patrick.net

Rep alternative: Keep health care privatized so profits continually increase & more patients can bankrupt.

Eliminate ACA & health care will only be $0.10/day.

He's Stale Gingrich at this point. Newt hasn't mattered since he started baby sitting his Lesbian daughter's love child.

Status quo is the Repubs answer.

Every election year has its Joe Lieberman.

HEY YOU says

Rep alternative: Keep health care privatized so profits continually increase & more patients can bankrupt.

Eliminate ACA & health care will only be $0.10/day.

Profits will be higher under Obamacare than without since it places no upper limit on what insurance can cost, doesn't let Americans opt out of it gets too expensive, places lower limits on what young people must spend (1/3 of what old people do), and provides subsidies for Americans to buy for profit insurance to cover for profit health care.

PhRMA (as in Pharmaceutical Research and Manufacturers of America, the industry PAC) liked the millions of new customers headed their way with government vouchers so much they spun up a pair of 501(c)(4) organizations and spent $150 million on an advertising campaign that they coordinated with the White House.

That is very similar to the last time the Republicans passed a health care law where by passed I mean Republican Speaker Hastert sponsored it, the two Republican houses passed it, and Republican President Bush signed the bill. PhRMA liked the $100B/year headed their way from Medicare Part D so much they thanked Republican Representative Billy Tauzin for his work with a seven figure job as their president.

The Republicans also worked on the Health Equity and Access Reform Act of 1993 which did not pass. That

- Had vouchers for low-income Americans ineligible for Medicaid to buy insurance from qroups
- Required employers to provide insurance
- Setup market places
- Required universal coverage

which is a lot like Obamacare.

The reality here is that the two parties are about the same - for big government with laws passed on behalf of their bipartisan corporate backers. The biggest differences are that Republicans want to control our crotches and Democrats our guns.

sbh says

You're actually right, for once, Sadsack. Any reflective Republican is obviously stale and needs to be dumped.

Unless they can bring them around to the dark side like they did with McCain.

drew_eckhardt says

The Republicans also worked on the Health Equity and Access Reform Act of 1993 which did not pass. That

- Had vouchers for low-income Americans ineligible for Medicaid to buy insurance from qroups

- Required employers to provide insurance

- Setup market places

- Required universal coverage

which is a lot like Obamacare.

Yet the republicans have voted 40 times to repeal Obamacare. This is not your father's republican party.

drew_eckhardt says

Profits will be higher under Obamacare than without since it places no upper limit on what insurance can cost, doesn't let Americans opt out of it gets too expensive, places lower limits on what young people must spend (1/3 of what old people do), and provides subsidies for Americans to buy for profit insurance to cover for profit health care.

You left out that there is a cap on profits. That doesn't surprise me, though - misinformation is the name of the game these days.

Also, please explain how it would work to have people "opt out". What would stop me from "opting out" while I'm healthy and don't need any medical care, then discovering I have cancer, opting back in, and draining a million dollars out of the system? Let's say ten million people do the same - do you really think a system like that would remain solvent? I'm just asking you to set aside the hatred and put some honest thought into that.

Homeboy says

You left out that there is a cap on profits. That doesn't surprise me, though - misinformation is the name of the game these days.

You've been misled.

There is no cap on profits, only gross margins. The law specifies a minimum medical loss ratio of 80% which means they can retain at most 20% of what they collect as premiums or markup what they're buying by at most 25% with $80 of product becoming $100 of premiums. For simplicity, I'm going to ignore the 85% base line for large group plans, and deductible factor multipliers of 1.164 - 1.736 which apply to high deductible small group plans with the later allowing a 46% medical loss ratio.

They can make more money with the same 25% markup on more expensive product. For instance they can choose to cover a $100/month patented drug containing only the R or S enantiomer of a molecule and keep $25 / month instead of limiting costs by restricting coverage to the version with both chiral forms on which the patent has expired allowing people to get $10/month generics on which they'd only net $2.50.

