quote:

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Originally posted by hilikuS:
Does anyone else feel like this Affordable Care Act is a triumph of compromise? It gives the Dems what they want, which is the health care, without spending more money (well maybe a bit, but nothing like government run health care), something the Republicans don't want to do. It also seems to at least try and promote competition to help fix the health care market in general, something the Dems want. Without much regulation, something those Republicans don't want.

If it works as intended, I think it will be looked back on as a great piece of legislature.

I understand that the Republican party has to posture, especially since their candidate has been pledging to get rid of Obamacare since day one, but still. I feel like that's the only reason to not be happy about this. How would Romney get rid of it now? It looks pretty darn good from either side of the argument.

Or am I missing something here?

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There are a lot of reasons not to be happy about it. First, it doesn't increase competition, in fact if anything it stifles it. Smaller insurance companies will likely have to fold because they can't afford to cover folks with expensive health problems, thus leaving you, the consumer, with fewer choices.

Second, even if the above scenario is false, insurance companies are forced to sell coverage to high cost patients, which wouldn't necessarily be so bad without the low premium ceiling. As a result, the ONLY way the insurance companies can cover themselves is to raise everyone else's premiums and/or squeeze their coverage even more. If you think they'll just be kind and absorb that cost, you've got a rude awakening ahead of you.

Third, if you didn't have coverage already, you're now forced to buy it or pay a "tax". With the economy these days (or any day really), there are a number of people who, through no real fault of their own, are living hand-to-mouth. They're making ends meet, but may not be able to come up with another $500 for this.

Finally, this sets a dangerous precedence. Congress and the President have now been told they can pass whatever they want, so long as they call the penalty or fine for disobedience a "tax". I heartily disagree with Roberts' assessment that this is a tax and not a fine. While one normally could argue the name of the horse doesn't matter, apparently in this case it very much does.

quote:

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Originally posted by coasterdude84:
There are a lot of reasons not to be happy about it. First, it doesn't increase competition, in fact if anything it stifles it. Smaller insurance companies will likely have to fold because they can't afford to cover folks with expensive health problems, thus leaving you, the consumer, with fewer choices.

Second, even if the above scenario is false, insurance companies are forced to sell coverage to high cost patients, which wouldn't necessarily be so bad without the low premium ceiling. As a result, the ONLY way the insurance companies can cover themselves is to raise everyone else's premiums and/or squeeze their coverage even more. If you think they'll just be kind and absorb that cost, you've got a rude awakening ahead of you.

Third, if you didn't have coverage already, you're now forced to buy it or pay a "tax". With the economy these days (or any day really), there are a number of people who, through no real fault of their own, are living hand-to-mouth. They're making ends meet, but may not be able to come up with another $500 for this.

Finally, this sets a dangerous precedence. Congress and the President have now been told they can pass whatever they want, so long as they call the penalty or fine for disobedience a "tax". I heartily disagree with Roberts' assessment that this is a tax and not a fine. While one normally could argue the name of the horse doesn't matter, apparently in this case it very much does.

My insurance costs me a small fortune already, and I'm actually worried about how much more I'm going to be paying in 2 years. I'm sure a number of you are under 26 and can still float on you parents' insurance, but for those of us in the over-30 club, this has a very scary outlook. Obama, the self-proclaimed champion of the middle-class, just gave us all a big middle finger. Sorry guys, Romney may be a giant D-bag, but I'll be voting for him.

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quote:

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Finally, this sets a dangerous precedence. Congress and the President have now been told they can pass whatever they want, so long as they call the penalty or fine for disobedience a "tax". I heartily disagree with Roberts' assessment that this is a tax and not a fine. While one normally could argue the name of the horse doesn't matter, apparently in this case it very much does.

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quote:

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Originally posted by coasterdude84:
Obama, the self-proclaimed champion of the middle-class, just gave us all a big middle finger. Sorry guys, Romney may be a giant D-bag, but I'll be voting for him.

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To what end? There is zero chance the law gets repealed, and if you think Obama gave you a middle finger, elect Romney and see what happens.

quote:

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Originally posted by coasterdude84:
Smaller insurance companies

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Such as...?

Odds are you'll be unaffected--except, of course, that you'll now have access to affordable healthcare. Which, you know, sucks the big one.

