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Many See I.R.S. Penalties as More Affordable Than Health Insurance

nytimes.com

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Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#41

Post by x5n1 »

jhulla wrote: post #4

Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each insurance change, our deductible has gone up, our premium has increased and our co-pay, co-insurance has increased. In effect, our ACA plan has become an extremely expensive catastrophic insurance plan.

And so it goes, National Healthcare like Britain or Canada is what America needs and what the medical establishment does not want. But somehow I think America would screw that up as well.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#42

Post by mgkimsal »

tptacek wrote: post #27
jhulla wrote: post #4

Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each insurance change, our deductible has gone up, our premium has increased and our co-pay, co-insurance has increased. In effect, our ACA plan has become an extremely expensive catastrophic insurance plan.

If you don't have preexisting conditions, you can still buy PPOs from the big insurers as non-ACA plans.

Don't you then face a penalty anyway for not having an ACA compatible plan?

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#43

Post by x3n0ph3n3 »

dibujante wrote: post #25
methodover wrote: post #17

> But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. They say they sorely need more healthy customers to balance out the costs of covering the sicker, older people who have flocked to exchange plans. Ah, the tragedy of the commons at work. Healthy people don't buy insurance because it's too expensive. Insurance i…

As a Canadian, I am astonished at how expensive even the cheapest of these plans are. My monthly healthcare cost amounts to $178, once you factor in the taxes I pay that go to healthcare. That's cheaper than any of the plans in this article. How do people find these prices bearable?

They don't, which is why they won't pay for them...

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#44

Post by yetanotherone »

tomohawk wrote: post #32

Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans. If they were really interested in making better, cheaper plans, they would roll back most of the ACA, eliminate the restrictions on buying across state lines (actually allow competition), and transfer the tax incentives for getting insurance from employers to employees. Basically, all they had to do to m…

It's a little offtopic, but this reminds me of Lessig's "the corrupting influence of money is the first problem facing this nation. That unless we solve this problem, we won’t solve anything else."

In my opinion the public option wouldn't have cost us much as a nation on the whole, and could have possibly worked out to great advantage, but was not going to happen because health insurance companies are too powerful for that sort of thing to get through.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#45

Post by teuobk »

tptacek wrote: post #27
jhulla wrote: post #4

Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each insurance change, our deductible has gone up, our premium has increased and our co-pay, co-insurance has increased. In effect, our ACA plan has become an extremely expensive catastrophic insurance plan.

If you don't have preexisting conditions, you can still buy PPOs from the big insurers as non-ACA plans.

Based on my search this year, that isn't necessarily true. Here in Denver, all of the insurers that were offering PPO plans in years past have left the individual market (not just the ACA exchange), save one: Anthem BCBS.

Availability appears to vary widely, both from state to state and within states. If I lived in western Colorado instead of on the Front Range, I'd have a couple of PPO insurer options. If I still lived in Minnesota (where my previous health insurance policy was written), I'd have dozens of options from at least four different insurance companies.

I really miss my insurance policy from BCBS of MN.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#46

Post by abawany »

This is unfortunate. Health problems are unpredictable and very expensive, in my experience.

I was grateful for ACA (unsubsidized) in 2015 in spite of being on a bronze plan with a high deductible. Why? Because even though I was generally paying for care out of pocket due to my high deductible, the insurance company had negotiated much lower rates for this care than what the providers wanted to charge me. I guess I could have dealt with the 10+ providers and negotiated lower cash prices myself but I have a day job. In my estimation, the negotiated rates saved me $3k compared to the billed rates.

People I know minimized the dent to their financial health as a result of it of ACA as well. Life and health is unpredictable and one can be hale and hearty one day and hospitalized in the ER the next. The thought of being without health insurance and allowing one's meager savings to be wiped out as a result is an outcome that sends chills down my spine.

