patrick.net

errc said: What are the real problems that one is allowed to legitimately criticize ppaca for?
Homeboy already said it, but I'll add a little more. In CA the biggest disaster appears to be limited to the Anthem Blue Cross plans and also the not for profit Blue Shield insurance. In their infinite wisdom, these insurers decided not to force doctors who accept their other plans to also accept ACA plans. As a result, it appears that many folks are having trouble finding a PCP. I'll make two predictions:
1. (And this one is a bit out there). There will be a small end of year ObamaCare rebate for folks who bought the Blue Cross and Blue Shield plans (because few services where actually used).
2. Kaiser will be the big winner next year as people flee BC and BS plans. Why? Because we now have an open and transparent marketplace where people can make choices based on how well they are served by their plans. Capitalism's finest hour.

Homeboy says

So then you don't even understand that insurance you get through your employer has nothing to do with the ACA state exchanges? You don't know that whether or not your employer-sponsored insurance has a deductible is in absolutely no way related to ACA?

I wasn't blaming Obamacare for high deductible policies offered at employers.

corntrollio says

And in addition, many employers give you HSAs to offset some of the deductible. I've seen some high deductible plans where the HSA amount they gave you was so high, that you almost got paid to have insurance.

HSA annual limit contribution is actually pretty small. I can only put $3300 into it this year. My employer does not contribute anything to it. Wells Fargo used to contribute a little to it, like $350 per year, but that was years ago and I would assume that's been done away with by now.

I'll make a much longer term prediction. Eventually, everyone will be insured under the ACA, however, few doctors will accept it. Lots of doctors will shift to payment at time of service, no insurance. The people who can't afford to pay for those doctors will wait in huge lines for ACA doctors, who will be the inferior ones who can't cut it in the competitive market. Hopefully, the non-insurance doctors will be reasonably affordable given that they'll have to compete on price.

corntrollio says

the hospital is required to coordinate network benefits, and generally speaking an in-network hospital should have in-network doctors

Since when??? Even a regular doctor visit I would remind them to only use an in-network lab, otherwise risk out of network fees. It's not like they or the hospital cares. This is where having Kaiser is a real benefit if they have hospitals in your area, since that won't happen.

myob says

Google "Oklahoma Surgical Center".

Damn, son, that shit is cheap. A lot of these are the cost that ins companies are charged for something simple like an MRI.

zzyzzx says

It's not like they or the hospital cares.

The hospital is generally required to do this under their contract with the insurer (and has been under every insurance plan I've been under), or else they don't get paid. Again, this applies to hospital stays with an in-network hospital. An out-of-network hospital is not required to do this and you may need to call yourself for pre-authorization.

For in-network hospital services, I once called the insurer just to confirm, and to paraphrase the response: "why the hell are you calling me? The hospital is required to coordinate this."

zzyzzx says

We do mostly have employer provided insurance, with the same extremely high deductible that practically guarantees that we pay for everything.

I would've thought it was a conservative argument that making people pay more connects them to their choices, which makes them less likely to abuse the system. Insurance distorts the capitalist mechanisms, does it not?

Isn't that the logic behind taxing that whiny bottom half of the citizenry, who have no stake in the taxes, yet reap the benefits of our system?

I thought "skin in the game" had been fully embraced by the right, whereas a more liberal argument would be "free healthcare for all!!"?

Now we complain about having price/pain points for healthcare?

CL says

I would've thought it was a conservative argument that making people pay more connects them to their choices, which makes them less likely to abuse the system.

I also find it insanely ironic that conservatives are whining about the cost of healthcare. But I think the point is that it costs more because BO is the commander in chief. Since, you know, health care costs dropped precipitously when GW was the decider.

CL says

zzyzzx says

We do mostly have employer provided insurance, with the same extremely high deductible that practically guarantees that we pay for everything.

I would've thought it was a conservative argument that making people pay more connects them to their choices, which makes them less likely to abuse the system. Insurance distorts the capitalist mechanisms, does it not?

Isn't that the logic behind taxing that whiny bottom half of the citizenry, who have no stake in the taxes, yet reap the benefits of our system?

I thought "skin in the game" had been fully embraced by the right, whereas a more liberal argument would be "free healthcare for all!!"?

Now we complain about having price/pain points for healthcare?

You have an odd perception of capitalism and conservatism, for that matter.

You also draw some loosely connected parallels, between what people pay for insurance, and their personal health decisions.

