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

nytimes.com

331–340 of 383 posts

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

#331
post #67

Earlier quoted context omitted.

When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services. And, to be totally frank, having had a pre-existing condition that kept me from buying any insur…

It isn't ACA that has caused me problems, or at least the law itself. The description given matched my experience with insurers before ACA. My problem with ACA is Healthcare.gov (still). It is possible to go through the entire application process, make one mistake or fail to provide the right detail, and end up disqualified from buying insurance through Healthcare.gov (in my case, I used a mail forwarding service add…

The federal exchanges (for which healthcare.gov is the portal) were never intended to be a good choice (or even to have to exist at all), they were in the law as a minimal fallback to be applied for states that failed to implement their own exchangees.

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

#332
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…

> "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. No, it's a consistent argument for those who think beyond themselves; it's good for society as a whole. One doesn't have to believe one personally benefits, that's now how liberals work. > A good market would be one where you paid your doctor A good mar…

No, but it is the only answer to how much those services cost, which is a necessary question to answer if you intend to apply accounting to resource allocation and consumption.

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

#333
post #104

Earlier quoted context omitted.

> Similar surgeries in the States have cost my insurance north of twenty grand. I'm assuming you're referring to the amount your insurance company had to pay, not the amount that you had to pay. If so, keep in mind that the prices insurance companies pay for procedures are not designed to make sense on an individual level[0]. I've explained this in more detail on previous comments, but basically, hospitals lose money…

I still had to pay my $2500 deductible on the $2600 ECG, so the insurance company didn't worry about haggling them too much. If you're young, relatively healthy, non-clumsy, male, and childless, chances are you might not go to the doctor once in a year, so it'd be a gamble, but you might very well statistically be better off pocketing the insurance premiums. Better yet, put on a furry suit, bark convincingly, and go…

$2600 for an ECG is a ridiculous sum.

Out of curiosity, I checked how much my insurance pays a doctor for an ECG (I live in Austria). My insurance (SVAGW) pays 36€ for an ECG. Of course, the total bill would be a bit more since the doctor would likely also charge for consultation (33€), draw blood, order lab diagnostics (6€) etc. The total would probably be well under 200€.

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

#334
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…

> "that's why you need to take the market out of it and have single payer." It's a consistent argument only if you believe that you'd be better off with single payer. No, it's a consistent argument for those who think beyond themselves; it's good for society as a whole. One doesn't have to believe one personally benefits, that's now how liberals work. > A good market would be one where you paid your doctor A good mar…

other "socialist" civilized countries, you know, like the ones that regularly innovate and push the boundaries of science and attract millions of people each year because of a higher standard of living and less taxes. oh, wait... The "market" is just a synonym for individuals co-operating together for their mutual benefit. The "public" option is one where a faceless bureaucracy with a monopoly on power steps in and dictates terms. Disclaimer: I have lived decades with a single payer system and left in part because of it.

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

#335
post #67

Earlier quoted context omitted.

When I read this stuff, I'm a little astounded about how bad the situation must be in other states. Here in the Pacific Northwest, my premiums have actually been going down and the plan offerings are getting better. The provider I was on did go out of business so I had to switch, and I'm now paying less for more services. And, to be totally frank, having had a pre-existing condition that kept me from buying any insur…

Unfortunately, your situation must be specific to Oregon. I'm in Washington, and the closest plan we could get to what we had pre-Obamacare went from a $2500 deductible to $6300 with a premium increase of around 40-50%. In my opinion, the problem was never the unavailability of insurance. The problem was (and still is) the out-of-control pricing of medical care -- $5000+ for non-sterile gloves [1] is a bit extreme. […

I think we need to talk way more about cost/pricing/fraud/transparency than the "insurance" red herring, which just became a problem because of cost in the healthcare sector.

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

#336

Earlier quoted context omitted.

Personal experience with nearly all health care insurance plans since the 90's: Each year the premiums go up, the out of pocket costs increase, and benefits decrease (beyond more than general inflation).

I understand premiums going up annually. I don't understand 30-50% increases year on year.

Because the ACA is the largest transfer of wealth from the youth to the aged that has ever been attempted. It also is because the fines for not buying into the system are too low that participation by healthy people isn't sufficient to pay for the sick.

The process is designed to make people so irritated with insurance companies that they demand the government take over as payer when it is the government that created the mess in the first place, approved the rates, and then set up the impossible system of not forcing everyone paying.

