"Obamacare"

[wetwillie]

Oh man, bend over young, wealthy cats.

Here's what could affect your coverage cost. This breakdown is only for those who buy plans on the individual market through the exchanges, and doesn't apply to those with employer-sponsored plans.

Income: One of the top factors determining how much you'll pay next year is your income. That's because subsidies are available to those with incomes of up to 400% of the poverty line -- roughly $45,000 for an individual or $92,000 for a family of four. Some 57% of enrollees will receive subsidies, and those subsidies will cover nearly two-thirds of the premium, on average, according to the Congressional Budget Office's estimates.

The young wealthy cats all have employer sponsored  High Deductible plans with HSA's

[kitten_mittons]

All I know is that I get paid something like $0.92 a paycheck for having my health insurance.  That doesn't include the $500 my employer puts into my HSA for me.

[Dr Rick Daris]

i am going to be outraged if the cost of healcare rises in the future. this is unprecedented and i won't stand for it.

[john "teach me how to" dougie]

i am going to be outraged if the cost of healcare rises in the future. this is unprecedented and i won't stand for it.

We are all used to the cost going up, but, we aren't used to the level of coverage going down at the same time.

[K-S-U-Wildcats!]

i am going to be outraged if the cost of healcare rises in the future. this is unprecedented and i won't stand for it.

If you don't think guaranteed issue is going to increase premiums more than they already are, you need a shrink. Fortunately, Obamacare will cover that.

[K-S-U-Wildcats!]

Oh man, bend over young, wealthy cats.

Here's what could affect your coverage cost. This breakdown is only for those who buy plans on the individual market through the exchanges, and doesn't apply to those with employer-sponsored plans.

Income: One of the top factors determining how much you'll pay next year is your income. That's because subsidies are available to those with incomes of up to 400% of the poverty line -- roughly $45,000 for an individual or $92,000 for a family of four. Some 57% of enrollees will receive subsidies, and those subsidies will cover nearly two-thirds of the premium, on average, according to the Congressional Budget Office's estimates.

The young wealthy cats all have employer sponsored  High Deductible plans with HSA's

Obamacare may wipe out some high deductible plans. Depends on whether they will meet the mandated, lowest level "bronze" coverage. The weird thing about Obamacare is that, it seems like just about everyone can agree that gold-plated policies that aren't really "insurance" distort the market and drive price up, and HDHP/HSA's encourage price shopping and drive price down, but Obamacare mandates that more people get on the bloated insurance plans.

It's almost like Obamacare was designed to ultimately destroy the private health insurance system....

[Institutional Control]

It's almost like Obamacare was designed to ultimately destroy the private health insurance system....

That wouldn't be a bad thing. The worst thing to ever happen to healthcare is when all the Blues decided to switch from non-profits to publicly traded companies. It then became all about the shareholders instead of the policyholders.

[chum1]

Man, what in the eff are you guys talking about?  It's like this stuff is coming from outer space.

[K-S-U-Wildcats!]

It's almost like Obamacare was designed to ultimately destroy the private health insurance system....

That wouldn't be a bad thing. The worst thing to ever happen to healthcare is when all the Blues decided to switch from non-profits to publicly traded companies. It then became all about the shareholders instead of the policyholders.

Nope. The worst thing that ever happened was when employers started offering health insurance as a benefit to skirt WWII era wage and price controls. These policies became more and more bloated, to the extent that they no longer resemble insurance at all, but are rather "prepaid healthcare."

Because somebody else is paying the bill now (the insurers) for virtually all services, it has distorted the market. Consumers lack incentive to price shop. "Single payer healthcare" - where the government pays the bills - is not going to help this. The government can artificially keep prices low, but it will ultimately lead to substandard care and shortage of care (see Canada).

If we used car insurance or home insurance to pay for routine repairs, he same as we do for health insurance, the price of those policies would go through the roof too.

He additional problem of tying insurance to employers is that it locks employees into jobs, which is again, very inefficient.

Naturally, ObamaCare mandates that large employers 50+ provide health insurance, and that policies cover every conceivable routine procedure under the sun. Exactly the opposite of what we should be doing.

