The Health Insurance Marketplace is coming soon
healthcare.gov
healthcare.gov
[1] The worst part was the scammy "comparison" websites, who presented themselves as third-party information aggregators, but often turned out to be stealth affiliate-marketing fronts for a small subset of companies.
Two of the provisions that are in place already that really raised the cost of the vast majority's health bills are having to cover pre-existing conditions and cover students well into adulthood.
If I were to predict, I think ultimately you see more people go for high deductible / catastrophic only plans, creating a more transparent, open marketplace for most non-emergent/outpatient care. Perhaps the plans will provide some exceptions, such as coverage for cancer care - although that will probably happen over time when the government requires them to. I think that leads to lower costs for individuals. With the availability of more interesting pricing schemes, would also hope the disastrous icd-9 and cpt systems get wiped out, but less optimistic about that.
Coverage is about the same for me and much better on my wife's plan.
My mother, who couldn't get insurance for less than about $2300/mo because of preexisting conditions now has insurance that runs about $300/mo with decent coverage.
If I don't have company health insurance by then, it'll be hard to decide between no insurance and paying $300/mo. The main thing I would miss is getting a negotiated rate on medical expenses, even if I have to pay out of pocket; I'd maybe be able to negotiate with specific doctors for that, though, or find doctors who refuse to take insurance and quote a cash price. I'd already be tempted to go to Thailand for anything in the $1-5k range which was non-emergent.
It's only if you have a pre-existing condition and no group insurance that you will see your prices drop.
This is also exactly what is going to eventually bring down the existing US privatized health system, btw.
The accounting doesn't add up when you force a cap on premiums and allow unlimited ~10M treatments.
People will pay the yearly fine until they have a major health problem, and then join up after the fact.
Imagine if you only had to buy car insurance after you had an accident. Absolute disaster for insurance companies - monthly incoming way down while claims go thru the roof.
There are some limitations on this, though not airtight ones. If you don't enroll in the initial open-enrollment period from October 1, 2013 — March 31, 2014, you can't enroll completely freely after that. Subsequent enrollments are allowed only when you have a "qualifying life event", such as a change in employment situation, or a move between states. The main one that's clearly health-linked is that you can enroll upon pregnancy or childbirth (the argument for that appears to be based on the desirability of the child having health coverage, even if the father and mother were previously remiss on the subject). But it doesn't appear to be the case that you could just wait until you have a motorcycle accident, and then enroll for treatment.
There are two possible outcomes.
1) They find a way to cap the hi-money costs (approvals, delays, mandated procedures that are below today's level of care, etc.)
2) Eat the costs, then cry for a (I'm too big to fail) bailout.
Claims wouldn't go through the roof - the availability of "retroactive" insurance wouldn't increase the number of car accidents.
Also, there are a lot of people out there today who are suffering, but don't have the insurance to pay for their operations, medication, etc.
If it's not life threatening and they aren't on medicare, etc, right now they are unserved.
I hope people don't get the wrong impression that I feel sorry for the insurance companies.
My perspectives are purely from an accounting point of view.
Companies will make their money first.
You can count on that, even if it leaves the average American with a poorer health-care experience than they enjoy today.
HDHPs were always cheaper for employers than PPOs. Its just that making the shift is hard for a company, because it pisses employees off, and some leave. Many, many companies made the shift when they were able to transfer blame onto a little understood, complex law, despite the fact that the real driver for them doing so was double digit health premium inflation, year after year.
How would a public insurance option change this?
Part of being in a society is shared responsibilities. I subsidize the education of other peoples' children by paying taxes that fund k-12 education. I have no children of my own. But I'm not being cheated because a society that has universal, free k-12 education is better than one that doesn't. Similarly a society that has free, universal healthcare is better than one that doesn't.
In the current system the U.S. spends around 40% more GDP per year on healthcare than any universal healthcare system and has much lower outcomes than many. The evidence is that it would be cheaper and better to have a single payer system.
It's great that you workout and lead a healthy life. What are you doing to counter genetic defects you may possess? Perhaps you have a predisposition to cancer or some rare disease that is expensive to cover. The reward in a single payer system is that everyone gets covered regardless of genetic or life circumstances.
Every person for themself makes us all(almost all!) poorer.
> Similarly a society that has free, universal healthcare is better than one that doesn't.
That's a pretty broad, unsubstantiated statement. And how is it free? Nothing is free; that's just propaganda.
So everyone benefits from better education, but after a certain point any individual is better off not paying into it, which breaks the system if you lack consequences.
This is even more of an issue for healthcare than education, since people have wildly differing costs, and the mix of things you can control (healthy living) and things you can't (genetics) make it clash with lots of Americans' underlying political ideals.
In stark economic theory, health care would be very simple if we just let people who couldn't afford it die, because then nobody would bear the costs of catastrophic care. We as a society (thankfully!) don't do that, so we end up paying for it anyway when a poor person goes into the ER. Given the baseline that you don't let people die who can be saved, it's a short jump to a collective action problem, especially given the wildly varying income inequality and the fact that health care is demand inelastic and price insensitive (you'll pay any amount of money to not die, and for the foreseeable future people will always get sick/injured). I'd argue that it's better to internalize those costs - Insured people are cheaper overall, so everyone gets insurance and it gets subsidized by everyone, with transparent-ish rates, than externalize them (the hospital has to cover the un-negotiated costs of a poor cancer patient, so tylenol is now $17/pill)
I did not make it seem like I pay for k-12 education voluntarily. the opposite is true. It was an essential part of my point that it isn't done voluntarily. It should be forced because some greedy self-centered person will refuse to pay for it. It's called the free rider problem.