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Originally posted by Volcanon:
IIRC Canada pays less per capita than the Americans do and we have health care for everybody, not just the poor and old.

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The US government (! Not even counting citizens' contributions!) pays the most for healthcare in the world, in fact, and as we all know it has the worst coverage in the developed world.

EDIT: Added the link.
__________________
"I have heard the mermaids singing, each to each. I do not think they will sing to me." -T.S. Eliot

RIP Ari

quote:

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Originally posted by coasterdude84:
There are a lot of reasons not to be happy about it. First, it doesn't increase competition, in fact if anything it stifles it. Smaller insurance companies will likely have to fold because they can't afford to cover folks with expensive health problems, thus leaving you, the consumer, with fewer choices.

Second, even if the above scenario is false, insurance companies are forced to sell coverage to high cost patients, which wouldn't necessarily be so bad without the low premium ceiling. As a result, the ONLY way the insurance companies can cover themselves is to raise everyone else's premiums and/or squeeze their coverage even more. If you think they'll just be kind and absorb that cost, you've got a rude awakening ahead of you.

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So the problems stem from the parts which prevent companies from capping lifetime expenses, disallowing pre-existing conditions, etc.? When I read that, I thought about the situation existing where those practices were necessary for the survivability of the company. I can't think of a scenario where they wouldn't be. Corporate types may seem like jerks, but it's just horrible business to have press like that if it does get out. Your company drops an 8 year old with cancer because of the bills. IMO you gotta have a very real financial reason to do that, not because it's immoral, but because it's just terrible press.

Is that the biggest problem you're seeing with the Act then? I guess that seems to me like it would be. I'm not an expert on insurance so I don't know how big of a problem that will be, but I see your point.

quote:

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Originally posted by coasterdude84:

Third, if you didn't have coverage already, you're now forced to buy it or pay a "tax". With the economy these days (or any day really), there are a number of people who, through no real fault of their own, are living hand-to-mouth. They're making ends meet, but may not be able to come up with another $500 for this.

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This was the other thing for me. I'd imagine that a lot of people are like, don't tell me what to do. The thing I'm wondering is how many of these people who are scraping by, or have a family to tend for are both just making ends meet, and ineligible for Medicaid? Again, I'm no expert but it seems the Medicaid would cover those people, and from what I understand they'll be increasing those benefits as well.

Being unable to decline insurance is basically telling people what to do, but IMO people should have insurance in case of emergency. The way health care costs are, and hospital visits now, if you end up with a serious condition, it will cost you an arm and a leg. It could potentially cripple you financially. I know Tranderas would always say he was a healthy dude, and didn't need it, but if he got hit by a bus and was in critical condition, he would go to the ER and end up with a butt ton of hospital bills.

quote:

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Originally posted by coasterdude84:
There are a lot of reasons not to be happy about it. First, it doesn't increase competition, in fact if anything it stifles it. Smaller insurance companies will likely have to fold because they can't afford to cover folks with expensive health problems, thus leaving you, the consumer, with fewer choices.

Second, even if the above scenario is false, insurance companies are forced to sell coverage to high cost patients, which wouldn't necessarily be so bad without the low premium ceiling. As a result, the ONLY way the insurance companies can cover themselves is to raise everyone else's premiums and/or squeeze their coverage even more. If you think they'll just be kind and absorb that cost, you've got a rude awakening ahead of you.

Third, if you didn't have coverage already, you're now forced to buy it or pay a "tax". With the economy these days (or any day really), there are a number of people who, through no real fault of their own, are living hand-to-mouth. They're making ends meet, but may not be able to come up with another $500 for this.

Finally, this sets a dangerous precedence. Congress and the President have now been told they can pass whatever they want, so long as they call the penalty or fine for disobedience a "tax". I heartily disagree with Roberts' assessment that this is a tax and not a fine. While one normally could argue the name of the horse doesn't matter, apparently in this case it very much does.

My insurance costs me a small fortune already, and I'm actually worried about how much more I'm going to be paying in 2 years. I'm sure a number of you are under 26 and can still float on you parents' insurance, but for those of us in the over-30 club, this has a very scary outlook. Obama, the self-proclaimed champion of the middle-class, just gave us all a big middle finger. Sorry guys, Romney may be a giant D-bag, but I'll be voting for him.

