Comment by wahern | Hacker News Reader

Comment by wahern | Hacker News Reader

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  The only thing I liked about Obama care was the pre-existing conditions clause.

You can't separate that clause from the mandate and minimum coverage clauses. All three were designed to keep costs from inflating on the one hand, and coverage becoming useless on the other. It's sort of like saying you like your lunch, but have a problem with having to pay for it.

We can quibble about rates for men vs women, but unless you were matured to adulthood in a lab, it's hard to argue that men as a class do not benefit from improved and cheaper access to reproductive healthcare for women. (Also, better reproductive health means fewer criminals, if only because they're born healthier and with fewer mental handicaps.)

Opening up insurance across states would be nice theoretically, but you must realize that it's a states' rights issue for a large segment of the GOP, and a cause for concern among Democrats. It would necessarily limit and perhaps destroy the ability for states to meaningfully regulate insurance within their own borders. Unchecked, it would also mean a race to the bottom in terms of regulatory oversight as every provider would only sell insurance from states with the least restrictive regulations.

What state do you live in? Coverage in states like California and many other states that haven't fought tooth-and-nail has been fairly stable as far I know. The Kaiser HMO rate at my company actually decreased slightly for 2017, with no change in coverage. And California not only has a rigorous regulatory framework, it even maintains a weird tax on hospital income to pay for uninsured coverage.

Also, you don't need a federal law to support an inter-state insurance scheme. States could voluntarily permit policies to be sold from other states. For example, states in different regions could elect to normalize their regulatory schemes and open up their markets to each other. There's plenty of precedent for this. It doesn't require Congressional approval; just coordination among state legislatures like is so often done for other regulatory frameworks.

In MA my family premium is climbing from $950 to $1600/month. And this is with high deductibles, so if we want to actually see a doctor it will be out of pocket.

What was it before with Romneycare?

That's true, it was higher then, about $1200/month. IIRC the deductibles were lower though, $3000/person vs. $6000 now.

I just don't see how this system will work for insurers in the long run -- I know I'm certainly not going to the Dr. unless I'm really sick. Somehow even yearly checkups seem to cost me over $500 so I delay those until they threaten to not renew prescriptions.

I don't see how the system will work for anyone.

A $6000 deductible is basically a catastrophic policy, it discourages care which is perhaps the point. Of course if you have ever seen an uninsured ER bill then that $6000 suddenly looks comparably cheap.

How expensive will it all get before it breaks?

Obamacare puts limits on the deductible for various types of common visits and procedures.

As an example (though I'm unsure if this is in particular a federal or state mandate in California), the maximum deductible for child delivery is much less than a typical policy's maximum deductible in the aggregate. Our deductible on our family policy is $3,500, I think; but we only had to cut a check for a fraction of that.

So when people say they have a $5,000 deductible, it absolutely does not mean that most care is entirely out-of-pocket. In fact, most routine preventative care has a very low deductible. Otherwise, as you said, it would basically be worthless to almost everybody.

On the Massachusetts Healthcare Exchange you can find unsubsidized Gold plans starting at $1,200/month for a family of 4. I just checked. $1,600 is the highest Gold plan, and is the start of Platinum territory.

$1,200 is typical for a decent-quality medical plan, if California is any measure. And California law has far stricter minimum coverage requirements than Obamacare.

It's true that under Obamacare it has been more difficult for some people to stick with their same, preferred insurance provider. It seems some providers will jack up rates in an attempt to reconfigure their insured base. I can't see how that would change without restricting insurance providers even more. Less regulation, as is likely with Republican policies, would likely lead to more shenanigans. It might lead to slightly cheaper coverage for the well-off, but I'd take a slightly higher premium knowing that if I got laid off and lost income I'd still be able to afford decent healthcare. Even with Obamacare a major medical condition can still bankrupt you, especially if you lose your job.

Purchasing insurance to subsidize income if you become sick or injured is still a smart thing to do. It's just that with solid minimum coverage requirements you're paying part of that premium directly in the cost of your healthcare.

"but unless you were matured to adulthood in a lab, it's hard to argue that men as a class do not benefit from improved and cheaper access to reproductive healthcare for women."

There are plenty of single men that should not be forced to pay for women's reproductive healthcare.

"What state do you live in? "

http://time.com/money/4535394/obamacare-plan-premium-price-i...

8 states rose by at least 30%.

"States could voluntarily permit policies to be sold from other states. For example, states in different regions could elect to normalize their regulatory schemes and open up their markets to each other. There's plenty of precedent for this. It doesn't require Congressional approval; just coordination among state legislatures like is so often done for other regulatory frameworks."

Great, but Obamacare in its current form needs to go.

> There are plenty of single men that should not be forced to pay for women's reproductive healthcare.

I have to say this attitude makes me viscerally angry. Men have a much higher incidence of heart disease, so maybe women should not be forced to pay for that? Men engage in lots of unhealthy, risky behaviors, but I've never heard a woman make a statement analogous to yours. It's like saying "Well I'm not handicapped, so why the hell should I have to pay for special accommodations for those people?".

If you accept that socialized healthcare is a good idea, then it seems to follow fairly obviously that we're all unique and will have individualized healthcare needs.

Let's be honest here: it's about children. The only difference between men and women that would substantially effect insurance coverage rates are prenatal care and birth.

But few men are willing to come out and plainly state that they aren't interested in subsidizing prenatal care. When you say it aloud it just sounds so obviously wrong, whether or not you're asexual, homosexual, or infertile. And it's especially hypocritical for the anti-abortion set.

It's like the argument that childless property taxpayers shouldn't have to subsidize public schools. People just rely on vague handwaving about fairness and risk allocation. And, FWIW, it's also like arguing that taxes paid by pacifists shouldn't support the military. Even most liberals understand that it's a ridiculous assertion as a practical matter.

Everybody agree aspects of it needs to be changed. It was passed hastily while the Democrats had the votes--they even required two Republican defectors. The necessity for change was admitted from day 1.

But there's a difference between change and discarding the whole thing. The _core_ part of Obamacare, particularly wrt fiscal viability of adequate universal coverage, are 1) no pre-existing exclusions, 2) individual mandate, 3) and minimum coverage requirements.

Even Obama agrees that the system of exchanges needs changing. Those and other details, like subsidies and integration with Medicaid and Medicare aren't part of the core calculus. They were part of the political horse trading (among politicians, with the insurance industry, etc) necessary to see any national program passed. If sentiments change than those details can obviously be changed, too.

But if neither of those three things change, you'll still basically have Obamacare, and middle-class independent contractors or people with employer-sponsored policies are unlikely to see substantial changes from the status quo. If any of those three things change, you're likely going to see either a contraction of coverage in both quantity and quality, or ballooning government deficits.

If all people really want to see is the name change, have at it.

7 of those 8 states (exception, Illinois) have strongly Republican state legislatures. I'm not sure what the particular causes for the inflation in each state are, and I'd bet they vary. But I also suspect the correlation is telling to some degree.

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