I hope I don't come across as shilling but I am grateful for the ACA. It is not perfect but just like democracy, it is the best that this country has been able to scrape up after 200+ years of SOL-care.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#47

Post by Spoom »

x5n1 wrote: post #41
jhulla wrote: post #4

Personal experience with ACA: As of 2016, we're onto our 3rd insurer. Each prior one has dropped our local doctors, physicians groups and hospital. With each insurance change, our deductible has gone up, our premium has increased and our co-pay, co-insurance has increased. In effect, our ACA plan has become an extremely expensive catastrophic insurance plan.

And so it goes, National Healthcare like Britain or Canada is what America needs and what the medical establishment does not want. But somehow I think America would screw that up as well.

For what it's worth, I have talked to doctors who want single payer just as much as some of us.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#48

Post by tomohawk »

epistasis wrote: post #36
tomohawk wrote: post #32

Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans. If they were really interested in making better, cheaper plans, they would roll back most of the ACA, eliminate the restrictions on buying across state lines (actually allow competition), and transfer the tax incentives for getting insurance from employers to employees. Basically, all they had to do to m…

>Inevitable result of thinking that adding even more government intervention would result in better, cheaper plans. and >open up the Federal employees plan to everyone and transfer the tax incentives to employees. Seem somewhat in contradiction. I'd go with the first being the incorrect part.

The Federal plan operates like a big market. Each year, you can change between plans from a menu of hundreds of plans. You can also see other people's reviews of those plans. Over time, plans that can't compete drop out. Other plans get better and service gets better in order to compete.

Prior to the ACA, health insurance was heavily regulated. You could not buy across state lines. You could only buy (affordably) within the plans offered by your employer. Individuals oftentimes couldn't even buy plans (for any amount) that were offered to groups. With the ACA, this is even worse, but that's beside the point.

Creating a single market with the Federal plan would have removed tons of anticompetitive regulation and enabled anyone, regardless of who they worked for or self employed or whatever, to buy a plan from that single market.

Moving the tax incentive to people instead of corporations would have allowed people to pay for those plans with pre tax dollars.

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#49

Post by privong »

methodover wrote: post #17

> But plenty of healthy holdouts remain, and their resistance helps explain why insurers are worried about the financial viability of the exchanges over time. They say they sorely need more healthy customers to balance out the costs of covering the sicker, older people who have flocked to exchange plans. Ah, the tragedy of the commons at work. Healthy people don't buy insurance because it's too expensive. Insurance i…

> It's a terrible feedback loop, one which the IRS penalties were designed to solve.

But it shouldn't be surprising that the IRS penalties (in current form) could not solve this. This eventuality was predicted before the law was passed in the Senate (e.g., [0]). It seems fairly obvious that this would happen unless fines are somehow pegged to the cheapest insurance rates (as dpweb notes in this same HN story[1]).

[0] https://reason.com/blog/2009/11/06/higher-premiums-less-cove...

[1] https://news.ycombinator.com/user?id=dpweb

Re: Many See I.R.S. Penalties as More Affordable Than Health Insurance

#50

Post by ploxiln »

djrogers wrote: post #37
pbreit wrote: post #9

Earlier quoted context omitted.

Are you getting subsidized or do you make $85k+? Why only catastrophic?

likely because the incredibly high base deductibles (6k per person for example) on most exchange plans mean that most people will never actually utilize any insurance.

Well, that's not traditionally how health insurance works in the US, but it's how all types of "insurance" should work - it should not be for routine costs. Insurance, generally, should be for unlikely unexpected costs. Otherwise, it's just involving an extra middle-man in payment, and that middle-man is going to make a profit.

It's unfortunate that in the US, even for completely routine medical costs, you can't skip the middle-man, because prices are hidden and fake, and the real prices are negotiated between the middle-men and the medical provider (as well as which tests or procedures are allowed, under what conditions). I think the fixation on "everyone should have good health insurance" is making this dysfunctional situation permanently unfixable.

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