Comment by VonGuard | Hacker News Reader

Comment by VonGuard | Hacker News Reader

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This comes from a very concerted effort by highly placed folks in the US (Koch Brothers, health care companies). Essentially, they create fear and confusion around the new laws through Fox News and dial-in radio, and American idiots eat it up like it was the Bible truth. The people in this country who are against the health care law, uniformly, know nothing about it and regurgitate Fox News BS when asked why it's a bad law.

Thing is, the law has its issues, but the other side never gets near them, they just make shit up "death panels" and government interference and stuff. I, as an American, am super embarrassed by all this. It doesn't help that the health care companies wrote the fucking law, anyway... now they're fighting against it!

The sad truth is, unless we have a single-payer, socialized medical system, none of these changes will help much. Really, the biggest change the new law enacts is that it forces health care companies to cover people with pre-existing conditions like Diabetes and heart disease. Right now, they can tell you to go away, they won't cover that stuff. IN 2014, I hear they'll be forced to at least offer you a psychotically expensive plan if you have diabetes.... Ah, this country sucks ass.

According to webmd, plan rates will only depend on age:

"" Q: Will there be a limit as to how high a premium insurance companies can charge if you have a pre-existing condition?

A: Yes. As of 2014, insurers cannot charge consumers different rates for health insurance because of health status or gender.

You can be charged more for your age, however, with older people paying a higher premium than young people. But that increased charge is capped at no more than three times the standard rate"[1]

Edit: Actually "The law allows for differences of premiums based only on four criteria: age, location, family size, and smoking."[2], which seems like a good way to do racial profiling and increasing premiums on poor people(since they're probably less healthy), as expected in the u.s, but at least pre existing conditions couldn't be a basis for a rate difference.

I wonder thought how legal would be doing data mining with this information (an other free datatbases) , and how much deanonimization could be practically achieved ?

[1]http://www.webmd.com/health-insurance/health-reform-insuranc...

[2]http://ahip.org/Issues/January-1-2014-Provisions.aspx [1]http://www.webmd.com/health-insurance/health-reform-insuranc...

I don't think I fit your description of those who don't like the ACA, but I don't like it none the less.

I believe we could fix health care costs by removing just one law.

Stop making health insurance a tax deductible employee benefit.

Think critically about the effect that small change would have and you'll see why our system is broken.

While I totally agree with your proposed change, I don't think that fixes the system as a whole - especially if it were the only change to the pre-ACA state of affairs.

As an interested non-American, how would that change the system?

In the US, if your employer pays for your health insurance, they pay for it with pre-tax dollars. If you buy it, you buy with post tax dollars. That's why employers pay for it in lieu of paying you more.

If your employer pays for your car insurance as a benefit, they pay for it with post tax dollars, so they don't do that.

So, employers pay the premium on your health care for the tax advantage. Now consider the how psychology behind not being the one who pays for the premium.

Do you care how much your services cost? No.

Do you care if the premium goes up? No.

Do you shop around for better insurance? No.

Do you care if you loose your job if you're sick? Hell yes.

In effect all normal market pressures are gone. No one who consumes resources cares about their costs because they're are completely disconnected from paying them or some derivative of them.

This is why doctors don't post prices.

While the net effect for people with employer provided health insurance is ever increasing rates, the effect on those people without health insurance is brutal. They are trying to enter a market that has no price pressure.

So essentially the market for health insurance is competitive on what companies can afford rather than individuals? So the proposed change would force insurance companies to be more competitive on a smaller scale and in the long run, cheaper. Interesting.

Health insurance is weird in the US. In World War II we had wage controls which kept wages tight. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers. As a result it became the defacto standard to get your insurance through your employer and your employer picks a company and group plan that spreads the risks over everyone and pays most or all of the premiums with before tax dollars. Employees can usually pick from a few plans (individual or family, maybe two levels of coverage) For example, my employer pays 2/3rds of my premiums and I pay 1/3rd. They would rather give me health insurance than money for my own health insurance because they don't have to pay taxes on the health insurance premiums they pay for me. Nobody gets a choice in what your employer picks as a health insurance. If I wanted my own insurance of my choice I would have to opt out my that extra money my employer kicks into my health insurance (I would lose it, I couldn't apply it to my own plan, and it is a substantial amount of money)

Sorry, I don't mean to take this out on you in particular. And I'm hardly an ACA fanboy myself. But your comment just goes to show that no one has a clue about what the ACA actually does, and it drives me crazy.

