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Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 11:41 am
by LawBeefaroni
Stealing the other thread title to start a new one.


Hearing a lot of rumor and speculation but some of the more solid views:
  • Pre-ex is going to go away as one of the first casualties.
  • Employer cash-out replacing employer coverage is going to happen a lot more (employers give employees a flat cash payment and let them fend for themselves in the individual insurance market).
  • Insurance premium tax writeoff for employees will happen (currently employers can write-off their contribution, Trump wants to allow employees to do this as well).
  • Safety-net hospitals are going to get killed when disproportionate share and other make-wholes are drastically diminished.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:41 pm
by stessier
LawBeefaroni wrote:Stealing the other thread title to start a new one.


Hearing a lot of rumor and speculation but some of the more solid views:
  • Pre-ex is going to go away as one of the first casualties.
Isn't that politically stupid? I thought I even heard Fox people (its on in the gym) saying it is one of the mostly widely approved up provisions.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:43 pm
by Jeff V
stessier wrote:
LawBeefaroni wrote:Stealing the other thread title to start a new one.


Hearing a lot of rumor and speculation but some of the more solid views:
  • Pre-ex is going to go away as one of the first casualties.
Isn't that politically stupid? I thought I even heard Fox people (its on in the gym) saying it is one of the mostly widely approved up provisions.
See, there you go thinking he's out to serve the people and not the insurance companies.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:44 pm
by Defiant
I thought the parts he wanted to keep were preexisting conditions and children being able to stay under their parents plans, and wanted to gut everything else.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:44 pm
by malchior
If you repeal the part where you mandate people get coverage than you have to get rid of pre-ex. They can't exist without each other.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:44 pm
by Paingod
stessier wrote:Isn't that politically stupid?
He has defied political intelligence thus far. He has none. Whatever he's doing isn't about his political career; he doesn't have one to worry about. We just have to rely on a whole lot of other people who do and hope they care, left or right. What disgusts me is that by getting rid of ACA, he'd be effectively killing countless people who wouldn't have survived without it.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:45 pm
by Defiant
The ACA made the practice of excluding select conditions illegal, forcing insurers to cover all illnesses, pre-existing and otherwise.

Trump says his plan will retain this provision.
Trump also vowed on “60 Minutes” to continue giving parents the option of cover their adult children until the age of 26.
http://wkrn.com/2016/11/21/trumps-obama ... whats-out/

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 3:48 pm
by stessier
Okay, I thought I heard that somewhere. Thanks.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 4:04 pm
by LawBeefaroni
malchior wrote:If you repeal the part where you mandate people get coverage than you have to get rid of pre-ex. They can't exist without each other.
This. It's like promising unicorns for every child under the age of 10. Sounds awesome but not possible. Well, unless you slap horns on ponies, call them unicorns, and spend a shitload of money. And even then it will be underwhelming.


I have no idea how they'll dress it up or couch it but it needs to go away if you intend to dismantle the rest of the ACA.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 4:07 pm
by LawBeefaroni
Defiant wrote:
The ACA made the practice of excluding select conditions illegal, forcing insurers to cover all illnesses, pre-existing and otherwise.

Trump says his plan will retain this provision.
Trump also vowed on “60 Minutes” to continue giving parents the option of cover their adult children until the age of 26.
http://wkrn.com/2016/11/21/trumps-obama ... whats-out/
He also said he would build a wall around the country, spend $1T on infrastructure, and lower taxes.


Coverage of dependents until the age of 26 is nothing. They're the healthiest demographic and if you make it an "option" you can always charge more. Adding 18-26 year-olds to the pool is a godsend.