I am all for a system that pays for checkups and catastrophic but lets be honest, if the system is wholly free so much money will be lost to worry warts it won't be funny. there needs to be a deductible but not so high that people who need something done don't

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

#337
I've always been a fan of HSAs + HDHP w/ extremely good coverage (no lifetime limits, etc.) beyond the self-insured amount. (Keep preventive care, birth control, etc. in the exempt amount, too, and especially public health stuff like vaccinations, since it reduces overall cost.)

I currently have an HRA (essentially a non-accruable form of HSA) through employer; it gets the incentives wrong so there's every incentive to use as much care as possible (slightly more convenient providers who charge 5x as much to the plan; as much care as possible).

I still have some hope ACA 2.0 could include:

0) Transparent pricing and mandate that anyone prepaying cash gets the medicare price. Maybe medicare prices have to rise.

1) Catastrophic/HDHP being encouraged for everyone. Potentially, subsidized for some income levels (i.e. money goes directly into your HSA, and HDHP premiums can be reduced.) I'd prefer if those premiums be market-based and then explicitly subsidized.

2) End employer deductibility for health insurance (over, say, 5-10y window); make it deductible, if at all, for individuals only. Employers for many many reasons should have nothing to do with health care -- privacy, portability, etc.

3) Pressure to reduce actual costs of health care delivery. End the AMA cartel's reign on care -- there is a LOT of care where 5% of the cost could produce a 90% as good solution, and people should be free to choose that if there are no negative externalities. Really, only antibiotics and contagious disease should have enforced minimum standards which can't be deviated from even w/ informed consent. This is especially meaningful for terminal or end of life care.

4) Any subsidies come from general tax and not from adjusting the underwriting (which is essentially a tax on people buying certain classes of health plan only, to cover others)

5) All government plans, except deployed active-duty military ONLY (i.e. care in war zones), go via this plan; end the VA and tricare. Provide superior care to gov/mil people by making this overall plan better, and for everyone. The President can have a personal doctor for COG reasons, but all other senior government people go through the plan, too.

6) Potentially fold medicare/medicaid into this as well.

7) Explore single-payer

8) Relatively unlimited access to medication (certainly imports from overseas), outside of antibiotics. If there is patent protection, shorten term. Reduce trials costs (safety must be shown, but not efficacy) -- efficacy and superiority can be decided by informed consumers, who may not be individuals, but could be insurers or other groups.

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

#338
post #138

Earlier quoted context omitted.

To me as someone living in the UK, this is bizarre. Why would you need an deductables at all for it not to be expensive? This in itself indicates that your entire healthcare sector is entirely dysfunctional. In 2013/2014, the UK National Health Service spent $2928/year per person. This is the average, and includes everything from the costs of births to the costs of expensive heart transplants or cancer treatments. Ge…

You've had a good experience, many others haven't. I personally had two family members die from NHS incompetence, and no compensation. There are horror stories like mine every day. I'd much rather have the US system, with all its flaws.

Can you elaborate? two deaths in the same family for negligence with no recourse to get compensation sounds sounds wrong.

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

#339
Interesting to see the anecdotal evidence in the comments that the ACA has been very good to some, and very bad to others.

It's been particularly bad for us. The covered employees are largely older (40+), with families, and it's a fairly high-end policy with a low deductible and a high percentage of covered inpatient costs.

We pay 100% of the premiums for employees. The cost, for one employee with a family, is now over $1800/month.

It is a high end policy, but...WOW.

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

#340
post #174

Earlier quoted context omitted.

The ability to get insurance for an affordable price (the parameters of which I realize people differ on) with pre-existing conditions outside of group plans has been one of the big wins of ACA. It's at least reasonable to argue that particular problem could have been addressed outside of the massive and controversial implementation that was ACA as a whole.

I agree. The Federal subsidies should actually be limited to subsidizing pre existing condition coverage. I am willing to allow tax dollars to cover the difference of pre-existing condition coverage since it would be a net gain for everyone. The problem is that the subsidies are available for everyone, regardless of prior insurability, thus, just like student loans have accelerated college cost inflation, subsidies f…

> The alleged goals of the ACA were to get everyone insured. However it shouldn't have taken thousands of pages to accomplish that. A good portion of ACA has nothing to do with insurance at all.

My own view is "getting insured" shouldn't really have been the goal, at least not with the current 'insurance' system in place. The goal should be making sure people have access to care/service, not access to purchase insurance. I have insurance, I'd be hard pressed to use it outside of a catastrophic event, because I have such a high deductible. Headaches with blurred vision... I may eventually go, but... I don't really want to be on the hook for $10k+ in bills just to find out "oh, it's nothing, get some rest".

Expanding medicaid would have ensured that more people would have had more direct access to care with minimal disruption to everything else.

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