Health Law Tax Penalty? I’ll Take It, Millions Say

Looks like not much of a role at all. After all of my experiences with insurance companies I'm quite okay with that.

A NHS-style system would still need staff in order to function and I expect many rank-and-file insurance people would end up there. The executives can go to hell as far as I'm concerned.

None.

Which is America's end game: to end that apparent scam.

This is why I actually had hope for the original draft of Obamacare: he straight up cloned the Netherlands system where insurance companies must insure x% of various classifications of sick people (cancer, AIDS, asthma, heart disease, overweight, etc), where x% approximates the national average...

... and they must spend ridiculous high levels of what they make on actual health care, AND the prices of health care are nationalized.

In the end, they fight over sick people (have a rare sickness? insurance companies will give you a discount to get you, instead of trying to figure out how to lifetime ban you from insurance instead). And what happens if an insurance company can't get enough people to meet the strict guidelines? They're banned from selling insurance in the Netherlands until they do.

This is essentially the original Obamacare, filtered through the American way of doing shit. What we got instead? Half of that, and maybe not even the good half.

We got fucked.

They'd still be providing insurance. A national body negotiating pricing doesn't necessarily mean any or all forms of healthcare would be affordable.

You assume that this current broken state was unintentional. I believe this situation is intentional and was predicted and expected.

Back when Obamacare was being debated I and many others argued that the best it could do would be to slow the meteoric rise of health care costs because it was painfully obvious (to me at least) that it didn't actually solve the problem. I have no doubt that the politicians knew this as well which was why Republicans fought so hard against it and why Democrats wanted it so bad.

I believe they wanted it to come to this. They wanted to demonstrate that even if you force people to get insurance it still wouldn't be enough. It is a real-world application of how, "the compromise" (forcing people to get insurance) doesn't actually impact the price much because health care costs are not controlled by traditional market forces.

What is the price, "the market will bear" when someone will die or suffer immensely without treatment?

Except the drug "schrekli" priced gouged was out of patent. It should have been a commodity, so why weren't any competitors allowed on the marketplace? Take a look at Washington for your answer.

There are lots of amazing companies trying to invent cures that don't otherwise exist, and need compensation for their work. Then you have Epipen and "schrekli" jacking up prices on 30 year old drugs.

" but even before it made it to being a law it got all messed up"

Requiring legislators to read legislation (and maybe even take a test on bills that are larger than 10 pages?) before they vote on it might help. Being told "we have to pass it before we can look inside of it" is... I can't think of anything less sane.

Re: Canada and other countries. I know in the UK you can get private insurance and "go private" for most services, or you can take the public option, which may involve waiting. Why we think here it's going to be 100% one thing... I don't understand. Your canada story already demosntrates that - someone with more money paid for faster service. I have a strong suspicion he could have had that done privately someone in canada for $x, but seattle was closer/easier (?)

Healthcare is always rationed, though. It can be rationed by need, ability to pay, or some other way, but there's no system for infinite healthcare yet developed.

arguably not everyone needs everything - many people can get by just fine without a car, or construction services, or other things you might list. Not too many people get by (for long) with poor/ailing health.

Some aspects of health care - basic stuff like getting people insulin they need and whatnot - does that not potentially get justified under "general welfare" clause? Many other countries seem to get by just fine with a baseline "health service" provided to everyone, with "premium" service paid for out of pocket or via private insurance. People should not have to face bankruptcy (or just extreme debt) because they happened to be born with the wrong genes.

What, you don't remember those articles immediately after Obamacare went into effect gloating about how everything was going fine?

The big successful aspects of the law remain in my mind: Elimination of lifetime caps, pre-existing conditions. Allowing children to remain on plans until 26. Insuring millions more via expansion of Medicaid or subsidies of premiums with initially more competitive plans.

By and large I think it was a success, albeit a completely temporary bandaid to a system that requires massive re-thinking

The market for widely used generic drugs in the US is incredibly competitive. It's niche and patented drugs that see crazy prices.

As far as doctors, the US currently has a surplus of medical school graduates and not enough residency slots to train them. I imagine the most immediate thing the US could do would be to train even more physicians assistants and nurse practitioners and then do a better job of billing less for lower levels of service.

That's not exactly how our economy works.

Those expensive wars are fought with expensive weapons, which are mostly still made here by American companies. Those soldiers fighting those wars are citizens with full time jobs for many years.

Healthcare is another thing that's made here and someone is getting paid when we pay an efficient amount or simply overpay.

So killing ourselves is all a matter of perspective, some people are doing quite well.

"We"?

Part of the issue is that Americans seem peculiarly unwilling to point their pitchforks in the right direction.

Blaming the elderly for our problems is a bad move. Simply because the laws of the universe say we will become old too.

Now I agree with you on your other points that the insurance companies took this law and said fuck it we will just raise prices. That is what happens with corporations they want to make money. The fact that the government thought they could just force these folks to do the right thing and cover people with pre-existing conditions and all this other stuff without a single consequence was a really bad oversight.

This law was written with input from the health insurance lobby. There was likely never any doubt how this would play out.