Keeping in pre-ex coverage goes against all actuarial logic.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 4:21 pm
by Jeff V
malchior wrote:If you repeal the part where you mandate people get coverage than you have to get rid of pre-ex. They can't exist without each other.
Well, not necessarily. You can't get rid of pre-existing conditions and also mandate every one get coverage, but the converse is not true. You could I suppose craft a law that states everyone who wishes to purchase health insurance be given opportunity to do so. Of course, I'm sure that insurance companies will arrange a loophole where they can set the price for pre-existing conditions. The law wouldn't state that it had to be affordable; that term is forever linked to Obamacare.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 4:24 pm
by RunningMn9
LawBeefaroni wrote:[*]Pre-ex is going to go away as one of the first casualties.
Isn't that the one that causes the most problems? That's the one that results in the possibility of 17-20M people losing their health insurance.
LawBeefaroni wrote:[*]Employer cash-out replacing employer coverage is going to happen a lot more (employers give employees a flat cash payment and let them fend for themselves in the individual insurance market).
Ironically, this was the biggest thing missing from the ACA as far as I was concerned. The system needs to be such that I am shopping for my health insurance, rather than my employer. I know my needs better than my Corporate Overlord. Although in this case, this specifically will hurt me, as my employer has decided that I need excellent insurance coverage, and that he should pay for all of the premium. I will take one for the team though.
LawBeefaroni wrote:[*]Insurance premium tax writeoff for employees will happen (currently employers can write-off their contribution, Trump wants to allow employees to do this as well).
Aren't insurance premiums generally paid with pre-tax dollars? I know that when they are part of a qualifying "cafeteria" plan, the premiums come out pre-tax.
LawBeefaroni wrote:[*]Safety-net hospitals are going to get killed when disproportionate share and other make-wholes are drastically diminished.
That sounds more like consequences of his plan, rather than his plan (presumably it's not a stated goal of any plan to kill safety-net hospitals).

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 4:43 pm
by malchior
RunningMn9 wrote:
LawBeefaroni wrote:[*]Insurance premium tax writeoff for employees will happen (currently employers can write-off their contribution, Drumpf wants to allow employees to do this as well).
Aren't insurance premiums generally paid with pre-tax dollars? I know that when they are part of a qualifying "cafeteria" plan, the premiums come out pre-tax.
They are when you are paying into an employer-sponsored plan. Otherwise they are post-tax. But that is a simplification. If you get over a certain threshold you can start deducting medical expenses on your own but the reality is the field is tilted towards you having an employer covering you. That harkens back to the health care policy of the "good old days" surviving to today.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 4:48 pm
by LordMortis
Let's make health care great again?

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:18 pm
by LawBeefaroni
RunningMn9 wrote:
LawBeefaroni wrote:[*]Employer cash-out replacing employer coverage is going to happen a lot more (employers give employees a flat cash payment and let them fend for themselves in the individual insurance market).
Ironically, this was the biggest thing missing from the ACA as far as I was concerned. The system needs to be such that I am shopping for my health insurance, rather than my employer. I know my needs better than my Corporate Overlord. Although in this case, this specifically will hurt me, as my employer has decided that I need excellent insurance coverage, and that he should pay for all of the premium. I will take one for the team though.
Except that your employer presumably has greater leverage in the insurance market than you do. And generally an employer that errs on the side of excellent coverage is going to have less care-averse and/or bankrupt employees. What do you think most people would do if they suddenly got a portion of their employer's premium liability along with their own contribution? Unless you force them to spend it all on healthcare, you're are going to have a lot of employees with new cars and appliances.

The best way to put the burden on the employee is aggressive cost sharing, not completely washing your hands of any responsibility, and market leverage, as an employer. Employers are starting down the former path. Well, they were.

RunningMn9 wrote:
LawBeefaroni wrote:[*]Insurance premium tax writeoff for employees will happen (currently employers can write-off their contribution, Trump wants to allow employees to do this as well).
Aren't insurance premiums generally paid with pre-tax dollars? I know that when they are part of a qualifying "cafeteria" plan, the premiums come out pre-tax.
From what I understand he wants everyone (who pays taxes) to be able to deduct the full amount of the premium. This is great for anyone with a tax liability buying individual insurance on the open market, and it ramps up with income and premium spend, obviously. So the independently wealthy buying Cadillac plans.
RunningMn9 wrote:
LawBeefaroni wrote:[*]Safety-net hospitals are going to get killed when disproportionate share and other make-wholes are drastically diminished.
That sounds more like consequences of his plan, rather than his plan (presumably it's not a stated goal of any plan to kill safety-net hospitals).
Sure. But it's a pretty important consequence. There are hospitals that will shut down overnight if they lose significant dish payments.






