The health care debate thread.

[wuapinmon]

Here's what I want.

Universal healthcare for anyone 18 & under, or up to 25 if enrolled full-time in a college or vocational degree-seeking accredited program.

Everyone else, pay for it like an adult, and save for old age.

No one should ever have to make decisions about their kids' health based on what they can afford. Adults should absolutely decide what they can afford. No more Medicare, no more Social Security, and no more Medicaid (except for maternity care) for anyone born after 1960. I'll keep paying the taxes until I'm 65 (25 more years) to put an end to those programs, my sacrifice to make up for the grossly irresponsible largesse of the "Greatest Generation" and the Boomers.

I also think that we should amend the Constitution to make it a law that Congress shall pass no law that exempts them from the laws to which their constituents are subject.

[Diehard Ute]

Here's what I want.

Universal healthcare for anyone 18 & under, or up to 25 if enrolled full-time in a college or vocational degree-seeking accredited program.

Everyone else, pay for it like an adult, and save for old age.

No one should ever have to make decisions about their kids' health based on what they can afford. Adults should absolutely decide what they can afford. No more Medicare, no more Social Security, and no more Medicaid (except for maternity care) for anyone born after 1960. I'll keep paying the taxes until I'm 65 (25 more years) to put an end to those programs, my sacrifice to make up for the grossly irresponsible largesse of the "Greatest Generation" and the Boomers.

I also think that we should amend the Constitution to make it a law that Congress shall pass no law that exempts them from the laws to which their constituents are subject.

So what do you do with all the people who are over 25? They're going to still go to the hospital and who's going to pay for it?

[wuapinmon]

So what do you do with all the people who are over 25? They're going to still go to the hospital and who's going to pay for it?

They're going to be adults and pay on their medical debts for years like I have.

[Diehard Ute]

They're going to be adults and pay on their medical debts for years like I have.

Ha. You've never worked in medicine have you?

[wuapinmon]

Ha. You've never worked in medicine have you?

I'm not that kind of doctor.

[Mormon Red Death]

I haven't been a part of this thread but I wanted to weigh in.

My overall assessment of the health care system is that as currently evolved, it rewards the rent-seekers spectacularly well.

Obamacare is simply going entrench and strengthen the status quo. It enriches, reinforces and solidifies the major players already in existence and will be a boon to Washington and large health care entities that play in that game.

There isn't anything affordable about the Affordable Care Act. Its primarily going to be funded by new money into the system by the young and healthy, who will no longer benefit from the information asymmetry they currently enjoy. Ironically, this is the segment that overwhelmingly voted for the guy that will screw them with a tax (as ruled by the Supreme Court) that will probably exceed their income taxes liability during their healthy-but-poor years.



In the end we will all pay more (as a % share of GDP), health outcomes will not have any needle-moving improvement, utilization will increase and the entire health system will have a growing share of a slowly growing GDP pie. All of this is clearly predicted from the Oregon Health Study: http://www.nber.org/oregon/

In a way, the problems of education and health care mirror each other and the "solutions" cannot be crafted in the context of better policies in this political environment. Both education and health systems fail by completely avoiding fundamental principles of economics.

How do the youth benef it from asymetrical information? Do you have that term confused with adverse selection?

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[LA Ute]

Daniel Henninger:

American progressivism is politics by cramdown. Ask Jamie Dimon. Ask the coal miners the EPA is putting out of business. Ask the union workers waiting for jobs on the Keystone XL pipeline. Ask Boeing BA +0.02% in South Carolina or the harmless tea party groups from towns no one has ever heard of that were shut down by the IRS, or the 20,000 inner-city parents and students who marched across the Brooklyn Bridge to protest obliteration of their charter schools by New York's progressive mayoral candidate, Bill de Blasio.

