New Study Shows Obamacare is Stabilizing, Not Imploding

tomkat364 said:

Here's my homework: My current policy, which is the cheapest marketplace plan (out of three plans from a single provider because all the others dropped out) requires me to pay $25,800 in premium and deductible before insurance covers dollar one. I used $0 of healthcare last year, so I'm certainly not making out well in this plan.

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katzgar said:

Pretty much everybody agrees the ACA needs fixing but like I said is true the vast majority of people have good affordable insurance policies now or on Medicaid that didn't have anything before

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tomkat364 said:

I find that hard to believe. Please give a link supporting this. Here's a link that suggests the opposite:
http://www.cnbc.com/2016/11/18/more...-over-100-per-month-for-health-insurance.html
Not only do people say they cannot afford a paltry $1200/yr premium, but that number is less than a third of the national average for the cheapest marketplace plan. The only reason people can "afford" their insurance is because they receive subsidies which come directly from taxes placed on those few who can afford it.
Not only have premiums gone up beyond what people "can afford", but deductibles are now averaging in ridiculous ranges ($6092 for the bronze plans). https://www.healthpocket.com/health...7-obamacare-premiums-deductibles#.WWZ00Yjytdg

If you call that affordable, then more power to you. But the unsubsidized consumer (like myself) is probably paying for your plan then too. Your welcome.

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katzgar said:

Actually they are getting tax credits you need to do your homework

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tomkat364 said:

Bull****. If people saved the tens of thousands of dollars they spend on premiums during their youth, it would more than cover their medical costs later in life. Mathematically true. Insurance companies pay almost all the medical bills incurred, right? They are paid premiums by consumers, which not only cover all those medical bills, but also a fair chunk of profit for the insurer as well, right? So all that money that goes to pay for total knee replacements came from... wait for it... the consumer. In fact, all insurance did in this situation is redistribute money that was already there, and take a piece of it in the meantime. So as a matter of fact, healthcare WITH insurance in the mix has to cost more than healthcare WITHOUT insurance in the mix. Not only because doctors have to employ entirely nonclinical staff to deal with the billing nightmares created by insurance, but because the insurance premium INCLUDES a markup on the healthcare itself.

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They are paid premiums by consumers, which not only cover all those medical bills, but also a fair chunk of profit for the insurer as well, right? So all that money that goes to pay for total knee replacements came from... wait for it... the consumer.

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jaeger19 said:

People had opportunities to "save tens of thousands of dollars they spent on premiums during their youth"..

Been there done that. We have been where the local doctor was paid in chickens. And you know what.. the care barely improved until.. either the government paid for it (WWI and WWII) or insurance paid for it.

I guess if we could all just decide to save those tens of thousands of dollars.. and then have our injuries when we are 90 years old and rich.. your idea pencils out mathematically.

but the young fellow starting his job in the apple orchard hasn't had time to "save tens of thousands of dollars".. when he got appendicitis and needed an appendectomy before he became septic. In the old days? He probably would die.. a good chance of that.

Or how about that 1 year old with influenza? How many thousands of dollars had he and his parents saved.



Right.. only because healthier people.. are paying for those that aren;t so healthy.. or have a problem.. or haven't had time to pay in enough before they get sick etc. ITS NOT that every person is capable of paying whenever they get sick.. that's why its called insurance.

Some individuals pay more in than they ever take out.. some individuals take out more than they ever put in.. that's how insurance works. Not that every individual is capable of putting in enough money to cover every eventuality..

So as a matter of fact.. that healthcare without insurance wouldn't cost much;. but it wouldn't be much.. just like in the past. If you want to go back to the late 1800's and early 1900's when it comes to care... okay.. but that's what would happen.

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tomkat364 said:

As further evidence that insurance is a huge reason prices are as high as they are, consider this.

I live in an area that has a large population of Mennonite and Amish (collectively referred to as the Plain Community). Most of these people do not have insurance, either because they are self-employed farmers or because it conflicts with their religious convictions, and they are among the few groups who are excluded form the Obamacare statutes due to this religious objection. As a result, they pay out of pocket for healthcare.

The primary hospital in our area found that the Plain Community had set up a transportation network to shuttle members to a nearby state in which elective procedures (like your knee replacement example) were less expensive than local providers. They actually got rides to other states to pay less money for their services. As a result, the local hospital created a cost sharing mechanism that allows card-carrying members of these churches (yes, they created ID cards for this specific purpose) to get a discount on local services to the tune of 45%.