Neither here nor there, but in the slow pre-Thanksgiving week, I get to do market research. I just did an analysis of the exchange plans available in our service area. The total is down to 38 from 69. That's not a big deal, the poor performers left the market and insurers lopped of the unpopular plans. Of note, however, is that average premiums are up 26%, average deductibles are up 25%, OOP max up 8%, and PCP copay up 20%. Medians all changed roughly the same % so it's not like they just added plans in the margins.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:24 pm
by Jeff V
RunningMn9 wrote:
LawBeefaroni wrote:[*]Pre-ex is going to go away as one of the first casualties.
Isn't that the one that causes the most problems? That's the one that results in the possibility of 17-20M people losing their health insurance.
When I was in between jobs once, I got a telemarketing call wanting to sell me health insurance. When I mentioned I was diabetic, the enthusiastic call (happy to not have the phone slammed on her), stopped mid spiel and apologized, saying there was nothing she could do for me and suggested I would only find coverage from an employer's group plan.
LawBeefaroni wrote:[*]Employer cash-out replacing employer coverage is going to happen a lot more (employers give employees a flat cash payment and let them fend for themselves in the individual insurance market).
Ironically, this was the biggest thing missing from the ACA as far as I was concerned. The system needs to be such that I am shopping for my health insurance, rather than my employer. I know my needs better than my Corporate Overlord. Although in this case, this specifically will hurt me, as my employer has decided that I need excellent insurance coverage, and that he should pay for all of the premium. I will take one for the team though.
I have shitty insurance, given my company's apathy towards it's employees, likely they are contributing the bare minimum. Theoretically though, it would still be cheaper (as a group plan) than what I would find, if I could find, something on the open market.
LawBeefaroni wrote:[*]Insurance premium tax writeoff for employees will happen (currently employers can write-off their contribution, Trump wants to allow employees to do this as well).
Aren't insurance premiums generally paid with pre-tax dollars? I know that when they are part of a qualifying "cafeteria" plan, the premiums come out pre-tax.
I know mine aren't. While this sounds like a nice bone, I bet the stratospheric rise in premiums will more than outpace any tax savings.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:25 pm
by gilraen
Jeff V wrote:
malchior wrote:If you repeal the part where you mandate people get coverage than you have to get rid of pre-ex. They can't exist without each other.
Well, not necessarily. You can't get rid of pre-existing conditions and also mandate every one get coverage, but the converse is not true. You could I suppose craft a law that states everyone who wishes to purchase health insurance be given opportunity to do so. Of course, I'm sure that insurance companies will arrange a loophole where they can set the price for pre-existing conditions. The law wouldn't state that it had to be affordable; that term is forever linked to Obamacare.
And that's the biggest question that Ryan et.al. aren't bothering to address in their pink unicorn dream of ACA replacement. Sure, you can pass a law that the insurance company is obligated to provide you with a policy. If that policy costs $5000 a month, they are still compliant with the law...never mind that no one that actually needs it will be able to afford it (and that will be the point, that's how you get rid of the most expensive patients).

If Republicans Repeal Obamacare, Ryan Has Replacement Blueprint
"Most of the care that most people need for most of their adult lives can be very inexpensive," Howard says.

So rather than spending a lot of money on premiums for insurance they don't need, people could save that money for when they do get sick. Howard says people could start young and save for major health problems over time.

"By the time you're 40, ideally, you would have built up a health savings plan that would be partly funded by government sources, plus your own sources, a significant nest egg," he says.
Uh...so they expect everyone to be able to save thousands of dollars when they are just starting out their careers, families, paying off student loans, trying to buy a house etc? This is just batshit insane.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:33 pm
by LawBeefaroni
gilraen wrote:
Jeff V wrote:
If Republicans Repeal Obamacare, Ryan Has Replacement Blueprint
"Most of the care that most people need for most of their adult lives can be very inexpensive," Howard says.

So rather than spending a lot of money on premiums for insurance they don't need, people could save that money for when they do get sick. Howard says people could start young and save for major health problems over time.

"By the time you're 40, ideally, you would have built up a health savings plan that would be partly funded by government sources, plus your own sources, a significant nest egg," he says.
Uh...so they expect everyone to be able to save thousands of dollars when they are just starting out their careers, families, paying off student loans, trying to buy a house etc? This is just batshit insane.
A "significant nest egg" for most people would be wiped out by a partial knee replacement or ER visit for chest pains. Hell, a few screws would liquidate a good chunk of most people's retirement. Unless they're going to regulate cost and charges this is an absurd idea.
"Most of the care that most people need for most of their adult lives can be very inexpensive," Howard says.
But there's that one or two inevitable times when it's not inexpensive. It's like saying "Most of the time people drive, they don't get into accidents. So why make them buy auto insurance when they could just save up and create a nice liability fund?" Look at Medicare, for F's sake.