Up to now, most of the events of the Obama presidency have passed in and out of the news as just politics. But with ObamaCare and its details touching so many people all at once, it has become impossible not to recognize that the Affordable Care Act is an offensive ideological exercise, not merely an entitlement program. By Mr. Obama's own admission, this law is the way he wants the world to work in the U.S.—whether in health, education, energy, infrastructure or finance. And what Americans now riding through the ObamaCare hurricane of canceled policies, disappearing doctors and rebooted promises have to be asking themselves is: Do I want to live with this level of personal enforcement in the U.S.?

http://online.wsj.com/news/articles/...pinion_LEADTop

[Rocker Ute]

Uhg, this makes me even more sick. I decided after my post to go back and look at our healthcare expenses over the past 4 years. I mentioned I was on a catastrophic coverage health plan ($10k deductible after which 100% was covered) coupled with an HSA, so everything over the past 4 years has been paid for out of pocket after charges were adjusted simply by being insured (that is another debate... if I wanted to just pay straight up, why would it cost more?)

So here is the breakdown

4 years ago - ~$6800 (We had a baby)
3 years ago - ~$260
2 years ago - ~$240
1 year ago - ~$360 (persistent ear ache for my son)
This year to date - $190

So even on the most gold-plated of gold-plated health plans we wouldn't even be getting into the deductible amount where we might get some return on having a plan. I should note those were all preventive care / scheduled check-ups and a couple of ear aches.

We're an insurers wet dream... we pay them money for doing nothing on even their very best plans. In the meantime we'd put enough into an HSA we were covered better than being on a gold plated plan if catastrophe struck.


I get it, things can change quick... one serious bike accident and in year two I might be singing a different tune, but don't we live our lives like that all the time? Do we all have a contingency plan for every disaster, particularly when we are young.

I like waup's everyone under 18 insured idea, heck why not under 21? In fact, I might even be okay with a yearly preventive care waiver for all people, where you get one doctor visit on the house.

This crap though... no thank you.

[Sisyphus]

How do the youth benef it from asymetrical information? Do you have that term confused with adverse selection?

Adverse selection is the existing consequence/condition of asymmetrical information possessed by the younger & healthier crowd about their own health status or risks.

The young/healthy know they are low risk for pretty much everything except pregnancies and accidents. Those that actually have health problems ( a friend of mine that has Type I Diabetes comes to mind) are sure to get insurance. Others that have very low risk forego insurance, avoiding thousands in premiums each year paid for an unlikely event.

[LA Ute]

What Everyone Knew About Obamacare and Wouldn't Say

As I noted the other day, when Obamacare "czar” Jeffrey Zients announced that the health-insurance exchanges would be working by Nov. 30, he bought the administration some time. Unfortunately for them, most of that time has so far been spent discussing “rate shock” and policy cancellations: the folks in the individual market whose policies were canceled thanks to new regulations and will now have to replace them with something more expensive or that carries a higher deductible.


We don’t actually know how bad a problem this is. Mathematically, two things must be true: There are some people in this country who are losing their current insurance and gaining better insurance at a lower cost, and there are some people in this country who are losing their current insurance and getting worse insurance at a higher cost. And there are some who are now getting insurance they couldn’t afford at all before.

We don’t know how many people are in each group. Nor do we know how big a problem rate shock will be for the folks who experience it. But that doesn’t matter for the news story, which, in the absence of data, will be a war of anecdotes. Not ideal, but frankly, most of the folks now complaining about the “rate shock” anecdata were often the same folks who eagerly showcased every anecdotal story about a poor single mom who was excited to be getting insurance for the first time. So I find it hard to take their distress too seriously...

[Diehard Ute]

I really don't think most people realize just how much charity care we all pay for without the use of Medicaid etc.

Many many people use 911 as their "doctor" and many more use emergency rooms for the same purpose.

Because an ER can't refuse service many of those charges are never paid for....meaning those of us who either have insurance, or pay cash, have those losses factored in.

The last year I worked at University Medical Center, 2006-07 there were roughly $250,000,000 in charges written off by the U's hospitals and clinics. (Approximately 25% of all charges that year).

