The Health Insurance Marketplace is coming soon • Hacker News Board

Re: The Health Insurance Marketplace is coming soon

#41

Post by yequalsx » Sun, Jul 28, 2013, 4:19 PM UTC

ahallock wrote: post #38

yequalsx wrote: post #30

Earlier quoted context omitted.

It wouldn't change that and this is a good thing. Part of being in a society is shared responsibilities. I subsidize the education of other peoples' children by paying taxes that fund k-12 education. I have no children of my own. But I'm not being cheated because a society that has universal, free k-12 education is better than one that doesn't. Similarly a society that has free, universal healthcare is better than on…

I agree with the shared responsibilities, but you make it sound as if you are voluntarily subsidizing other peoples' children when in fact you are forced to. If you would contribute to the education and the health costs of others, why do you need to be forced to do it? And if people agree with you, they will do so without a gang of people coercing them to. So cut out the middleman. > Similarly a society that has free…

We all know that nothing, ultimately is free. However, the colloquial usage of the term means free means that the person receiving a free service means they don't fork over money specifically for that service. Free healthcare means, in essence, a person receiving it is not in danger of going bankrupt or of having significantly less money as a result of the care.

I did not make it seem like I pay for k-12 education voluntarily. the opposite is true. It was an essential part of my point that it isn't done voluntarily. It should be forced because some greedy self-centered person will refuse to pay for it. It's called the free rider problem.

Societies that don't have free, universal healthcare overwhelmingly have worse health outcomes, and are crappier places to live.

Re: The Health Insurance Marketplace is coming soon

#42

Post by rdl » Sun, Jul 28, 2013, 4:22 PM UTC

bane wrote: post #40

300bps wrote: post #14

Earlier quoted context omitted.

It looks nicer than my.company's website for open enrollment. Since Obamacare was enacted, I've gone from a PPO that pays for just about everything to a HDHP that only pays for catastrophic things. But at least the price of the coverage only went up 28% for the vastly inferior coverage. Two of the provisions that are in place already that really raised the cost of the vast majority's health bills are having to cover…

My anecdote refutes yours, since the Obamacare vote, my employer provided insurance went from costing me ~$200/mo on a regular PPO for me and my wife to $150/mo for both of us on a high deductible plan (with employer provided $3k per year in an HSA account), to no cost for me at all and $70/mo for my wife on her employer's plan. Coverage is about the same for me and much better on my wife's plan. My mother, who could…

Since Obamacare, my HDHP went from $80/mo to $91/mo to $118/mo to discontinued at the end of 2013. Since I can't get an HDHP as an alternative, it looks like I'd be paying $200-300 for slightly better coverage as an absolute minimum. Girlfriend's $150-200/mo HDHP is also ending in 2013.

If I don't have company health insurance by then, it'll be hard to decide between no insurance and paying $300/mo. The main thing I would miss is getting a negotiated rate on medical expenses, even if I have to pay out of pocket; I'd maybe be able to negotiate with specific doctors for that, though, or find doctors who refuse to take insurance and quote a cash price. I'd already be tempted to go to Thailand for anything in the $1-5k range which was non-emergent.

Re: The Health Insurance Marketplace is coming soon

#43

Post by rdl » Sun, Jul 28, 2013, 4:31 PM UTC

yummyfajitas wrote: post #31

jjoonathan wrote: post #29

Earlier quoted context omitted.

You've got it backwards: fat people and smokers cost less to cover because their bodies tend to fail more quickly and the most costly health care centers around slightly prolonging the lives of healthy people. Economically speaking, you should be penalized for your healthy habits. Of course, that doesn't fit in to the "we care about your health" line that insurers like to toss around, so they often just lie about wha…

You are conflating the overall cost with the per-year cost. Per-year, fatties and smokers cost more. Since insurance premiums are also paid on a per-year basis, per-year is the relevant point of comparison. Of course, in a single payer system which only receives payments from people while they work, it would in fact be beneficial to induce people to die earlier.

Insurance premiums are insignificant for lifelong unhealthy people who heavily use healthcare. A $500/mo/person premium (which is about the maximum you could get per individual in the new system) is $240k total for 40 years. There's no compounding since the price of healthcare goes up faster than regulated premiums, and because expenses per-year exceed the premiums. $6k covers not a lot of care in a year, and the whole lifetime number is blown away by one serious event.

Re: The Health Insurance Marketplace is coming soon

#44

Post by insla » Sun, Jul 28, 2013, 4:40 PM UTC

Weltan wrote: post #16

300bps wrote: post #14

Earlier quoted context omitted.