Call my cynical, but I'm just not of the belief that most Americans are good self-insurers.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:36 pm
by RunningMn9
LawBeefaroni wrote:Except that your employer presumably has greater leverage in the insurance market than you do. And generally an employer that errs on the side of excellent coverage is going to have less care-averse and/or bankrupt employees. What do you think most people would do if they suddenly got a portion of their employer's premium liability along with their own contribution? Unless you force them to spend it all on healthcare, you're are going to have a lot of employees with new cars and appliances.

The best way to put the burden on the employee is aggressive cost sharing, not completely washing your hands of any responsibility, and market leverage, as an employer. Employers are starting down the former path. Well, they were.
A couple of thoughts:
1) My particular employer probably doesn't have any greater leverage than I do. It's a very small company. He's just awesome, that's all.

2) As a general rule, employers aren't using their leverage to the benefit of employees. Employers are using their leverage to the benefit of employers.

3) One size does not fit all. The insurance plan that I need is not the insurance plan that some of the older folks need, or some of the younger folks, or some of the folks that are the same age. My employer has no opportunity to comparison shop based on what *I* need from a health insurance plan.

4) The best way to put the burden on the employee is to recognize that as a strategy for insuring people - tying it to employment is stupid, for all the same reasons that I wouldn't want my car insurance tied to my employment.

5) I might spend it all on hookers and blow. But I've got kids, and they need to be kept healthy, and I need insurance to do that. So I probably won't spend it all on hookers and blow. But yes, I almost certainly won't spend it on health insurance, because I don't need the extensive health insurance policy that my employer currently offers.

6) And here's where I'm asking questions - one of the reasons that I suspect that the individual exchanges are how they are is that there are 100+M healthy people that aren't buying insurance through them, no? If the exchanges are limited to individuals and the previously uninsurable, that will jack up premiums over time, no? By getting all manner of healthy folks out of employer-sponsored plans and into exchange-based plans, that changes the balance, no?

7) I don't have any leverage when it comes to buying car insurance, except that I do. Why? Because me buying car insurance is tied to free market principles. While I must buy car insurance here in NJ, I don't have to buy it from any particular insurance company. The insurance company must do what they can to attract my business. The insurance company must then do what they can to retain my business.

Employer-provided health insurance is stupid.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:39 pm
by RunningMn9
Buying on the individual market now is not like buying on the individual market in a world without employer-provided/subsidized plans.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:42 pm
by LordMortis
RunningMn9 wrote:7) I don't have any leverage when it comes to buying car insurance, except that I do. Why? Because me buying car insurance is tied to free market principles. While I must buy car insurance here in NJ, I don't have to buy it from any particular insurance company. The insurance company must do what they can to attract my business. The insurance company must then do what they can to retain my business.

Employer-provided health insurance is stupid.
Won't car insurance rape you if you make claim after claim after claim? It seems like auto insurance and health insurance hold different spheres. One seems to be designed to control on going costs. The other is meant to never be used.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:52 pm
by Jeff V
RunningMn9 wrote:
7) I don't have any leverage when it comes to buying car insurance, except that I do.
We have a group car insurance plan available, and the rates are MUCH cheaper than anything else top tier on the market. I thought I was getting a good rate before switching, and this cut it in half. :shock:

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 5:58 pm
by RunningMn9
LordMortis wrote:Won't car insurance rape you if you make claim after claim after claim? It seems like auto insurance and health insurance hold different spheres. One seems to be designed to control on going costs. The other is meant to never be used.
Car insurance is structurally different, and I am not comparing health insurance to auto insurance. I am comparing the health insurance market to the auto insurance market. Within the auto insurance market, insurers are forced to compete to obtain and retain my business. Right now, for most of us in the private health insurance market, insurers are not forced to compete to obtain and retain my business. No one is directly addressing my needs.
JeffV wrote:We have a group car insurance plan available, and the rates are MUCH cheaper than anything else top tier on the market. I thought I was getting a good rate before switching, and this cut it in half.
I don't know what to make of your anecdotal example. Is the plan subsidized? Were your previous investigations into rates faulty? I have no idea. I know that I cut my rate in half as well, and I don't have access to a group car insurance plan. Either way - tying my car insurance to my employer is also stupid.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 6:07 pm
by LawBeefaroni
RunningMn9 wrote:
LawBeefaroni wrote:Except that your employer presumably has greater leverage in the insurance market than you do. And generally an employer that errs on the side of excellent coverage is going to have less care-averse and/or bankrupt employees. What do you think most people would do if they suddenly got a portion of their employer's premium liability along with their own contribution? Unless you force them to spend it all on healthcare, you're are going to have a lot of employees with new cars and appliances.