I have no idea what the cost the abuse of EMS is. But I know I go to a lot of non emergent calls with the fire department

[Sisyphus]

So here is the breakdown

4 years ago - ~$6800 (We had a baby)
3 years ago - ~$260
2 years ago - ~$240
1 year ago - ~$360 (persistent ear ache for my son)
This year to date - $190

We're an insurers wet dream... we pay them money for doing nothing on even their very best plans. In the meantime we'd put enough into an HSA we were covered better than being on a gold plated plan if catastrophe struck.

The dirty, GIANT secret of the whole system is that 90% of us are just like you and would drop insurance in an instant if we just had access to the same pricing that insurance companies have. The bulk of us, frankly, are scared into getting insurance because of the possibility of financial ruin from a medical emergency generating 300-400% marked up charges totaling in the 10s of thousands of dollars. Insurance Companies ends up paying 10-20% of those huge bills. If there was true price transparency, total health coverage plan enrollment would be waaaaaay lower and catastrophic coverage would be the norm to cover something that might happen once every 10-20 years, similar to Homeowners' Insurance.

LA Ute can confirm/refute this but I recall over half of all expenditures of the system are "consumed" by less than 2% of the population, a large portion of whom are in their last 30 days of life.

If you have a more sensible and dignified end-of-life process compared to our "anything and everything it takes, damn the costs" approach our costs as a share of GDP get cut in half.

There is a big difference in the whole "value of life" conversation in the US vs the rest of the developed world. The US has a different value tradition, circa 2010 than other, more secular nations, particularly compared to Western Europe and Japan. This all shows up within the Health Care and the Abortion debates. Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

Nowhere has this change in culture/expectations been discussed. To try to do something about it is to be accused of wanting "Death Panels"

[Sullyute]

The dirty, GIANT secret of the whole system is that 90% of us are just like you and would drop insurance in an instant if we just had access to the same pricing that insurance companies have. The bulk of us, frankly, are scared into getting insurance because of the possibility of financial ruin from a medical emergency generating 300-400% marked up charges totaling in the 10s of thousands of dollars. Insurance Companies ends up paying 10-20% of those huge bills. If there was true price transparency, total health coverage plan enrollment would be waaaaaay lower and catastrophic coverage would be the norm to cover something that might happen once every 10-20 years, similar to Homeowners' Insurance.

LA Ute can confirm/refute this but I recall over half of all expenditures of the system are "consumed" by less than 2% of the population, a large portion of whom are in their last 30 days of life.

If you have a more sensible and dignified end-of-life process compared to our "anything and everything it takes, damn the costs" approach our costs as a share of GDP get cut in half.

There is a big difference in the whole "value of life" conversation in the US vs the rest of the developed world. The US has a different value tradition, circa 2010 than other, more secular nations, particularly compared to Western Europe and Japan. This all shows up within the Health Care and the Abortion debates. Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

Nowhere has this change in culture/expectations been discussed. To try to do something about it is to be accused of wanting "Death Panels"

I agree with everything you say, but it is much easier to change a policy than a culture. I also think that it is not fair to compare the hodgepodge of cultures in the US to the much more homogenous cultures of Europe and Japan.

In the US we tend to be a little more ambivolent to/accepting of violent death (war, crime, movies, video games, etc.) , but we have a harder time aceepting natural death. How do you change or reverse that? Maybe we should have mandatory viewings of the movie Cocoon?

[U-Ute]

Maybe we should have mandatory viewings of the movie Cocoon?

I was thinking maybe Soylent Green.

[U-Ute]

L.A. Times:

Some health insurance gets pricier as Obamacare rolls out

"I was all for Obamacare until I found out I was paying for it...."

It turns out she was wrong

Her current plan, from Anthem Blue Cross, is a catastrophic coverage plan for which she pays $293 a month as an individual policyholder. It requires her to pay a deductible of $5,000 a year and limits her out-of-pocket costs to $8,500 a year. Her plan also limits her to two doctor visits a year, for which she shoulders a copay of $40 each. After that, she pays the whole cost of subsequent visits.

At her age, she's eligible for a good "silver" plan for $333 a month after the subsidy -- $40 a month more than she's paying now. But the plan is much better than her current plan -- the deductible is $2,000, not $5,000. The maximum out-of-pocket expense is $6,350, not $8,500. Her co-pays would be $45 for a primary care visit and $65 for a specialty visit -- but all visits would be covered, not just two.