It looks nicer than my.company's website for open enrollment. Since Obamacare was enacted, I've gone from a PPO that pays for just about everything to a HDHP that only pays for catastrophic things. But at least the price of the coverage only went up 28% for the vastly inferior coverage. Two of the provisions that are in place already that really raised the cost of the vast majority's health bills are having to cover…

That's one of the reasons why subsidising and regulating private health insurance is not a good approach. If the government worked the way it was supposed to (rationally), then they would have voted for a public insurance option. They went half-way, and everyone will now pay the price.

Government-provided insurance is not necessarily better than properly regulated private insurance. Consider the current situation in California vs. Illinois.

Under the federal HIPAA law, individuals coming off group plans must have an option available to purchase a new plan without the possibility of denial due to pre-existing conditions. It is up to each state, however, to decide exactly how this will be implemented.

In Illinois, it is implemented as a state-provided insurance plan. In California, it is implemented through regulation of private insurance companies.

I have a very costly pre-existing condition and I can tell you which one I'd rather be on: California.

The reason is that the Illinois government is basically insolvent. Right now they are engaged in a political battle where even the state's lawmakers are threatened with not receiving a paycheck due to budgetary issues. This does not inspire my confidence that I want my health insurance provided by that organization (the state).

However, in California, I have Blue Shield, and no worries about its imminent dysfunction due to budget problems and political games. The insurance I get is expensive compared to what is optimal, but at least it is there.

Re: The Health Insurance Marketplace is coming soon

#45

Post by showerst » Sun, Jul 28, 2013, 5:14 PM UTC

ahallock wrote: post #38

yequalsx wrote: post #30

Earlier quoted context omitted.

It wouldn't change that and this is a good thing. Part of being in a society is shared responsibilities. I subsidize the education of other peoples' children by paying taxes that fund k-12 education. I have no children of my own. But I'm not being cheated because a society that has universal, free k-12 education is better than one that doesn't. Similarly a society that has free, universal healthcare is better than on…

I agree with the shared responsibilities, but you make it sound as if you are voluntarily subsidizing other peoples' children when in fact you are forced to. If you would contribute to the education and the health costs of others, why do you need to be forced to do it? And if people agree with you, they will do so without a gang of people coercing them to. So cut out the middleman. > Similarly a society that has free…

In most political philosophies, one of the main purposes of government is to tackle collective action/free rider problems. You're forced to subsidize everyone's education because although it's rational to subsidize it up to a point, if you can continue to accrue the benefits without paying, then why do so?

So everyone benefits from better education, but after a certain point any individual is better off not paying into it, which breaks the system if you lack consequences.

This is even more of an issue for healthcare than education, since people have wildly differing costs, and the mix of things you can control (healthy living) and things you can't (genetics) make it clash with lots of Americans' underlying political ideals.

In stark economic theory, health care would be very simple if we just let people who couldn't afford it die, because then nobody would bear the costs of catastrophic care. We as a society (thankfully!) don't do that, so we end up paying for it anyway when a poor person goes into the ER. Given the baseline that you don't let people die who can be saved, it's a short jump to a collective action problem, especially given the wildly varying income inequality and the fact that health care is demand inelastic and price insensitive (you'll pay any amount of money to not die, and for the foreseeable future people will always get sick/injured). I'd argue that it's better to internalize those costs - Insured people are cheaper overall, so everyone gets insurance and it gets subsidized by everyone, with transparent-ish rates, than externalize them (the hospital has to cover the un-negotiated costs of a poor cancer patient, so tylenol is now $17/pill)

[1] https://en.wikipedia.org/wiki/Free_rider_problem

Re: The Health Insurance Marketplace is coming soon

#46

Post by FireBeyond » Sun, Jul 28, 2013, 5:19 PM UTC

swamp40 wrote: post #27

YokoZar wrote: post #23

Earlier quoted context omitted.

Conversely, if you had a preexisting condition, you may have just seen your health bills plumet.

Group plans were/are always forced to cover pre-existing conditions. It's only if you have a pre-existing condition and no group insurance that you will see your prices drop. This is also exactly what is going to eventually bring down the existing US privatized health system, btw. The accounting doesn't add up when you force a cap on premiums and allow unlimited ~10M treatments. People will pay the yearly fine until…

"monthly incoming way down while claims go thru the roof"

Claims wouldn't go through the roof - the availability of "retroactive" insurance wouldn't increase the number of car accidents.

Re: The Health Insurance Marketplace is coming soon

#47

Post by ahallock » Sun, Jul 28, 2013, 5:24 PM UTC

yequalsx wrote: post #41

ahallock wrote: post #38

Earlier quoted context omitted.