The best way to put the burden on the employee is aggressive cost sharing, not completely washing your hands of any responsibility, and market leverage, as an employer. Employers are starting down the former path. Well, they were.
A couple of thoughts:
1) My particular employer probably doesn't have any greater leverage than I do. It's a very small company. He's just awesome, that's all.
If he doesn't have any leverage, he should. As a side project last year I got group leverage for a bunch of 3-20 employee independent offices. There are several fast-and-loose rules that small businesses can use to get at least slightly-better-than-individual pricing.
2) As a general rule, employers aren't using their leverage to the benefit of employees. Employers are using their leverage to the benefit of employers.
Often the benefits of the employee and employer align.


3) One size does not fit all. The insurance plan that I need is not the insurance plan that some of the older folks need, or some of the younger folks, or some of the folks that are the same age. My employer has no opportunity to comparison shop based on what *I* need from a health insurance plan.
This is true. It's a trade off between cost and customization. And if everyone only buys what they think they need the sick and elderly will be priced out of insurance. And so you'll end up paying for them anyway (or you'll be stepping over their corpses in the street).
4) The best way to put the burden on the employee is to recognize that as a strategy for insuring people - tying it to employment is stupid, for all the same reasons that I wouldn't want my car insurance tied to my employment.
Ok, but right now most people not insured by the government are insured by their employers. I agree that it should be a strategy for all health insurance and there is nothing keeping it off the individual marketplace.
5) I might spend it all on hookers and blow. But I've got kids, and they need to be kept healthy, and I need insurance to do that. So I probably won't spend it all on hookers and blow. But yes, I almost certainly won't spend it on health insurance, because I don't need the extensive health insurance policy that my employer currently offers.
You might not need all the bells and whistles, I agree. And you're probably well equipped to make the proper decision for you and your family. Everyone else feels the same way. But not everyone else is right.

6) And here's where I'm asking questions - one of the reasons that I suspect that the individual exchanges are how they are is that there are 100+M healthy people that aren't buying insurance through them, no? If the exchanges are limited to individuals and the previously uninsurable, that will jack up premiums over time, no? By getting all manner of healthy folks out of employer-sponsored plans and into exchange-based plans, that changes the balance, no?
That was the intent. And it's true, in theory, it should work that way. Getting all those healthy individuals into the pool will lower everyone's cost. Part of the failure of the ACA Exchanges was the gutting of the language that required greater participation. It's not something you can gradually shift to. Everyone in or it doesn't work

7) I don't have any leverage when it comes to buying car insurance, except that I do. Why? Because me buying car insurance is tied to free market principles. While I must buy car insurance here in NJ, I don't have to buy it from any particular insurance company. The insurance company must do what they can to attract my business. The insurance company must then do what they can to retain my business.

Employer-provided health insurance is stupid.
If we mandated insurance, as in you had to have it as a condition of driving your body around legally, and didn't allow people to opt-out by paying a token penalty, that would be a great model.

