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Politics Obamacare

Discussion in 'Tilted Philosophy, Politics, and Economics' started by pan6467, Mar 28, 2012.

  1. Aceventura

    Aceventura Slightly Tilted

    Location:
    North Carolina
    Here is my starting outline: First, all elderly have coverage. Second most children in poverty have healthcare available - I would expand this to include all children unconditionally to age 18. Third, make eligibility for health insurance mandatory at 18. Fourth, allow policies across state lines with a focus on individual insurance rather than employer based insurance. Here we still have the problem of some who may refuse to purchase coverage stating at a young age when premiums would be small, but it would be an individuals choice and given a healthy competitive insurance market everyone would have more options.

    Or, have a single payer medicare type system for all - combined with optional private supplemental plans.
    --- merged: Apr 2, 2012 at 1:43 PM ---
    Of course it is not a new concept. I don't know what the historic ratios have been in the health insurance market but no doubt it fluctuates and competition forces insurance companies to try and control costs. This is a built in conflict of interest, but again, when people have choice along with information the consumer would avoid companies that employe the strategy of not properly paying legitimate claims. However, I think you missed the point of my post. With Obamacare, insurance companies will happily accept the new rules within the law. For them everyone has to comply, they no longer have an interest in 80% of the costs. And the 20% becomes much more valued. Premiums will go up, they will go up because no party has an interest in controlling 80% of the costs. Well, I guess the government does, but what can they do - cost controls? Premium controls? At that point why not just go to single payer? Why waist time and effort? Isn't that the goal anyway? Why play games? Or is this one of those "political" things that I don't get?

    I am sure they can. Again, I think you miss the point. An insurance company can be perfectly in line with the ratios today, but because we know some illnesses have long tails (treatment period can be over many years), it is very easy for the insurer to not be prepared for future costs. We can predict the treatment costs of some illnesses with high certainty, others we can not - so reserving for future costs can be more important than current cost reporting.
     
    Last edited by a moderator: Apr 9, 2012
  2. redux

    redux Very Tilted

    Location:
    Foggy Bottom
    The law includes a rate review process and requires insurance companies to justify double digit (10+ percent) increases in annual premiums.

    The federal government cant and wont enforce the limitations on premium increases, but more states (more than 40) now have that authority (and grant funds) since the law passed. Before the ACA, only about half the states had the authority. The review process has already contributed to controlling premium increases.

    More: 28 states get new HHS grants to review insurance hikes....42 used similar funds to scale back premium increases for individual and small group plans.
     
    Last edited: Apr 2, 2012
  3. pan6467

    pan6467 a triangle in a circular world.

    Why do we allow government to force us to buy car insurance but we don't want them to force us to buy health insurance?

    We say it is to protect property... however, what's more valuable to a person, their car or their health?

    The fact is when car insurance became mandatory, the premiums went down and now you can buy policies dirt cheap.
     
    • Like Like x 1
  4. Aceventura

    Aceventura Slightly Tilted

    Location:
    North Carolina
    The justification is going to be based on increasing costs (the 80%), that is the part they will have no incentive to control. Remember; the insured will have no incentive to control those costs; doctors will have no incentive to control those costs, hospitals will have no incentive to control those costs, pharmaceutical companies will have no incentive to control those costs, medical device makers have no incentive to control those costs, nor will other service providers. There will be an exceptional amount of pressure to push costs up.

    If there is something in the bill to address the pressures on increasing costs, please share. I have not fully read the over 2,000 page bill

    What? States currently regulate health insurance companies - it is my understanding that rates or premiums have to be approved by state regulators.

    Insurance companies have long-term outlooks - for a reason. It seems, based on my interaction with you, that there will be much more emphasis on the short-term. If true this does not bode well for the long-term stability in the health insurance market.
    --- merged: Apr 2, 2012 at 3:40 PM ---
    Because driving on public roads is a privilege not a right.

