<p>There are pros and cons mentioned in the article. I have no problem with that. Your reading comprehension is very poor GP. You project your bs too much. I am liberal and I am pro business too. I worked in the financial markets off and on for 30 years. I dont buy your political bs because I know how markets work. ;)</p>
<p>I wrote earlier that if there is demand, supply will show up. Why do I think that? Maybe because I saw this happen…so many times. </p>
<p>Now there is a guy in your article that wants to fill increasing demand for health services. </p>
<p>It is not going to go smoothly. Maybe some reimbursements will have to be raised. This Thorp guy keeps trashing medicaid reimbursements but they have been raised for a couple of years to medicare rates, right? Thorp has an agenda. That is his right. </p>
<p>I see more people getting covered. Listening to you, you would think nobody is newly insured. Now there are too many. Lol.</p>
<p>If people would just let ACA play out it will work. </p>
<p>I like the article. I thought it was a great article.</p>
<p>I think that if the employer wants to purchase group coverage – either directly from a company or via the SHOP exchange - then the insurance needs to be made available pretty much to all full time, permanent employees who have been with the company for a requisite qualifying period. </p>
<p>The company that wants to differentiate in that way might do better to focus on direct compensation packages – nothing to stop them from paying some employees more than others, with the expectation that the added compensation can be applied to buying individual policies. (Of course that turns a tax-free benefit into a taxable one, but it’s better for the employee than no benefit at all)</p>
<p>NOTE: This isn’t the most authoritative source – but it answers your question as to SHOP:</p>
<p>We are looking at ignoring SHOP and go for a direct discount. However, some will get nothing based on the visa status which means their pay needs to go much higher but unintended consequence can be that they want to keep it instead of be insured. So trying to figure out if it is allowed to let some go to exchange while insuring the others.</p>
<p>Are you saying that you would like to insure your employees, but you think that they will do better with exchange-based subsidies – but some are not eligible because of their visa status?</p>
<p>It would make no sense (policy-wise) to allow a company to subsidize insurance for some, but not all, of its employees on SHOP – but then offload others onto the taxpayers to get their subsidies via exchange policies. There would be a strong incentive for companies to subsidize insurance for its higher paid staff and leave the others to fend for themselves on the exchanges. So SHOP is going to make it an all-or-none proposition: either you offer insurance to all your employees, or go elsewhere.</p>
<p>I doubt that there is any insurance company that will work with you for group-based private insurance to allow you to pick and choose which employees will be covered. The group contracts probably require you to offer the policies to all employees.</p>
<p>This is a nonprofit with fewer than 50 employees, right? You should be OK providing insurance to some, since you’re not required to provide insurance to any.</p>
<p>I know a little about business and markets, too. A market which doesn’t allow choice (identical policies from a few insurance companies is essentially a monopoly) and colludes to fix prices by excluding many participants is not a market by the definition of the word as I know it. In such a market, supply will not keep up with demand and will inevitably lead to shortages and less access to medical care. The bare cupboards in supermarkets in the old Soviet Union is an example of govt meddling in markets.</p>
<p>“H-1B, F-1, J-1 visas. Individuals who are on work visas, student visas, or have been in the country for less than five years are eligible to buy insurance through the health care exchange, but they do not qualify for Medicaid.” </p>
<p>Texaspg, I am not quite getting this …
People with work visas can buy insurance…</p>
<p>GP, I have been saying this for 10 years in CC and when I say this people read socialism. Maybe… If one of the most successful capitalists of all time says the following people will understand. Probably not though. I guess Bill Gates is a commie.</p>
<p>"“Our priorities are tilted by marketplace imperatives,” he said. “The malaria vaccine in humanist terms is the biggest need. But it gets virtually no funding. But if you are working on male baldness or other things you get an order of magnitude more research funding because of the voice in the marketplace than something like malaria.”</p>
