patrick.net

Time is on my side.

The shit will hit the fan when "EVERYBODY" starts getting the bill.

Only the Premiums are subsidized genius. These subsidized people are going to be shit out of luck when serious ailment hits and they go to the hospital under the misguided assumption that they are fully insured.

There's already been plenty of reports on the sticker shock, after the "Entitlements" of Obamacare stops, and the lining of your pocketbook starts.

The mark of success for a health insurance system is not how many people sign up, but rather when these people get sick, are they treated promptly and is that treatment covered.

Of course, you can use the violence of the state to force people to pay for insurance, fining them if they don't, ceasing their excess tax payments. But this does not force the insurance companies to stop hindering people from seeking treatment. They still play all the same games to delay and deny treatment making it truly a pain in the ass to seek treatment sooner while it is cheaper.

Nor does the ACA in any way address the true problems of our healthcare system.
1. Health insurance companies are parasitic and must cease to exist.
2. Hospitals create fraudulent bills that do not in any way reflect costs.
3. Pricing is secret and the bill for the same exact service varies hugely from person to person.
4. Administrative waste.
5. Health providers have a perverse incentive to keep people sick.

Yeah, the ACA won't collapse. Neither would the prior system. Hell, the ACA is almost identical to the prior system except that
- people are forced to buy insurance
- insurers can't bar you for a pre-existing conditions, but they can raise the rates for everyone because of these, hence the need for young, healthy people to subsidize the rich old people

But, in my opinion, the ACA is a disastrous failure. There was an opportunity for real reform and improvement, but because the ACA was passed, all political pressure to reform the system has deflated. The ACA has prevented real reform including single payer, which would have given us transparent pricing, no price discrimination, and greatly reduced administration costs.

I guess we'll have to wait for another generation of people getting screwed over by the health care industry before we get real reform.

Dan8267 says

But this does not force the insurance companies to stop hindering people from seeking treatment.

"In California, plans offered by Blue Shield through Covered California included just 60 percent of the doctors that participate in the insurer's group plans and just 75 percent of the hospitals. On top of that, Blue Shield is reimbursing doctors and hospitals in Covered California policies up to 30 percent less than those not in the exchange, spokesman Stephen Shivinsky said."

http://www.sfgate.com/health/article/Covered-California-clients-have-trouble-finding-5169944.php

Gov. Jerry Brown on Friday signed a budget for the 2014-15 fiscal year that accommodates an influx of uninsured residents into Medi-Cal, the state's Medicaid program. But at Brown's request, the Legislature left in place a 10% recession-era cut to most doctors, dentists and other healthcare providers who treat Medi-Cal patients, many whom are children.

http://www.modernhealthcare.com/article/20140621/INFO/306219940#

hence the need for young, healthy people to subsidize the rich old people

ACA rates rise with age, too

But the extent there is cost-shifting going on, smoothing out health costs over one's lifetime is a good thing, assuming this rate structure subsidy still exists when today's youth become old people.

All taxes come out of rents, so the more we pre-pay our future costs in our 20-40s, the less we will bid up the cost of housing. That's my theory at least.

marcus says

But there they are talking exclusively to people who are indeed worse off because of Obamacare (with taxes that is).

ooh, the 1% must hate the new 3% medicare tax on investment income with the heat of a million suns.

That's what the GOP's "repeal and replace" bullshit is/was really all about.

curious2 says

it was designed to increase spending

ACA was designed to be the maximal change the system's "stake holders" would tolerate.

Tough for politicians to go toe-to-toe with the biggest industry this nation has. People are deathly afraid of losing what access they enjoy, and any reform has to "change" things, not necessarily for the better of everyone.

PPACA creamed Russ Feingold in 2010, and that was thanks to outright lies about what ACA was changing.

(Ironically a medical device corporation owner took his seat, LOL)

Bellingham Bill says

curious2 says

it was designed to increase spending

ACA was designed to be the maximal change the system's "stake holders" would tolerate.

Tough for politicians to go toe-to-toe with the biggest industry this nation has. People are deathly afraid of losing what access they enjoy, and any reform has to "change" things, not necessarily for the better of everyone.

PPACA creamed Russ Feingold in 2010, and that was thanks to outright lies about what ACA was changing.

(Ironically a medical device corporation owner took his seat, LOL)

Which is why "big reform" gets killed in its crib. A little cost shifting and subsidy deal helps reduce the number of uninsured, and by a lot. In the end, I would suspect that more would end up in PRIVATE insurance, not the Government plan. Both parties believe in various levels of laissez-faire free-market Reagan-style capitalism. The Democrats are hardly paternalists any more.

Since we all believe in the magic of the market, why not push them into the miracle of insurance markets? Watch it, praise it, and pray to it. Why wouldn't it look kindly upon us for our offering?

