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'A full-blown crisis': Americans brace for a surge in healthcare costs

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Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#221

Post by nradov »

_DeadFred_ wrote: post #217
nradov wrote: post #111

Earlier quoted context omitted.

That's all true, but insurers are ramping up premiums faster than inflation largely because providers have raised their prices, and utilization has greatly increased due to an aging sicker population. The ACA minimum medical loss ratio means that health plans profits aren't increasing much.

Percentage wise profits might not increase, but 10% profits on a $2000 plan make an insurance company (and execs) more than 10% profits on a $200 plan. It's in their interests and income stream for costs to constantly go up so they can get their 10% take. Efficiencies and price savings would actually hurt them (can't have plan rates go back down and only get their 10% off of $200).

That ignores competitive pressures. Commercial health plans aggressively negotiate rates with their network providers in order to get market share with cost sensitive customers. If your claim was accurate then insurers would just take whatever rates that providers set but the reality is that doesn't happen. Health plans routinely drop more expensive providers from their networks.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#222

Post by nradov »

loeg wrote: post #215
mritterhoff wrote: post #207

Earlier quoted context omitted.

> because healthcare demand is unlimited. How's that? Beyond some level of care I suspect demand drops of a cliff. No one goes to the doctor for the fun of it.

> No one goes to the doctor for the fun of it. "Fun" isn't the right word, but ~hypochondriacs will get unnecessary care if they perceive it to be free. This adds cost to the system without improving outcomes.

Yes, and there is also an enormous amount of low-value or unnecessary care delivered which also doesn't improve outcomes (or even makes them worse). Depending on which estimate you believe this might be a quarter of all healthcare spending.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#223

Post by shuckles »

UncleMeat wrote: post #183
nradov wrote: post #34

Earlier quoted context omitted.

I support subsidies to help low-income citizens who legitimately can't afford health insurance, but some of the temporary ACA subsidies passed in 2021 were ridiculous. They were handing out cash to early retirees as young as age 55 with incomes over 400% of the poverty line. https://www.cnbc.com/2025/10/17/aca-enhanced-subsidy-lapse-g... I don't want my tax dollars wasted on subsidizing them. Give the money to someon…

400% FPL is $62,000 for a single person. Not exactly rolling in it.

Income isn't wealth. Someone making $62,000/yr in income without working at 55 (i.e. no Social Security) is likely comfortable. That's >$1m in invested assets plus whatever is owed to them as retirement income when they reach retirement age. It's especially unclear if everyone else's payroll taxes should be spent allowing this person to retire a few years earlier.

This is all before including the other large personal expense (housing) for this person is likely imputed rents from homeownership which aren't counted as income but function that way.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#224

Post by altairprime »

nradov wrote: post #189
altairprime wrote: post #157

Earlier quoted context omitted.

Year-over-year increase in GDP in the U.S. right now is almost exclusively “production” output from the healthcare industry, whose profits are stratospheric and rising. So there’s two useful datapoints here: first, the bill must be paid, or U.S. GDP growth year-over-year falters, not because healthcare costs this much; and second, household debt continues to increase year-over-year to permit continued wage stagnation…

Commercial health insurers have relatively low profit margins. This is forced by the ACA minimum medical loss ratio. In theory Congress could increase that ratio slightly but it wouldn't do much to improve affordability for consumers.

That restriction is mysteriously absent from the actual published data showing their revenue growth rate spiking sharply when ACA was passed. There’s lots of sources for that data, but I liked this chart for its simplicity:

https://images.jacobinmag.com/wp-content/uploads/2024/12/111...

It presents nice easy datapoints: Cigna raised its profits by $40B/yr, an increase of 400% of its pre-subsidy profits, in just a decade — and one can safely assume that now that they’re accustomed to the new profit levels, there is no way they’ll voluntarily give them up. Whatever was intended with the medical loss ratio, Congress fucked up by not including a simple dollars-per-subscriber cap on net revenue.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#225

Post by ethbr1 »

tirant wrote: post #184
docdeek wrote: post #179

Earlier quoted context omitted.

>> In your case you believe your cost is only 1200€ a year, because your government has not made at all clear to you how much you’re paying from your other taxes into the healthcare system. I absolutely do not believe my healthcare costs only €1200 a year. As I wrote, my top-up insurance costs about €1200 a year, and the healthcare costs more and that is why my taxes are so high.

