The future of the health care plan, revisited

[CitizenCain]

The new federal health care law tries to avoid the death spiral by requiring everyone to have insurance and penalizing those who do not, as well as offering subsidies to low-income customers. But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.

And on that note, the same thing's already happening in Mass, but worse in many ways.

http://reason.com/blog/2010/04/05/qu...es-with-my-hea

Thousands of consumers are gaming Massachusetts’ 2006 health insurance law by buying insurance when they need to cover pricey medical care, such as fertility treatments and knee surgery, and then swiftly dropping coverage, a practice that insurance executives say is driving up costs for other people and small businesses.

In 2009 alone, 936 people signed up for coverage with Blue Cross and Blue Shield of Massachusetts for three months or less and ran up claims of more than $1,000 per month while in the plan. Their medical spending while insured was more than four times the average for consumers who buy coverage on their own and retain it in a normal fashion, according to data the state’s largest private insurer provided the Globe.

The typical monthly premium for these short-term members was $400, but their average claims exceeded $2,200 per month. The previous year, the company’s data show it had even more high-spending, short-term members. Over those two years, the figures suggest the price tag ran into the millions.

And, of course, Mass. has all the other problems too... spiraling costs breaking the budget, the adverse selection death spiral, etc... and, even more interestingly, only 37% of the people directly affected by the law (i.e., those who use it to get medical insurance)... support it. There really is no such thing as a free lunch - who knew?

[Young Mage]

Well, it's harder than you might think to find appropriate reading material for a short trip like the subway. Too short, and you finish before the trip's over, and you have to amuse yourself by mind-fucking other passengers for the remainder of your journey. Too long, and you end up with the problem of remembering what you were reading. You probably don't want something too intellectually stimulating, or you risk missing your stop or not seeing the strange Canadian sneaking up to give you a Wet Willie. But you don't want something so intellectually light that you're bored and end up resorting to the mind-fucking strangers thing. It really is a more complicated decision than you seem to be aware of -not easy to find something of the right depth and length for a regular, short commute like the subway.

Frankly, that's one of the reasons I don't read when I commute... though I do also find it difficult to steer and read at the same time, so that's part of it too.

How do you come up with this stuff?

[CitizenCain]

I'm pretty sure it's a by-product of being a jaded, cynical lone wolf who'd just as soon kill everyone as tolerate all their bullshit (AKA peaceful co-existence).

Not something I'd recommend to anyone I don't hate.

[GGT]

New York’s insurance companies are vigorously fighting prior approval. Mark L. Wagar, the president of Empire BlueCross BlueShield, said New York’s problem was not deregulation of rates, but the lack of an effective mandate for everyone to buy insurance. To illustrate, he offered a statistic on how many people in the 18-to-26 age group, who are largely healthy, have bought individual insurance coverage through his company: 88 people out of 6 million insured by his company statewide.

Duh. If there's a mandate, there has to be a fine that's more than the policy costs. Cain's reference to MA just shows more loopholes in the industry--buy a policy within the minimum activation window, use the policy, then cancel. Works great for elective procedures with high price tag, as far as 'gaming' the system goes.

This is partly why I don't think "Insurance for everyone!" will work. Whether their profit margin is 2% or 25%, that's a whole lotta cash feeding paper pushers, not funding care or care-givers. But the industry is big and powerful, their lobbyists are effective, bipartisan efforts will keep it going and getting bigger.

Anything about the collective health and well being of our nation would be SSSocialism, wouldn't it?

[Dreadnaught]

Yes, but otherwise I think you're on the ball.

[Lewkowski]

Anything about the collective health and well being of our nation would be SSSocialism, wouldn't it?

Because having your pet treated for cancer quicker then a human is the hall mark of a civilized society...

[GGT]

THAN!

[GGT]

Premium subsidies, which will be available to people who buy insurance through the exchanges being established, are supposed to address that [affordability] problem, experts say. A 40-year-old in a medium-cost geographic area who earns $21,660 (200 percent of the federal poverty level) and whose annual premium is $3,500, for example, would receive a subsidy of $2,135 that goes directly to the insurer, while he or she pays $1,365. A family of four with an income of $44,100 would pay $2,778 while the government subsidizes the plan to the tune of $6,656.

The proportion of income people at this level have to pay for insurance is capped at no more than 6.3 percent of their earnings.

As income increases, the subsidy drops; families earning 300 to 400 percent of the federal poverty level are expected to pay up to 9.5 percent of their income, an amount that ranges from $6,284 to $8,379 per year; the federal subsidy is from $3,150 to $1,056. At the same time, however, a provision states that anyone who cannot find a premium that costs less than 8 percent of their income is exempted from the penalty.

It’s hard to predict whether the carrots and sticks of subsidies and penalties will suffice to bring people into the system, when there are so many are unemployed or underemployed people, many earning less in today’s economy than before and worried about job security and prospects.

