Hopefully the new plans will eliminate costly coverages that many people do not want or need. I think many would prefer to pay lower premiums and not have coverage for certain things that are now mandated to be included in the policies. To make a cable TV analogy - I don’t want to pay for channels I never watch and never will watch. I would prefer to have a custom package of channels, cut down on the number of channels and save money.
It was mentioned in the other ACA thread.
Of course, the popular prohibition on denial for pre-existing conditions is linked to the unpopular universal individual mandate which is intended to bring masses of healthier people into the insurance pools, instead of seeing people go uninsured while healthy and then buying insurance only when they have an expensive medical condition (the latter is called adverse selection, analogous to if your house is on fire, buying fire insurance before calling the fire department). ACA’s individual mandate (in the form of a tax penalty if one does not have medical insurance) is relatively weak (the tax penalty is often much smaller than the cost of a “bronze” insurance plan), so it is not sufficient to stop adverse selection from causing prices to go up and/or driving insurance companies out of the ACA individual market.
So a partial repeal of ACA that removes the universal individual mandate but not the prohibition on denial for pre-existing conditions would only make adverse selection worse and accelerate the failure of the individual market.
The highway tax doesn’t come close to covering the cost of roads and policing them any more. I don’t drive, but I can’t avoid subsiding drivers. This is a poor example. Saying someone can avoid property taxes by renting is even poorer; the landlord must pay property taxes, which are then passed along to the renter.
@TatinG --following up on your Cable TV analogy…I agree, but I don’t know if that will be possible with health care.
The cable TV provider does not suffer anti-selection that would occur if some health insurance plans included coverage for say maternity and others for behavioral health. AFAIK, the cable company pays the content provider based on # of subscribers for the premium channels. (And I would like to unbundle those bundles further and knock my cable bill even lower, but that’s another story.)
In theory the unbundling of cable channel sounds great but the reality is you would be paying the same or more for fewer channels.
bluebayou, My interpretation of selling insurance across state lines is that an out-of-state insurer can come in to a state and sell insurance without having to follow the insurance rules of the state they’re selling in. The clear advantage of this, to the insurer, is avoiding burdensome state regulations. The advantage to the buyer is buying insurance that doesn’t cover things their state requires but that they don’t want.
In the present environment, the insurer gains little by selling across state lines, because all insurance policies are required to cover the standard things and offer the same price to everyone of the same age. In the post-ACA world, where California (let’s say) mandates no pre-ex exclusion and Idaho doesn’t, the advantage to the healthy subscriber would be substantial. All healthy Californians would buy the cheap no-sick-people insurance from Idaho, and the rest of Californians wouldn’t be able to afford insurance.
Do you have some other definition? Please supply it. In your interpretation, what would be the advantage to the insurer, and what would be the advantage to the consumer? If Idaho and California right now want to make it possible for insurers in one state to sell in the other, they could get together and make an agreement-- it’s right in the ACA. No insurers have pushed this idea. No insurers now are interested in this idea.
Not have coverage for certain things that are now mandated to be included in the policies, like covering sick people and pregnant women. We know. Screw you, sick people.
No insurers have pushed the idea or are interested because operating under ACA is a sure money loser. Insurance companies are contracting, not expanding.
And yet some insurers are making money selling individual policies, because they provide a product people want. And of course all insurers are making money in the employer market, which covers the large majority of Americans under 65.
Strawman arguments are not helpful. Nobody wants to “screw sick people”. However, if you don’t make insurance affordable for people who see little potential use for it, they will not sign up, causing a death spiral like we are in now. Maybe the solution is to increase the age rate band from 3 to 5, cutting mental health and other frivolous treatments from the minimum package, or setting up high risk pools for those expensive illnesses, but the current system does not work, will not work and was never designed to work.
I’m sorry? Come again? Treating schizophrenia is now frivolous? Be sure to inform Maine Longhorn of your insight. Also I’m interested to hear that my son’s therapy is frivolous.
Calling mental health treatment “frivolous” sounds exactly like “Screw you, sick people” to me. But then, I would say that. My son has autism.