Ok, then I misinterpreted you. However it’s still unclear how much you’re paying, as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever. There are of course also negative second order consequences. In socialized health care systems, where doctors and hospitals are payed the same no…

> as the problem with socialized services like healthcare is that you never know exactly how much you’re paying and if you’re overpaying or underpaying as there’s no free competition whatsoever.

Also true in America, in which there is no socialized healthcare. (In any standard use of the term)

Hell, even Medicare ended up partially privatized. (At huge extra cost)

The worst thing about government-run monopoly services is there's little bottom-up incentive to optimize.

The worst thing about private-run services is there's little incentive for anything other than profit.

Given the fundamental realities of must-deliver services (e.g. healthcare, prison, etc.), I'd rather have them government-delivered than some bastardized free market without competition.

At least the former has a path to excellence. The latter just inevitably turns into a hostile hellscape for the end consumer.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#226

Post by ethbr1 »

xtiansimon wrote: post #178
runako wrote: post #42

Earlier quoted context omitted.

Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.) Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter. One other thing the ACA did is stop the scourge of scam insurers. This is a thing where peo…

Don’t forget the repeal of the ACA healthcare mandate: “The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019.” https://pmc.ncbi.nlm.nih.gov/articles/PMC8886708/

Aka Republicans being pissy about the ACA (despite having come up with no feasible alternative plan at the time and unanimously voting against it even after it incorporated Republican characteristics) and choosing to try to intentionally financially torpedo it so they could campaign on its failure.

I'm pretty centrist, but the sheer evil of fucking over a country's access to health services for political points is appalling.

Especially since, you know, coming up with an alternative plan was eminently doable -- just not a priority for Republican leadership (then or "we have an idea of a plan" now).

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#227

Post by ethbr1 »

dboreham wrote: post #79
runako wrote: post #42

Earlier quoted context omitted.

Quick summary: the US does not have anything approaching a modern healthcare system. (And likely will not for quite some time due to a set of structural factors.) Obamacare (the Affordable Care Act or ACA) was an attempt to expand coverage and slow the rate of increase of costs. It did the former but less well with the latter. One other thing the ACA did is stop the scourge of scam insurers. This is a thing where peo…

Quick note that for people aged 65 and over the US does have a healthcare system somewhat like other developed nations.

Medicare Advantage?

https://m.youtube.com/watch?v=Ejoi9yfLVCc

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#228

Post by ethbr1 »

Jordan-117 wrote: post #201
dogemaster2028 wrote: post #43

Earlier quoted context omitted.

Obamacare failed at reducing costs. It mostly focused on insurance expansion and in consumer protections, not on dealing with hospital, drug, and provider pricing structures that actually drive the spending in the US healthcare system.

The ACA had its most effective cost-control mechanisms stripped by its political opponents. Sen. Lieberman (a turncoat Dem who had campaigned for John McCain) forced the removal of the public option, which would have helped hold prices down through competition. The Supreme Court struck the requirement for states to participate in Medicaid expansion, which limited the benefits for millions in a swath of conservative s…

It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity.

You shouldn't change all the parts in an engine to different specifications at the same time.

The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, etc.) with lubrication (individual mandate) in an effort to move the whole morass forward.

The worst part about the ACA is that neither party tried to pass ACA Pt 2, that went further. (And yes! That could have been a Republican effort too!)

The previous system was broken. The current system is less broken. It's possible to create an even less broken future system.

The real ridiculousness is anyone campaigning on status quo and/or 'it's impossible to improve things.'

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#229

Post by ethbr1 »

_DeadFred_ wrote: post #214
thallium205 wrote: post #101

Earlier quoted context omitted.

All house and senate GOP members voted "no" on ACA. Obamacare is a lot of things, but a "GOP healthcare plan" isn't one of those things.

Strangely it actually was based on the GOPs 'Romneycare' that was promoted by The Heritage Foundation.

Qft. Many of the provisions in ACA are direct GOP asks from the bipartisan negotiations around it... before the party decided to unanimously vote against it at the 11th hour.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#230

Post by johnnienaked »

JKCalhoun wrote: post #175
johnnienaked wrote: post #124

Earlier quoted context omitted.

I pay $120/mo. I don't understand. Are you including the employer paid share in this calculation?

You are lucky to have employer-provided health care.

Every employer in the United States with >50 employees must provide health care.
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