An example of said burden on the middle class. I make a senior software engineers salary and my wife has Lupus. I'm beginning to have signs of having Lupus and RA myself. Her prescriptions alone barely have any coverage until we meet our out of pocket max, and by then, 10-15% of our income is gone paying just for drugs. This is on top of 25-30% taxes, plus the rising cost of food, and now they are telling me I may need the same drugs as her? So in this new found world, I could potentially lose up to 55% of my income in taxes and health coverage. Oh and for a laugh, Medicare won't cover her because I make too much. This is insane.

Despite this, I'm of the mind that we can't return to the way things were before ACA, and ACA isn't the answer either. Something has to change or we may have to move to another country with better options. People huff about waiting lists, but neglect to realize that waiting lists are often for non-life threatening surgeries. They also forget to tell the part about how routine office visits don't have the same types of waits, and how prescription coverage is still free.

All of my crying aside, I'm left with one thought. How in the actual fuck do poor people afford this shit? I grew up poor and I know what we did--we didn't have insurance and thankfully we were lucky enough not to have any chronic illnesses in my immediate family when I was growing up.

On a lighter note, a small joke: I downloaded the GoodRx and it physically started emitting laughter from the speakers once I typed in the drug names.

We do ban other kinds of advertisements already when we deem them against the greater public good.

So I can see how banning drug advertisements falls into the same category as banning cigarette ads, in that it makes for a more healthy public. The same thing can of course be said about just about anything, but sometimes you just have to stand on that slippery slope.

If you qualify for Medicaid based on income, I don't think you can buy from the exchanges (the option is a similar plan off exchange).

> It's also really difficult to say what premiums would have been without the changes the ACA made.

No it's not. Forcing insurers to take people with pre-existing conditions completely screws up risk pools. Anyone could've told you that doing so would make premiums rise much faster than if those customers could be denied.

It should have been done as part of the ACA. Remove the tax incentive and encourage all those people to go to the exchanges. It would probably have to have been done in a staged manner.

After that, eliminate Medicaid in favor of fully priced exchange subsidies (I say "fully priced" because as far as I can tell, much of the funding for Medicaid comes from jacking up prices that other people pay for care, creating a tax that gets hidden in insurance premiums and deductibles).

Instead the ACA placed more requirements on employers and expanded Medicaid.

> Getting access to health care is what matters

And how do you provide access to extremely expensive health care without insurance or government? Risk sharing is the issue and in this case it seems fraught with moral hazards regardless of how it is done.

If you don't give a rip about insurance, you should be especially irritated at ACA and the ACA status quo ante, because the insurance companies and hospital chains quietly negotiate the prices for health care services, collude to establish favorable prices for the insurers, and lock individual consumers out of those prices.

A fun experiment I've had the pleasure of running: try to get an MRI done outside of your insurance policy --- that is, try to pay the rack rate for an MRI, out of pocket.

>The fine is structured such that only people that can pay for health insurance are hit with it.The various income tests and whatever might not be perfect though.

That is to say the least. It is all based on the poverty line and that is extremely flawed.

"The current federal poverty level is $23,550 a year for a family of four and $19,530 for a family of three. But this measure is based on a methodology developed in the 1960s and now widely recognized as outdated. One major criticism is that the official poverty level is too low. Current research suggests that, on average, families need an income of about twice the federal poverty level just to afford basic expenses. Moreover, although the cost of living varies significantly within and across states, the federal poverty level is the same across the continental U.S."

http://www.nccp.org/topics/measuringpoverty.html

The solution seems obvious. Instead of fining (those who can afford it), use that money to pay for their Medicaid/Medicare.

That way they have insurance, which was the goal of this program, no?

You had kind of a good point until you called someone pathetic and wrongheaded...?

Huh?

The article is about Obamacare, aka Hillarycare. Seems on-topic to me.

Free market + insurance version of healthcare. How much of my money(my premiums) are you willing to spend to control your diabetes, risk of heart-attack, or cure your cancer? I'll give you a hint, all of it.

The Affordable Care Act is extremely similar to the healthcare plan Hillary championed while she was First Lady.

Price controls? We already have doctors willing to pull out of medicaid because it doesn't cover their costs. Price controls just reduce supply and give you situations like in China where medical scalpers sell places in line for doctor visits at up to $500 a pop.

Price controls? How about bloody telling the price for stuff?

"How much is this procedure/appointment?"

And all I get are sneers of derision or confusion. Then I'm told, "The bill will be in the mail." Yeah, well fuck you too.

You want price controls; I want an estimate, and a list of procedures and their costs.

Then again, I'm waiting to sue someone over the lack of informed consent based on financial availability. I'd do it, but I'm not a lawyer.

Neither is proposing something that could work.

Normalized pricing based on income with transparency on procedures and tests. Deductible + premiums + out of pocket should add up to no more than 8-10% of my income.

And out of pocket should be some fraction of real price based on income. It should always cost 3x to go to a hospital than a doctors office its just the amount should vary based on income.

Let private insurance compete in the supplemental market. And offer public option on exchange.