If she wanted to pay less, Cavallaro could opt for lesser coverage in a "bronze" plan. She could buy one from the California exchange for as little as $194 a month. From Anthem, it's $256, or $444 a year less than she's paying now. That buys her a $5,000 deductible (the same as she's paying today) but the out-of-pocket limit is lower, $6,350. Office visits would be $60 for primary care and $70 for specialties, but again with no limit on the number of visits. Factor in the premium savings, and it's hard to deny that she's still ahead.

It sounds like she didn't quite shop around like she thought she did.

[LA Ute]

It turns out she was wrong....

Anecdotes are like that.

[Mormon Red Death]

The dirty, GIANT secret of the whole system is that 90% of us are just like you and would drop insurance in an instant if we just had access to the same pricing that insurance companies have. The bulk of us, frankly, are scared into getting insurance because of the possibility of financial ruin from a medical emergency generating 300-400% marked up charges totaling in the 10s of thousands of dollars. Insurance Companies ends up paying 10-20% of those huge bills. If there was true price transparency, total health coverage plan enrollment would be waaaaaay lower and catastrophic coverage would be the norm to cover something that might happen once every 10-20 years, similar to Homeowners' Insurance.

LA Ute can confirm/refute this but I recall over half of all expenditures of the system are "consumed" by less than 2% of the population, a large portion of whom are in their last 30 days of life.

If you have a more sensible and dignified end-of-life process compared to our "anything and everything it takes, damn the costs" approach our costs as a share of GDP get cut in half.

There is a big difference in the whole "value of life" conversation in the US vs the rest of the developed world. The US has a different value tradition, circa 2010 than other, more secular nations, particularly compared to Western Europe and Japan. This all shows up within the Health Care and the Abortion debates. Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

Nowhere has this change in culture/expectations been discussed. To try to do something about it is to be accused of wanting "Death Panels"

You will spend more in the last 6 months of your life than the rest combined

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[LA Ute]

Here's a younger citizen who thinks his generation is paying too much under Obamacare. And he's not happy about it.

http://touch.latimes.com/#section/-1.../p2p-77972774/

[Diehard Ute]

Here's a younger citizen who thinks his generation is paying too much under Obamacare. And he's not happy about it.

http://touch.latimes.com/#section/-1.../p2p-77972774/

Reality is our entire system of who pays for what is screwed up. It's certainly never been based on who uses what

[LA Ute]

Reality is our entire system of who pays for what is screwed up. It's certainly never been based on who uses what

The dirty secret of healthcare (which everyone in the industry knows) is that no one knows what it really costs. I can tell you what is charged for an artificial hip but no one can tell you what it actually costs.

[LA Ute]

It turns out she was wrong

It sounds like she didn't quite shop around like she thought she did.

By the way, with a silver and bronze plan in CA, your choices of physician and hospital are very limited. They're called "narrow networks." It's especially narrow with Bronze plans. So I'll bet that while her choices seem decent in terms of cost, they're not so good when it comes to choice of provider. This is one of the next things people will be upset about as they discover what has happened.

More about that here:

http://dailycaller.com/2013/10/30/wh...llyannas-miss/

[GarthUte]

[LA Ute]

CNN: Senate Democrats supported rule that led to insurance cancellations

Senate Democrats voted unanimously three years ago to support the Obamacare rule that is largely responsible for some of the health insurance cancellation letters that are going out.

In September 2010, Senate Republicans brought a resolution to the floor to block implementation of the grandfather rule, warning that it would result in canceled policies and violate President Barack Obama’s promise that people could keep their insurance if they liked it.

“The District of Columbia is an island surrounded by reality. Only in the District of Columbia could you get away with telling the people if you like what you have you can keep it, and then pass regulations six months later that do just the opposite and figure that people are going to ignore it. But common sense is eventually going to prevail in this town and common sense is going to have to prevail on this piece of legislation as well,” Iowa Sen. Chuck Grassley said at the time.

