Obamacare Premiums Set to Rise, Even for Savvy Shoppers
nytimes.com
nytimes.com
Besides, my opinion of the comment has no bearing on my opinion of the healthcare system in any way. I can be offended by both at the same time thank you very much.
Norway Pop. 5M (approx) Finland Pop. 5M (approx) England Pop. 53M (approx) Canada Pop. 35M (approx) United States Pop. 318M (approx)
The scale is way off from many other countries who have implemented the kind of healthcare reform being talked about.
When you get to hundreds of millions of people all kinds of issues arise that you don't see elsewhere.
China and India are the only countries more populous than the United States and I'd be nervous to experience their health care system. In fact you have to go quite far down the population list to get a first world country where that kind of healthcare is being implemented (happy to be proven wrong here)
So at least some large portion of this cost increase is going into the pockets of executives and shareholders.
[1] https://personal.vanguard.com/us/funds/snapshot?FundId=5485&...
It's not so easy as just waving your hand and saying "Free Healthcare! Free for everyone!"
The NHS is fantastic.
The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting.
I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
Based on the available evidence for healthcare: it drops like a stone because the sole customer has all the leverage.
If the government directly pays the Doctor a salary.. he doesn't care what the "profit" on a procedure is. In fact, base his pay on how good his outcomes are and how efficient he is.. i.e. pay him more to do better. Then we don't need to worry about some doctors not offering some procedures, because they are paid by salary and not salesmen.
Right now private practice doctors are salesmen. They are compensated MORE for selling unnecessary procedures. If the they can sneak it by the insurance? They do it.
Most doctors make a salary, they don't care what the 'profit' on a procedure is. They probably don't even know what most of the stuff costs. It's like college professors and textbooks.
Also, who's worrying about some doctors not offering some procedures?
Even IF that's the case it's still wildly better than the current system.
Second, what evidence do you have that it would be cheaper in those countries than if they were using a private medical system? Are there numbers from before the NHS was put together? That would be an interesting analysis.
Although, becoming a citizen has become a chore because it takes too freaking long for so many.
Of course, this is from the viewpoint of a citizen so take that into account as I don't see it from the other side.
That's the problem, I have trust issues with the people in power being capable of doing such a thing.
But it's not so bad that it can't get much worse. Getting worse is not abstract - it translates into people dying needlessly. (So does the current system being bad.) "Just change something" is only good advice if you're currently at a local minimum. And "iterate rapidly to improve" doesn't work when each change takes an act of Congress.
In particular: The last change was, what, six years ago? And the last change before that was, what, in the 1970s? You may only get one or two more chance to change this in your lifetime.
Also, iteration and government intervention don't really mix, as has been pointed out.
Take all our money we spend in various healthcare programs already. Take 20% off our military budget. Boom, free healthcare for everyone.
I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
We aren't. That part is constant.
> And why do you think that expanding that program to cover everyone in the country is going to come out to be 20% of the military budget?
We can do the math if we want. Perhaps it will take 50% of the Military budget. Perhaps people earning more than 50k will need to pay a new tax that is more or less equal to what they currently pay in health insurance premiums. The math can be made to work.
> I took the money I use to pay rent, and the used it to pay rent. Boom free rent? I'm sorry, but that's kind of what your argument sounds like to me.
No more like - You spend $600 a month on smoking, and $600 a month on rent. Quit smoking, BOOM, free rent. At the end of the day, your costs dropped $600 which was the price of your rent.
It's the handwaving that's the frustrating part. What amount of the military budget is it? How are you going to charge me a new tax equivalent to my current healthcare that's going to cover me and at least one other person (just under half in the country actually pay income tax). That still sounds like magic thinking. Taxes would have to go up, how could they not? Or you gut the military, and even then I don't think it would necessarily be enough. Add in the push to completely ignore illegal immigration, and accord them the rights of citizens, and agree with that policy or not, you have to acknowledge the cost will go up even more.
It's easy to handwave the numbers. It happens a lot, but it's not a trivial detail. It has real consequences. What happens when the US Navy is no longer patrolling trade routes? Or when younger generations are crushed by a combination of increased tax burden and school loan debt?
I would prefer they just take a step back for a while.
Why is it a common assumption that the government can fix, with more government, the problems government created? Maybe fixing the damn problem is for the government to reduce its involvement in the problems it created?
The issue is our entire healthcare system is for profit and there is no market driver to reduce costs. Insurance companies collude with the AMA, hospitals, and pharmaceutical companies to raise prices on all aspects of healthcare.
The government needs to create that driver to reduce cost, since the industry is unwilling to. This could be many things, from public hospitals that provide free or low cost care (reducing the need for insurance), to creating a mutual insurance company whose charter is to minimize healthcare cost (creating competition in the marketplace).
You are poor? You die.
You are rich? Here is a nice bed and 3 doctors to care for you.
I do not want to live in that world. I do not want my children to live in that world.
There likely will never be endless free healthcare for everybody. Until then its rationed. How do you do that? As my old minister used to say, we can have all the morals we can afford.
I'm also in favor of reasonable free healthcare for everybody, to a point. Because, enlightened self-interest. Its cheaper to have a healthy populace, for everybody.
So some middle ground is necessary, between blue-sky endless free healthcare, and a free market.
You are rich? Fly to that other country for immediate treatment.
There are pros and cons to everything. The trick is to find the middle ground that suits the most people possible the best it can. I'm just not convinced a total government solution is best for everybody across the board.
In the current world, not everyone gets treatment.
I think I will take these problems over the current.
That is, until you have to sit in severe pain for six months.
I think what's needed is likely more than outreach: there are two big problems with the insurance market right now that prevent competition.
First, the barriers to entry to start a new health insurance company are incredibly high. There have been four health insurance startups (Oscar, Clover, Bright, SeeChange) launched in the last several years. SeeChange went out of business. Bright has yet to launch. Oscar and Clover are active in a handful of markets, but for 90+% of people, their choices are limited to the insurers that existed before the ACA.
Why is it so hard to start a new health insurance company? First, it requires $50m+ in reserve capital to get a state license before you can sell your first policy. Second, once you're in business, your ability to negotiate prices with hospitals is determined by your scale, so new entrants are at an inherent disadvantage: they're negotiating on behalf of perhaps 10,000 members. United, in comparison, negotiates on behalf of 70 million people. There's an inherent vicious cycle here of worse prices => fewer members => worse prices.
Second, the Affordable Care Act built in several financial mechanisms--risk adjustment, reinsurance, and risk corridors--to stabilize premiums. Some of those are being defunded by Congress, and so the result is that in some places, premiums are destabilized; in others, insurers are withdrawing entirely. Our general political disfunction is now having a very specific and negative impact on people's lives.
Does this mean government regulation is all bad? I don't think so. There are certainly places where repealing regulation could help create a competitive market, but also places where adding carefully-crafted regulation could promote competition.
For example, passing a law requiring hospitals to charge all insurers the same rate (they can set the rate to whatever they like) would mean that new insurers are competing on a level playing field with the giants. Functioning reinsurance would lower the reserve capital requirements for a new insurance startup to stay in the market for long enough to build a membership base.
With those two changes, would level of competition and innovation in health insurance be the same as in photo sharing apps? Not quite. Healthcare is a complex business. But I think we could get substantially closer to that level of innovation, and that would be good for everybody.
Right?