For example, given the choice, id opt not to overpay by an order of magnitude, for "health" "insurance". I also value my/our health, more than anything else. I dedicated a lot of time to unlearning all the misinformation about nutrition, and educating myself about proper nutrition. I put the dollars and hours in the kitchen, preparing, cooking, and cleaning, so we can eat healthful foods. As a result, we don't ever go to the doctor,,,we rarely if ever get sick. In a free market capitalist system, I could utilize the savings that others aren't working for, to pay down my mortgage and further capital accretion. Instead, you demand I am penalized to subsidize all of your piss poor health choices. Thanks a lot, obama voters!

CL says

I thought "skin in the game" had been fully embraced by the right, whereas a more liberal argument would be "free healthcare for all!!"?

When providers are required to post prices so that people can comparison shop, then your argument might be valid.

EBGuy says

errc said: What are the real problems that one is allowed to legitimately criticize ppaca for?

2. Kaiser will be the big winner next year as people flee BC and BS plans. Why? Because we now have an open and transparent marketplace where people can make choices based on how well they are served by their plans. Capitalism's finest hour.

I'm going to lose my lunch. Capitalisms finest hour? You have got to be kidding me. The government putting a gun to our heads, forcing us to purchase private insurance. Increasing opacity, not open and transparent. I think the word you are searching for is Fascism

Homeboy says

I don't know that I agree. He most likely would have liked to regulate the industry,

By healthcare industry, I meant all of them involved. This includes hospitals and drug companies. They dictate regulatory laws, and thus prevent competition. They prevent building of newer hospitals too. They are Obama's buddies.

Homeboy says

You cannot give away cheap bus tickets to everyone without increasing the number of seats.

Not sure what this is supposed to mean. Deductibles and insurance over-billing existed long before ACA was even being debated. Surely you aren't suggesting these problems are Obama's fault.

No, he is just like anyone else. He knew he could not actually fix the regulatory problems and anti-competitive patent laws in healthcare. So he decided to sugarcoat this with mandatory insurance.

myob says

Oh, I'm 100% with you, and I would love to see the medical system be competitive, but "insurance", which is actually pre-paid pooled service, hides prices from people and so, there is no price competition. I fully realize that I was using a benefit, albeit one which I pay for and want to use. If medical pricing wasn't such a racket, going uninsured and negotiating prices ahead of time would have worked great.

In my opinion, this glibertopian idea of true free-market health insurance is simply a pipe dream, and always will be. The part where your fantasy breaks down is when you are in a serious accident that renders you unconscious, or fall into a coma, or contract a serious illness that requires immediate treatment. There are just too many scenarios under which it would not be possible to shop around and negotiate prices. To truly negotiate, one must be able to walk away. If I want to get a good deal on a new car, for example, I must be willing to leave if the price I want is not offered. If buying the car were an absolute necessity for me, and the car dealer knew that, it would not be possible for me to negotiate. So it is with healthcare.

gsr says

By healthcare industry, I meant all of them involved. This includes hospitals and drug companies. They dictate regulatory laws, and thus prevent competition. They prevent building of newer hospitals too. They are Obama's buddies.

Again, you are blaming Obama for a situation that existed long before he was even president. Why?

gsr says

No, he is just like anyone else. He knew he could not actually fix the regulatory problems and anti-competitive patent laws in healthcare. So he decided to sugarcoat this with mandatory insurance.

Again, you seem to be complaining about things that aren't really the main problem. Going without insurance is not a realistic option. What would you do if you got cancer and it cost a million dollars to treat it? It's just not realistic to think you don't need health insurance. So why do you object to something being mandatory that you would need to have anyway?

errc says

For example, given the choice, id opt not to overpay by an order of magnitude, for "health" "insurance". I also value my/our health, more than anything else. I dedicated a lot of time to unlearning all the misinformation about nutrition, and educating myself about proper nutrition. I put the dollars and hours in the kitchen, preparing, cooking, and cleaning, so we can eat healthful foods. As a result, we don't ever go to the doctor,,,we rarely if ever get sick. In a free market capitalist system, I could utilize the savings that others aren't working for, to pay down my mortgage and further capital accretion. Instead, you demand I am penalized to subsidize all of your piss poor health choices. Thanks a lot, obama voters!

The problem is, people like you, who don't happen to be sick at this particular moment, and wrongly believe yourself to be immortal, WILL need medical care at some point in your life. At that point, you will demand medical treatment, even if you can't afford it, and someone will be forced to treat you. That kind of system can't work. We can't have people opt out when they feel fine and then demand healthcare when they get sick. Who's going to pay for it?

Incorrect, homeboy. The problem is hypochondriacs like you, that watch too much tv. Your belief system is built upon the faulty assumption that everyone needs medical care.