Again, the take home being that people WITH insurance accept higher priced care because they are not actually paying the bill, they are paying their premium. Those without insurance make more frugal choices, and as a result the market prices lower to attract business.[/QUOTE

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Yeah., its not evidence...

Here is what you don't know..

Local providers were not more expensive because of people having health insurance. They were more expensive BECAUSE PEOPLE NOT HAVING INSURANCE. In other words.. the local hospital probably had a larger percentage of people that were not capable of paying the bill but still got care because hospitals are federally mandated to provide care. In order to make the cost of unpaid care back.. the hospital had to charge higher rates from the insurance companies and people that WOULD/COULD pay.

The out of state providers they were going to.. STILL accepted insurance.. most certainly.. but since it was elective surgeries.. those providers were probably in an outpatient hospital or surgical center that did not have the costs of having an ER and getting stuck with unpaid care. They probably got the cream of the crop when it came to insurance reimbursements as well.. so they could offer lower cost surgeries because they were actually making more profit.

Once the local hospital figured out was happening.. they did a couple of back flips to get be able to give a cash discount to PLAIN Community without hurting their reimbursement from the other insurance companies.

In both cases.. the likelihood is that the better paying insurance companies were in part subsidizing the discount that the PLAIN community was getting.

IF what you said were true.. then all of us providers would simply not accept insurance.. and just have you pay upfront in cash. Some services can work like that. But most services.. particularly the non elective ones.. where a person needs it and needs it right now.. simply don't work that way.

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tomkat364 said:

I get what you are saying. But your dates are a bit off. You see, insurance didn't become "the way we pay for healthcare" until about the mid 1980s. Check out the graph on this link I posted earlier: https://fee.org/articles/if-cosmetic-surgery-has-a-working-market-why-can-t-medical-care/

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Furthermore, it was not the advent of health insurance that paved the road for advancements in healthcare. Discoveries like disinfectant, penicillin, and even the first vaccines all came before health insurance was available or at least prevalent.

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The increasingly obvious value of penicillin in the war effort led the War Production Board (WPB) in 1943 to take responsibility for increased production of the drug. The WPB investigated more than 175 companies before selecting 21 to participate in a penicillin program under the direction of Albert Elder; in addition to Lederle, Merck, Pfizer and Squibb, Abbott Laboratories (which had also been among the major producers of clinical supplies of penicillin to mid-1943) was one of the first companies to begin large-scale production. These firms received top priority on construction materials and other supplies necessary to meet the production goals. The WPB controlled the disposition of all of the penicillin produced.

One of the major goals was to have an adequate supply of the drug on hand for the proposed D-Day invasion of Europe. Feelings of wartime patriotism greatly stimulated work on penicillin in the United Kingdom and the United States. For example, Albert Elder wrote to manufacturers in 1943: "You are urged to impress upon every worker in your plant that penicillin produced today will be saving the life of someone in a few days or curing the disease of someone now incapacitated. Put up slogans in your plant! Place notices in pay envelopes! Create an enthusiasm for the job down to the lowest worker in your plant."

As publicity concerning this new "miracle drug" began to reach the public, the demand for penicillin increased. But supplies at first were limited, and priority was given to military use.

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National efforts to promote vaccine use among all children began with the appropriation of federal funds for polio vaccination after introduction of the vaccine in 1955

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The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza

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jaeger19 said:

and PS the one year old with influenza won't be just fine.. Mortality rates NOW are relatively low.. because of our healthcare system and its advancements in support for children.. from IV's to respiratory drugs to ventilators.

Prior to that.. influenza strains killed millions.

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tomkat364 said:

Other than during the periodic epidemics, the infant mortality rate from influenza was still relatively low (worst quoted rate I can find is 10% of those who were infected in German Samoa during the 1918 pandemic). The vast majority of people who got the flu, got better. And then, now, etc. there is still no treatment that is particularly successful for influenza. QUOTE]

Yeah.. you are just not getting it.. you just don't understand the economics of healthcare.

But are you trying to tell me that EACH 1 year old with the flu would DIE without treatment?

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nope.. not at all.. that's the point. If each 1 year old was going to die without a ventilator.. then the demand for ventilators would skyrocket.. there would be such volume.. that prices for said ventilator would likely drop (to some degree.. the cost of the technology would limit that but more volume allows a lower price in general).