Bellingham Bill says

But the extent there is cost-shifting going on, smoothing out health costs over one's lifetime is a good thing, assuming this rate structure subsidy still exists when today's youth become old people.

The ACA does not do that. It would be one thing if the Boomers paid into the system their entire lives, but that's not the case. The Millennials are paying for Boomers who did not have to have insurance when they were young.

This is easily fix, but won't be since the entire point is to steal from the young to pay for the greedy, old folks who own all the stocks and real estate. All we'd have to do is set age brackets for the spending. All money received from a given bracket can only be spent in that bracket. Problem solved.

Health insurance should get more expensive as you get older as your health care costs go up. The purpose of insurance is to spread risk, not costs. Buying health insurance does not make health care costs go down. For that, you need to fix the problems with outrageous care costs.

Dan8267 says

Health insurance should get more expensive as you get older as your health care costs go up.

Gold 80 Plan for 30 yo is ~$380/mo; Silver 70 is ~$330

For 60 yo this is ~$900 and ~$750

rates go from ~$4500/yr to ~$11,000 as you get older

I'd like to see more subsidy, not less, actually. People retiring on Social Security in the 40s and 50s got a good deal, too, but that's OK

The purpose of insurance is to spread risk, not costs.

to a point, yes. But there's also a social element here. Not everything has to have a goddamn hard-ass economics element. That's the secret of the nordic socialist paradises I bet, though of course in certain areas (wrt household debt) they're skating on pretty thin ice it looks like.

Bellingham Bill says

Not everything has to have a goddamn hard-ass economics element.

But it should be socially just. I see no justice in having a poor generation subsidize the richest generation in American history, especially when that generation is the reason the careers of the younger generation are so dismal.

Also, the math does not work. Even Call it Crazy, who has the IQ so low you have to frack for it, realizes this.

The Boomers are a big generation. They can parasitically leach off the Millennials, another large generation. It will greatly impoverish the Millennials, but there's enough blood to suck. However, when the Millennials retire and there's a much smaller generation of young people, the system will collapse. Eventually this must happen as population cannot grow forever and eventually there will be generations that are smaller than their parents or grandparents.

In fact, even ignore the unethical aspects of leaching off the younger generations, it's simply not practical. Whenever a system pays out generation N of investors with the revenue collected from generation M > N, the system is by definition a Ponzi Scheme. And the thing about Ponzi Schemes is that they are mathematically doomed to fail. They cannot end any other way. It's just math and math doesn't lie.

The correct way to set up any social program is to have each generation pay its own way, neither taking nor giving to any other generation. This has nothing to do with meanness; it's just the only sustainable way to run a system because generations can and do fluctuate in terms of both population and wealth.

For example, a large and wealthy generation will pay more for health care because it has greater demand, but it can afford to pay more. A small and poor generation won't be able to pay as much, but won't have to because the demand will be far less. This is called a negative feedback. Negative feedback are the critical component of any sustainable system whether economic, ecological, biological, or anything else. Without strong negative feedback mechanisms, all systems are unstable.

Politics cannot invalidate mathematical law. If you want a health care system that can be sustained for generations, you have to do the math.

http://www.youtube.com/embed/CLv3SkF_Eag

CaptainShuddup says

Time is on my side.

The shit will hit the fan when "EVERYBODY" starts getting the bill.

Yep.

Global warming? Fake.

Saddam's WMD's? Real.

Tax cuts? They boost revenue.

Obamacare? Failure.

Obama? Born in Nairobi.

The proof is coming in, any day now. I just know it.

Hydro this is the Obamacare failure thread if you'd like to debate me on any of his THOUSANDS of other failures please pick one of the Millions of other threads on the subject, or start a new thread about a new calamity. I would be happy to join you there.

Responding to more of my POINTLESS dribble I see.

You're getting pretty good at doing nothing.

HydroCabron says

Yep.

Global warming? Fake.

Saddam's WMD's? Real.

Tax cuts? They boost revenue.

Obamacare? Failure.

Obama? Born in Nairobi.

The proof is coming in, any day now. I just know it.

Good summary. Apparently the captain doesn't like to see so many of the right's key delusional tenets at one time. It causes cognitive dissonance, and then he has to spend time at the fox news website until he feels better.

Dan8267 says

But it should be socially just. I see no justice in having a poor generation subsidize the richest generation in American history, especially when that generation is the reason the careers of the younger generation are so dismal.

following generations inherit the richest generation's stuff anyway; it's all a wash in the end

Bellingham Bill says

it's all a wash in the end

If you believe that than you'd have no problem with the old subsidizing the young instead.

In any case, you have not addressed any of the objections I had to the ACA including it's ultimate doom.