You depend on healthy people like me, to subsidize your poor health choices.

errc says

Incorrect, homeboy. The problem is hypochondriacs like you, that watch too much tv. Your belief system is built upon the faulty assumption that everyone needs medical care.

You depend on healthy people like me, to subsidize your poor health choices.

You will need medical care. You just aren't old enough yet.

zzyzzx says

CL says

I thought "skin in the game" had been fully embraced by the right, whereas a more liberal argument would be "free healthcare for all!!"?

When providers are required to post prices so that people can comparison shop, then your argument might be valid.

I thought you were for a free market system, why are you advocating a government mandate? Which is it?

bob2356 says

errc says

Incorrect, homeboy. The problem is hypochondriacs like you, that watch too much tv. Your belief system is built upon the faulty assumption that everyone needs medical care.

You depend on healthy people like me, to subsidize your poor health choices.

You will need medical care. You just aren't old enough yet.

I don't understand why some of you conflate a supposed need for medical care, with a need for health insurance.

People sign DNRs all the time. Or at least we were allowed to refuse treatment.

So why can't I refuse insurance? Why do you statists demand that people pay either a fine to the IRS, or pay exorbitant rapings to private insurers?

What happens if tthe private health insurer goes bankrupt? After someone like me paid in 250k in annual premiums over a lifetime. Then what happens?

Homeboy says

In my opinion, this glibertopian idea of true free-market health insurance is simply a pipe dream, and always will be. The part where your fantasy breaks down is when you are in a serious accident that renders you unconscious, or fall into a coma, or contract a serious illness that requires immediate treatment.

You get catastrophic insurance for this scenario. Generally this would carry a high deductible if you want to go on the cheap. Then you pay for an optional benefit for things like well checks and general medicine that you can plan for.

Oh shit, did I just describe Canada's health care system?

Socialism does not work.
Socialism does not work.
Socialism does not work.
Socialism does not work.

(Except on Wall Street.)

Homeboy says

Again, you are blaming Obama for a situation that existed long before he was even president. Why?

Sigh! Please read the previous comment here
http://patrick.net/?p=1241717&c=1076418#comment-1076418

Homeboy says

Again, you seem to be complaining about things that aren't really the main problem. Going without insurance is not a realistic option. What would you do if you got cancer and it cost a million dollars to treat it?

So you think cost of healthcare is not the main problem? The fact that prescription drugs costs so much more here than anywhere in the world is normal? Even diehard Obama supporters acknowledge that healthcare cost is too high in the country.

Yes, an insurance is supposed to cover catastrophic illnesses like cancer. But the current policy will make sure everyone stays financially broke forever. And believe me, that will still be not enough to cover cancer if, God forbid ever happens to someone.

errc says

I don't understand why some of you conflate a supposed need for medical care, with a need for health insurance.

It's not a conflation; it is a matter of one idea following logically from another. I already explained this, but since you didn't get it, I will repeat it: People like you who wrongly imagine themselves to be immortal, are not. Just because you don't feel that you need medical care right now at this moment, doesn't mean you NEVER will. You WILL need medical care at some time in your life. If you were allowed to opt out of the health insurance system, never pay a cent into insurance, and then suddenly demand medical treatment when you DO get sick, I ask again: Who will pay for your medical treatment if the cost exceeds what you can afford?

errc says

People sign DNRs all the time. Or at least we were allowed to refuse treatment.

So why can't I refuse insurance?

See, you are full of it. Right now, you claim that you would refuse treatment if and when you get sick. But I don't believe you. I know people, and I know that people don't want to die. When you get sick, you WILL seek medical care. And they will have to provide it, because we don't just let people die in a civilized country, no matter how arrogant they are. The government can't make you sign a paper saying you will refuse medical treatment when you get sick, because it would be callous to hold you to such an agreement and just let you die. Can't you understand that?

errc says

Incorrect, homeboy. The problem is hypochondriacs like you, that watch too much tv

This comment is infantile and not worthy of a response.

errc says

Your belief system is built upon the faulty assumption that everyone needs medical care.

No, it's a fact. Everyone WILL need medical care at some time in their life. YOUR belief system is based on the faulty assumption that you are immortal. NO human being is immortal. Your belief is absurd on its face.

gsr says

Homeboy says

Again, you are blaming Obama for a situation that existed long before he was even president. Why?

Sigh! Please read the previous comment here

Sigh, indeed. I read your stupid comment already, AND responded to it. Why must I read it again? So I can be EXTRA sure you're blaming Obama for a condition that already existed?

gsr says

So you think cost of healthcare is not the main problem?