[Institutional Control]

Well, you're wrong but that's ok, you're entitled to a wrong opinion or two.

I was working in the health insurance industry in the 90s when most of the Blues converted to public corporations and I can tell you that premiums began to skyrocket and benefits/coverage began to decline immediately. But it wasn't just coverage to the policyholders that declined, but payments to the providers of service began to decrease dramatically as well. Doctors and hospitals didn't have a choice but to accept these lower payments because they had become completely dependent on the insurance industry.  So, they made up the difference by overcharging the uninsured. So, now, the uninsured can't afford to go the hospital or the doctor because they're being overcharged to compensate for the low ball payments the insurance companies are making. 

If you don't have your oil changed in your car and the engine blows... well, your car doesn't run. You buy a new car or engine, or a bike or walk wearing you're going but at least you're not dead.  If you can't afford to go to a doctor and you get cancer or heart disease and you die.... I personally don't put auto and home repairs on the same level as health.

[Institutional Control]

He additional problem of tying insurance to employers is that it locks employees into jobs, which is again, very inefficient.

Before HIPAA? Sure. Now? Not so much.

[K-S-U-Wildcats!]

I was working in the health insurance industry in the 90s when most of the Blues converted to public corporations and I can tell you that premiums began to skyrocket and benefits/coverage began to decline immediately.   

That's interesting. Do you have anything to back that up? I looked, but couldn't find anything in support. I did find, however, that insurance companies average a measly 3% average margin, well near the bottom of industries. See, e.g., http://mjperry.blogspot.com/2010/02/health-insurance-companies-rank-88-by.html Take away all that profit, and it would only nominally reduce the price of premiums.

Doctors and hospitals didn't have a choice but to accept these lower payments because they had become completely dependent on the insurance industry.  So, they made up the difference by overcharging the uninsured. So, now, the uninsured can't afford to go the hospital or the doctor because they're being overcharged to compensate for the low ball payments the insurance companies are making.

Now, I know this isn't true, because my wife works in the healthcare industry. For the uninsured and paying cash out of pocket, they charge a lower price than if you're insured.

If you don't have your oil changed in your car and the engine blows... well, your car doesn't run. You buy a new car or engine, or a bike or walk wearing you're going but at least you're not dead.  If you can't afford to go to a doctor and you get cancer or heart disease and you die.... I personally don't put auto and home repairs on the same level as health.

The same economic principles apply. And from a policy standpoint, the evidence is mixed how effective preventive care is, or whether it will save any money. In fact, recent studies indicate that wider access to preventive care will actually cost quite a bit more.

[sys]

Now, I know this isn't true, because my wife works in the healthcare industry. For the uninsured and paying cash out of pocket, they charge a lower price than if you're insured.

you aren't the least bit curious why your wife won't tell you where she really goes during the week?

[Institutional Control]

Hospitals and doctors might give a discount from their overpriced charge to an uninsured patient but, I promise, it is still higher than the amount they are accepting from insurance companies.  And it will be much higher than the amount they will accept from Medicare.

The Bloomberg report surveys the recent earnings of five of the country's largest insurers -- WellPoint, UnitedHealth Group, Aetna, Humana and Cigna -- and finds that their profit margins have climbed to an average of 8.24 percent in the year and a half since the health care reform package was signed into law.

http://www.huffingtonpost.com/2012/01/06/insurer-profits-health-care-reform_n_1190344.html

If they were a non-profit they wouldn't probably need to spend billions on lobbyists.

[chum1]

1.  Of course premiums went up in the last 20 years.  Healthcare costs went up in the last 20 years.  Insurance companies view themselves as mere middlemen between the consumer and the service providers.  If the cost for the service goes up, the cost of the premium goes up.  They are in the unique position of determining their profits because, in short, they know how to project how many people are going to get sick.  But their profits are neither high or low relative to the healthcare insustry.  They target the middle.  That's where they are.  It's by design.  It's so they don't get in trouble.

2.  I don't know how healthcare providers could increase their profits by charging higher rates to people who can't afford insurance in the first place.  They don't get any payment at all in many of those cases.  They get a tax write off. 