Bellingham Bill says

Dan8267 says

But it should be socially just. I see no justice in having a poor generation subsidize the richest generation in American history, especially when that generation is the reason the careers of the younger generation are so dismal.

following generations inherit the richest generation's stuff anyway; it's all a wash in the end

That's some irrational boomer hate right there.

A "medicare for all" single payer type system would be better and more efficient, but it would be the same in the sense that the young pay in for benefits they mostly receive when they are older. And like the ACA, the older people are paying an amount that is less than their commensurate risk.

Dan doesn't seem to realize that what's bothering him is a sort of one time benefit that the older people just starting on the ACA now receive, not having had to be insured when they were younger and healthier, or if they did, it cost less.

This is like people that were say 45 when social security started. They ended up taking out far more from the system than they paid in. Some will try to complain that it's a pay as you go "ponzi scheme" even now (which it isn't - especially if done right).But sure - the people that were older when it started and didn't pay in their whole lives benefited in a way that later generations didn't.

It's a one time phenomenon, and the government picks up the tab, through debt or whatever - spread out over time. Not sure why this is hard to comprehend or deal with - unless as I say, it's just some sort of irrational boomer hate.

Bellingham Bill says

Dan8267 says

especially when that generation is the reason the careers of the younger generation are so dismal.

Maybe some kind of soylent green is the answer ?

How does an entire generation, including many millions whose careers are non existant or reaaly weak, take the wrap for the time interval that bad government policies from Reagan to GWB took place ? What, just becasue they are closer in age to Reagan or GWB ? I don't get it.

elliemae says

Wow, people are insured now? What a failure!

It's a "failure" in the minds of rich white male right-wingers, because they honestly believe that nobody else in the country deserves to have anything that they have.

Call it Quits and Captain Shuddup have invested so much of their personal self-worth and energy into hating ACA, that it doesn't matter WHAT happens. It could be the most wildly successful healthcare program on earth, and they would NEVER admit it to be anything but a failure. Their beliefs were already pre-determined 5 years ago, before the law was even passed.

Very true.

And then we waste a bunch of energy causing this.

http://www.skepdic.com/backfireeffect.html

http://www.brainpickings.org/index.php/2014/05/13/backfire-effect-mcraney/

I feel like heritagefoundationcare has been wildly succesful. Look how profitable and easier to soak even more people, to an even higher degree of soaking, ppaca has been for the "health" industry.

Party on, wayne

Precisely.
What kind of non-coverage astronomical deduction/copay plan do they get for 82 bucks/mo? They would be better off with no insurance and living a stone's throw away from the country's emergency rooms, where it all can be had basically for free.

Call it Crazy says

Wait, they're getting screwed paying $82/month...

They need to be FULLY subsidized by the rest of the country and go on Medicaid!!!

This appears to be true as long as you ignore the fact that we own the printing press...

Dan8267 says

Whenever a system pays out generation N of investors with the revenue collected from generation M > N, the system is by definition a Ponzi Scheme. And the thing about Ponzi Schemes is that they are mathematically doomed to fail. They cannot end any other way. It's just math and math doesn't lie.

Wow. We finally agree...

marcus says

Dan doesn't seem to realize

If there is a $6000 deductible for people who can't afford healthcare. How does that make sense? They will use the insurance in a catastrophic situation, but that is it, or more likely they will go to the ER and not pay the bill.

So what has changed?

I guess they now pay $82.00 a month?

Call it Crazy says

NOTHING!!! Except a quicker road to bankruptcy when they find out that $6000 has to be paid by them for their NEW FREE Obamacare...

This is just not going to work. I predict that the ACA will be repealed. Even the libs are not this stupid, er ah I hope?

marcus says

..."if the average person on subsidized rates is paying $82/ month.

I'm sure though that when republicans have their fund raising meetings with groups of rich doners they still diss the ACA plenty. But there they are talking exclusively to people who are indeed worse off because of Obamacare (with taxes that is).

Seems like we switched from a system where the middle class had to pay for the health care of the poor (being inefficiently delivered and often late and from emergency rooms), to a system where more of that cost hits the rich. Either way it's redistribution, but this is clearly better, especially for those who are insured inexpensively. "

I seem to be one of the very few people posting here who has any experience w/the new system. Premium: $126.13 per month for Kaiser Silver. Max yearly deductible: $5,600. I now have higher co-pays and drug costs.

I fully expect that my premiums will rise next year, because I'm not paying 16 percent of my GROSS income to Kaiser for premiums alone. So my taxes should reflect a rise in income and I will pay more. And I know lots of other people who've seen their medical premiums go down because of this new law.

Is it single payer? Of course not. Maybe, instead of the Fed handing out trillions to banksters in free money to speculate with, they should fund a REAL single payer system and take this issue off the table.

marcus says

Dan doesn't seem to realize that what's bothering him is a sort of one time benefit that the older people just starting on the ACA now receive, not having had to be insured when they were younger and healthier, or if they did, it cost less.

