<p>Comparisons are pointless. </p>
<p>But then we have to figure out a way to make health care available to everyone </p>
<p>It’s as important as clean water, access to electricity, police protection, education. </p>
<p>I’m just not convinced “insurance for everyone” has a single thing to do with healthcare for everyone. I’m just not sure working with the current model, which developed based on a different concept of health care, is the most effective way to go.</p>
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<p>Thats the wrong sample. We are talking about the people who didnt have insurance because they are young and healthy. If they can be forced into the system they will pay way more than they get out, thus keeping it afloat. </p>
<p>But they dont even have to pay up until April 2015 (or at all if they adjust their withholding) so why would they pay more in Jan 2014 or less in April 2015?</p>
<p>They wont.</p>
<p>What does this system subsidize? </p>
<p>That’s a good question to start with. </p>
<p>Does it subsidize healthcare directly?</p>
<p>I really don’t see why catastrophic plans don’t work. You pay out of pocket for check-ups, minor procedures and use the insurance when costs go above a certain level. No one uses their homeowner’s insurance for broken windows. It’s for when the house burns down.</p>
<p>A page or so ago, Poetgrl asked about US health care costs:</p>
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<p>No. This is the zombie myth. The usual form is something like: “Half our health care dollars go to people in the last year/six months/six weeks of life! Aaah!” It’s just not true. </p>
<p>Most Americans die at age 65 or older, so if we want to look at end-of-life payments, we should look there. About a quarter of Medicare payments go to people in their last year of life:
[Long-Term</a> Trends in Medicare Payments in the Last Year of Life](<a href=“http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838161/]Long-Term”>Long-Term Trends in Medicare Payments in the Last Year of Life - PMC)
Medicare is about a fifth of all US health care, and no other spending source (not Medicaid, not private insurance, not out of pocket) will have anything close to a quarter of expenditures going to people in the last year of life. So when we average out all costs on care for people in the last year of life, we’re going to see that it’ll be something around ten or fifteen percent of health costs, maybe less.</p>
<p>I’m not saying that the US spends the right amount on end-of-life care. I think we do too much and spend too much. Rather, I’m saying end-of-life care is not the sole explanation for the US’s sky-high health expenditures. If we got rid of every single dollar spent on end-of-life care, if we didn’t spend one cent on end-of-life care, we’d still have the highest per person health expenditures in the world. By a lot.</p>
<p>Our costs are high everywhere. We pay doctors more, we pay more for drugs, we pay more for medical devices, we pay hospitals more. The same procedure costs a lot more in the US than it costs anywhere else.</p>
<p>Understanding health care costs and how to lower them is a hobby of mine. The more I learn, the more I see that it’s an incredibly complicated problem with no simple answers. Rather than looking for a non-existent magic bullet, we have to chip away at different facets of the problem.</p>
<p>Tatin G</p>
<p>I agree. The effort here seems to be to make sure everyone fixes their windows. Not sure that’s workable. Even if we all chip in to pay for repairs.</p>
<p>I still want to know what this new system subsidizes. </p>
<p>It’s supposed to lower medical costs. So it’s not designed to subsidize healthcare. </p>
<p>The subsidies are not being paid to doctors or other providers. </p>
<p>What does this new system subsidize?</p>
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<p>They work fine for the people that choose them. And if everyone had a catastrophic plan and nothing more, that model would be sustainable. (You’d need subsidies for poor people even under the deductible because lots of people with chronic health needs simply can’t afford to pony up $6000 or whatever the deductible is, every year.)</p>
<p>What doesn’t work is catastrophic for healthy people and lower-deductible plans for unhealthy people; that’s adverse selection, which will drive up the premium costs for the lower-deductible plans.</p>
<p>“They sound rich”</p>
<p>They aren’t rich. </p>
<p>“Thats the wrong sample. We are talking about the people who didnt have insurance because they are young and healthy.”</p>
<p>But that group is an even bigger cash cow. Healthy and older. Like Poetgirl. </p>
<p>As for the young and healthy - that didn’t turn out to be the case in Mass, but we will have to see. Up until 26 a lot will now be on their parent’s insurance. After 27, they are doing things like getting married and having children and imo, recognize the need insurance. </p>
<p>Since you are on this board, I assume you have a kids who are adults or nearing adulthood. Are you going to tell them to forgo insurance and pay the penalty instead?</p>
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<p>Insurance premiums. And then the insurance pays for health care costs.</p>
<p>Emilybee - Our kids are not the sample either.</p>
<p>"It’s just not true. "</p>
<p>It is true because “the last year of life” is no longer the last year of like. </p>
<p>For example Ariel Sharon suffered a fatal stroke in 2006. Except it wasnt a fatal stroke because has been kept alive since then. </p>
<p>I remember there being a cartoon with a doctor telling a patient “There is nothing the matter with you that expensive medical treatments cant prolong.”</p>
<p>'Emilybee - Our kids are not the sample either."</p>
<p>Why, are they somehow more special than other kids?</p>
<p>For the most part they are somewhat privileged, yes.</p>
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<p>Could it not be expanded to include everything everywhere and let patients decide what to do? MediBid makes it sound like a win win; it will save money on the patient part and weed out bad doctors/hospitals.</p>
<p>“The center competes on price and cuts out insurers.
Smith says this approach forces it to offer good care: The center cannot hide in an insurer’s network and continue to receive patients regardless of the job it does.”</p>
<p>Flossy, you can agree all you want. The numbers dont work. The catastrophic plans dont work. </p>
<p>The Kaiser Foundation report that CF posted earlier says we get very close to universal coverage under ACA. There is not a lot of support to provide insurance to illegal or undocumented workers. That might be 10 million people that still wont have insurance. That is a large group of people that are going to be uninsured. </p>
<p>Except, because many states are not expanding medicaid. How many more insured us that going to leave us now? CF? About 10 millon maybe?</p>
<p>My opinion is we are going to see ACA very successful in many states and while doing poorly in others. Then it is going to get very interesting.</p>
<p>Poetgrl writes:</p>
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<p>The individual mandate/community rating/exchange subsidies part of the ACA is not supposed to lower medical costs. That is, it lowers insurance costs for people who get subsidies, but it doesn’t lower the costs actually paid to medical providers like doctors, hospitals and pharmacies. It’s not supposed to.</p>
<p>There are other parts of the ACA that are supposed to lower costs: readmission penalties, accountable care organizations, training more nurse practitioners and other non-doctor providers, some Medicare payment stuff, some other experiments. And I guess you can hope that making the individual insurance market clearer to consumers you might reduce costs as the insurance companies are fighting for business.</p>
<p>No, CF, it subsidizes insurance premiums, and deductibles, in some cases, and 85% of those subsidies “must be” paid for health care.</p>
<p>What does this system subsidize?</p>
<p>Interestingly, I just read the law:</p>
<p>85% must be spend from employer health insurance on health care.</p>
<p>only 80% from the individual exchange based policies.</p>
<p>So, let me revise: 80% of those subsidies must be paid for health care.</p>
<p>What does this system subsidize?</p>
<p>dstark - I agree it’s getting interesting. I haven’t been affected yet at all but I do expect to join the cancellation pile sometime soon.</p>
<p>Mostly, I’m just fascinated by the clumsy execution thus far and waiting to see how this all shakes out. Whatever I was talking about upthread was a tiny detail. And, details will be revised.</p>
<p>[The</a> Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/]The”>How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? | KFF)</p>
<p>About five million adults fall in the “coverage gap.” They aren’t eligible for Medicaid because their states didn’t expand it, but they make too little to be eligible for subsidies.</p>