Huh, whaaa?!!! Try not to misquote me, please. You wrote: "he decided to sugarcoat this with mandatory insurance", and I said you aren't focusing on the main problem. I said mandatory insurance is not the main problem. Where are you getting that I said cost is not the main problem? I feel like you're having a conversation with someone else entirely.

gsr says

Yes, an insurance is supposed to cover catastrophic illnesses like cancer. But the current policy will make sure everyone stays financially broke forever.

Again, you are blaming ACA for a condition that already existed. Healthcare costs were ALREADY too high. How can you blame that on ACA? Like I said, there ARE some legitimate problems with ACA that need to be addressed - problems that were CAUSED by ACA. So why waste breath blaming ACA for problems it didn't cause?

sbh says

The fair and free market presumes a sentient, viable customer in command of information at the time of any important election. Once you're incapacitated you essentially become a lazy spendthrift without self interest. Gotcha.

I have no idea what point you're trying to make.

errc says

I don't understand why some of you conflate a supposed need for medical care, with a need for health insurance.

Because no matter how well you eat unless you are extraodinariily lucky, and it is luck, at some point you will need health care that you can't afford without declaring bankruptcy. So you are saying you don't want to pay for insurance, you'll just pass the cost on to everyone else when the inevitable happens. That would make you a mark 1 mod 0 it's all about me libertarian.

I don't like paying for health insurance, or the entire US health care system for that matter, any more than you do/ But it's a cost of being part of American society. Don't like it move overseas, you and I have been outvoted. That's the downside with being in a democracy, the will of the people (or in the US the will of the lobbyists) might not match your will but you are stuck with it. Health care plus being in a police state has me seriously considering expatiating and turning in my passport after only being back in the states 3 months. When this taking care of aging parent responsibility is over, I'm out of here for good.

bob2356 says

I thought you were for a free market system, why are you advocating a government mandate? Which is it?

I am advocating a free market. A free market would require people to know costs upfront.

Homeboy says

So why waste breath blaming ACA for problems it didn't cause?

ACA exacerbated the problem. It added a bunch of mandatory freebies with insurance. There is a difference between mandatory cancer coverage and free birth control pills for everyone. Of course, a pregnancy would be catastrophic for a 80 year old man with no ovaries.

zzyzzx says

bob2356 says

I thought you were for a free market system, why are you advocating a government mandate? Which is it?

I am advocating a free market. A free market would require people to know costs upfront.

Ok I get it, a free market with government mandates.

Homeboy says

errc says

Your belief system is built upon the faulty assumption that everyone needs medical care.

No, it's a fact. Everyone WILL need medical care at some time in their life.

I could think of a few scenarios when one minute you are perfectly healthy and the next you are being carried to the morgue by the coroner. Maybe this is the quick death that your buddy is counting on. Because, you know, we all plan our deaths.

gsr says

There is a difference between mandatory cancer coverage and free birth control pills for everyone.

The cost of birth control pills, say $30/mo, only comes to $10k over a 30 year span. That is ironically cheaper than a night in the hospital having a baby.

Yes. Birth control coverage should be mandatory. Pregnancy is a luxury and it should be paid out of pocket.

JH says

The cost of birth control pills, say $30/mo, only comes to $10k over a 30 year span. That is ironically cheaper than a night in the hospital having a baby.

You still don't get it! Do you think a 80 year man can get pregnant?

Peter P says

Yes. Birth control coverage should be mandatory. Pregnancy is a luxury and it should be paid out of pocket.

Then do this for all women of childbearing age. Why the entire society needs to bear this?

gsr says

ACA exacerbated the problem. It added a bunch of mandatory freebies with insurance. There is a difference between mandatory cancer coverage and free birth control pills for everyone.

So your big problem with ACA is that it requires insurance to cover birth control pills for women. All right, I think I get where you're coming from now. Keep 'em barefoot and pregnant, eh?

No.
It's about personal responsibility.
Why should anyone subsidize anyone elses sexual behavior?
If they choose to have sex, they should bear the responsibility, not anyone else.

Homeboy says

gsr says

ACA exacerbated the problem. It added a bunch of mandatory freebies with insurance. There is a difference between mandatory cancer coverage and free birth control pills for everyone.

So your big problem with ACA is that it requires insurance to cover birth control pills for women. All right, I think I get where you're coming from now. Keep 'em barefoot and pregnant, eh?

But condoms or pills are cheaper than unwanted kids.

gsr says

You still don't get it! Do you think a 80 year man can get pregnant?

Don't get what? Your joke? No I don't.