Hacker News Reader

Comment by skylan_q | Hacker News Reader

an act which would border on criminal negligence if it was done in the private sector and someone was harmed

For example, someone thought they got coverage for something and they didn't. That mis-communication can lead to actual harm when it comes to medical and financial issues.

View on HN

The good news is that the head of the new management of this project, the fix-it czar Jeffrey Zients, is saying the very top item of his punch list is to stop feeding garbage to the insurance companies.

The bad news it that it's taken this long for anyone in authority to even admit there's a major problem there, when there's only 7 weeks left to correct it for those who lose their insurance Jan 1.

Someone in another discussion brought up the Space Shuttle accidents. I'll bet you more people will die because of this monumental monstrosity ... except they didn't volunteer for something obviously dangerous.

While I agree with the rest of what you said, it's jumping to a few conclusions to say that lots of people will die because of this. People will think they are insured when they aren't, but the usual outcome of that is bankruptcy -- or a bunch of ugly and public lawsuits over who pays the bill.

I'm making a wild guess than more than 14 people will fall through the cracks and die. Certainly such stories have been used to sell Obamacare.

Ah, I just remembered that economists can predict over large populations how many will prematurely die if you remove X dollars from the population. I forget the now obsolete figures, but I'll bet on that basis alone there will be that many casualties.

Any time the visible foot of government makes such big steps people will die, it's a given.

I know those stories of "X number of people die every year from lack of insurance," which were sincerely believed by their speaks but lacking in rigor.

I'm expecting over the next few years, as the number of uninsured drops close to zero, that there will be no discernible drop in the number of annual deaths.

"I'm expecting over the next few years, as the number of uninsured drops close to zero"

Errm, it's as I understand it a well established fact that tens of millions will remain without coverage. Try a search like this: https://www.google.com/search?q=obamacare+won't+cover+everyo...

The first two links said 30 and 26 million, which agrees with my general memory. It was obviously a very early criticism of the ACA.

What I find is that the people who criticize the ACA on this point are also often opposed to the solutions that would shrink the number. It's dishonest.

1) Offering insurance to undocumented immigrants would shrink the number 2) Strengthening the mandate would shrink the number 3) Expanding medicaid to the states that "opted out" due to the Supreme Court decision would shrink the number

You also have to factor in life expectancy of various cohorts. Poor people will be healthier. Also note that the goal of ACA wasn't entirely to drop deathrates. Unlike before, the combination of pre-existing conditions, and elimination of annual/lifetime maximums means that people are now able to get essential health care without risking bankruptcy from medical bills. There really is a true out-of-pocket maximum now for essential care, for anyone that has health insurance. This was not true before the ACA.

I think that is very much setting the wrong bar. This sounds awful and cynical, but you have to compare the deaths the website might lead to, to the estimated counterfactual - how many would die in the status quo. The ACA prohibits "pre-existing condition" rejections, and it also prohibits "annual and lifetime maximums" (where the insurance companies say, "Oops, looks like we already paid out a million bucks on your cancer, you're on your own now!") And there's also the expanded Medicaid. So you have to factor in the lives that will be saved by the law.

Indeed. Although I'll note the not all plans really eliminate maximums, some require 20-30% (from what I've seen) copays after you max out your deductible.

People are going to be trying to figure this out for a long time (even if the ACA gets terminated with extreme prejudice in a few years). There are a LOT of factors:

The cost of guaranteed issue and community ratings is huge price increases for the under 50 set to subsidize the inherently more expensive 50-64 set (or so I've read, but I'm sure its roughly true).

A lot of people are losing the ability to work more than 29 hours at one place, or are just plain getting fired because they now cost more than they can produce, and that loss of wealth will have significant effects. Heck, the #1 piece of advice to get more subsidies is to make less money.

Then we get into the messy dynamic effects, where "Europe" is the object lesson: due to the changed game, a bunch of companies are not going to be founded or make it, or fail ... and in the longer term people are going to notice that there's no scenario where being married doesn't result in higher costs. Accounting for the effects of the latter is supremely difficult.

And then there's the argument this with all else Obama et. al. are doing (most certainly including the eGOP) is moving the US rapidly to failed nation status. It's hardly beyond the realm of possibility that will kill 10s of millions. If it denies me the medications I need to live, I'll be one of them....

ADDED: now that you've labeled me as dishonest (e.g. for not wanting to provide health care for illegal aliens (which, yes, is a harsh position)), I'm not sure there's much point in continuing to discuss this.

But also add the effects of reduced medical innovation. Starting with the 2.3% excise tax on medical devices, which we know from the history of "socialized medicine" will continue. One reason health care is so expensive in the US is that we pay nearly all the burden of new drug development....

If we manage to curtail the already feeble new antibiotic development efforts the results world wide will be measured in ... biblical proportions.

Just to respond to your first sentence. All ACA plans have a "coinsurance maximum". Meaning, you pay your deductible. Then you pay your 20%-30% coinsurance. And then when you reach your coinsurance maximum, your health insurance pays 100% of your health care costs. The coinsurance maximum varies with the plan but they're not very high. Mine is around $3500, and the biggest I've seen is $12,500 for "out of network care". On top of that, "annual/lifetime maximums" (where the insurance company STOPS paying for your care after a certain amount) are prohibited. And that is different than before. The upshot is that everyone on a health insurance plan truly has an out-of-pocket maximum now. (There's always the chance that I have missed something here, but this understanding is consistent with the intent of the law.)

I'm in my low 40's and my premium went down over 20%. I think the premium increases for people are also very much about the improved quality level of the plans, and some of that quality increase is "hidden" due to the old plans having lots of against-the-patient "tricks" that are now outlawed.

BTW, you have referred to my other comment a couple of times now. I am not saying it is dishonest to not want to provide health care for undocumented immigrants. I am saying that is intellectually dishonest to have that position, and simultaneously criticize Obamacare for not covering that number of uncovered patients. I believe that if someone criticizes a problem, it is their responsibility to also be in favor of the solution. That's a basic value in rational discourse/dialectic.

I'm covered by Medicare so I don't know these details; I do agree it would be insane to have unlimited coinsurance, and a little research shows that it's capped through the out-of-pocket maximum. Which in the Humana plan I just looked includes the larger deductable.

WRT to dishonesty, "e.g." -> for example, illegal aliens aren't the only ones included, just the most clear cut and harshest example for me; trust me, you're labeling me as dishonest.

Reply on news.ycombinator.com