I'm fulling aware of what's bothering me about the ACA and why. What you mentioned above is not insignificant by any means, yet it is only one of many objections, ethical and practical, that I have about the ACA.

marcus says

Maybe some kind of soylent green is the answer ?

You may joke about it, but essentially disproportionally shorter lives for later generations is the effect that is inevitable when earlier generations exploit later ones. Again, the math ensures this.

You can trump up false virtues of the ACA all you like, and you may convince people that the ACA is far better than it really is. You might even get the world to ignore all the warnings from rationalists like myself. However, that does not change that the ACA is disastrous. Ultimately, the health care system is a technology and should be treated as such, built to engineering standards, and not determined by politics and popularity contests.

For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.

SoftShell says

This appears to be true as long as you ignore the fact that we own the printing press...

Dan8267 says

Whenever a system pays out generation N of investors with the revenue collected from generation M > N, the system is by definition a Ponzi Scheme. And the thing about Ponzi Schemes is that they are mathematically doomed to fail. They cannot end any other way. It's just math and math doesn't lie.

The number of monetary units is irrelevant. Printing money does not create wealth.

SoftShell says

Wow. We finally agree...

marcus says

Dan doesn't seem to realize

What further indication is required that you are both wrong?

Call it Crazy says

monkframe says

I seem to be one of the very few people posting here who has any experience w/the new system. Premium: $126.13 per month for Kaiser Silver. Max yearly deductible: $5,600. I now have higher co-pays and drug costs.

Have you had to change your doctor or hospital selection on this plan and what else changed in coverage on your plan?

For all its shortcomings, I have Kaiser Permanente, which means no changes in doctors or hospitals. The increased co-pays and drugs, and the high deductible are the major changes. I'm very fortunate in that regard, and I know it.

The profit motive is really what's wrong with the present system. Once that is removed and we have health care provided as a right, and the administrative costs are brought down to a level of, say the Social Security system, (3 percent) we'll have a chance at universal health care, single-payer, whatever you want to call it. We pay more and get less than any other industrialized country on earth right now.

Doctors are getting into close to mid 6 figure debt in med school because there is payoff at the end. That is the crux of the problem. ACA and previous system maintain the status quo from that standpoint, money just gets shuffled around. Lowest 20% do benefit, for the middle class it is at best a wash over the long term in aggregate. The ones that are truly "screwed" are not the high roller ballers with their investment taxes, it is a single person who makes perhaps around $70K in bay area with no health coverage at work. Those guys will get roasted good.

Call it Crazy says

The beliefs were pre-determined when you watch how the government has handled Medicare, Medicaid and the VA veterans healthcare....

I'll take that as an admission that you have had a vested interest in believing Obamacare will fail, before it even started! LOL - thanks for proving that one.

Call it Crazy says

NOTHING!!! Except a quicker road to bankruptcy when they find out that $6000 has to be paid by them for their NEW FREE Obamacare...

Nobody thinks Obamacare is free (except maybe some ultra right-wing idiots), and everyone is aware that some policies have deductibles. It's VERY clearly spelled out, in a huge font, on the exchange websites.

Homeboy says

and everyone is aware that some policies have deductibles. It's VERY clearly spelled out, in a huge font, on the exchange websites.

Then what in the hell are you worried about then, MickeyD?

BenghaziCare is either free or not free!

If it's free, then ZOMG WELFARE WELFARE WHO WILL PAY FOR THIS COMMUNISM FASCISM WHERE'S MAH GUN?!

If it's not free, then ZOMG GUMMINT TAKE ALL MAH MUNNAH COMMUNISM SOCIALISM FASCISM WHERE'S MAH GUN?!

Get the difference?

indigenous says

This is just not going to work. I predict that the ACA will be repealed. Even the libs are not this stupid, er ah I hope?

Seeing as how the GOP basically stopped doing whatever it is they did before and just spent the past 4 years trying to repeal it and failed Its clearly not going anywhere. When even the tea party and various wing-nut sites stop posting "repeal Obamacare!" stories you know the game is over. The GOP has long moved onto other time-wasting efforts.

If you're happy with your Obamcare plan you can keep it.

Huh? Huh? Yeah?

edvard2 says

When even the tea party and various wing-nut sites stop posting "repeal Obamacare!" stories you know the game is over.

Maybe they can start holding up "Get your government hands off my Medicare" signs again like the ones I saw back in the day.

edvard2 says

he GOP has long moved onto other time-wasting efforts.

IMO opinion the ACA is a country ending event not quickly or soon but slowly and surely, it will end this country. You don't think so, but you ARE economically illiterate.

I'm actually waiting for the "Keep you GOP hands off my Obamacare" signs come next election season. Self employed folks showing up with one of those signs at a Republican rally is the GOPs worst nightmare.