<p>I think the numbers in the end will be relatively close. I think most people who will need to buy individual insurance will find the prices in the marketplace better than off the exchanges - even if they don’t get a subsidy. Time will tell.</p>
<p>“You know, this whole will enough sign-up thing baffles me a little. It’s the law. We already know it’s unpopular but it’s not exactly voluntary. Explain?”</p>
<p>Some believe a lot of people will just opt to pay the penalty.</p>
<p>“Some believe a lot of people will just opt to pay the penalty”</p>
<p>I think some of the young who currently have the option to get it from their employer will probably continue to wing it. They just don’t want to spend the money and ACA won’t change their opinion if the difference in paying for insurance is much higher compared to a fine. They have already had insurance available to them before ACA and chose to ignore it.</p>
<p>Assuming people will ignore insurance because the price went up does not have much basis.</p>
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<p>You are being too literal. It hardly matter if the guy is in the US or in Israel. The point is that things that used to immediate killers are now stretched out over years. </p>
<p>The idea of “last year of life” is the disproportionate amount of costs is correct. Except now we make a chronic illness last multiple years. </p>
<p>Look at the example dstark just gave from his family. All the 80 yo’s are on a battery of medicines and all are managing expensive conditions. </p>
<p>Whats the trend line? Is there going to be less management of chronic illness in the future or will we find more ways to prolong life?</p>
<p>Well, of course they will opt out if it’s 95 dollars. And those are probably the young and healthy who don’t go to the doctor anyway and are working at the mall or attending a CC and struggling to pay rent and have never heard of ACA because they have other priorities like the car won’t start or relationship drama and all those things that happen when you are 25 with no parents to pay for your life and if that happens the risk pool rises and the costs get ironically unaffordable and that’s that. Got it. Thanks.</p>
<p>“I think some of the young who currently have the option to get it from their employer will probably continue to wing it.”</p>
<p>I find this mind-boggling. Most young people I know will do almost anything to get a job which offers health insurance. </p>
<p>If I was an employer I would think someone who doesn’t want to enroll in my health care program was too stupid to hire.</p>
<p>"poetgrl
Senior Member</p>
<p>"I think when you say med students are subsidized, it’s kind of like saying Student Loans are financial aid.</p>
<p>I think med SCHOOLS are subsidized. The students? Not so much."</p>
<p>Yeah…a lot of truth to the above. </p>
<p>.As far as ACA goes, the poor, the precondition people, some sick pick are going to see their access is improved with the subsidies. The economy can improve too if these people become more productive. </p>
<p>The actual money is going to flow to the medical system. There are going to be winners and losers in the med system, but overall there are going to be more customers and more money. I have to think overall its a win health care industry.</p>
<p>I have spent way too much time at Kaiser this year, but I marvel at all the expansion taking place in Redwood City, San Rafael. A month ago I was at the Kaiser in SF and I was blown away by how nice the building was. I think the building was on Geary or O’Farrell. I remember that building being a dump. And now there are Kaiser offices all over the place. Kaiser is going to have more locations than McDonald’s. :)</p>
<p>41% of people dont know who the Vice President is. To expect them to be aware of these issues and take any action is optimistic. </p>
<p>After all their health plan is still in place- if something major happens go to the ER and give a fake name.</p>
<p>UC San Francisco (which educates only medical, pharmacy and dental students) gets 5% of its funding from the state. 1% comes from tuition. The bulk of the funding comes from grants and from the profits it makes from its hospitals. </p>
<p>However, that doesn’t mean the medical education is heavily subsidized. Those grants are for research, bench and clinical. </p>
<p>It’s impossible to separate out what it costs to educate a medical doctor from the other places the money goes in operating a health system and medical school.</p>
<p>Regarding the subsidies: I’ve read that the subsidies don’t come off the top. That is, if your premium is $500 a month but you would be entitled to a $100 a month subsidy for example, you pay the $500. Then when you get your tax refund, you’d get $1200 to cover the subsidy. </p>
<p>That’s a lot of cash flow outlay for a lot of people, particularly if they need the subsidy.</p>
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<p>You talk as if managing chronic illness is a bad thing. We can agree that paying for years for people in comas they will never recover from is wasted money, but if you want me to agree that treating dstark’s parents’ Parkinsons is wasting money, you have another think coming.</p>
<p>I’m glad we have new ways to treat chronic diseases that might have been quickly fatal in the past.</p>
<p>When people talk disparagingly about end of life costs, they usually mean pointless surgeries and chemos for people who are dying, not drugs to treat Parkinsons in mentally alert people who will survive with Parkinsons for years.</p>
<p>Post 2730 is incorrect. Calmom has written about that quite a bit.