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This entire post sounds like it's coming from someone who's never actually had to purchase health insurance. I'll hit your arguments point by point.

1. Categorically false. If you add 30 million people to the pool of folks that are purchasing insurance, competition is a natural by-product of the increased demand. Furthermore, that's the ENTIRE POINT of the government-mandated insurance exchanges that each state has to create by Jan 1st 2013.

2. The problem isn't costs, it's the type of care Americans focus on, i.e. non-preventative care. Diabetes is one of the costliest diseases someone can contract, and the vast majority of diabetes in America is type II, which is adult-onset Diabetes, usually the result of diet and a lack of exercise. Insurance companies at this point have no incentive to push preventative care because without the ACA they can dump clients once they stop being profitable, hence the current high costs of medical care.

3. I suggest you actually look at the coverage ceilings for health insurance after all the pieces of the ACA go into effect. Yeah some people will feel the crunch, but a greater number of people won't be financially ruined by a catastrophic injury in the family.

4. Guess who mandated all automobile owners need car insurance on a Federal level? Reagan. The ACA is constitutional, and despite your kicking and screaming, it's actually good for you too. But don't worry, you can still suck down deep-fried butter sticks and wash them down with a 128 oz. soda. That's still legal too.

@ Volcanon: Yeah, pretty much. If you can figure out how to pay for a single-payer system without raising taxes by more than what I'm already paying into the health care system, then by all means. Additionally, I'd like the quality of my care to stay the same and not have to wait for it either. Figure that out, and I'm in.

@Nitelite: I know Congress has always had the power to pass whatever tax they like. What I'm saying is they now can pass anything they like, so long as they give you an out to pay an additional tax. Basically, eat your vegetables or pay the non-veggie-eater tax.

@JoshSherman: That may be, but there certainly would be zero chance if we have another 4 years of Obama. And as badly as everyone seems to think of Romney, no one has yet told me what he's going to do that will negatively affect me.

@Bugger: I certainly don't know specific names, and frankly am too lazy to look them all up. My financial planner reps about 30 different ones, so if it really bothers you I can get you a list. Specifically, my work uses a local outfit called HFN, and every doctor I go to always says, "Who?" They must be cheaper than BlueCross/BlueShield, but I'd never heard of them before this job.

@Goas: Agreed, it's probably not enforceable, nor will it affect me as I already do have insurance. The question is, what's it going to do to my costs? An article in WSJ some months ago when all this broke indicated I could see a substantial increase (I believe 15-20%, but I can't find the article now, so don't hold me to it).

@hilikuS: I honestly couldn't care less about the well being of the insurance companies, as they've screwed me a number of times. However, I suppose I do care somewhat because I know they will be quick as hell to pass those costs onto me. And I agree, everyone should have insurance, it just makes financial sense. However, it should not be mandated. If you don't have insurance and get hurt, well, I guess you've managed to screw yourself then, haven't you? No one else should be paying for your mistake. Sounds kinda heartless, I know, but we need people to take a little responsibility for themselves.

@Zeckk: Not sure how that first bit was warranted, but actually, yes, I have. Have you?
1. Depends entirely on that 30 million population. If they're mostly healthy, then sure, won't be a problem. Otherwise, costs will universally go up.
2. Not sure what your point here is, but this isn't going to suddenly change people's lifestyles. Insurance companies may push for it like you said, but like everything, it always comes down to costs. Preventative programs cost money, so even if they save on the back end, it's still an increased cost that's coming my way.
3. So you're suggesting the Pelosi approach of implement it to see what it will cost?
4. I don't care about car insurance; that's not a fair comparison. I'm not forced to drive a car, I can choose to walk, take the bus, or ride my bike. The alternative to living though is a little more daunting. And like I said already, I have insurance. I just take exception with it being mandated. And while it may have been judged constitutional, I'm still going to disagree with that assessment.

quote:

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Originally posted by coasterdude84:
This is why I usually stay out of this thread. From top to bottom:

@ Volcanon: Yeah, pretty much. If you can figure out how to pay for a single-payer system without raising taxes by more than what I'm already paying into the health care system, then by all means. Additionally, I'd like the quality of my care to stay the same and not have to wait for it either. Figure that out, and I'm in.

