The state of healthcare on the working poor

[fskimospy]

Somehow the GAO has already managed to weigh in on the early adoption of insurance expansion, and it's not good for your position. Or maybe those were exactly the consequences you had in mind?

I'm not sure why you would say that's not good for my position, as I haven't actually articulated a position on any of that in this thread. I was simply saying that your statement that the nature of government spending is irrelevant was not correct. If anything, this supports my position that the nature of spending does in fact alter health care profiles.

My position would actually be mandatory catastropic insurance for all (I'm agnostic on whether to pay for it from taxpayer funds as a universal benefit) and changing the current employer-linked health insurance tax benefit into a "Health Savings Account" type vessel. That provides:

1. True health insurance for all (low rate coverage against only truly unforeseen medical events instead of what is effectively pre-paid medical expense accounts administered by insurance companies.

2. A client-driven system of medical care delivery where patients and doctors make rational economic cost-benefit decisions instead of central planning from an insurance plan or government.

Basically anything we can do to break open the black box of medical costs and spending in this country is a good thing. The problem isn't that consumers are paying for healthcare rather than the government, it's that most of the actors don't know or care about costs.

This would be my preferred model as well, as I've noted in previous threads. I do not think such a model will ever end up being enacted however, and so a single payer system is a good second choice.

 

[Texashiker]

:raises hand:
Question!

Why should the employer be paying for his medical coverage in the first place?

Most employers pay for the employees health insurance.

The employee then pays for the family.

 

[sunzt]

Most employers pay for the employees health insurance.

The employee then pays for the family.

thanks for the response, but that's not an answer to the question.

 

[Hayabusa Rider]

I pay into medicare, so why cant I use it?

My stepson pays into medicare, so why cant he use it?

You can when you are old enough.

 

[Hayabusa Rider]

Who pays for the coverage is beside the point. The point is that the medical cartels have established a strong monopoly and have used the levers of government to strengthen their position and drive up prices to absurd levels. And no one is even interested in breaking that monopoly or lowering prices. People only argue over who should pay.

You can cut costs. Just cut services. Europe does that with HIV.

 

[nehalem256]

:raises hand:
Question!

Why should the employer be paying for his medical coverage in the first place?

There is no inherent reason. It would make more sense for companies to cut all benefits and increase wages to compensate. However, would you really trust companies to increase wages instead of pocketing the benefit costs as profits?

Of course we can ask the obvious next question:

Why should the government by paying for medical coverage in the first place?

 

[palehorse]

The greatest Obamacare irony is that the ONLY parties that will pay less for insurance in the future are our employers, yet the entire program was sold to the American people as "being cheaper."

ALL healthcare costs will soon be on the shoulders of the middle class -- whose individual costs will rise between 50-200% almost overnight -- and the entire middle class will eventually collapse as a result.

bet?

 

[fskimospy]

The greatest Obamacare irony is that the ONLY parties that will pay less for insurance in the future are our employers, yet the entire program was sold to the American people as "being cheaper."

ALL healthcare costs will soon be on the shoulders of the middle class -- whose individual costs will rise between 50-200% almost overnight -- and the entire middle class will eventually collapse as a result.

bet?

I'll take that bet. $500 sound good?

If the median per family health care expenditure increases by 50% or more from 1 January, 2014 (when the ACA takes effect) and 1 January, 2015 as measured by the CBO or another nonpartisan research entity, you win. Increase of 49% or less, I win. We can decide on exactly what sources would be considered acceptable if you want.

If you would like to make other bets about the 'collapse' of the middle class due to this I'm happy to make those as well, but you will have to define your terms better.

 

[sunzt]

There is no inherent reason. It would make more sense for companies to cut all benefits and increase wages to compensate. However, would you really trust companies to increase wages instead of pocketing the benefit costs as profits?

It seems some companies could be using ACA as an excuse (justified or not) to do exactly that.

Of course we can ask the obvious next question:

Why should the government by paying for medical coverage in the first place?

That answer would rely on how society feels about paying for medical coverage for people who can't afford it. Should the government be obligated to create a safety net? Or, should the government be so hands off that there is no safety net and leave everyone to fend for themselves whether they are capable or not.

I think a safety net is need to provide some stability in society, especially as we age, have less capability to earn income, and increased medical costs at that age. This stability also improves overall quality of life for everyone so that I have less worry about my parents getting adequate medical care, they can contribute to the economy in other sectors, and live constructively in retirement (e.g: provide wisdom to younger generations, volunteering).

Without stability comes unrest, crime, and other negative externalities that affects other aspects of our economy and lives.

The biggest difference between the GOP and Dems is not if gov should subsidize, but HOW it does so.

 

[palehorse]

I'll take that bet. $500 sound good?

If the median per family health care expenditure increases by 50% or more from 1 January, 2014 (when the ACA takes effect) and 1 January, 2015 as measured by the CBO or another nonpartisan research entity, you win. Increase of 49% or less, I win. We can decide on exactly what sources would be considered acceptable if you want.