But not every 1 year old is going to die.. maybe 1/100 is going to die.. now that's a lot of kids.. but its still one in one hundred. so that means I am developing a ventilator.. for only one in 100 kids. That's pretty low volume.

So to recoup all that expense developing it.. keeping it.. education for someone to run it when its needed so on and so forth.. I would say have to charge 50,000 for each kid that uses it.. since its so few kids.

How many parents could afford 50,000 dollar treatments? Not dang many..

BUT because of insurance.. that father that just started work at the auto plant, who has insurance.. he can now afford it because his insurance paid for it. Because that's how insurance works.. all those other people without sick kids paying in. .just in CASE they end up being 1 in a 100. But they aren;t.. but that means the money is available to the one that needs it.

Without that pooling of money.. there is no profit in developing a ventilator.

Part of the dramatic fear mongering that we deal with in the media is based on inflating the danger of illnesses. I'm not arguing that influenza is not a problem, or that it CAN'T be deadly. But holding up a random 1 y/o with the flu and saying that they would suffer significantly without healthcare is just plain manipulative and wrong.

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But here is the problem.. you are basing your impression that its fear mongering based on ignorance. We had periodic epidemics that did kill millions. We don't know because of the medical system we have in place.. that's largely there BECAUSE OF THE ECONOMIC EFFECT OF INSURANCE.
You basically are pointing to the medical system/innovation that was built on insurance money. And saying "see we don't need insurance".. Your premise is not logical.

As to your other statements, Govt funding for research does not equate to health insurance

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It equates to MONEY which is what is necessary for research and development of new technologies.. particularly if those technologies are going to benefit only a rare few.

As far as the plain community, that is a clear example of competition (they go where the price is lower) driving reduction in prices (lower rate to incentivize staying in the area

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Yeah no.. there was NO REDUCTION IN PRICE.. none. The hospital did backflips to be able to get to their rate that they make profit on... just like the hospital charged the insurance companies say 5000 for a service and the insurance negotiates that to 2500.

When people don't have insurance.. they get screwed because they don't have much negotiation power for things that are insurance based.. usually the only way we can offer a discount is through the "cash up front" discount.

Say I charge 200 for an office visit. Some insurances pay 200 for it.. some pay 140 for it.. some pay 120 for it.. some 160. It depends on the negotiated rate based on the volume and costs associated with that insurance. Now.. someone comes in without insurance. by law.. the charge is 200 dollars an office visit. I cannot say.. "just pay me what medicare would pay".. that's considered fraud. Insurance companies flip out if I offer services for less (even if they get a reduction). The only way that I can give a discount is if I give a cash discount.. or as in this hospital... they created all sorts of rigamorale to get around it.

You notice that they did not simply accept less.. they "did a cost sharing ID cards blah blah blah" for these people. They didn't simply lower their prices... they went through a bunch of hoops to get them a discount. And that discount was probably due in part because other insurances were paying MORE.. the same with the other facility.

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But they make better financial choices than the people who accept higher costs in this area DUE to the fact that they are self pay.

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Another area that is very similar is dental insurance.

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tomkat364 said:

I find that hard to believe. Please give a link supporting this. Here's a link that suggests the opposite:
http://www.cnbc.com/2016/11/18/more...-over-100-per-month-for-health-insurance.html
Not only do people say they cannot afford a paltry $1200/yr premium, but that number is less than a third of the national average for the cheapest marketplace plan. The only reason people can "afford" their insurance is because they receive subsidies which come directly from taxes placed on those few who can afford it.
Not only have premiums gone up beyond what people "can afford", but deductibles are now averaging in ridiculous ranges ($6092 for the bronze plans). https://www.healthpocket.com/health...7-obamacare-premiums-deductibles#.WWZ00Yjytdg

If you call that affordable, then more power to you. But the unsubsidized consumer (like myself) is probably paying for your plan then too. Your welcome.

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katzgar said:

77% of those enrolled in the ACA qualify for the aptc and have a premium of less than $100

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tomkat364 said:

Provide a reference please, and tell me, does that $100 premium include the aptc "discount" or not?
Your stat is self-serving, as obviously people who qualify for the aptc would likely opt for a marketplace plan. Those who don't get the tax credit are likely to a.) go without insurance, as millions do, b.) have an employer-sponsored group plan, or c.) have a non ACA compliant catastrophic plan and pay the penalty.