    I agree with the fundamental principle that everyone should prove a level of financial responsibility in regard to healthcare and insurance is the simplest way to do that - but in a voluntary market what level of financial responsibility should be required. For example a person can have a high deductible plan with low limits - virtually uninsured and may still need subsidized care. Many policies cap at $1 million, some conditions can easily go over that amount...what do you do then? My conclusion is to either leave the choice an individual choice or have a single payer system funded through taxation (mandatory participation at a statutory minimum level of coverage for all).



    I agree. Why would a man or woman spend money on cell phones and internet (or any of the other things people spend money on that they could do without) before buying insurance for their family? I think American have grown to expect others to pay for their healthcare.

    In my state I have choices of over 50 auto insurance companies, but about 2 or 3 health insurance companies and really on one in my circumstance. When I moved from California to North Carolina, I could not keep the policy I had - a policy underwritten when I was younger and less of a risk, making the premiums cheaper.
     
    Last edited by a moderator: Apr 9, 2012
  5. Bodkin van Horn

    Bodkin van Horn One of the Four Horsewomyn of the Fempocalypse

    What incentive did insurers ever have to control the cost of care? None. If the cost of care goes up, they raise their premiums.
     
  6. redux

    redux Very Tilted

    Location:
    Foggy Bottom
    There is little competition in the health insurance market and annual profits of the handful of companies controlling the marketplace are in the $billions.

    A recent AMA study:
    Ace, what you appear to want -- more competition (more insurance companies and more choices in the types of plans and levels of coverage with varying premium costs) - is what the Insurance Exchanges would provide -- through federal regulation. An Exchange in North Carolina, either administered by the state or by the fed (if the state opts out), expands your choices.

    Allowing the purchase of insurance across state lines w/o federal regulation or a lack of uniformity in rate reviews and enforcement will only lead the insurance companies to operate out of the least regulated states.
     
    Last edited: Apr 2, 2012
  7. Aceventura

    Aceventura Slightly Tilted

    Location:
    North Carolina
    Assuming a competitive market, competition is an incentive. If company A and company B both charge the same premiums at the start, but company A does a better job of legitimate cost control, company A will make more profits and be in a potions to lower premiums and gain market share. However with competition if company A is more or less cheating their insureds by not paying legitimate claims, people with choice will go to company B

    True - but they would love to make it easier to make profits. They would love restrictions to competition and the ability to shift responsibility for cost control out of their profit equation. I think where the incentives are is very important. I understand that others may not agree - time will tell in this situation. My bet is that costs will continue to go up at a rate significantly greater than CPI in healthcare under Obamacare. There are other ways, better more efficient ways to reform healthcare.
    --- merged: Apr 2, 2012 at 5:59 PM ---
    I agree. However, I do not see how the Exchanges are going to control costs. The odds are that the Exchanges not having a profit motive will contribute to increasing costs. In addition, like in Medicare and Medicaid there is a risk that some medical practices will not accept these plans. Unless they are forced to, creating a two tier system.

    That is not true with other forms of insurance. Think about it. Why would I pay more for a substandard product? Why would I pay the same for a substandard product? I wouldn't, would you? We can employs a means to help protect people from fraud across state lines.

    I went to Aetna website and looked at their annual report for 2010. Interesting they had a 19.3% operating expense ration (admin/sales) and a 5.2 % after-tax profit margin. In '09 the numbers were 18.2% and 3.7%. The 80/20 regulation may simply reflect historic numbers and is of little significance. Here is a link:

    Aetna 2010 Annual Report | Financial Highlights

    {Added} Actually in the detail of the report they show their MBR (Medical benefit ratio) as 80.6% in 2010 for their commerial business. Over 87% for Meicare and Medicade.
     
    Last edited by a moderator: Apr 9, 2012
  8. redux

    redux Very Tilted

    Location:
    Foggy Bottom
    What competition? Not in half the states where two companies have 70 percent market share....or in 83 percent of metropolitan markets where a "significant absence of health insurance competition exists".
    The Exchanges will not provide insurance, but simply the mechanism through which more private insurers can get a piece of the market in the states and metropolitan areas highlighted above. In terms of non-profits, the only requirement is for the Exchange offer at least one non-profit alternative to the multiple private insurers. Both factors contribute to greater competition in both the number of companies and the number of plan options.