<p>As a result, governments and philanthropic organisations have to step in to offset this “flaw in the pure capitalistic approach”. The Gates Foundation focuses on finding under invested areas of basic science and focusing an innovation agenda on the needs of the poor, specifically looking at education and health."</p>
<p>We don’t use SHOP and don’t plan to. Currently provide insurance to everyone but don’t see why we should since it is less than 20 employees. We can cover the premiums after subsidy. However, we want to cover those without subsidies fully but don’t know if they will buy insurance if we start handing out an extra 1500$ in some cases since we know for certain they would rather keep the money.</p>
<p>dstark, what Gates is referring to is hardly analogous of the what we are seeing in healthcare today. The reason why I mentioned food shortages in the Soviet Union is because of that govt’s attempt to fix prices and choices not unlike what we are seeing now with Obamacare. If you want a better analogy I would refer you to the long waiting times for elective procedures in Canada and England.</p>
<p>Having said the above, I am not advocating for an unfettered free market for a healthcare system. I think the govt should strictly enforce anti-trust laws and require providers to be totally transparent regarding their prices. This was a problem pre-Obamacare and will continue to be a problem because Obamacare has done nothing to fix this problem. Instead, it has restricted consumers’ access to providers and has tried to impose a one-size-fits-all solution on all the participants in the system today. </p>
<p>It has provided a thin veneer of a private market by allowing a few insurance companies to dominate the marketplace, but in reality they are vessels of govt regulation to impose a health plan written by the govt on unwilling consumers. </p>
<p>Gates is right and it is analogous to health care in this country. I do agree with you on transparency and enforcing anti trust laws. </p>
<p>People who need malaria vaccines cant afford to pay enough to make the vaccines profitable. </p>
<p>We cant have a free market for health care because the unprofitable people will not receive health care. And lets not play too many games here. We have a subsidized employer based market. We have medicare. We have medicaid. We limit the amount of doctors. We have a FDA. (That’s good). There isnt a successful free market health care system in the world.</p>
<p>There isnt going to be a free market successful health care system either if you want to insure almost everybody. Read the Kaiser Family Foundation study on the uninsured. </p>
<p>We have 50 million uninsured. Maybe 30 million are eligible under ACA. Out of these 30 million, 27 million people cant afford the insurance. They couldnt afford the insurance you like…and they cant afford it now. They need to be subsidized.</p>
<p>The health insurance market needs an intervention. Sorry. We have to have enough revenues to care for the sick. You post stuff like the networks are too small or the doctors want more pay. </p>
<p>Well… If you pay people more, if you increase network size, where is the money going to come from? You complain about costs and the things you post increases costs.</p>
<p>You are a little disingenuous. The best way to lower costs is to insure more healthy people. You can at least get your larger networks. Yet you trash ACA over and over. You will have a stroke if 7 million uninsured sign up, yet that will be the best way to lower your costs. </p>
<p>We have pretty good wait times here too. My friend got lung cancer. It took 4 or 5 weeks after his diagnosis for him to get his operation. Those extra few weeks could kill him. Hopefully not.</p>
<p>I don’t really understand what Texaspg wants to do. It seems likes Texaspg has been paying insurance for all employees, but now wants to let the federal government take over for some of them through direct subsidies… but maybe I am misunderstandng.</p>
<p>An employer is free to give employees different compensation packages as long as it is not done in a discriminatory fashion (assuming there’s no union contract requiring otherwise). So texaspg can pay some employees a bonus, and not others - or raise the pay for some and not others – and can choose to reimburse some personal expenses. For example – employers might give employees a per diem while traveling, or pay a transportation allowance, or reimburse child care costs. Generally those payments are going to be taxable income for the employee. </p>
<p>Dstark, I like your last post. But I think you’re making an erroneous assumption, that everyone agrees that universal coverage is a worthy goal. Sadly, there are those who don’t give a d*mn about that, as long as they get everything * they * want.</p>
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