<p>“Second, millions of new subscribers will be coming into the pool, subscribers who are on average younger and healthier than the current pool.”</p>
<p>Now this is the part I don’t believe. In Washington State alone, some 60,000 people - mostly younger - who are addicted to opiates and receiving absolutely no care for their addiction will enter the system (out of perhaps 95,000 who qualify), with huge chemical dependency, mental health, and physical health needs that will continue for years… And no system to treat them (the current system is already beyond capacity.)</p>
<p>I have looked up close and personal at the projections around costs and savings from Obamacare in Washington State, and I can say with certainty that none of this has been part of the projections.</p>
<p>“All they want to do is charge enough so that they don’t take a loss on the 80%, and make their money on the 20%. Still the same for the insured.”</p>
<p>Risky move to charge high premiums and plan to rebate the extra, because another insurance company will undercut you and get all your customers. Charging a high price that you have to refund is not smart business, if you have competitors.</p>
<p>mini, there are almost a million uninsured people in Washington. The population you’re talking about, while tragic, is not a numerically significant part of that.</p>
<p>LasMa and others: MA health insurance is absurdly, sickeningly expensive for young people - like $300 a month, minimum. Most of my friends are either working in very high paying jobs or moved out of state because they simply cannot afford it here. Also recall that MA is one of the wealthiest, most educated states around. You’re not going to get a 25-year-old, healthy admin to pony up four grand a year in health insurance, but an engineer of the same age would. The MA model will not work in other states. Period. </p>
<p>High deductible plans are going away, or people will pay penalties for having them. </p>
<p>The provision about young people staying on their parents’ plans is great - if their parents have health care plans. </p>
<p>I don’t expect a bunch of high-earning middle-aged people to see the downside in this, but it’s horrible for young people, low wage workers who will see their hours cut to avoid the employer mandate, etc. Let’s cut through the pretty talk about young people bringing down the cost of insurance for everyone and translate: young people will pay more for insurance than they should, and the extra money is a nice subsidy for wealthier, middle-aged people. A sixty year old has about 45 times the net worth, and many times the earnings, of a 25 year old, but damn, that 25 year old, drowning in student loans, trying to get a toehold in this economy, is now legally mandated to help pay for that sixty year old’s health care.</p>
<p>…and this should be paid out of pocket…healthy people should have the option of high ded. plan…does obamacare have HD plans for the young and healthy?..Nope, they are supposed to cover everyone else. Worst piece of legislation ever …</p>
<p>ariesathena, I am neither illiterate not socialist. But I do know that unfettered free-marketism does not work for all goods and services, assuming a society values anything besides wealth. But please, enlighten me and explain – precisely – how the Invisible Hand will get decent, affordable insurance to every American. Or perhaps you’re in agreement with an audience last year which, when asked if people without insurance should just die, said, “YEAH!” Perhaps you believe that health care should be strictly allocated based on ability to pay and nothing else. </p>
<p>As far as younger people paying premiums so that older people can get health care – well, yes, that’s how insurance works. (Actually, younger people pay premiums so that THEY can get health care services too). A very large number of people pay into the pool, most of whom won’t use as much in services as they pay in premiums. But when someone needs health care – and again, that INCLUDES young people – the funds are there. </p>
<p>In 40 years of driving, I have never filed an auto insurance claim. My insurance rates are much lower than they’d be if I had a bad driving history. But they’re not zero. I’m nonetheless required to carry insurance because it’s impossible to say with certainty that I won’t be an a catastrophic accident tomorrow and might finally need the benefits I’ve been paying for all along. Like most young people in the health insurance market, I am low-risk in the auto insurance market. It’s likely that I’ll never get back in claims what I’ve paid in premiums over my lifetime. So should I refuse to pay for auto insurance any more, because I don’t like the fact that other people are getting the benefits of THEIR auto insurance? If so, and I have a catastrophic accident, who’s supposed to pick up the tab? </p>
<p>I’d also be interested in your thoughts on this:</p>
<p>"MA health insurance is absurdly, sickeningly expensive for young people - like $300 a month, minimum. Most of my friends are either working in very high paying jobs or moved out of state because they simply cannot afford it here.</p>
<p>I don’t expect a bunch of high-earning middle-aged people to see the downside in this, but it’s horrible for young people, low wage workers who will see their hours cut to avoid the employer mandate, etc. Let’s cut through the pretty talk about young people bringing down the cost of insurance for everyone and translate: young people will pay more for insurance than they should, and the extra money is a nice subsidy for wealthier, middle-aged people"</p>
<p>As a high earning, middle aged person, I do see the downside of this. It is patently unfair for young people to pay that kind of money for insurance they probably will barely use. People should be able to get a high deductible. low cost policy. Many kids who graduate from college nowadays have all the costs associated with higher inflation, lower salaries because of the economy, student loans, and zero net worth. They are completely subsidizing older people who have healthy salaries and bank accounts and could afford to pay far more. I don’t want young people to be screwed anymore than they already are.</p>
<p>I can see a huge amount of generational resentment ahead of us. The elderly won’t retire, so the job market is tighter than it should be. People are sickly and overweight, but because of modern medicine they can live decades longer, with high medical costs. We keep spending and spending, making the deficit go up so young people have higher debt to pay off in their future. I’ll be one of the beneficiaries of this system, no doubt, but it seems unfair and unbalanced.</p>