“The administration's own regulations prove this is not the case. Under the grandfathering regulation, according to the White House's own economic impact analysis, as many as 69 percent of businesses will lose their grandfathered status by 2013 and be forced to buy government-approved plans,” the Iowa Republican said.

On a party line vote, Democrats killed the resolution, which could come back to haunt vulnerable Democrats up for re-election this year.

Senate Democrats like Mary Landrieu, Jeanne Shaheen, Mark Pryor, Kay Hagan and Mark Begich – all of whom voted against stopping the rule from going into effect and have since supported delaying parts of Obamacare.

[Dawminator]

That's pretty damning of the democrats.

[LA Ute]

People are posting photos of their cancellation notices at:

http://mycancellation.com/

[GarthUte]

Let's just hope there aren't enough people to start a mypinkslip.com.

Why would they get fired? The law stole their insurance from them, not their employers.

[Rocker Ute]

Doing everything in one's power, even against all odds, to preserve life is enabled and even culturally "right" in the US. It's almost taboo to let people live out their life in peace and refuse additional treatment, as a good friend of mine chose to do for her dying 50 year old son just last week. This is much more commonplace elsewhere.

This reminds me of the passing of my grandpa over ten years ago now. He had been in a care facility for some time and a quick deterioration in his health indicated he was approaching the end of his life. He had a living will that explicitly spelled out what he wanted done, particularly that if he wasn't responsive and there wasn't hope of returning to a reasonable quality of life to let him go. My father and uncle made the tough decision based on this to switch him to hospice care and to let him go. My father described it as one of the toughest decisions of his life.

When the let their decision be known my grandfather's doctor protested vehemently. He accused my dad and uncle of just wanting to cash out their inheritance (he was a high school teacher his whole life and had been in a rest home for a number of years, there wasn't much left to inherit) and a number of other rotten things. As it turns out, the doctor actually was part owner of the facility my grandpa was in, so his death represented $4000/mo going away.

So as they argued the doctor said he refused to take him off of life support, to which my dad replied, "Okay, well then you're fired... you are no longer his doctor." The doctor incredulous said, "I don't work for you, you can't fire me!" My dad said, "Watch me..." Called some friends to find a good doctor in the area and that was that. The new doctor came in, agreed that he wouldn't return to any quality of life and helped put him on hospice care.

Point being, some people think it is pretty cold to not fight for the last breath, while others find dignity in passing as nature may want. My grandpa was smart enough to spell out what he wanted beforehand.

Interestingly one of the very last lucent conversations my grandpa had with my dad was him quoting the church hymn, "Do what is right let the consequence follow / Battle for freedom in spirit and might / And with stout hearts look ye forth till tomorrow / God will protect you so do what is right."

Good advice for anyone regardless of religious affiliation I think.

[LA Ute]

Looks like the White House knew about the impending Obamacare rollout disaster long before those wascally wepublicans started obstructing.

http://m.washingtonpost.com/politics...b78_story.html

[Rocker Ute]

Looks like the White House knew about the impending Obamacare rollout disaster long before those wascally wepublicans started obstructing.

http://m.washingtonpost.com/politics...b78_story.html

Ironically, and I thought this the whole time during the government shutdown, if the Republicans had been principled enough and actually believed what they were saying about Obamacare they should have stop obstructing and could have let it collapse under the weight of its own hubris and then had a solid platform to run on going forward the "We told you so / Repair or Repeal Obamacare" all the way through to the 2016 presidency.

I say this of course assuming by their previous actions that they (along with most of our elected officials) really don't care about collapsing our government.

[Mormon Red Death]

Ironically, and I thought this the whole time during the government shutdown, if the Republicans had been principled enough and actually believed what they were saying about Obamacare they should have stop obstructing and could have let it collapse under the weight of its own hubris and then had a solid platform to run on going forward the "We told you so / Repair or Repeal Obamacare" all the way through to the 2016 presidency.

I say this of course assuming by their previous actions that they (along with most of our elected officials) really don't care about collapsing our government.

The problem is that once an entitlement starts its near impossible to revoke it

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