Have you tried pricing out individual coverage? I'd recommend doing so and seeing what kind of coverage you can get at what price.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 6:18 pm
by LawBeefaroni
Another thing to consider that sets health insurance apart from other insurance is that most people don't view health care as a straight commodity. A human knee isn't like a front fender on a car. What this means could be an interesting discussion but the short version is that with hospital networks, doctors, and individual physiology, health insurance is a fucked up business.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 6:21 pm
by malchior
RunningMn9 wrote:Employer-provided health insurance is stupid.
Yep - we've taken a nation of people who are all humans and subject to the same risks (generally speaking) and divided us up into relatively small risk pools and hope they don't individually hit the inverse lottery necessitating the company take the hit or pass it along to the employees. As an example, our largest private employer employs around a half-percent of the population and probably has less than half in their plan (Walmart naturally). So now you have to worry about how big your employer is, how much profit they have to absorb losses, and how competitive that employer has to be to keep employees. It's a completely illogical way to run an insurance system. And the employer's have figured that out so have been systematically shedding as much risk as the market can bear onto the employee. The system has mutated to be opaque, user unfriendly, full of financial traps you have little chance of avoiding, and is systematically unfair to entire segments of the population. Yet repealing the ACA without a top down reform only returns to a previous state where it was trending to a far worse place. Selling across state lines might help with the pooling problem but it doesn't help with all the jurisdictional issues and how health care delivery networks are laid out right now. Any change you make in pieces serves to only trigger a cascading failure somewhere else in the system. That is why ACA was built so much on the existing system - it is a very unstable and inefficient system.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 6:24 pm
by Jeff V
RunningMn9 wrote:
JeffV wrote:We have a group car insurance plan available, and the rates are MUCH cheaper than anything else top tier on the market. I thought I was getting a good rate before switching, and this cut it in half.
I don't know what to make of your anecdotal example. Is the plan subsidized? Were your previous investigations into rates faulty? I have no idea. I know that I cut my rate in half as well, and I don't have access to a group car insurance plan. Either way - tying my car insurance to my employer is also stupid.
Our company uses this insurer for other things, such as life insurance and long-term disability. I have no idea if the rate a function of accrued discounts from other sectors (ie, if you bought life/home/car insurance yourself from the same vendor, they provide a discount). Prior to this, I had a 3-policy discount from a major insurer that was far less than any offers received each time I went shopping. Going through my employer was a substantial savings. I've also had two incidents since being with them and my rate has not changed. With my prior insurer, I had to eat everything myself because the after deductible amounts were not big enough to offset the immediate rate hike.

In any case, if being stupid means I get to save a lot of $$$, fine, call me a moron.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 7:06 pm
by RunningMn9
LawBeefaroni wrote:Another thing to consider that sets health insurance apart from other insurance is that most people don't view health care as a straight commodity. A human knee isn't like a front fender on a car. What this means could be an interesting discussion but the short version is that with hospital networks, doctors, and individual physiology, health insurance is a fucked up business.
Somewhere in the digital ether I have a very complex position paper on why I believe that the free market does not and cannot apply to healthcare, and your comment here is the crux of it.

There are a number of factors required in order for free markets to work properly. Consumers need to be able to choose from alternatives that compete on cost / features / etc. Consumers need to have that information in advance, and not six months after they consumed. They need time to make decisions. And most importantly, they need to be able to not consume.

I used DVRs as my perfect example of how free markets work. The healthcare analogue for me was voluntary procedures like lasik. The quality is consistently going up, while costs have gone way down since the procedure was introduced.

This is because people don't typically *need* lasik. They can take their time, find the right doctor based on quality/cost metrics that they define. It has worked beautifully.

But if my heart detonates, I have no time to make a decision. The utility in repairing my detonated heart approaches infinity, and I always want the best quality of care regardless of cost (which I won't know for months anyway).

Detonating hearts cannot be dealt with by free markets.

Re: Trump's Full Court Press on healthcare

Posted: Mon Nov 21, 2016 9:03 pm
by Zarathud
Allowing out-of-state plans allows insurers to move to the lowest cost state to sell the crappiest minimum insurance.

Right now insurance is state regulated. The People's Republic of New Jersey can require coverage in their state to address regular health risks of the population. The Deregulated State of Alaska can take a more relaxed approach on the theory that you know the risks of being in the arctic. Based on cost concerns in each state, regulators can act to make sure the insurer can cover claims. Moving all that to one state creates a very powerful business lobby in the most weak-willed state.

It's a poorly thought out ideological approach that rewards business, as usual.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 11:32 am
by Fireball
Zarathud wrote:Allowing out-of-state plans allows insurers to move to the lowest cost state to sell the crappiest minimum insurance.

Right now insurance is state regulated. The People's Republic of New Jersey can require coverage in their state to address regular health risks of the population. The Deregulated State of Alaska can take a more relaxed approach on the theory that you know the risks of being in the arctic. Based on cost concerns in each state, regulators can act to make sure the insurer can cover claims. Moving all that to one state creates a very powerful business lobby in the most weak-willed state.

It's a poorly thought out ideological approach that rewards business, as usual.
Yup. This would be a replay of what happened with credit cards. Every credit card issuing entity moved to states with weak usury laws, and the average interest payments Americans were saddled with for credit cards shot up dramatically.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 12:29 pm
by Zarathud
The credit card changes led to a surge of predatory lending, followed by increased personal bankruptcies and then denunciations of personal responsibility by those who abdicated political responsibility.