3.  Preventive care is a pretty small part of the complex issue of rising healthcare costs.  The amount of coverage added for new preventive services under typical health plans in the past 15 years is negligible compared to how much overall healthcare costs have increased in that time.

4.  Price shopping really has nothing to do with anything.  Rising healthcare costs, again, is a complex issue.  Costs increased a crap ton for all healthcare providers for many reasons.  They all had to respond by charging more.  The bigger issue on the consumer end of things is that they could often go to the doctor  as much as they wanted with little to no costs to themselves.  They didn't have to think about the bill.  Their employers who were paying it did.  And that's why dedutibles are now increasingly being applied to covered services.  It's to force people to think about whether or not they really need to go to the doctor because they have a cough.

[p1k3]

1.  Of course premiums went up in the last 20 years.  Healthcare costs went up in the last 20 years.  Insurance companies view themselves as mere middlemen between the consumer and the service providers.  If the cost for the service goes up, the cost of the premium goes up.  They are in the unique position of determining their profits because, in short, they know how to project how many people are going to get sick.  But their profits are neither high or low relative to the healthcare insustry.  They target the middle.  That's where they are.  It's by design.  It's so they don't get in trouble.

2.  I don't know how healthcare providers could increase their profits by charging higher rates to people who can't afford insurance in the first place.  They don't get any payment at all in many of those cases.  They get a tax write off. 

3.  Preventive care is a pretty small part of the complex issue of rising healthcare costs.  The amount of coverage added for new preventive services under typical health plans in the past 15 years is negligible compared to how much overall healthcare costs have increased in that time.

4.  Price shopping really has nothing to do with anything.  Rising healthcare costs, again, is a complex issue.  Costs increased a crap ton for all healthcare providers for many reasons.  They all had to respond by charging more.  The bigger issue on the consumer end of things is that they could often go to the doctor  as much as they wanted with little to no costs to themselves.  They didn't have to think about the bill.  Their employers who were paying it did.  And that's why dedutibles are now increasingly being applied to covered services.  It's to force people to think about whether or not they really need to go to the doctor because they have a cough.

It's because the FDA creates a monopoly for big pharma. End the FDA and other government agencies and costs will go down

[eastcat]

1.  Of course premiums went up in the last 20 years.  Healthcare costs went up in the last 20 years.  Insurance companies view themselves as mere middlemen between the consumer and the service providers.  If the cost for the service goes up, the cost of the premium goes up.  They are in the unique position of determining their profits because, in short, they know how to project how many people are going to get sick.  But their profits are neither high or low relative to the healthcare insustry.  They target the middle.  That's where they are.  It's by design.  It's so they don't get in trouble.

2.  I don't know how healthcare providers could increase their profits by charging higher rates to people who can't afford insurance in the first place.  They don't get any payment at all in many of those cases.  They get a tax write off. 

3.  Preventive care is a pretty small part of the complex issue of rising healthcare costs.  The amount of coverage added for new preventive services under typical health plans in the past 15 years is negligible compared to how much overall healthcare costs have increased in that time.

4.  Price shopping really has nothing to do with anything.  Rising healthcare costs, again, is a complex issue.  Costs increased a crap ton for all healthcare providers for many reasons.  They all had to respond by charging more.  The bigger issue on the consumer end of things is that they could often go to the doctor  as much as they wanted with little to no costs to themselves.  They didn't have to think about the bill.  Their employers who were paying it did.  And that's why dedutibles are now increasingly being applied to covered services.  It's to force people to think about whether or not they really need to go to the doctor because they have a cough.

It's because the FDA creates a monopoly for big pharma. End the FDA and other government agencies and costs will go down

Quoted for truth.

The FDA has made the approval process of drugs so expensive that only the largest of the large corporations can afford it. Like hundreds of millions of dollars. Then they grant that company rights to it for x years so they can recoup the costs.

Government is the problem, not the solution.

[p1k3]

1.  Of course premiums went up in the last 20 years.  Healthcare costs went up in the last 20 years.  Insurance companies view themselves as mere middlemen between the consumer and the service providers.  If the cost for the service goes up, the cost of the premium goes up.  They are in the unique position of determining their profits because, in short, they know how to project how many people are going to get sick.  But their profits are neither high or low relative to the healthcare insustry.  They target the middle.  That's where they are.  It's by design.  It's so they don't get in trouble.

