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

nytimes.com

321–330 of 383 posts

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

#321

Earlier quoted context omitted.

FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of each covered person's residence or workplace", specialists within 60 minutes or 30 miles, and that there be sufficient capacity for doctors within those limits to accept new patients[1]. Getting that enforced isn't easy, but that situation not only shouldn't…

If you read the document in your link, you will see that that regulation expired last July.

That was just the emergency amendment. It's codified: https://govt.westlaw.com/calregs/Document/IE282722688B248DFA...

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

#322

Earlier quoted context omitted.

> OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some are…

If a insurance network can't meet its obligations it will be fined or shut down What are you claiming its obligations are? Its obligations are to pay valid claims made by covered parties. It does not have a legal obligation to add provider capacity to a given region.

> Its obligations are to pay valid claims made by covered parties

No, its obligations are to operate legally within the state.

> What are you claiming its obligations are?

https://govt.westlaw.com/calregs/Browse/Home/California/Cali...

> It does not have a legal obligation to add provider capacity to a given region.

Correct. The other option is it could not operate in that given region at all.

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

#323
post #275

Earlier quoted context omitted.

Because socialism works? Just today: change of health insurance. Need primary care physician. Takes six weeks to be seen. Six weeks, to be scheduled for minor surgery. You might choose to waste an hour on the phone to find a less booked-out physician. In Socialist Britain you are guaranteed to be seen within 48 hours! Here in the US the only thing guaranteed is the waste of time. Seems that is a feature of the plan.…

If you're not literally about to die in Canada you're looking at multi-month delays to see any kind of specialist. Meanwhile my friends in SV just whip out their credit cards, pay a small deductible, and get seen immediately. Single payer isn't all sunshine and roses.

It isn't but in most countries that have single payer - you also have the option to go private if you can afford it. Single payer is there if you need it so no-one goes bankrupt, but those with the means can get quicker treatment if they want to pay for it.

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

#324
Before ACA we could barely afford health insurance for our family. After ACA it became evident that we can't afford to participate in this mafia racket if we truly want some money left over to pay for necessary medical expenditure. We were ready to face the tax penalty, but then my accountant found a loop hole. It's time for a repeal and replace -with some introduction of market competition. This unholy alliance of hospital-insurance-government mafia cartel needs to be broken.

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

#325
post #133

Earlier quoted context omitted.

It's was pretty easy to predict: allowing enrollment after a diagnosis was politically popular but a terrible economic disincentive to not buy insurance (because at that point, it isn't insurance -- it's a subscription plan for your treatments). The young and healthy needed to enroll for the economics to work, but the individual mandate was delayed for years -- because coercion isn't popular politically, and there wa…

"It's no coincidence that laser eye surgery, teeth whitening, cosmetic surgery is all generally affordable -- markets and competition have formed." This isn't the best example to have chosen. All of these procedures are discretionary and nonessential. If I find the cost of an elective nose job too pricey, I can take my time and shop around. Or I can just go without a nose job altogether and be totally fine. The only…

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

#326
post #109

Earlier quoted context omitted.

> I think the fixation on "everyone should have good health insurance" is making this dysfunctional situation permanently unfixable. Nah. Every citizen should have good health insurance that requires no out-of-pocket expenditures. There should be one plan, available to every citizen. There should be one payer, the Federal Government. Anything else is a recipe for price-gouging and ballooning costs.

And what will happen is you will not get much health care. Certainly much less than you got in 2005, for much more than you paid in 2005. Insurers routinely pay out over %100 of premiums in claims. Meanwhile government programs with benefits- like welfare- blow %75 of their budget on overhead and only pay out %25. Economics is like physics. You can wish it wasn't so. You can look at optical illusions, but the reality…

"The bottom line: Government spends about 70% of tax dollars to get 30% of tax dollars to the poor. The private sector does the opposite, spending about 30% or less to get 70% of aid to the poor."

https://www.theadvocates.org/effective-government-welfare-co...

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

#327

Earlier quoted context omitted.

> OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some are…

That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense. That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers? I'd guess that most p…

> That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense.

They weren't falsely bragging about numbers in marketing materials, they were listing specific doctors at specific addresses in their tools for finding in-network doctors that were not in their network or were not at that address. Different from geographic density but related.

> That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers?

It's really not complicated: by saying they can't operate in a certain area without a sufficient network. They either recruit more doctors or they pack up.

Perhaps you're missing that insurance companies in California don't usually operate statewide? I assume this is common across the country. The key is that care has to be available near your house or workplace. When applying for insurance you are specifically offered companies that have coverage in those areas (often at the county or city level of granularity).

You can't sign up for an insurance policy at the other end of the state from a company's network of doctors and expect them to sign up doctors around you, because, again, if they don't have sufficient density of doctors where you are, they don't cover people there in the first place.

> There is no element of law that says to an underwriter, "Hey, you gotta add more providers in this area and that area now, or we will punish you." The law doesn't give government that power.

Yes, it really really does.

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

#328

> 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?

we don't. It is akin to a mafiosi stopping by every month asking for his "protection" money in case a terrorist group will take you hostage and ransack your place. In all other "normal" cases where you need security that said mafiosi says you have to pay for it yourself. The ACA proponent gladly accepts this outrageous proposition.

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

#329

Earlier quoted context omitted.

Yeah, it's pretty crappy in NC. First year of ACA we only had one company even offering any insurance in my county. And yeah, it's county-based for some reason - if I lived 2 miles in another direction I'd have had multiple options about 10-15% cheaper than what I had available. Second year we had another option in our county which was about 15% higher than BCBS (which had gone up about 25% from the year before). App…

> Apparently some/much of this has to do with our state choosing to opt out of dealing with increased medicaid funding, so... yay... I guess they get to show obama how bad ACA is by... digging in their heels while we all just pay insanely increasing pricing? Well, the increased Medicaid funding is temporary, but comes with permanently higher Medicaid spending. So a state might reasonably not want to accept that offer…

The increased Medicaid funding is permanent, though the 100% federal funding share for the expansion population drops in stages down to its permanent level, which is "only" 90%.

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

#330

As an European living in the US, the US health system is so utterly broken and asinine, it's not even funny. You take a non-free market (I get sick, I need help - no choice involved) and apply seemingly free market logic to it. The result is a disaster, tada. Single payer, all the way, everyday. Add private, optional insurance on top to allow well-off people to get private rooms, etc. But no one should worry about go…

It's not a free market system. I wish it was. It's amazing how people vote for government protected cartels. It took the press (Time magazine article two years back) an incredibly long time to start digging into fraudulent healthcare pricing - since then some things have started moving (legislation in some states to force hospitals to show prices, at least to bring in some semblance of a market and allow market forces to start operating). In a true free market environment such abuse by an incumbent/system would lead to innovation and new ideas that would quickly obliterate the monopoly, in this case the monopoly has the guns (i.e. regulation/government protected insurance and health care industry). Disclaimer: I lived in Austria/Germany for decades and their system is worse because it's totally closed to any potential market innovation while taxing the living daylights out of the middle class.
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