggy people out of work. Robotics are putting factory workers out of work. If we want to have a sane health system, we need to move away from private health insurance.
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Do you think there is a difference between:
A) An invention that supplants a competitive product through the natural process of consumer selection
and
B) A purposeful government initiative that intentionally dislocates hundreds of thousands of people and leaves them unemployed and bankrupt?

To me, there's a bit of a difference. And while I might believe that the goal in the second case is desirable, I'm still going to approach it with considerably more care... and I am certainly not going to heartlessly assume that the ends justify the means and that sacrifices must be made with real people's lives.
 
Emily's Cat said:
Do you think there is a difference between:
A) An invention that supplants a competitive product through the natural process of consumer selection
and
B) A purposeful government initiative that intentionally dislocates hundreds of thousands of people and leaves them unemployed and bankrupt?

To me, there's a bit of a difference. And while I might believe that the goal in the second case is desirable, I'm still going to approach it with considerably more care... and I am certainly not going to heartlessly assume that the ends justify the means and that sacrifices must be made with real people's lives.
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There are estimates that some 45,000 people die every year because the current private system prices them out of care. While it would suck for people to endure financial hardships, I would place a higher priority on preventing that than I would protecting health insurance jobs. Besides, smart folks with experience could find work with the a single payer regime. They'd still need actuaries and analysts and administrators.
 
Unabogie said:
There are estimates that some 45,000 people die every year because the current private system prices them out of care.
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There are also estimates that as many as 6 million Americans have been abducted by aliens.

The existence of an estimate isn't significant in and of itself, especially an unsourced one.
 
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