This is like saying that 77% of Catholics go to church, so the whole country is religious.

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jaeger19 said:

I understand fully how insurance works. We have other insurance systems in place that operate much differently than health insurance, like car insurance. When people have to pay for the car themselves, they choose which car they can afford that meets their needs. They have to pay for maintenance themselves, they have to pay for upgrades (new tires, etc.) themselves. All the insurance covers is the catastrophic loss of the vehicle or damage caused by it. When an accident is caused by inappropriate use (i.e. DUI), insurance is not responsible. Because of how this works, the cost of the car, the upgrades, the maintenance, etc. is not tied to the insurance itself, and people have to choose their expenses. They know that a mercedes costs more than a ford, and they choose accordingly.

Now, with health insurance, maintenance, upgrades, etc. are all paid as part of the "package" you buy. Again, people shop for insurance, not healthcare. As such, there is no competition for the actual product that we ACTUALLY care about. And prices go up accordingly.

You make a big deal out of the fact that medical research is paid for by insurance. Without insurance, this may be slower and we may not be as awesome as we are today. Yeah, I'm not really arguing with that notion. But the more STUFF we do, the more cost is incurred. MRI's are great, they can really help make certain diagnoses which improve patient outcomes. But they cost money. And so if you are saying that insurance is the reason we have more expensive diagnostic testing, then that is just another way in which insurance has helped to drive up the cost of care. The care may be better, but many of the costly MRI's ordered do not actually change patient care.

I know influenza WAS deadly. But the true ignorance is not understanding the ways in which medical progress have actually helped. Influenza is a very interesting subject, because the only true advancement we have made is preventative. But the flu vaccine is somewhat contentious in just how much it has affected the rates of flu infection. The long and short of it is that without ANY treatment, most people who get the flu get better. There are fewer rates of hospitalization now then there were in the past, so your talk of ventilators and stuff is missing the mark. People actually got sicker from the flu in years past. It isn't that the treatment is better now, because there still isn't any. It's that people are healthier in general, the immunization may help to diminish outbreaks, and quite possibly the viruses we have experienced are not as virulent as previous strains.

Insurance may increase access to healthcare, access to healthcare increases revenue, and revenue increases research/advancement. This is your point, right? Well that increases cost as well. And no, I appreciate the advancements, but that doesn't change the fact that cost has outpaced what people are WILLING to pay for the treatment.

And yes, insurance is a cost pooling proposition. I know. Some people never benefit, some benefit a lot. I get it, I do. But there is plenty of data that shows that the higher the out of pocket cost, generally the less enthusiastic the person is toward treatment.

Here's an example: There is this big kick for people to get screened for hepatitis c. Now hepatitis c has risk factors, i.e. sex, iv drugs, etc. Most of the people who are diagnosed with Hep C were baby boomers, and so the govt in all its wisdom encourages all baby boomers to get screened. Now a clinician I know presents his patients with full disclosure, "if you haven't done these things, you are unlikely to get the illness." And the only question the patients ask is "Does insurance cover it." They don't care about their risk, they don't care about the illness, they only care about the cost. Same goes for the shingles vaccine. Same even goes for viagra. Lots of men want the pill, but when it costs $70 a pill, and insurance doesn't pay, they go with out or buy it from canada. These are MEN not willing to pay for SEX! But if insurance paid for it, you better believe they would get the prescription.

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tomkat364 said:

jaeger19 said:

I understand fully how insurance works. We have other insurance systems in place that operate much differently than health insurance, like car insurance. .

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Yes.. it acts a bit differently because 1. If you make the wrong decision about a car.. you sell it..and get another. 2. If you make wrong decisions regarding healthcare.. you can die.

When people have to pay for the car themselves, they choose which car they can afford that meets their needs. They have to pay for maintenance themselves, they have to pay for upgrades (new tires, etc.) themselves

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First of all.. that BS.. totally. People don't choose which car they can afford that meets their needs. They choose the car they want the most and try to find a way to pay for it.. usually by going into debt for YEARS.. in some cases a decade. Be honest here. You have tons of soccer moms driving around in gas guzzling SUV's that costs upwards of 50,000 dollars, plus gas and maintence. that have 4 wheel drive that will never get used. That have engines and suspension that can haul a boat or a travel trailer.. that will never do such.