    Right, but not just fraud....federal regulation to ensure greater uniformity across the country for pricing (standards for reviewing and addressing "extraordinary" premium increases ) and practices (eliminate cherry picking or risk selection of consumers).
     
    Last edited: Apr 2, 2012
  9. pan6467

    pan6467 a triangle in a circular world.

    Ok, we'll look at the argument "car insurance is to protect other people" true, and like carrie said it is usually at the bare minimum (because it is cheaper). Now we look at health insurance, how many hospitals are losing money and going b
    ankrupt because people can't pay? Taxes go to pay to keep some hospital doors open and pay for people to stay alive through Medicaid and other government plans..... NOW if EVERYONE had insurance, the tax dollars going to hospitals would be far less and people would be treated regardless of "life or death situations".
    Car insurance supposedly covers one's medical bills and property damage, money that those uninsured would not be able to pay, again eaten by tax dollars because it may cause bankruptcies not only by the uninsured driver but the innocent property owner that suffered the damage.
    The same can be said about health insurance, unless it is life or death a hospital doesn't want to treat a person without insurance of some form. Had I had insurance and was able to get true preventative care and not just "here you go be on your way." I wouldn't have had to have had 5 surgeries on the tax payer's dime, plus follow up, plus meds, and so on. So in reality, it cost taxpayers far more for me to have to be in a "life or death" situation than had I received better care in the first place.
    By opening up insurance to be affordable TO ALL, then you take away a great deal of taxpayer liability. I don't believe EVERYONE should be forced to buy health insurance, but I do believe that it should be affordable to ALL. IF people had to pay for it and not the companies (as a benefit) wages may go up, jobs may open because the companies would have more money.
    30 years ago car insurance was far less expensive today as compared to health insurance. 30 years ago people argued over being forced to buy auto insurance... that was going to bankrupt people, the government had no right demanding people buy car insurance.... and yet it happened.
    I really don't see a feasible argument as to the difference. Again, I am NOT saying people should be forced to, I am saying that premiums should be made affordable TO ALL. But if you say those who don't buy it should get equal care... we're in the same position OR worse than we are in now. we'll have people dying for profit because of lack of insurance, people not getting preventative care until it becomes a crucial life or death situation and the tax payer still pays.
    The only other way for a decent healthcare system is to just make it universal and public, period. Then tax fatty foods, dangerous activities and so on. Again, with companies not having to pay their employees premiums, they can open more jobs and raise wages. the raise in wages then covers the taxes that have been raised.
    Unless you have a better idea for ALL people to get insurance.... or a way to improve the system then all i can say is you are too worried about your own dollar than a medical system where the average life expectancy is falling, deaths of children under 5 is rising and people without insurance are dying from simple health issues because they lack insurance.
     
  10. Bodkin van Horn

    Bodkin van Horn One of the Four Horsewomyn of the Fempocalypse

    But competition will still exist.

    Why would they suddenly not need to worry about cost controls? Are people going to be unable to shop around? Are the companies that provide these benefits to their employees going to suddenly not concern themselves with getting the best bang for their buck?
     
    Last edited: Apr 3, 2012
  11. pan6467

    pan6467 a triangle in a circular world.


    Just wanted to touch on this one aspect, are the roads not covered by taxes paid, thus a right not a privilege to drive on them (so long as you are of legal age and have a legal right (drivers license) to do so.

    It also reminds me of what Reagan did to get his will done and states to change laws to what HE wanted. Back in the 80's Reagan demanded that ALL 50 states raise their drinking age to 21. 2 states refused, Ohio and Louisianna.

    La.'s age was 18 and the governor at the time said that was a state tradition and nothing Reagan could do would stomp on the rights of his state.

    Ohio had an election, OVERwhelmingly people voted for a drinking age of 19. So the state's people spoke and thus the age was 19.

    Reagan unhappy with the VOTERS of Ohio and the people of La. REFUSING him, (why who were these lowly people to refuse what was BEST for them, when Reagan and the GOP KNEW what was best for everyone?) decided to with hold the Federal funding for those states highways.

