Affordable Care Act and Ramifications Discussion

Parent Cafe
921

<p>Yes, you could tax cigarettes now. But people have known that cigarettes cause cancer and emphysema and other diseases for 40 years now and during that time cigarettes were not taxed to pay for the healthcare of smokers. So they should pay high insurance premiums.</p>

<p>As for juice and cookies? Really. It’s the calories, not where they come from. But that’s another can of worms.</p>

922

<p>But how would institute that and as a result if a smoker did not buy health insurance would you refuse treatment when they got sick?</p>

<p>How about people that due to poor luck just ended up with chronic expensive hc costs what happens to them?</p>

923

<p>ACA requires coverage. Smokers should pay a lot more than non smokers for insurance or in fines if they don’t insure. </p>

<p>Bad luck should not be financially penalized at all. </p>

<p>But so much of healthcare costs are due to preventable things.</p>

924

<p>[Why</a> Is American Health Care So Ridiculously Expensive? - Atlantic Mobile](<a href=“http://m.theatlantic.com/business/archive/2013/03/why-is-american-health-care-so-ridiculously-expensive/274425/]Why”>Why Is American Health Care So Ridiculously Expensive? - The Atlantic)</p>

<p>"In the U.S. health care system, everything costs more. Being in a hospital cost more. Because our drugs cost more (prescription drug prices can be 10X the rate in the UK or Germany). And our doctors cost more (a US family physician makes 3X her German counterpart). Because their education costs more (the education for a German physician’s education is nearly free). And on it goes.</p>

<p>Near the end of the book, Reid expands on two big reasons why U.S. health care is so expensive: (1) Unlike other countries, the U.S. government doesn’t manage prices; and (2) the complications created by our for-profit system adds tremendous costs."</p>

<p>A list of procedures and drugs and the costs…</p>

<p><a href=“http://m.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/?wprss=rss_ezra-klein[/url]”>http://m.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/?wprss=rss_ezra-klein&lt;/a&gt;&lt;/p&gt;

925

<p>Could someone please explain to me why the employer mandate is necessary? I’m sure I knew the answer to this at one time, but I’ve forgotten. Lol</p>

926

<p>While I agree that one of the biggest problems with health care in this country is administrative costs and basically agree with tom1944 about the best solution to that problem, when compared to other developed countries, virtually all of the excess health care spending in the United States can be traced to the amount that we pay for health care for older Americans</p>

<p><a href=“https://www.google.com/search?q=medical+costs+by+country+elderly&client=firefox-a&hs=NHe&rls=org.mozilla:en-US:official&tbm=isch&tbo=u&source=univ&sa=X&ei=Nab6UdHhLdeo4APBloH4Bw&ved=0CG8QsAQ&biw=1024&bih=622#facrc=_&imgrc=UF1c05wEM_-idM%3A%3BssMc5GmycuW0cM%3Bhttp%253A%252F%252Fwww.motherjones.com%252Ffiles%252Fblog_healthcare_costs_age.jpg%3Bhttp%253A%252F%252Fwww.motherjones.com%252Fkevin-drum%252F2012%252F12%252Fquick-look-us-healthcare-costs-elderly%3B500%3B301[/url]”>https://www.google.com/search?q=medical+costs+by+country+elderly&client=firefox-a&hs=NHe&rls=org.mozilla:en-US:official&tbm=isch&tbo=u&source=univ&sa=X&ei=Nab6UdHhLdeo4APBloH4Bw&ved=0CG8QsAQ&biw=1024&bih=622#facrc=_&imgrc=UF1c05wEM_-idM%3A%3BssMc5GmycuW0cM%3Bhttp%253A%252F%252Fwww.motherjones.com%252Ffiles%252Fblog_healthcare_costs_age.jpg%3Bhttp%253A%252F%252Fwww.motherjones.com%252Fkevin-drum%252F2012%252F12%252Fquick-look-us-healthcare-costs-elderly%3B500%3B301&lt;/a&gt;&lt;/p&gt;

<p>Bottom line: Nobody wants to make the hard choices about not providing expensive care from older people in cases where the potential benefits are limited.</p>

927

<p>Answering my own question (lol), there is actually no employer insurance mandate, just a “shared responsibility fee,” if a large employer doesn’t offer insurance.</p>

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<p><a href=“http://www.whitehouse.gov/files/documents/health_reform_for_small_businesses.pdf[/url]”>http://www.whitehouse.gov/files/documents/health_reform_for_small_businesses.pdf&lt;/a&gt;&lt;/p&gt;