When they could haul those same kids around in a 10 year old Dodge Caravan for 5,000 dollars.

You have guys driving around in lifted diesel trucks.. which cost 50,000 and more.. that will NEVER have a need for that diesel engine. Ever. When a two wheel drive old Toyota pickup with a 6 cylinder would meet their needs just as well.

So please stop you fantasy here.

Secondly.. and here is the irony.. While the insurance company writes you a check and says have fun... when you have health insurance.. you don't get a blank check from the insurance company. Where as your choices are not limited when buying a truck.. an insurance company limits your choices.. which doctors are approved.. which surgery is approved. OR they don't pay. You act like its a blank check when its far from it. Not only that.. you physician is constrained by ethics laws and appropriateness of care.

You can walk into a Dodge Dealership and say " I want that Viper in the showroom".. and the dealer will try to make it happen for you. No matter how bad for your credit and finances.

You walk into a hospital and say " I want back surgery".. by and large if its not indicated for your issue.. then you are not going to get back surgery regardless of what you are willing to pay.

So enough with these ridiculous comparisons that have no validity whatsoever.

You make a big deal out of the fact that medical research is paid for by insurance. Without insurance, this may be slower and we may not be as awesome as we are today. Yeah, I'm not really arguing with that notion. But the more STUFF we do, the more cost is incurred. MRI's are great, they can really help make certain diagnoses which improve patient outcomes. But they cost money. And so if you are saying that insurance is the reason we have more expensive diagnostic testing, then that is just another way in which insurance has helped to drive up the cost of care. The care may be better, but many of the costly MRI's ordered do not actually change patient care.

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Yep.. all true.. in fact.. that's one way that single payer countries control their costs.. by reducing access to things like MRI and specialist type care and diagnostics. Because you are right.. the more that are available.. the higher the cost that has to be recouped to make it profitable.

And its not really a valid argument against MRI;s to say "well they don't change patient care".. . In many ways MRI's save money by ruling out conditions.. that prior to MRI. doctors would be doing "exploratory surgeries".. to discover what was going wrong with a patient.

There is no doubt that we have issues when it comes to how test or ordered, how insurance pays for such things etc.. BUT the overriding issues is that the answer is NOT to get rid of insurance and go back to healthcare of the late 1800s.

I know influenza WAS deadly. But the true ignorance is not understanding the ways in which medical progress have actually helped. Influenza is a very interesting subject, because the only true advancement we have made is preventative

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Yeah not at all. The biggest advancements we have made is in supportive care.

There are fewer rates of hospitalization now then there were in the past, so your talk of ventilators and stuff is missing the mark.

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That's because supportive care can start in outpatient clinics rather than in the hospital when its an emergency. Do in large part to what? Insurance.

It's that people are healthier in general,

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That's probably not really true. We are more sedentary, more obese, have exposure to more environmental hazards, and so on than at previous times in history.

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Insurance may increase access to healthcare, access to healthcare increases revenue, and revenue increases research/advancement. This is your point, right? Well that increases cost as well. And no, I appreciate the advancements, but that doesn't change the fact that cost has outpaced what people are WILLING to pay for the treatment.

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And yes, insurance is a cost pooling proposition. I know. Some people never benefit, some benefit a lot. I get it, I do. But there is plenty of data that shows that the higher the out of pocket cost, generally the less enthusiastic the person is toward treatment.

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There is this big kick for people to get screened for hepatitis c. Now hepatitis c has risk factors, i.e. sex, iv drugs, etc. Most of the people who are diagnosed with Hep C were baby boomers, and so the govt in all its wisdom encourages all baby boomers to get screened. Now a clinician I know presents his patients with full disclosure, "if you haven't done these things, you are unlikely to get the illness." And the only question the patients ask is "Does insurance cover it." They don't care about their risk, they don't care about the illness, they only care about the cost

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tomkat364 said:

Provide a reference please, and tell me, does that $100 premium include the aptc "discount" or not?
Your stat is self-serving, as obviously people who qualify for the aptc would likely opt for a marketplace plan. Those who don't get the tax credit are likely to a.) go without insurance, as millions do, b.) have an employer-sponsored group plan, or c.) have a non ACA compliant catastrophic plan and pay the penalty.

This is like saying that 77% of Catholics go to church, so the whole country is religious.

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