If you would like to make other bets about the 'collapse' of the middle class due to this I'm happy to make those as well, but you will have to define your terms better.

We'll need to refine those terms a bit to make the bet accurate to what I said.

--For starters, I said "middle class." Therefore, the sample group needs to be much more specific (EDIT: or more broad?) than "median per family health care expenditures."

--I'd also extend the end-date to 31 December 2018 to capture all or most of the planned (read: known) increases for middle class individuals and families. (There's a published roll-out schedule).

As for the eventual collapse, that's probably going to take too long for a realistic bet. But, rest assured, I still believe healthcare costs will be the leading cause of said collapse.

 

[fskimospy]

We'll need to refine those terms a bit to make the bet accurate to what I said.

--For starters, I said "middle class," specifically. Therefore, the sample group needs to be much more specific than "median per family health care expenditures."

--I'd also extend the end-date to 31 December 2018 to capture all or most of the planned (read: known) increases for middle class individuals and families. (There's a published roll-out schedule).

As for the eventual collapse, that's probably going to take too long for a realistic bet. But, rest assured, I still believe healthcare costs will be the leading cause of said collapse.

So by 'overnight' you meant 'half a decade'. Secondly, health care inflation has (depending on what metric you use) averaged around 6-8% annually in recent years. Simple compound interest over your five year period would get you more than half of the way to your 50% level, so your prediction is silly in that respect.

As far as what you think the 'middle class' would be, data is unlikely to be available by some arbitrary income level that you're going to define as middle class. Median would work quite well.

I get the strong impression that you didn't actually think any of this through and just made something up.

 

[ivwshane]

:raises hand:
Question!

Why should the employer be paying for his medical coverage in the first place?

They shouldn't be. It's a bad system for all of those involved but the ideologues among us refuse to put in place a system that woułd work and be more beneficial.

 

[Texashiker]

health care inflation has (depending on what metric you use) averaged around 6-8% annually in recent years.

What was the rate of inflation during those years? The standard rate of inflation s what, around 3%?

Was that 6% - 8% increase during the recent economic downturn of 2008 to now?

I'll just throw this out there, the rate of health increases is bypassing all other economic factors, except maybe the price of housing, fuel and food.

The economy simply can not support something as important as health care increasing at double and close to triple the rate of inflation.

 

[fskimospy]

What was the rate of inflation during those years? The standard rate of inflation s what, around 3%?

Was that 6% - 8% increase during the recent economic downturn of 2008 to now?

I'll just throw this out there, the rate of health increases is bypassing all other economic factors, except maybe the price of housing, fuel and food.

The economy simply can not support something as important as health care increasing at double and close to triple the rate of inflation.

I wholeheartedly agree, you can't have a sector that is 1/6th of our economy growing in cost like that. In the early 2000's health care inflation was totally out of control, but in the last few years the rate of inflation has slowed considerably.

Oh, and the Fed's target inflation rate is 2%.

 

[palehorse]

So by 'overnight' you meant 'half a decade'. Secondly, health care inflation has (depending on what metric you use) averaged around 6-8% annually in recent years. Simple compound interest over your five year period would get you more than half of the way to your 50% level, so your prediction is silly in that respect.

First, I said "almost overnight."

Second, it would be completely disingenuous (read: pointless) to measure just one year of the increasing costs when the ACA itself lays out a finite schedule for the increases over a period of 4-5 years.

Third, I know damn well that the average increase has been 6-8%, annually, during the last decade -- my own coverage rates rose approx. 7% last year. I also know that such increases could equal (or possibly even slightly surpass) the ACA's minimum 50% increase after five years. However, I also know two other things:

• The range of the ACA rate increases is expected to be between 50% to 200% -- depending on current costs, income level, and a few other factors. Why do you keep focusing on just the 50% figure? What about those, like me, who face an increase that is dramatically higher than 50%? My wife and I are in the upper middle-class (using median as the standard), but that doesn't mean I'm going to sit idly by while we get raped with an increase of 100%, or more, once my employer decides to cancel coverage!
• The ACA was sold to the American people as being the solution to the annual 6-8% increases you mentioned. Why is it, then, that the ACA itself will actually result in increases that are equal to, or dramatically higher than, that 6-8% amount? WTF happened to the ACA supposedly curbing those rate increases!? Wasn't reducing those increases half of the g'damned point?! D:

As far as what you think the 'middle class' would be, data is unlikely to be available by some arbitrary income level that you're going to define as middle class. Median would work quite well.

We'll probably need to examine the cost increases across all of the various "median income" categories, such as those found on wikipedia's description of the American Middle Class

I get the strong impression that you didn't actually think any of this through and just made something up.

Wrong again.

 

[fskimospy]

First, I said "almost overnight."

