1691

I recently decided to dig into things a bit, and get some historical data on premiums, as this is the primary attack against the ACA by those who argue for its repeal.

Here’s something I found.

Note, this is from 2012, prior to the ACA. Thus, it was not created to defend the ACA, but rather to argue for why we needed healthcare reform.

An important data point here, is the rate at which healthcare premiums were rising prior to the ACA. Note, they discuss the trend from 2003-2011 (many folks seem to forget how premiums were skyrocketing at that point. I don’t.).

With the trend from 2003-2011, they talk about the projected premiums in the future (which is now the present), for the purpose of discussing potential savings. But the actual value of these projections is important to note.

Extrapolating from the trend of national premium prices in the period prior to enactment of the ACA, they were projecting that in 2015 the national average for healthcare premiums would be $18,721. (Exhibit 10, page 15)

In 2016, with folks complaining about how their premiums have exploded, what was the national average premium? $18,142.

So we see that in 2016, with the ACA, premiums are actually lower than they would likely have been WITHOUT the ACA, a year earlier. So the ACA’s apparent effect on premiums is potentially that it slowed the growth rate of premiums slightly. It certainly did not result in them skyrocketing, as it is portrayed by many in the media.

1692

CNN was talking about it this morning with one of the R folks. (Sorry, I didn’t catch who it was.) The GOP rep kept saying premiums “exploded” and made healthcare “impossible” for Americans, and that’s why the ACA had to be repealed. CNN was doing a good job of rebutting. Premiums did increase for a minority slice of middle Americans that had insurance before, but the GOP was also counting everyone that previously did not pay for insurance at all, so of course going from $0 a year to whatever they now pay was a 1 gajillion percent rise in their healthcare.

1693

At least two local hospitals (Kaiser and one of the biggest children’s hospitals in the state) have put construction work on hold. Projects planned last year and scheduled for this year have been stopped. Kaiser has even laid off staff.

I wonder if any of this is tied to questions about what Trump/GOP might do to healthcare?

1694

Two things…does that take into account that many plans now have much larger co-pays and deductibles than pre-ACA?

Also, I have been surprised how many on the right hate the mere idea that someone is forcing them to buy health insurance. I understand if you can’t afford it, but being willing to take the gamble that you won’t need it amazes me.

1695

A large portion of the Right just doesn’t want the government to force them to do anything. When they say “smaller government”, what they really mean is “less of the government telling me what I can and can’t do”. If you pass a law that requires power plants to reduce their CO2 emissions by 2%, the Right would be upset. If, on the flip side, you were to pass a law that requires power plants to maintain or increase CO2 emissions, the Right would still be upset. The politicians may talk about how it increases the cost per KWh or whatnot. The rank and file, however, is more upset because the “government tried to tell someone to do something!”

1696

There is a large segment of people who are absolutely against the Government telling them what to do while at the same demanding the Government tells others what to do. They are unable or unwilling to acknowledge the contradiction here. They are the same people who believe anyone receiving unemployment is a lazy freeloader until they lose their job and then they paid their taxes while they were working so they have earned unemployment and the Government should do more to protect their jobs or train them for new ones. The minute their kids leave public schools they immediately declare that they shouldn’t be paying taxes to support schools ignoring that others paid to help support it for their kids.

1697

Trump is giving a job to Rudy Giuliani. He’s going to be Trump’s Cyber-Security expert. Does this make us feel optimistic?

1698

I find that old, confused men who might be psychotic make the best computer guys.

1699

Nothing says computer savvy like a 72yo senile imbecile.

1700

His solution is to have the private sector do it better. I wish I was kidding.

1701

This is a fair point, and I honestly do not know the answer.

[quote=“Scuzz, post:1694, topic:126890”]Also, I have been surprised how many on the right hate the mere idea that someone is forcing them to buy health insurance. I understand if you can’t afford it, but being willing to take the gamble that you won’t need it amazes me.
[/quote]
I understand the ideological resistance to being forced to buy a service. In general, this is bad.

However, in the case here, we’re dealing with a situation of the genie already being out of the bottle. If we are willing to allow people to choose not to purchase health insurance, then we need to FORCE those people to live with the consequences of their decision. We cannot privatize the choice, and then socialize the repercussions of that choice.

Since we currently require that healthcare providers provide care to everyone, no matter what, we cannot allow people to skate on paying for the insurance, and then have more responsible people carry their weight when they get sick. That’s bullshit. That’s not capitalism. That’s just an exceptionally incompetent breed of socialism.

Now, if we really want to go the route of individual responsibility and choice, then I’m totally for that… but we need to do it all the way. Not half-assed pretender version of libertarianism.

What I would suggest, in order to eliminate concerns about forced purchase of goods, I would say that people are able to opt out of purchasing insurance… But in doing so, they waive ANY right to healthcare. Meaning, you can say, “I don’t want to pay for insurance… and when I show up in a hospital, unless I can prove to them that I have the ability to pay for service, then they are able to throw me out on the street to die.”