<p>EMM1,</p>

<p>I agree with your analysis. Unfortunately, it leads us back to the “death panels” issue. I would like to know how other countries handle this, but for some reason I don’t think we are allowed to discuss other countries on this thread.</p>

928

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<p>I’m not sure how I feel about ACA, since I still really can’t make any sense of it. I will reserve my judgment on that till it’s been in effect for a little while. I really would love for Medicare to be available to anyone who chooses it. It makes sense to me that adding younger/healthier people to Medicare would allow the premium to be reduced for everyone.</p>

929

<p>You guys can agree all you want but rge old sge thing is false. Somewhere in those hundreds if slides is the answer. </p>

<p>EMM1, you didnt really look at all those slides, did you?</p>

930

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<p>That is a real good question! If you want to hire someone to work for you, seems your responsibility is to pay them enough money so that they want to work for you. Why should an employer be obligated to provide healthcare insurance? That should either be a government function - if you think the govt should be providing healthcare - or the employee should have to buy the insurance himself, which I guess is going to happen in many cases. </p>

<p>Just because large employers have been very generous in the past by providing a wide range of benefits that also often includes health insurance is not a reason to require (by law) that they do so.</p>

<p>I have often been amazed at the effort, resourcefulness, and money that it takes for an individual to run a small business that actually employs people.</p>

931

<p>No, just the graph the describes health care costs by age. I’d seen it somewhere else, but couldn’t immediately put my finger on a website that had just that chart.</p>

932

<p>dstark,
Yes, I understand what you are saying -elderly end of life does not consume the largest percentage of the pie, but it does consume a disproportionate amount and much more than other countries spend in the same age ranges.</p>

933

<p>tom, </p>

<p>I would like to explore your statement:</p>

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<p>Many people, including on this thread, say something like, they want employers out of the business of healthcare.</p>

<p>I don’t quite understand why they feel this is important.</p>

<p>Currently, employers are not required to provide insurance for their employees, nor will they be required to provide it under the ACA (but they will have to pay a per capita “fee” if they don’t).</p>

<p>Are you (and others) proposing that employers should be prohibited from offering insurance coverage as a benefit? Why would this be beneficial to do?</p>

934

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<p>The problem with an opt-in for Medicare is what’s known as “adverse selection.” The benefit of opting into Medicare would be greatest for those with chronic and/or extremely costly medical conditions. Younger, healthier people might elect to stay away in droves, figuring they don’t need Medicare’s extensive coverage just yet, with the expectation that they can always opt in later if they become sick or have a serious or debilitating injury. Rather than lowering costs and premiums, an opt-in might very well raise average costs and premiums.</p>

<p>That’s essentially why individual health insurance on the voluntary private market is so expensive: it’s most valuable to those who generate the highest medical bills, while many younger and healthier people are willing to take a chance and forego coverage. It’s also why, pre-ACA, private insurers almost always excluded or denied coverage for “pre-existing conditions” in individual policies; they didn’t want to be left holding the bag if someone learns they’re seriously ill, and only then goes out and buys insurance coverage as a way of shifting the cost to the insurer. (It’s different in the case of group policies, e.g., employer-sponsored coverage, because even if some members of that risk pool are sick, others will be healthy, and the insurer can make reasonable actuarial assumptions about what its costs are likely to be). But from the consumer’s point of view, exclusion of pre-existing conditions results in a nonsensical health care system in which you can’t get health care coverage for the diseases or conditions that most adversely affect you.</p>

<p>Opinions on the ACA are mixed, but there now seems to be overwhelming support for some of its central features, including the elimination of exclusions or denial of coverage for pre-existing conditions. But you can’t just require coverage of pre-existing conditions without doing something to address the adverse selection problem, or adverse selection will only grow worse. And essentially, that means you’ve got to make coverage mandatory in some form or another. </p>

<p>I’ve always thought Medicare-for-all was the simplest, cleanest, and most efficient solution, and the core administrative machinery is already in place to make it work. But that smacks of “socialized medicine” to some people, so essentially the ACA picked up on an old conservative think-tank idea and tries to impose universal coverage through a complicated mix of managed market mechanisms, incentives, and penalties. It becomes mind-numbingly complicated. Maybe it will work, maybe it won’t. It does seem to work fairly well in Massachusetts, but the jury’s still out at the national scale. I’d still prefer to see Medicare-for-all, but I am presently half-heartedly in support of ACA as an experimental second-best solution. If it fails, I’ll be right back to Medicare-for-all.</p>