The gross margin limit also only applies to insurance companies. Some are working around the problem by purchasing hospitals so their share holders can make more even though their gross margin as insurers remains within prescribed legal limits.

The Quiet Takeover: Insurers Buying Physicians and Hospitals

Also, please explain how it would work to have people "opt out".

Insurance companies would be forced to price their product at a price people would be willing to spend on their own like the $80 a month I was spending on my adult son's coverage before the shenanigans started (now it's $150).

What would stop me from "opting out" while I'm healthy and don't need any medical care, then discovering I have cancer, opting back in, and draining a million dollars out of the system?

Nothing, although in the more likely case of you breaking bones in an accident you'd be screwed because you'd get the care needed to save the affected limbs not sports medicine to have you running again.

Let's say ten million people do the same - do you really think a system like that would remain solvent? I'm just asking you to set aside the hatred and put some honest thought into that.

That would work fine for the insurers although more people earning over 400% of the federal poverty level but ineligible for group plans would choose to remain uninsured.

The law provides subsidies of the delta between the second lowest cost silver plan available and 2% (up to 133%) to 9.5% (400%) of income with no limit on that.

The insurance companies could charge $10K or $20K a year if that's what it took to cover an average of $8K/year or $16K/year of spending due to people not joining until they needed to. Out of pocket costs would be the same for that segment of the population and the insurance companies would collect enough to be profitable.

The government would cover the low wage earners, the high wage earners would get our insurance from our companies with better aggregate demographics like we do now (60% of Americans are in employer plans), and many people in the middle would pay their fines and remain un-insured.

If the politicians really cared about insurance for everyone they'd extend the not-for-profit Medicare program and be like the rest of the OECD-24 which cover their entire populations for the same per-capita spending that helps only the 25% of us who are too old or poor to be profitable.

drew_eckhardt says

[Insurers] can make more money...with the same 25% markup on more expensive product.

Exactly, and they've been buying hospital corporations and corporate practice groups so they can mark up the billed price of the "product" without increasing their actual costs. The additional profit simply shifts from the insurance side of the business to the hospital side, and flows up to the same parent corporation and its CEO. As an added bonus from the insurers' POV, raising prices at hospitals means the uninsured have to pay even more, which is an indirect penalty inducing them to buy insurance. The net results are higher prices and more spending, which translate to more revenue and power for the sponsors and authors of the legislation, which was the goal.

BTW, watch out for those "out of network" hospitals, which can be most of them, because in many states coverage may be only a fraction of the actual bill. You might be unconscious when you're taken to a hospital that you didn't choose, but that doesn't relieve you of financial responsibility. Even if the emergency department might be covered, that might not extend to the ICU. Even where hospital employees might be covered, that might not extend to the independent contractors. The billing opportunities go on and on, and whatever fraction might eventually get covered by insurance can then be marked up an additional 25% as you've illustrated.

drew_eckhardt says

You've been misled.

Nonsense.

drew_eckhardt says

There is no cap on profits, only gross margins.

Sophistry.

The law specifies a minimum medical loss ratio of 80% which means they can retain at most 20% of what they collect as premiums or markup what they're buying by at most 25% with $80 of product becoming $100 of premiums. For simplicity, I'm going to ignore the 85% base line for large group plans, and deductible factor multipliers of 1.164 - 1.736 which apply to high deductible small group plans with the later allowing a 46% medical loss ratio.

You completely failed to mention the caps in your earlier posts. Now that I brought them up, you are spewing a bunch of mumbo jumbo about it. Your prose is difficult to parse, but I'm guessing your argument is that they will charge more for procedures so that their profit is 20% of a larger amount. First of all, you are claiming they COULD do that, but you haven't shown that they HAVE done it. Second, what would your alternative be? You want an exact dollar amount that a company can make as profit, like, "You can only make $500,000 a year"? Doesn't seem very fair or very realistic.

Insurance companies would be forced to price their product at a price people would be willing to spend on their own like the $80 a month I was spending on my adult son's coverage before the shenanigans started (now it's $150).