And when that happens to people, it will suck for them and their families. But that is necessary if you’re going to allow people to make poor choices. You can’t let them make bad choices, and then shelter them from the result.

I’m totally on board with allowing folks to make bad choices. But I’m not at all interested in paying for their idiocy. That’s on them. Let them take responsibility for themselves.

1702

That’s well and good but what about the kids of people who make poor choices? I know that’s a problem that extends beyond healthcare, but in a compassionate society we should strive to give them the best chance we can.

1703

@Timex I can understand your ideological argument, but there are several fatal flaws.

One is that healthcare in the US is already ridiculously expensive, especially compared to other nations. You do acknowledge that there is a vast amount of people whom could not afford health insurance on their own, right? People who do everything right, but lack financial means. Especially in this day of growing wealth and income stratification.

What you propose is ‘if you are poor, and get sick, you die’. Flat out, your proposal would kill literal millions of people.

1704

Yep. Which is why the obvious solution that every other civilized country has figured out is to pay for it with taxes and be done with it. Letting a kid lose his sight or the use of her legs the rest of their lives because their parents are idiots (or were kicked off their insurance plan) is not something I am okay with.

I don’t want the government running the hospitals, but I do want the cut out the cancer that is the insurance industry. Single payer, single system, fix the problems as they arise.

1705

Deductibles and co-pays were also increasing at alarming rates well before the ACA.

The HDHP (High-Deductible Healthcare Plan) was a brainchild of the insurance industry long before the ACA came along. The industry pushed HDHPs on companies that were concerned about ever-increasing premium costs as a way to keep those costs way down. It basically put all the risk and expense on the employee. With an HDHP, the employee was supposedly getting the “insurance adjusted rate” for all services, but then had to pay for all services out-of-pocket until they reached their deductible limit, after which normally 80%-100% of the additional costs would be absorbed by the insurance company. The layman term for this is “Catastrophic Insurance” because it doesn’t really kick in for the insured unless they have a healthcare event that costs thousands of dollars.

Originally, these high deductible plans were pushed as a great solution because their premiums were very low compared to most other coverage. So low that often companies could afford to simply pay the entire premium for the employee instead of subsidizing, making then an attractive “no cost” plan for healthy employees. Later, when the government allowed people to take advantage of the Healthcare Savings Account (HSA) to deposit money from their paychecks pre-tax into bank accounts that could be used for healthcare, the HDHP became an even more attractive option.

But as the industry continued to push double digit percentage increases in rates year after year, and copays and deductibles rose to ever higher levels, some companies pre-ACA were forced to reduce their benefit offerings to ONLY the HDHP options, and even then many companies had to begin passing on the costs of a portion of the premiums to their employees.

So my argument to Conservatives so eager to repeal everything ACA is this : Imagine yourself employed pre-ACA at a company that could only afford to offer you a HDHP option for coverage for your 4-person family. Your premium per-paycheck for this coverage was $200. Your deductible was $5,500 per person, $11,000 for family combined. At 26 pay periods per year, you were paying $5,200 a year just for the privilege of being “covered” by insurance that wouldn’t pay you a nickel until you had more than $5,500 in medical bills for a single person in your home. Should it even be considered “coverage” when you pay out nearly $11,000 before the insurance company pays out anything? It’s no wonder so many people found it cheaper to just roll the dice and go without insurance pre-ACA.

Post ACA that same family could purchase a Silver plan with $50 doctor visit copays, $100 specialist co-pays, $250 a day hospital co-pays, etc. for around $250 per pay period on the Exchange. Sure, you’re paying $1,300 a year more in premiums, but now a trip to the ER for your kid’s broken arm only costs $250 instead of $1,200, and those tests the doctor ordered for that lump your wife discovered only cost $150 instead of $2,400.

Thanks to Republicans though, in 2018 it will be back to the catastrophic insurance for your family.

1706

It would always be possible to have government simply subsidize healthcare for all children, through something like CHIP.

1707

I think you’re misunderstanding my suggestion.

What I’m suggesting is that the ACA continue, but that it allows people to voluntarily opt out of it, whereas the ACA currently requires everyone to purchase healthcare (or pay a small fine, which is actually much too small a fine).

But, in opting out, you would be forced to sign a waiver, saying that you waived any requirement for anyone to provide you with healthcare.

1708

Yeah, that’s where I break with libertarianism.

What @Timex proposes is absolutely a solution to the problem of socializing the risk and privatizing the profit (in this case, the savings of not paying premiums).

You just have to be okay with letting people die in the streets for any of the hundreds of reasons they don’t have prior insurance or the cash on hand to pay for needed treatment.

I am not okay with that.

1709

Again, this isn’t what I’m proposing.

The only people who would die on the street, under the system I proposed, would be people who had the money to purchase health insurance, and then chose not to.

1710

It wouldn’t work because the healthy would opt out, and the sick would opt in (or those likely to be sick)

you’d have a death sprial.