935

<p>Bay since I want a national system where everyone is covered it does several things that I feel would help the economy</p>

<p>1- it allows people to take the risk to become entrepreneurs because they do not have the burden of health care tied to a job
2- I believe a national system is the only way to drive down costs
3- the burden of health care costs being lifted from employers may mean less jobs get sent overseas
4- I think health care is something that should be provided as a society for all of its citizens
5- I think providing a job is one of the single most important things someone can do for another person and that alone is enough from the employer. I would also lift the burden of all other employer taxes and fees and fund programs through broader taxes. That is really a way to see if the program is really worthwhile.</p>

<p>bclintock’s post is one I agree with and why I support the ACA for now.</p>

936

<p>^Okay, so when you say you want employers out of the business of health care, you mean because you want government-run health care. Thanks for the clarification.</p>

937

<p>I have been clear on that from the beginning. I have posted many times- I want Medicare for all with the ability to purchase gap policies like seniors do now.</p>

938

<p>Can someone please explain this? I’m using the Kaiser Subsidy Calculator. </p>

<p>If you put in 1 person in the household with an income of $12,000, and 1 person seeking coverage, you get this message: “You will not be eligible for subsidies in the exchanges because your income is below 100% of the federal poverty level.”</p>

<p>What is the person below poverty level supposed to do?</p>

939

<p>Sorry, I can’t help you amw, but you reminded me of another question I had. </p>

<p>Can an adult under age 26 get his/her own subsidized insurance coverage at the exchanges if s/he is low income, even if his/her parents have coverage that includes children up to age 26?</p>

940

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<p>Employer-sponsored health insurance is a problem for many employers competing globally, and indirectly for their employees. To offer a simple example: for many decades it’s been cheaper for General Motors, Ford, and Chrysler to build cars in Ontario than in Michigan because Ontario has a single-payer, government-sponsored, taxpayer-supported health care system while in Michigan employees’ health care costs are covered by the employer and treated as part of its cost of doing business. Of course, until recently there’s been no law mandating that GM et al. cover their workers’ health care costs, but union contracts since the 1950s have required it, and salaried employees have come to expect it as something close to a birthright. The alternative, of throwing them all into the private market for individual coverage, seemed unthinkably cruel, not to mention impractical if they wanted to avoid being shut down by strikes and mass departures of salaried personnel. GM estimates that something like $2,000 of the cost of every U.S.-made car represents its health insurance costs. And it’s not only Ontario that can build cars cheaper (after all, shifting production to Ontario may hurt U.S. autoworkers and cities like Detroit, Flint, and Toledo, but as far as GM is concerned it just shifts around the profit centers within the corporation). Employer-sponsored health care costs are cheaper everywhere in the world, either because they have single-payer systems, or because if the employers do pay some of the cost (as in Japan), the total health care bill is lower and the employer’s share is much less. Going to a single-payer system wouldn’t eliminate all the costs of health care, but it would shift who pays, and it would reduce many employers’ direct costs, making them more competitive globally.</p>

<p>The United Auto Workers union, by the way, has been a strong advocate for single-payer for many decades, in part because it recognizes that employer-sponsored health care makes American-made automobiles more costly and less competitive, reducing employment and putting downward pressure on wages in the U.S. auto industry. But also, union negotiators would prefer that health care not be a subject of collective bargaining, because spiraling health care costs also put downward pressure on cash wages and other benefits, and put the union on the defensive at the bargaining table.</p>

<p>Employer-sponsored health care also makes the labor market “sticker” than it should be. Lots of employees, especially those with “pre-existing conditions,” feel locked into jobs they hate because they can’t afford to give up the health benefits. Some might decline otherwise attractive jobs because the health benefits aren’t as good. Others might prefer go to part-time, or strike out on their own as entrepreneurs, but can’t absorb the cost of individual health insurance (or, pre-ACA, get coverage for pre-existing conditions). On the other side of the coin, employer-sponsored health care creates a disincentive for cost-conscious employers to hire full-time workers–it’s generally cheaper to hire two part-timers and offer neither of them health insurance than to hire one full-timer who expects health insurance as part of the compensation package. This forces more people to accept part-time work, even if they would prefer to be working full-time. These are all labor market “distortions,” and they all carry real economic costs.</p>