The ACA does remove that tax exemption, albeit partially. Every dollar above $10k or so ends up being taxed now. And not a small amount, either: the tax is to the tune of 40%. And since the cost of healthcare will continue to rise faster than inflation for the foreseeable future, more and more employer health plans are going to be hitting that number.

I'd certainly prefer the tax exclusion to disappear entirely, but the ACA is nothing if not an attempt to offer coverage to the poor and people with pre-existing conditions while doing the minimum possible to disrupt the healthcare market. That's why it's a bit of a Frankenstein: no one in their ideal world would have chosen the ACA as their ideal policy. But given the set of institutional actors and the setup of our government, it may well be the best that was possible. That's how the Obama administration thought of it, at least.

IIRC that tax was actually a pretty nasty fight between the Obama administration and labor unions, who get their members relatively good benefits and will be hit disproportionately by it. And you know what? The tax-free cap may well have been significantly lower with Republican input. But they chose to put 100% of their efforts into making a mediocre law fail than trying to turn it into a good or great one.

Apologies for the angry rant.

Pretty sure that's wrong.

Employer premium contributions for employees and their opposite-sex spouses and tax dependents are 100% deductible as business expenses under federal and state tax law. This is true regardless of business type-sole proprietorship, partnership, LLC, corporation, etc. These rules also apply to owners of C corporations and LLCs classified as corporations for tax purposes. These business owners are considered to be employees of the business for purposes of the tax treatment of premium contributions.

http://healthcoverageguide.org/reference-guide/laws-and-righ...

No, that website is mistaken, or at least not addressing the same thing we're talking about.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?br...

Here's the important bits:

A 40 percent excise tax will be assessed, beginning in 2018, on the cost of coverage for health plans that exceed a certain annual limit ($10,200 for individual coverage and $27,500 for self and spouse or family coverage). Health insurance issuers and sponsors of self-funded group health plans must pay the tax of 40 percent of any dollar amount beyond the caps that is considered "excess" health spending.

So, you cherry picked a bunch of stuff here.

1) Neglected to state it starts 4 years from now...a lot can happen in that time.

2) Neglected to state 10K limit is for individuals, 27K for families.

3) Confused excise tax and tax exemption.

I don't think anything here refutes my point or makes what I said incorrect.

You complained that no one is proposing that we tax employer health plans instead of creating a subsidy that distorts the market and raises prices.

I point out that the ACA did do that. Not enough to yours or my liking, but it did nonetheless.

Your response is to complain that it didn't go far enough. Sure. But the least you can do is recognize that the ACA certainly does do something in the spirit of what you were claiming no one had attempted. That doesn't mean you have to like the law as a whole.

I respectfully disagree - I think the biggest change the law enacts is the cap on the MLR. Telling insurance companies they have to cover those with pre-existing conditions doesn't make them want to cover those with pre-existing conditions, it just makes them not want to be sued for one more thing. That is no kind of motivation to keep costs down or provide decent service - if Joe Sicko says "screw this, I am going to your competition" they break out the champaigne. With the MLR cap, having one more person means they can take home more money, so long as they're operating near the cap to begin with.

I love how you make baseless accusations directed at the "Koch brothers" based on an article that doesn't even say that there were actual denial of service attacks.

Then you poke fun at "American idiots", and then admit in your last sentence that you don't really even know how the law works yourself.

Bonus points for picking the two conditions, heart disease and diabetes, that mostly result from poor choices instead of random innocent victims.

Your whole post is like a parody of pseudo-intellectual liberalism.

Uhm.... Diabetes can be a life-long disease. Way to discount people for being irresponsible. Clearly people who eat too many sweets don't deserve health care in your eyes.

Which is why I said "mostly". Anyway, remove that sentence and the rest of my comment stands.

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