I agree with the shared responsibilities, but you make it sound as if you are voluntarily subsidizing other peoples' children when in fact you are forced to. If you would contribute to the education and the health costs of others, why do you need to be forced to do it? And if people agree with you, they will do so without a gang of people coercing them to. So cut out the middleman. > Similarly a society that has free…

We all know that nothing, ultimately is free. However, the colloquial usage of the term means free means that the person receiving a free service means they don't fork over money specifically for that service. Free healthcare means, in essence, a person receiving it is not in danger of going bankrupt or of having significantly less money as a result of the care. I did not make it seem like I pay for k-12 education vo…

I find it funny that the person using force is calling the other people greedy and self-centered. You are being self-centered by acting like your ideas and needs trump everyone else's to the point of being mandatory. I'm sorry, they don't. If your ideas are good, you will get support. You can put down the guns. If you have kids and think that education is important (I agree), then work for it and get support from those around you. I know it's not easy as pointing guns at people via the State, but I don't think k-12 education is a hard sell.

Re: The Health Insurance Marketplace is coming soon

#48

Post by tosseraccount » Sun, Jul 28, 2013, 5:32 PM UTC

yequalsx wrote: post #30

yummyfajitas wrote: post #18

Earlier quoted context omitted.

300bps is complaining about the fact that as a person with a low actuarial cost, he is being forced to subsidize others with a high actuarial cost. I too share this complaint - I wake up and hit the gym from 8-9:30 every day - as a reward for taking care of myself, I'm obligated to subsidize diabetes treatment for people who wake up and eat donuts. How would a public insurance option change this?

It wouldn't change that and this is a good thing. Part of being in a society is shared responsibilities. I subsidize the education of other peoples' children by paying taxes that fund k-12 education. I have no children of my own. But I'm not being cheated because a society that has universal, free k-12 education is better than one that doesn't. Similarly a society that has free, universal healthcare is better than on…

U.S. spends around 40% more GDP per year on healthcare ...

"evidence" or speculation?

Re: The Health Insurance Marketplace is coming soon

#49

Post by showerst » Sun, Jul 28, 2013, 5:39 PM UTC

ahallock wrote: post #47

yequalsx wrote: post #41

Earlier quoted context omitted.

We all know that nothing, ultimately is free. However, the colloquial usage of the term means free means that the person receiving a free service means they don't fork over money specifically for that service. Free healthcare means, in essence, a person receiving it is not in danger of going bankrupt or of having significantly less money as a result of the care. I did not make it seem like I pay for k-12 education vo…

I find it funny that the person using force is calling the other people greedy and self-centered. You are being self-centered by acting like your ideas and needs trump everyone else's to the point of being mandatory. I'm sorry, they don't. If your ideas are good, you will get support. You can put down the guns. If you have kids and think that education is important (I agree), then work for it and get support from tho…

The problem is, at some point it becomes the _individual's_ best interest not to pay for education, but it's in _everyone's_ best interest to have more education. This is a classic collective action/free rider problem.

So you if your ideas are good, you get support from your neighbors, and you get your idea moving, so the benefits start to accrue. Then the situation changes so that education 'exists' whether you individually pay for it or not, so you need to put in some penalty for not-paying otherwise the system falls apart when people start acting in their best interests... and next thing you know you've ended up with governance.

Re: The Health Insurance Marketplace is coming soon

#50

Post by jjoonathan » Sun, Jul 28, 2013, 5:48 PM UTC

yummyfajitas wrote: post #31

jjoonathan wrote: post #29

Earlier quoted context omitted.

You've got it backwards: fat people and smokers cost less to cover because their bodies tend to fail more quickly and the most costly health care centers around slightly prolonging the lives of healthy people. Economically speaking, you should be penalized for your healthy habits. Of course, that doesn't fit in to the "we care about your health" line that insurers like to toss around, so they often just lie about wha…

You are conflating the overall cost with the per-year cost. Per-year, fatties and smokers cost more. Since insurance premiums are also paid on a per-year basis, per-year is the relevant point of comparison. Of course, in a single payer system which only receives payments from people while they work, it would in fact be beneficial to induce people to die earlier.

> You are conflating the overall cost with the per-year cost.

Performing the division to approximate yearly costs from the source I linked does not support your point. Obese people may have had the highest costs, but not the highest average yearly costs.

In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more. OTOH, private insurance wants to dump you as quickly as legally possible the moment your costs exceed your premiums weather you are healthy or not.