Societies that don't have free, universal healthcare overwhelmingly have worse health outcomes, and are crappier places to live.
So you if your ideas are good, you get support from your neighbors, and you get your idea moving, so the benefits start to accrue. Then the situation changes so that education 'exists' whether you individually pay for it or not, so you need to put in some penalty for not-paying otherwise the system falls apart when people start acting in their best interests... and next thing you know you've ended up with governance.
"evidence" or speculation?
[1] http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...
Unlucky people, in addition. Some people I know currently excluded by the preexisting condition issue: a person with MS, and a person with a congenital heart condition. They can get coverage only via employer group plans and cannot work for themselves, i.e. they are mandated to work for either a government or a corporation. That's a bizarre intrusion on personal liberty, much more severe than some taxes, and the fact that it's somehow a "natural" one doesn't make an ethical difference. See F.A. Hayek for a more extensive argument on a mechanism to cover "risks common to all" as a prerequisite for an individualist society, because the alternative is forcing people into nonconsensual collectivist arrangements (like having to work for a company to get a group health plan, or having to stay affiliated with the Mormon church or family clan to receive safety nets via such groups).
But hey, continue to rationalize your greed by despising everyone less fortunate than yourself as your lesser. People with MS should've gone to the gym more; poor people should've worked harder; you are John Galt.
Because when the guy who eats donuts has some numbness in his foot due to Type 2 diabetes, he's going to go to a doctor for advice since he has insurance. The doctor could catch him early enough to prevent the most devastating parts of diabetes and saving you more money than had he woken up one day unable to walk and called 911 and received an amputation that the state picked up the tab for.
This applies for everything. Poor people regularly never see doctors in their offices. They go to the ER when it's nearly too late and rack up huge bills in the most expensive facilities. We don't turn away patients with emergencies. The hospital will bill you and the state will cover you if you don't pay.
Edit: Here's a public health idea: tax sugar (or crops such as corn turned into sugar). We tax cigarettes; it's only fair in my opinion. And the tax on cigarettes makes e-cigarettes very economical.
Economically speaking, you should be penalized for your healthy habits. Of course, that doesn't fit in to the "we care about your health" line that insurers like to toss around, so they often just lie about what makes them money and use fat/smoker fines as a selling point aimed at healthy people. You've been had.
http://www.outsidethebeltway.com/fat_people_smokers_have_low...
Since insurance premiums are also paid on a per-year basis, per-year is the relevant point of comparison. Of course, in a single payer system which only receives payments from people while they work, it would in fact be beneficial to induce people to die earlier.
Performing the division to approximate yearly costs from the source I linked does not support your point. Obese people may have had the highest costs, but not the highest average yearly costs.
In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more. OTOH, private insurance wants to dump you as quickly as legally possible the moment your costs exceed your premiums weather you are healthy or not.
You are correct that for long term health insurance contracts (i.e., contracts which are guaranteed to cover people past the age of 56 at a fixed cost), fatties and smokers should pay less.
In a single payer health system, the "insurance provider" sees ROI from peoples' productivity, meaning the single payer system has incentive to keep people healthy even if it costs more.
This makes no sense. According to your link, the healthy people cost more due to medical costs incurred during their unproductive years. There is no incentive for a single payer system to keep people alive in their unproductive years.
As for subsidizing people, younger people are also subsidizing their older future selves, so it's not entirely win-lose.
Under the federal HIPAA law, individuals coming off group plans must have an option available to purchase a new plan without the possibility of denial due to pre-existing conditions. It is up to each state, however, to decide exactly how this will be implemented.
In Illinois, it is implemented as a state-provided insurance plan. In California, it is implemented through regulation of private insurance companies.
I have a very costly pre-existing condition and I can tell you which one I'd rather be on: California.
The reason is that the Illinois government is basically insolvent. Right now they are engaged in a political battle where even the state's lawmakers are threatened with not receiving a paycheck due to budgetary issues. This does not inspire my confidence that I want my health insurance provided by that organization (the state).
However, in California, I have Blue Shield, and no worries about its imminent dysfunction due to budget problems and political games. The insurance I get is expensive compared to what is optimal, but at least it is there.
Nice government website with an API? Get out.
I'm a little less impressed.
Philip Greenspun wrote a post about that sometime back.
http://blogs.law.harvard.edu/philg/2012/09/15/californias-st...
That's like saying medallion cabs have too much control on taxi service, therefore we should not remove restrictions which keep Uber and other competitors out of the market.
Since not every state insurance commissioner is captured by the insurance industry, this is a big problem for them so they're heavily lobbying the feds to create a situation where insurance policies are regulated by the state the company is based out of.
This will let them set up an operation like corporate governance and consumer lending have, where one of the most corrupt states like Delaware sets up rules that let insurance companies do whatever they want.
(1) To allow people to compare apples to apples by having, in the exchange, groups of plans that offer the same coverage.
In the current individual insurance marketplace, it is basically impossible to compare policies because they all differ on many different details, and finding out those details is a laborious, unrewarding, and confusing slog.
(2) To make sure that the plans in the exchanges would be considered insurance to a rational person. Right now, the individual market has a lot of low premium plans (i.e., plans for which you don't have to pay very much per month) which are next to useless when you actually NEED the insurance, because they don't cover very much at all. The idea is to maintain minimum standards of coverage so if you ever are in a situation when you really NEED insurance, you actually will HAVE insurance.