Totally naive. It's a demonstrable fact that the rate hikes started BEFORE Obamacare, so you can blame the expense of your son's insurance on the PREVIOUS system, not Obamacare. And in the previous system, companies didn't have to insure anyone they didn't want to insure.

So now your argument appears to be that insurance companies, that were raising rates every year even when they could turn high-risk people down, who now have to accept ANYONE, would lower their prices if the high-risk people were able to sign up AFTER they became high-risk? That makes absolutely no sense. I don't think you understand anything about business at all.

That's like saying that if nobody had to have car insurance, but anyone could buy car insurance AFTER they crashed their car, and get a big payout, that auto insurance rates would go down. Um, not bloody likely.

drew_eckhardt says

That would work fine for the insurers

Oh, well glad YOU think so. I happen to disagree. See car insurance analogy above.

drew_eckhardt says

The insurance companies could charge $10K or $20K a year if that's what it took to cover an average of $8K/year or $16K/year of spending due to people not joining until they needed to. Out of pocket costs would be the same for that segment of the population and the insurance companies would collect enough to be profitable.

Where did these numbers come from? Out of your ass? And could you state your argument in plain English? It seems like you are arguing that insurance companies would charge existing customers more in order to subsidize the freeloaders who sign up AFTER they get sick. No thanks, buddy.

drew_eckhardt says

the high wage earners would get our insurance from our companies with better aggregate demographics like we do now

I think this says it all. You appear to be including yourself in the "high wage earner" category. In other words, you are in the elite and don't want the middle class to get what you're getting. And that's exactly the reason the republicans voted 40 times to repeal ACA, and are talking about shutting down the whole government just to sabotage the law - because they are the party of privilege. This is really about the one percenters not wanting to share one thin dime of their lopsided portion of the wealth.

Homeboy says

drew_eckhardt says

the high wage earners would get our insurance from our companies with better aggregate demographics like we do now

I think this says it all. You appear to be including yourself in the "high wage earner" category. In other words, you are in the elite and don't want the middle class to get what you're getting.

Nope.

I'm fine with the government providing health insurance for everyone like they currently do for 25% of the population through Medicare and Medicaid. Those are not for profit programs and limit what hospitals charge them. I'm not fine with the government paying companies to profit from providing the insurance, where the amount they spend and therefore charge is unbounded, where the companies in question are exempt from Federal anti-trust legislation.

This is really about the one percenters not wanting to share one thin dime of their lopsided portion of the wealth.

It's about marketing to the voters allowed to choose between the candidates put in front of us by the 0.4% of natural people (those who make campaign contributions big enough to require FEC reporting, the majority of which total $10K per couple for some politicians at the $2500 per person per election limit with primary and general elections considered separate) and PACs. Suggesting their opponents' biggest program is going to fail can't hurt.

drew_eckhardt says

I'm fine with the government providing health insurance for everyone like they currently do for 25% of the population through Medicare and Medicaid. Those are not for profit programs and limit what hospitals charge them. I'm not fine with the government paying companies to profit from providing the insurance, where the amount they spend and therefore charge is unbounded, where the companies in question are exempt from Federal anti-trust legislation

What are you talking about? The government isn't paying private health insurance companies. They are requiring people to buy their own insurance, or if they are full-time employees, requiring their employer to provide insurance for them. There is still competition, and the insurance companies are still making money through premiums. If your doom and gloom scenario is true, then why have states that already figured out what their rates will be, like California and New York, discovered that the premiums are going to cost LESS than expected?

sbh says

This sticks in my craw as well.

LOL. It would stick in my craw too, if it were TRUE. But it's a lie. In fact, there never WERE any limits on how much insurance companies can charge, but now there at least is a cap on profits.

You have to think about what is politically realistic RIGHT NOW. Clinton tried to pass a healthcare bill that DID regulate prices, and it never saw the light of day. Obamacare is not ideal, but it's at least better than what we had before.

sbh says

It's the neoliberalism that has evolved in order to match up with the general shift to the right that has occurred across American politics.