2.  I don't know how healthcare providers could increase their profits by charging higher rates to people who can't afford insurance in the first place.  They don't get any payment at all in many of those cases.  They get a tax write off. 

3.  Preventive care is a pretty small part of the complex issue of rising healthcare costs.  The amount of coverage added for new preventive services under typical health plans in the past 15 years is negligible compared to how much overall healthcare costs have increased in that time.

4.  Price shopping really has nothing to do with anything.  Rising healthcare costs, again, is a complex issue.  Costs increased a crap ton for all healthcare providers for many reasons.  They all had to respond by charging more.  The bigger issue on the consumer end of things is that they could often go to the doctor  as much as they wanted with little to no costs to themselves.  They didn't have to think about the bill.  Their employers who were paying it did.  And that's why dedutibles are now increasingly being applied to covered services.  It's to force people to think about whether or not they really need to go to the doctor because they have a cough.

It's because the FDA creates a monopoly for big pharma. End the FDA and other government agencies and costs will go down

Quoted for truth.

The FDA has made the approval process of drugs so expensive that only the largest of the large corporations can afford it. Like hundreds of millions of dollars. Then they grant that company rights to it for x years so they can recoup the costs.

Government is the problem, not the solution.

Agree. But of course it's much more complicated and corrupt than that

[kim carnes]

poor people love going to the doctor.  we are so mumped.

[Panjandrum]

1.  Of course premiums went up in the last 20 years.  Healthcare costs went up in the last 20 years.  Insurance companies view themselves as mere middlemen between the consumer and the service providers.  If the cost for the service goes up, the cost of the premium goes up.  They are in the unique position of determining their profits because, in short, they know how to project how many people are going to get sick.  But their profits are neither high or low relative to the healthcare insustry.  They target the middle.  That's where they are.  It's by design.  It's so they don't get in trouble.

2.  I don't know how healthcare providers could increase their profits by charging higher rates to people who can't afford insurance in the first place.  They don't get any payment at all in many of those cases.  They get a tax write off. 

3.  Preventive care is a pretty small part of the complex issue of rising healthcare costs.  The amount of coverage added for new preventive services under typical health plans in the past 15 years is negligible compared to how much overall healthcare costs have increased in that time.

4.  Price shopping really has nothing to do with anything.  Rising healthcare costs, again, is a complex issue.  Costs increased a crap ton for all healthcare providers for many reasons.  They all had to respond by charging more.  The bigger issue on the consumer end of things is that they could often go to the doctor  as much as they wanted with little to no costs to themselves.  They didn't have to think about the bill.  Their employers who were paying it did.  And that's why dedutibles are now increasingly being applied to covered services.  It's to force people to think about whether or not they really need to go to the doctor because they have a cough.

Well said.

[john "teach me how to" dougie]

poor people love going to the doctor.  we are so mumped.

Hospitals will become the new libraries.

[kim carnes]

poor people love going to the doctor.  we are so mumped.

Hospitals will become the new libraries.

yeah

[TheHamburglar]

Since we are talking about rising health care costs, I'm going to throw in the single talking point I always add in.  I'm not saying it's a significant driver in rising costs, but it still bothers the hell out of me. 

Part of the rising cost of health care is due to the number of machines/equipment/resources that exist and need to be paid for and the quantity of these capital resources vs the population base they serve.  A lot of America is rural, like western Kansas.  There are a lot of towns with populations from 8,000 to 25,000 all between 45-70 miles apart, and they all have the exact same equipment.  You go to the hospitals in Garden City, Dodge City, Liberal, Great Bend, Hays, Emporia, Pittsburg, Newton, McPherson, Pratt, Colby, and probably Concordia & Norton.  They all have the same very expensive MRI machines.  Why?  So that when someone has strange pain they don't have to drive two hours round trip to get scanned.  Salina probably had 5 and Wichita probably has 20+ MRIs between the hospitals, cancer centers, and other "surgical arts" complexes.  Those things need to be paid for.  We have the ability to create amazing technology, but we can't afford it at the level that we can produce it.  However, since its in the name of health, we do it anyway and need to create reasons/ways to pay for it. 