Prior to ACA, US had two major problems with healthcare: 1) coverage and 2) costs. ACA was addressed at 1) and did next to nothing for 2) (and in some ways made costs worse). To me, the bigger problem is cost and addressing that would help with coverage (some people don’t have coverage because they cannot afford it and making it cheaper would mean more people could afford coverage). But cost is also the tougher problem to address.
Problem is cost isn’t subject to a silver bullet solution. Complicated issue that isn’t subject to sound bites or 140 characters so its often difficult to even discuss much less address. I don’t think is a coincidence that two things with costs outpacing inflation (by a lot in both cases) are medical care and college education. What other product/service is delivered/sold with neither the buyer nor seller knowing the costs or having a real incentive for them to be lower (and the seller has incentives for them to be higher). Ask your doctor next time they order a test, procedure, script, etc. what the cost will be and its incredibly likely she/he will not know. Insurance insulates people from the costs.
Financial aid does the same thing for college costs (can’t count the number of times I heard admins from colleges say “don’t worry about sticker price because nobody pays it”) though not to the same degree.
Imagine what the price of other goods/services would be if neither seller nor buyer knew the price and the buyer was only paying a portion of it?
Ads for drugs also create cost issues. Many people in the US are unhealthy and lead unhealthy lives. Popping pills can help cure a lot of those ills but at what cost? Would it be cheaper to live a more healthy life style? Not if I am only paying a co-pay (another part of the problem with insurance).
None of that is to say we should abandon people who cannot afford medical treatment. Or catastrophic illnesses shouldn’t be covered. But seems to me we need to find some way to create incentives for costs to be reduced (or at least contained).
Other option would be price fixing (which essentially is what single payer does). There are issues with that in terms of over demand and under supply when prices are lower than what market would otherwise dictate.
To me the incentive option is the better way to do with subsidies as needed. Starting over, I wouldn’t start with the universal insurance coverage approach we have now. I would not adopt single payer. However, even if we do not adopt single payer, we are moving in that direction anyway. Something like 40% of the country is on Medicare or Medicaid. And those percentages will increase as the boomers retire. At some point we get to a time with more than half the country under single payer insurance.
People with untreated mental health issues sometimes end up as part of the homeless problem. Or they end up as a significant percentage of police incidents, where the police are called because they caused an annoyance to someone else and the police then have to pick them up and deliver them to the hospital.
Untreated mental health conditions cost us a hell of a lot more than any increase in insurance ever will.
(And, actually, we can substitute mental health for any other health condition and the statement still stands. This includes ER costs but also lost productivity, etc)
Ucbalumnus, I think you’d enjoy this excellent series from Aaron Carroll about why US health care is so expensive: http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-introduction/
The short answer is: everything.
Only a tiny part of our excess spending is due to disease prevalence, including obesity. http://theincidentaleconomist.com/wordpress/the-blame-du-jour/
There is a proposal from the incoming administration to make health care premiums tax deductible. That would help.
Making premiums deductible helps rich people more than it helps poor or middle class people, because poor people don’t pay income tax anyway and middle class people pay at a lower rate than people in the higher brackets. Is there a way to make the deduction help everyone equally?
Well, the poor and some middle class are getting the subsidies. Those just over the threshold are not, but a tax deduction would help with the costs. My premiums for the year are over $7,200. It’s a big chunk of my savings year in and year out. And I used it zero last year.
I pay $11,500 just for my premium,so I understand the problem, TatinG. But the threshold for a single person is a bit under $50K, even if we assume the new administration that makes premiums tax deductible also keeps the subsidies (I thought they were going to get rid of them). The 60 year old woman with the income of $50K and the insurance cost of $10,000 isn’t getting a lot of help from the tax deduction, and she’s the one who needs it most.
I’m not really understanding this objection that refers to “not using” insurance. The whole concept of insurance is not necessarily “using” it. I hope I last the whole thirty-year term of my life insurance and never use it.
The rationale behind preventative care also being covered is actuarial in addition to being humanitarian. People who get vaccines, birth control, etc. end up costing society less in the long run. (This is the answer to, why wouldn’t car insurance cover oil changes if we’re talking the broader idea of insurance in a parallel, hope never to use it, scenario. If oil changes prevented covered services, you can bet they’d be encouraged financially by being covered.)