I agree, but you guys are pining for something that couldn't possibly have happened right now. If you think the repubs are trying hard to kill Obamacare, imagine how hard they would have tried to kill a 100% government-paid system with regulated prices.

APOCALYPSEFUCK is Shostakovich says

He's not a conservative, he's a fucking terrorist freak who leads a hillbilly mob over whom he can claim suzerainty because they believe his assertion that he read a book once and understood what it said.

Exactly. So when Gingrich becomes the only voice of reason in the republican party, you KNOW something ain't right.

Homeboy says

What are you talking about?

People earning less than 400% of the Federal poverty level who buy their insurance through a state exchange have their spending on health insurance legislatively capped with the government paying the difference between the cap and cost of the second least expensive silver plan.

That cut-off happens at $94,200 for a family of 4 which was in the top 27% earning households as of the 2010 census.

The required contribution varies from 2% of income up to 133% of the federal poverty level to 9.5% at 350-400%

The government isn't paying private health insurance companies.

Technically true. They'll just require you to buy health insurance from a private company and give you a subsidy to do so when you're both in the bottom earning 73% and lack employer coverage.

There is still competition,

Among companies that choose to participate in the state exchanges (major player Aetna opted out of the California exchange) and without Federal anti-trust law applying.

If your doom and gloom scenario is true, then why have states that already figured out what their rates will be, like California and New York, discovered that the premiums are going to cost LESS than expected?

Less than expected isn't comparable to what we were spending before things got out of hand and that's only for the first year.

drew_eckhardt says

People earning less than 400% of the Federal poverty level who are not eligible for employer provided plan have their spending on health insurance legislatively capped with the government paying the difference between the cap and cost of the second least expensive silver plan.

Who is the government paying? Not who you think. I don't understand what mechanism you believe ACA has brought into place that allows insurance companies to make more profit than they did before ACA. They were making pretty insane profits before anyone even started TALKING about ACA.

Homeboy says

Who is the government paying?

The insurance companies by way of Americans earning less than 400% of the Federal poverty level buying insurance through the state exchanges who do not neglect to claim their credit.

Here in California a family of 4 making $90,000 a year with parents aged 40 and 2 children under 21 have estimated spending of $880 a month with a $168/month or $2016/year credit from the government.

I assumed this calculator was accurate.

Not who you think. I don't understand what mechanism you believe ACA has brought into place that allows insurance companies to make more profit than they did before ACA.

Easy money always increases prices. Each $1 of Federal money supporting college students has been accompanied by a $0.60 increase in tuition. Federal money and special treatment of private loans in bankruptcy court have allowed price increases in nominal dollars to quadruple inflation although wages remain stagnant.

During the housing bubble loans which couldn't be repaid allowed prices to double their long term average in real inflation adjusted dollars.

They were making pretty insane profits before anyone even started TALKING about ACA.

ACA makes life even better for insurers. Otherwise they wouldn't have let it pass.

drew_eckhardt says

Homeboy says

Who is the government paying?

The insurance companies by way of Americans earning less than 400% of the Federal poverty level buying insurance through the state exchanges who do not neglect to claim their credit.

"By way of"? WTF? That's weak and you know it. The government isn't paying the insurance companies, despite your attempt to mislead us into believing that's the case.

drew_eckhardt says

Easy money always increases prices.

Not interested in vague generalities. Where is your PROOF that Obamacare has caused people's healthcare expenses to rise faster than they were rising before Obamacare? You don't have any proof, because that didn't happen. Theories are fine, but the proof is in the pudding.

drew_eckhardt says

ACA makes life even better for insurers. Otherwise they wouldn't have let it pass.