We'll see insurance exclusions increasing, lifetime limits and fewer opportunities to contest denials of coverage. Your employer won't even be able to keep your coverage. Without a lifetime to save for one-time catastrophic expenses, the HSAs will fail to cover the need. Millions with recurring medical problems will be unable to buy coverage at any price. But profits of predatory insurers will be up enough to fund PR and lobbying campaigns.

These events aren't hard to forecast if you think rationally about economic behavior.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 12:50 pm
by PLW
RunningMn9 wrote:Buying on the individual market now is not like buying on the individual market in a world without employer-provided/subsidized plans.
This! Trump will never do it, but dropping the employer mandate/subsidy and moving everyone into the individual market with no other significant changes, really would be repealing and replacing Obamacare in a way I could get behind.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 1:16 pm
by LawBeefaroni
PLW wrote:
RunningMn9 wrote:Buying on the individual market now is not like buying on the individual market in a world without employer-provided/subsidized plans.
This! Trump will never do it, but dropping the employer mandate/subsidy and moving everyone into the individual market with no other significant changes, really would be repealing and replacing Obamacare in a way I could get behind.
Employers would still offer healthcare as a benefit to attract talent. So you'd then have the plebs with their individual insurance and the employer group insureds with their employer backed and grouped plans. Unless you want to prohibit employers from offering healthcare as a benefit.

Also, what happens to Medicare/Caid and VA/Federal plans in such a scenario? What about union employee and retiree insureds? There are a lot of people with healthcare-for-life promises that you'd have to deal with.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 2:06 pm
by PLW
No. I don't want the govt to encourage or discourage firms offering health insurance. I believe that removing the encouragement/mandate would result in lots of folks moving to the individual market.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 2:51 pm
by Zarathud
As a middle age dude with kids who have health conditions, I want to stay away from individual markets.

Our health care system restricts entrepreneurs because the health risks add to the business risks. If Obamacare was allowed to create healthy public exchanges, you could make work decisions independent of health care needs.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 3:09 pm
by LordMortis
Zarathud wrote:As a middle age dude with kids who have health conditions, I want to stay away from individual markets.

Our health care system restricts entrepreneurs because the health risks add to the business risks. If Obamacare was allowed to create healthy public exchanges, you could make work decisions independent of health care needs.
Yeah, I'm as good as dead when I retire. I should just retire now, enjoy what I've saved with the remnants of the health I have left and save just enough to find a Jack Kavorkian I can afford so I'm not a burden or alternatively forced to languish to assuage some sort of everyone must fight to live forever guilt that nearly everybody seems to have.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 3:38 pm
by PLW
Zarathud wrote:As a middle age dude with kids who have health conditions, I want to stay away from individual markets.

Our health care system restricts entrepreneurs because the health risks add to the business risks. If Obamacare was allowed to create healthy public exchanges, you could make work decisions independent of health care needs.
Old people should pay more. That's not an idiosyncratic risk. People with health conditions should not. That's the point of insurance. I think individual markets where you set a list of dimensions along which firms are allowed to price discriminate is my ideal setup. Of course, they will try to game it with formularies and what not, so it will take some regulation.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 3:53 pm
by Paingod
PLW wrote:Old people should pay more. That's not an idiosyncratic risk. People with health conditions should not. That's the point of insurance. I think individual markets where you set a list of dimensions along which firms are allowed to price discriminate is my ideal setup. Of course, they will try to game it with formularies and what not, so it will take some regulation.
Old people very often have more health issues. I'm not sure how you separate the two. At which point does someone stop being 'unhealthy' and become 'old and unhealthy' ... ?

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 4:17 pm
by Jeff V
I'm sure a dramatic decline in life expectancy will solve all of our problems.

Re: Trump's Full Court Press on healthcare

Posted: Tue Nov 22, 2016 4:25 pm
by PLW
Paingod wrote:
PLW wrote:Old people should pay more. That's not an idiosyncratic risk. People with health conditions should not. That's the point of insurance. I think individual markets where you set a list of dimensions along which firms are allowed to price discriminate is my ideal setup. Of course, they will try to game it with formularies and what not, so it will take some regulation.
Old people very often have more health issues. I'm not sure how you separate the two. At which point does someone stop being 'unhealthy' and become 'old and unhealthy' ... ?
Sure. But the point of insurance is to help with variance. Older people are more expensive on average. That's not a risk, it's a reality. The only alternative is worse.