    Needless to say La buckled and Ohio, shortly passed a grandfather clause, FORCED by the president that the GOP hold up a savior, so exactly what has Obama done that Reagan didn't do first? Obama at least isn't blackmailing states refusing tax dollars to states. Back in the 80's did Ohioans and Louisiannians NOT pay federal taxes that their states should have had equal rights to?

    Oh wait Reagan was a Republican and had Robertson's stamp of approval on his ass, while Obama is a black Democrat that many in the deep South have been brainwashed to believe he's Islamic by Faux News and Pat Robertson.

    So sadly THERE is a double standard.
     
  12. Baraka_Guru

    Baraka_Guru Möderätor Staff Member

    Location:
    Toronto
    Those who think "Obamacare" needs to be scrapped are likely misguided (or misguiding).

    Perhaps the viability of "Obamacare" is based simply on how it is funded.

    Perhaps changing how its funded is the way to go, whether this means going to single-payer or some of the other options of a universal system (one example being both federal- and state-level pay-ins.)

    Regardless, why scrap something that people otherwise support? Why scrap the entirety of something based on one or two aspects that could be amended? Are there other motives?

    [​IMG]
    The Anatomy of Obamacare (What's Not to Like?)
     
    Last edited: Apr 29, 2012
  13. rogue49

    rogue49 Tech Kung Fu Artist Staff Member

    Location:
    Baltimore/DC
    Interesting...

    So...basically, since it is such a bad & horrible thing to happen to this country.
    We cannot repeal it or replace it,
    because those that say it is bad, can't think of anything to replace it with
    and don't have the strength/will to repeal it.

    I get it.
    Kick, scream, shout...then punt.
     
    Last edited: May 16, 2012
  14. pan6467

    pan6467 a triangle in a circular world.

    Ahhhh so Romney was for Universal Healthcare until he was against it??? That worked so well for Kerry. :p
     
  15. Baraka_Guru

    Baraka_Guru Möderätor Staff Member

    Location:
    Toronto
    Last edited: Jun 28, 2012
  16. Joniemack

    Joniemack Beta brainwaves in session

    Location:
    Reading, UK
    I still don't (can't) believe the conservatives on the Court will rule against the mandate and in essence, rule against the insurance industry. It's just not the way they roll.

    I guess I'll see shortly whether I'm right or wrong.
     
  17. Baraka_Guru

    Baraka_Guru Möderätor Staff Member

    Location:
    Toronto
    A helpful recent post on the Guardian blog following this.....

    Supreme court ruling on healthcare law – live coverage | Law | guardian.co.uk
     
    Last edited: Jun 28, 2012
  18. Bodkin van Horn

    Bodkin van Horn One of the Four Horsewomyn of the Fempocalypse

    I bet the court rules that the constitution is a person and so any limitations the government places on the constitution are a violation of its first amendment rights.

    Supreme Court:disbanded.
     
    • Like Like x 1
  19. Baraka_Guru

    Baraka_Guru Möderätor Staff Member

    Location:
    Toronto
    UPDATE:

    According to Tom at SCOTUSblog:
    Apparently the individual mandate survives not as falling under the commerce clause but as a tax.

    It's still early and a bit confusing to parse, but I'm sure we'll here more later today.

    Republicans are probably already moving forward with their plans to repeal in the House.
     
  20. redux

    redux Very Tilted

    Location:
    Foggy Bottom
    I was shocked to hear Roberts side with the liberals on the mandate (under Congressional taxing powers). But by denying the commerce clause argument, the catch is now there is no penalty for those who refuse to purchase insurance or the pay the tax.

    The medicaid issue appears to have the same double edge result. The medicaid expansion in the law was not invalidated, but existing medicaid funding to states cant be withheld, thus allowing states to opt out.

    Its a win for Obama, but it will certainly make implementation much more difficult. W/o the mandate penalty and with states able to opt out of expanded medicaid (where many of those w/o insurance would fall), the math on how to pay for it becomes much more fuzzy.
     
    Last edited: Jun 28, 2012