They didn't "let" it pass, they spent $102.4 million dollars to try to defeat it. If it made their lives so much better, why did they try to block it?

http://www.forbes.com/sites/rickungar/2012/06/25/busted-health-insurers-secretly-spent-huge-to-defeat-health-care-reform-while-pretending-to-support-obamacare/

Homeboy says

drew_eckhardt says

ACA makes life even better for insurers. Otherwise they wouldn't have let it pass.

They didn't "let" it pass, they spent $102.4 million dollars to try to defeat it. If it made their lives so much better, why did they try to block it?

http://www.forbes.com/sites/rickungar/2012/06/25/busted-health-insurers-secretly-spent-huge-to-defeat-health-care-reform-while-pretending-to-support-obamacare/

The biggest winners from Obamacare are PhRMA and two Chicago-based organizations, the AHA and AMA. (Most doctors oppose Obamacare, but the AMA stands to make $$$ off licensing the billing codes.) The insurance companies began in favor, then switched to opposing when the mandate penalties got watered down. The article Homeboy linked to says the insurers oppose the MLR. In reality, they're sidestepping that by buying providers, especially hospital corporations, so the AHA wins again. The funny part of the article is where it says insurers can't be trusted and calls them the worst people in the world - it's funny because the legislation requires you trust those same insurers at precisely the moment when you're most vulnerable.

Homeboy says

What would stop me from "opting out" while I'm healthy and don't need any medical care, then discovering I have cancer, opting back in, and draining a million dollars out of the system?

That is a major flaw in the ACA system-you have to buy insurance or pay a fine, but the fine is less than the insurance.

So many will forgo insurance (perhaps for years/decades) and pay the fine. If they ever need costly medical care they will simply buy insurance at that time with no troubles because they can't be denied due to a preexisting condition.

The fine goes to the government not the insurance company. So the newly insured person has paid nothing to the insurance company and will only cost the insurance company.

Homeboy says

drew_eckhardt says

People earning less than 400% of the Federal poverty level who are not eligible for employer provided plan have their spending on health insurance legislatively capped with the government paying the difference between the cap and cost of the second least expensive silver plan.

Who is the government paying? Not who you think. I don't understand what mechanism you believe ACA has brought into place that allows insurance companies to make more profit than they did before ACA. They were making pretty insane profits before anyone even started TALKING about ACA.

The only argument I can see how this helps insurance companies is the old 'they make it up on volume' reason.

The ACA adds the uninsured that can't afford insurance or chose to remain uninsured for whatever reason to the ranks of the insured so the insurance companies get more customers.

The extra customers come at a big cost though so I'm not sure the insurance companies come out ahead.

smaulgld says

so I'm not sure the insurance companies come out ahead.

Well here let me help you out with that.
When Insurance profits aren't over 80% pure gravy. They pull out of a given market. capicé?

smaulgld says

The fine goes to the government not the insurance company.

That's misleading. The fine goes to fund healthcare. While technically it does go "to the government", it will not be theirs to spend as they please. I'm not sure why you think this is a "flaw". ACA was designed to be self-funding. The penalty is one of the means of funding the program.

As to your complaint that the money doesn't go to the insurance companies, I'm at a loss as to how to respond. The other anti-Obamacare voices here are saying the insurance companies will make TOO MUCH profit, while you are arguing that they won't make ENOUGH profit. But that's pretty typical of the criticism - it's all over the place and isn't even consistent within itself. For example, the "it goes too far"/ "it doesn't go far enough" dichotomy among the critics. Both can't be true at the same time.

smaulgld says

The only argument I can see how this helps insurance companies is the old 'they make it up on volume' reason.

The ACA adds the uninsured that can't afford insurance or chose to remain uninsured for whatever reason to the ranks of the insured so the insurance companies get more customers.

The extra customers come at a big cost though so I'm not sure the insurance companies come out ahead.

Well it's supposed to balance out. Insurance companies and medical device manufacturers are expected to receive a windfall of new customers which would be balanced out by taxes and restrictions on how they do business. Again, half the critics say it will hurt business, and the other half say it will help business too much, while proponents think it will be even. I guess we'll have to wait and see.