Second, it would be completely disingenuous (read: pointless) to measure just one year of the increasing costs when the ACA itself lays out a finite schedule for the increases over a period of 4-5 years.

I'm going to go out on a limb and say that most people don't consider half a decade to be 'almost overnight'.

Third, I know damn well that the average increase has been 6-8%, annually, during the last decade -- my own coverage rates rose approx. 7% last year. I also know that such increases could equal (or possibly even slightly surpass) the 50% increase after five years.

If you know that under the old order health care inflation could have resulted in a 50% increase over five years then what was the point?

However, I also know two other things:
0. The range is expected to be between 50 to 200%. Why do you keep focusing on the 50% figure? What about those, like me, who face an increase that is dramatically higher than 50%? My wife and I are in the upper middle-class (using median as the standard), but that doesn't mean I'm going to sit idly by while we get raped with an increase of 100%, or more, once my employer decides to cancel coverage!

I was trying to be as friendly to your betting terms as possible. I have no doubt that I will easily win this bet, but I wanted to give you a fighting chance. If you want to lose for absolute certain as opposed to lose just mostly for certain we can use a different figure. Which do you suggest?

1. The ACA was sold to the American people as being the solution to the annual 6-8% increases you mentioned. Why is it, then, that the ACA itself will actually result in increases that are equal to, or dramatically higher than, that 6-8% amount? WTF happened to the ACA supposedly curbing those rate increases!? Wasn't reducing those increases half of the g'damned point?! D:

Did you know that since the passage of the ACA, health care cost inflation has been dramatically lower than in previous years? As I said before, correlation does not equal causation, but so far you should be exceptionally pleased with the rate of health care inflation since its passage. Happy now?

We'll probably need to examine the cost increases across all of the various "median income" categories, such as those found on wikipedia's description of the American Middle Class

I find it unlikely that the agencies responsible for reporting this information will slice it by income levels like that, therefore we will be forced to take a proxy. Median health care costs seems like the best one I'm aware of.

 

[Darwin333]

It sounds like you're advocating for socialism. The free market is the only system that works. The US was built on the free market.

If you like socialism so much then go move to Europe.

I am no fan of socialism but what you just said is patently false. There are tons of real world examples of socialized medicine working far better than our current system.

Personally, I know for a fact that we will never have a true free market healthcare system in this country so the massive amount of cost shifting will continue. Knowing that as fact, the next best thing would be universal healthcare or perhaps some hybrid where people can purchase "upgraded" plans. Unfortunately I have zero trust in any sort of healthcare system that would be made up by those idiots in Washington.

 

[palehorse]

If you know that under the old order health care inflation could have resulted in a 50% increase over five years then what was the point?

My point was that the expected ACA 50% increase is just the starting point. The entire range for the middle class is expected to be between 50% to 200%.

Hell, that doesn't even take into consideration that the previous annual increases would normally be spread out over five years, while the ACA increases may happen MUCH faster than that.

If you're one of the unlucky ones whose employer decides to drop coverage in 2014 or 2015, then guess what: you'll get to enjoy that 50% to 200% increase in just one or two years!! woohoooo!

I was trying to be as friendly to your betting terms as possible. I have no doubt that I will easily win this bet, but I wanted to give you a fighting chance. If you want to lose for absolute certain as opposed to lose just mostly for certain we can use a different figure. Which do you suggest?

I have no issue with the bet remaining at the minimum. What I do take issue with is that you're also completely ignoring the 51-200% increases, as though my point with those in the actual debate is irrelevant. Why is that?

Did you know that since the passage of the ACA, health care cost inflation has been dramatically lower than in previous years? As I said before, correlation does not equal causation, but so far you should be exceptionally pleased with the rate of health care inflation since its passage. Happy now?

You know as well as I do that the recent lower annual increases have nothing to do with the ACA since the vast majority of the ACA changes haven't even started yet. If anything, the recent lower increases only prove that ACA is entirely unnecessary -- or worse, it sheds light on the fact that the increases under ACA will be even higher!

The irony, of course, is that once ACA kicks into full speed, we're going to look back at these smaller annual increases and say "Damnnnn, I really wish we could go back to 2013 when we had reasonable increases!"

I find it unlikely that the agencies responsible for reporting this information will slice it by income levels like that, therefore we will be forced to take a proxy. Median health care costs seems like the best one I'm aware of.

My issue with using median health care costs is that it completely ignores the dramatically higher increases that will still hit people in the middle class. Second, how will we account for those who pay the penalty instead of buying a plan? Will those numbers even be considered when they calculate the median healthcare costs? If not, it may not even be possible to figure out the actual results of this bet...

 

[palehorse]

So, in response to dramatically increased premiums for many people who have employer-provided coverage, Obama is now blaming employers for passing on newly increased healthcare costs to their employees -- as if that wasn't one of the biggest gripes/predictions with the ACA from the very beginning?

WTF did he think employers would do with the increased costs?!