Example: I live in a city of 30,000 people, 6 miles north of Tulsa.  We have two competing hospitals that are one mile apart from each other.  Both are full service, three story hospitals full of the same, expensive pieces of equipment.  One night I woke up at 1:00 am with a pretty bad kidney stone.  It was the throwing up from pain kind, so I knew my Loritabs weren't going to do it.  I finally broke down and went to the hospital.  I get to the hospital and they don't believe I have a kidney stone, even though I've had 15 before.  I pee blood to show them I have a stone.  Now they believe me, but they "want to be sure" it's not my appendix.  They say screw it and send me for an MRI anyway.  What do they care, the machine and tech are sitting idle at 2:00 AM, so it's an easy $2,000 they get to bill out.  All I needed was a little morphine (so I could keep down the gallon of water I was trying to drink) and a couple bags of fluid.  If they didn't regularly send people for unnecessary MRI's to charge the insurance companies, I'm sure they'd just raise the price on something else so they'd hit their budgeted revenue.  However, the citizens of my town (and their insurance companies) have to pay for two MRI machines and two of everything else.  Both need to hit their target revenue to pay for their redundant resources.  It's insanely stupid overkill, and this is going on all over the country in towns like those I listed in the paragraph above.  That's part of the reason health care costs are going up. 

/hamburglar-health-care-cost-rant

[john "teach me how to" dougie]

Since we are talking about rising health care costs, I'm going to throw in the single talking point I always add in.  I'm not saying it's a significant driver in rising costs, but it still bothers the hell out of me. 

Part of the rising cost of health care is due to the number of machines/equipment/resources that exist and need to be paid for and the quantity of these capital resources vs the population base they serve.  A lot of America is rural, like western Kansas.  There are a lot of towns with populations from 8,000 to 25,000 all between 45-70 miles apart, and they all have the exact same equipment.  You go to the hospitals in Garden City, Dodge City, Liberal, Great Bend, Hays, Emporia, Pittsburg, Newton, McPherson, Pratt, Colby, and probably Concordia & Norton.  They all have the same very expensive MRI machines.  Why?  So that when someone has strange pain they don't have to drive two hours round trip to get scanned.  Salina probably had 5 and Wichita probably has 20+ MRIs between the hospitals, cancer centers, and other "surgical arts" complexes.  Those things need to be paid for.  We have the ability to create amazing technology, but we can't afford it at the level that we can produce it.  However, since its in the name of health, we do it anyway and need to create reasons/ways to pay for it. 

Example: I live in a city of 30,000 people, 6 miles north of Tulsa.  We have two competing hospitals that are one mile apart from each other.  Both are full service, three story hospitals full of the same, expensive pieces of equipment.  One night I woke up at 1:00 am with a pretty bad kidney stone.  It was the throwing up from pain kind, so I knew my Loritabs weren't going to do it.  I finally broke down and went to the hospital.  I get to the hospital and they don't believe I have a kidney stone, even though I've had 15 before.  I pee blood to show them I have a stone.  Now they believe me, but they "want to be sure" it's not my appendix.  They say screw it and send me for an MRI anyway.  What do they care, the machine and tech are sitting idle at 2:00 AM, so it's an easy $2,000 they get to bill out.  All I needed was a little morphine (so I could keep down the gallon of water I was trying to drink) and a couple bags of fluid.  If they didn't regularly send people for unnecessary MRI's to charge the insurance companies, I'm sure they'd just raise the price on something else so they'd hit their budgeted revenue.  However, the citizens of my town (and their insurance companies) have to pay for two MRI machines and two of everything else.  Both need to hit their target revenue to pay for their redundant resources.  It's insanely stupid overkill, and this is going on all over the country in towns like those I listed in the paragraph above.  That's part of the reason health care costs are going up. 

/hamburglar-health-care-cost-rant

If your appendix had ruptured and you died, your family may have sued the hospital for several million dollars. This is the reason poor people can't afford health insurance today.

[eastcat]

FWIW modern MRI machines are not super expensive anymore.

My uncle sells them down in FL.