From a pure dollars-and-cents point of view, it is cheaper for people just to pay the penalty. Even when fully implemented in 2016, the penalty is limited to no more than 2.5 percent of taxable income, and it starts out even lower, with a penalty of $95 or 1 percent of income in 2014.

“It’s hard to analyze because people are making health decisions based on their wallets,” said Sara Horowitz, who founded the Freelancers Union, a nonprofit organization that offers health insurance to freelancers.

http://www.nytimes.com/2010/04/20/he...scape.html?hpw

Bound to fail.

Anyone care to say what percentage of income you pay in health insurance, and how much your employer pays for you?

[']['ear]

http://www.nytimes.com/2010/04/20/he...scape.html?hpw

Bound to fail.

Anyone care to say what percentage of income you pay in health insurance, and how much your employer pays for you?

The wife and I pay 5% just in premiums, and that is subsidized by the employer. Oour state is in very bad shape, and total costs have increased hugely in the 7 years I've worked here. Rx copays alone have increased from $20 to $60 in 7 years. I pay another 10% yearly just for me, and I have since 1997, when I started having health problems. I've been uninsurable my entire life (yes, I tried), because it was known that my father had PKD. So, 50% chance of inheriting guarantees nobody will insure you, even at age 22 and fresh out of college, unless you are part of a plan. This actually influenced my career choices: no options for self-employment, so must always work for large employer. This was part of my decision not to go to med school: a large number of MDs are self-employed, and buy their own insurance. Which is a large part of why the AMA backed this reform, BTW.

Wrt the MA system: they have enacted little to investigate how to deliver better care more cheaply, so they are stuck paying the spiraling costs of a broken system. The only difference is that the state actually gives a **** about other citizens, rather than the rest of the country and the likes of Lewk and Cain, where they just say "**** 'em, let 'em die." It's debatable whether the latter is a mistake or not, but the former certainly is. Because spending the money to figure out where and how health care can be changed is the key to the whole mess. And it's in the Obama plan in spades, which is really the main thing I wanted to see happen, from either party. My approval of the plan is based mostly on that, plus the minor variant that I just think that somebody needed the stones to do something.

Besides, we are still faced with the fact that the GOP passed on dealing with this issue, and instead tried to sweep it under the rug. So regardless of what comes out, it is a result of a failure starting with the GOP. The system is unsustainable. It WILL fail. It IS failing, becoming a huge drag on our economy. The GOP has blocked any reform for decades, and then entirely failed to do anything when they had all 3 branches for 6 years. This IS the starting point of any discussion. If you are do-nothings, then somebody else will step up and try something to answer the exigent situation, and you damned well may not like it. Whom do you have to blame but yourself? You could have done something much more desirable, couldn't you? So tough shit for the conservatives who hid their heads in the sand. They should be ashamed for their spinelessness, rather than casting stones.

[GGT]

Tear, you pay 15% of your income in premiums? Is any of the total cost paid by your employer and that's just your 'share'?

I haven't really calculated my percentage, but I'd want to include OOP costs too, including the deductible, to see what my overall costs are compared to income. (I pay a lot in OOP costs )

[']['ear]

Tear, you pay 15% of your income in premiums? Is any of the total cost paid by your employer and that's just your 'share'?

No, 5% in premiums, like I said. But I have high expenses on top of that. The deductible and max per year have doubled since I started this job. And even after I have maxed, co-pays are harsh. 2009 was exceptional, of course.

We all pay a ton in OOP if we have any problems. That's how companies are coping: they shift costs to subscribers. Thus, my Rx co-pay increased 200% since I started. Deductible and max also tripled, and premiums doubled. AND, premiums are still subsidized in part by my employer. Yes, the system is about to burst.

[GGT]

It's gonna blow!

I thought you meant your extra 10% was for premiums, not just Rx.

For a family making $50,000/yr, just paying a $5,000 deductible is 10% of income right there. Adding in premiums, co-pays and OOP can bring it up to 20-25% + pretty fast. Without a prescription discount, meds can get really expensive (as you know, much more than a $60 co-pay).

But maybe we can start bartering with chickens and house painting in exchange for doctor's services.

[Being]

We could always refuse the services to avoid the costs. Unless of course they consider that a form of suicide and legislate against it. If they were to do that though they'd have to offer a government run alternative to private sector health care. Come to think of it that alternative already exists; go to jail and get free government sponsored health care. What a wacky fucking country we live in...

[GGT]

It is wacky. Can get a GED or a college degree in prison, see a doctor regularly and get medications. They finally took Viagra off the approved list, though. But prisons are strapped for funding too, so they're getting early release or home arrest. If they have a home.

[Being]

But prisons are strapped for funding too, so they're getting early release or home arrest. If they have a home.

Will they arrest you if you refuse to leave?