<p>busdriver, it’s a fact that our health system is unfair and unbalanced, a result of decades of the most screwed-up idea about how people should get their insurance, and filled with inequalities and perverse incentives. It is going to take a long time to get it straightened out, and it’s not going to be easy. If we’d gone with universal coverage back in the 40s, like every other country, we’d be paying half of what we do now, and everyone would have access. Hopefully that’s in our future, but it will take some time to get there.</p>
<p>Anyone who’s unhappy with Obamacare should have to answer two questions IMO. First, what should we have done instead? And second, as tom asked, how do other modern democracies manage to cover all their people at half the cost?</p>
I think it’s patently unfair for my family’s exorbitant insurance premiums to pay medical providers for the services rendered to people who have no insurance, by choice or circumstance, or who choose unhealthy lifestyles–unprotected sex, alcohol, drugs, etc. So I’m not sure the “fairness” argument gets us anywhere. However, it’s also patently unfair for anyone to have to pay taxes for expenditures they don’t choose–let’s see, in my case, I have to pay for roads I never use, national parks I have no interest in, ill-conceived military actions, farm subsidies to agribusiness, etc.–but we all accept that model. And a single payer system would use that same model and be far more palatable than the patched together mess we’ve lived with for 50 years and apparently will live with for the next 50.</p>
<p>“mini, there are almost a million uninsured people in Washington. The population you’re talking about, while tragic, is not a numerically significant part of that.”</p>
<p>Costwise, this population costs about 20X the amount of the average healthy young person. We have data on this. (This is what I used to do for a living). This population will cost more than half a million young people. And I’m assuming about half of them still won’t get needed care (at least initially).</p>
<p>" First, what should we have done instead? And second, as tom asked, how do other modern democracies manage to cover all their people at half the cost?"</p>
<ol>
<li>Medicare for all. </li>
<li>Among the smorgasbord: Eliminate the 20-29% overhead associated with “managing-to-care-less”; eliminate pent-up demand by catching conditions at an earlier phase (in other words, worry more about underutilization than overutilization); invest more heavily in public health; include dental care (lack of dental care is associated with higher heart disease rates); make medical education free, but clamp down heavily on salaries; control pharmaceutical advertising; bargain on pharmaceutical pricing; provide much better coverage for mental health and chemical dependency; every insurer gets exactly the same amount per patient or per service (so they have to compete on quality of care alone) - well, there’s a start.</li>
</ol>
<p>Most of them currently don’t get any health care at all, except in the ERs, and often simply when they are hospital-shopping for prescription opioids. (I am personally responsible, with others, for developing new ER hospital protocols around pain drugs, which are now posted in every ER and emergency clinic in Washington, and is now spreading nationally. One of the results, predictably, is that people who can no longer get their prescription opioids have turned to heroin - we have the highest heroin use rates ever.) You pay for it.</p>
<p>“I think it’s patently unfair for my family’s exorbitant insurance premiums to pay medical providers for the services rendered to people who have no insurance, by choice of circumstance, or who choose unhealthy lifestyles–unprotected sex, alcohol, drugs, etc. So I’m not sure the “fairness” argument gets us anywhere. However, it’s also patently unfair for anyone to have to pay taxes for expenditures they don’t choose–let’s see, in my case, I have to pay for roads I never use, national parks I have no interest in, ill-conceived military actions, farm subsidies to agribusiness, etc.–but we all accept that model”</p>
<p>True, the fairness argument doesn’t get us anywhere. Ever. And I don’t have a big objection against Obamacare, nor do I have any grand ideas about solving the health care issue. I just don’t know if depleting young people’s resources so early in their lives via increased taxes on social security, medicare, increasing state taxes, Obamacare, forced minimum premiums…when they will be dealing with inflation and debt, lower salaries, higher costs, is the answer. Especially when there are plenty of older people who can pay their own freight. I never was sure why you got inexpensive healthcare regardless of income just because you turned 65. I’m all for means testing and making medicare a gift for low income earners like welfare. If you can afford it, you pay your way. Now I know Obamacare will allow for subsidies, but that’s certainly not the same.</p>
<p>Maybe the answer is that young people will never be able to afford to move out of their parents house. There will be less people starting families, as they won’t be able to afford them. Perpetual childhood.</p>
<p>"Ok…I see your edit or addition to post 35…looks good to me… "</p>
<p>I should have added one thing: All those nations we are talking about pretty much have one thing in common: they don’t send their young people off to wars, and then have to figure out how to deal or not deal with their inflated health care needs for the next 60 years.</p>
<p>“I should have added one thing: All those nations we are talking about pretty much have one thing in common: they don’t send their young people off to wars, and then have to figure out how to deal or not deal with their inflated health care needs for the next 60 years.”</p>
<p>Yes, for the most part they are happy to support us sacrificing our children and money for that.</p>
<p>Yes, and complaining when we don’t. We are damned if we do and damned if we don’t in that regard.</p>
<p>I heard that 68 million Americans are going to lose their employer sponsored health care because of this law. We really ought to be able to do better.</p>
<p>We really ought to do away with employer supported health care altogether, imho. </p>
<p>Thanks for the link, tom. That’s interesting, seems like a very efficient, effective and cheap system. Hard to imagine one of the best healthcare systems in the world also comes with such an inexpensive cost.</p>