[UCSF</a> Office of the Registrar - School of Medicine](<a href=“http://registrar.ucsf.edu/registration/fees/medicine]UCSF”>School of Medicine 2020-21 | UCSF Office of the Registrar)</p>
<p>Look at that instate tuition at UCSF. And SF is so expensive. I dont know what the exact subsidy is but it is a ton.</p>
<p>Great place. The school is a bargain.</p>
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<p>I don’t think calmom is around, so I’ll field this one. We’ve discussed it already in this thread, and calmom has explained it beautifully. If you go on the exchanges, you can get the subsidies advanced to you if you want. That is, if you buy a policy on the exchanges, you can get the subsidies paid right to the insurance company each month, and you are only liable for the remainder. </p>
<p>You don’t have to come up with the money and get reimbursed the next year.</p>
<p><a href=“https://www.aamc.org/download/321466/data/2012factstable5.pdf[/url]”>https://www.aamc.org/download/321466/data/2012factstable5.pdf</a></p>
<p>Medical school admissions in a lot of cases are determined by residency in a State since most med schools are funded by the State and the State dictates how many students can be accepted OOS in their public schools. The chart shows how many stay in state compared to those who have to get trained elsewhere.</p>
<p>UCSF gets only 5% of its budget from the state. </p>
<p>And how much of that budget is related to student education is an unknown.</p>
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<p>No, I specifically didnt make any value judgements about it.</p>
<p>I am pointing out that things that were terminal in the 70’s are now expensively managed for years. And that trend is likely to increase. I am not saying anything about quality of life or utility or anything else. </p>
<p>I think there is a question if a lot of things that we’d like to do are actually an insurance product.</p>
<p>emilybee - Can you please tell the largest employer what you think. :p</p>
<p>[Young</a>, immortal and uninsured! - FederalNewsRadio.com](<a href=“http://www.federalnewsradio.com/20/3490862/Young-immortal-and-uninsured]Young”>http://www.federalnewsradio.com/20/3490862/Young-immortal-and-uninsured)</p>
<p>Well I’m here now. If you are subsidy eligible, you have the option to have the subsidy paid directly to the insurance company, in advance, up to the total amount that you qualify for (based on the information that you provide and which can be verified now). </p>
<p>But it will be reconciled in 2015 against your 2014, against your return. If you have underestimated income & overestimated the subsidy, you could owe the money back with your taxes. At higher income levels you would be liable for the entire subsidy. On the lower end, the max repayment levels are set much lower. </p>
<p>You also have the option to refuse the subsidy, and just wait for your tax return. If you have bought on the exchange, then you would get a tax credit for the full amount of the subsidy. This is a refundable credit – that is, it could be sent to you in the form of a refund check. However, you have to buy on the exchange to qualify - if you buy the exact same policy directly from the company, at the exact same premium – no tax credit. </p>
<p>You also can do anything in-between – for example let’s say that the insurance premium is $500 and you are entitled to a $200 subsidy – you could opt to take a $100 subsidy instead. (That might make sense if you are unsure of 2014 income – for example maybe somebody earned $30,000 in 2012 and hopes to earn $34,000 in 2014 – either number is subsidy eligible, but it might make financial sense to plan based on the higher earnings figure.)</p>
<p>argbargy, Let’s agree on some terminology. You are using “end-of-life costs” to mean the costs of managing chronic diseases that would, fifty years ago, have been quickly fatal. That is not what most people mean when they use the term. </p>
<p>Let’s reserve “end-of-life” for the period when someone has been diagnosed with a condition that is, on expectation, fatal in the next six months. Let’s use “managing chronic diseases” for care for a condition that, with current medicine, can be managed for years, even if it used to be fatal.</p>
<p>So treatment for elderly people with diabetes, heart disease, heart failure, Parkinsons, emphysema and so forth would be “managing chronic diseases.” Now that we agree on terms, we can look at “managing chronic diseases” and attempt to determine how much of that care is unnecessary or overly expensive. We can also ask whether the US is more aggressive in managing chronic diseases than other first-world countries.</p>
<p>TatinG, this is the way I look at things. </p>
<p>If the average cost if a school is 80,000 and I am charged 36,000 and the school is in SF, there is a big subsidy here.
5 percent comes from the state? To run all of UCSF? The numbers are probably around somewhere on how much UCSF costs to run. Th med school is just a tiny part of UCSF.</p>