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Sure. Quarter military spending. Stop all foreign aid. Close all military bases outside of US territory.

Use that money to bring in something like what the rest of the first world has.

Repeal assinine drug laws that put users and minor dealers into jail. Jail is teh expensive yo. Repeal any law that has an adverse economic effect, like death penalty laws. Stop all subsidies by the DoA. Close all tax loopholes and come down very hard on people hiding income in the Caymans or somewhere.

Stop expensive and useless blockade of Cuba and other nations. Build that damn pipeline. Get people to work fixing America's dilapidated infrastructure, and so on.

quote:

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@Zeckk: Not sure how that first bit was warranted, but actually, yes, I have. Have you?
1. Depends entirely on that 30 million population. If they're mostly healthy, then sure, won't be a problem. Otherwise, costs will universally go up.
2. Not sure what your point here is, but this isn't going to suddenly change people's lifestyles. Insurance companies may push for it like you said, but like everything, it always comes down to costs. Preventative programs cost money, so even if they save on the back end, it's still an increased cost that's coming my way.
3. So you're suggesting the Pelosi approach of implement it to see what it will cost?
4. I don't care about car insurance; that's not a fair comparison. I'm not forced to drive a car, I can choose to walk, take the bus, or ride my bike. The alternative to living though is a little more daunting. And like I said already, I have insurance. I just take exception with it being mandated. And while it may have been judged constitutional, I'm still going to disagree with that assessment.
[/B]

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1. Healthy or not, increased demand is increased demand. And you clearly don't understand what the insurance exchange markets are meant to do. The current system in America strongly ties your ability to get insurance with whatever insurer your workplace uses as a group plan. That's about the least-competitive system possible, for a number of reasons. If insurance firms actually had to post coverage rates and options the way airlines compete on travel sites, then you are going to see a rather impressive drop in pricing, otherwise the non-competitive firms will drop like flies.

2. Did you actually read what you just wrote? Preventative care saves money, period. Insurance incentives to maintain a healthy weight, stop smoking, stop drinking, etc. have all been proven to be the cheapest and most effective way of keeping medical bills in check.

3. What are you even talking about? You're acting as if this bill was passed on a whim without any consideration to the numbers. Take a deep breath, realize that there's more than just the Fox News Group as an informational outlet, and google "ACA bill details". Also, factcheck.org has a really good breakdown of the costs and savings affiliated with the bill.

4. It's a VERY fair comparison. People want to make the argument that not everyone drives a car, but EVERYONE incurs medical costs over the course of their lifetime. Implementing a de facto tax isn't the most elegant way to sell a bill to voters, but the reality is that medical care is a purchased product that has 2 unfortunate drawbacks - people buying medical care typically wish they didn't have to, and medical care is typically not budgeted for. Those 2 factors have resulted in the bloated insurance premiums, forcing those with insurance to pick up the bill for those without.

People can choose to forgo medical services when they don't have either insurance to help cover costs and/or the funds to pay for medical care from professionals. Some also choose to forgo costly regular medical insurance premiums and instead seek to only pay for treatment(s) when necessary.

Yes, everyone does "incur medical costs" but not everyone does so in the same way and in the same circumstances.

I think universal medical coverage is a great thing to promote. However, there needs to be other steps taken before it can be implemented.

"How many other areas beyond health-care (ie. student loans, mortgages, other areas unknown to myself at this time) does it branch into?"

The root of my frustations w/ it are that:

- No one who voted for/against the bill read it
- Who that has read the bill could fully understand it?

The US government is loaded w/ a bunch of people who collectively have enough manual dexterity to make a sandwich and yet there making decisions that will affect the future the country. IMO, priority #1 should be, and should have been since Jan 2009, to get people working in this country again; America needs to encourage companies to keep their investments here and to employ Americans to make their products, not encourage them to move overseas for cheap labor and ship it back to sell. This won't happen unless our trade policy is changed and that is something that has been deemed taboo by both parties and more importantly the media, all the media!

I'll ask a question, how many of you reading this have ever heard of the Trans-Pacific Partnership? If you haven't then I advise you to take a moment, do some searching and get educated. As a matter of fact take more than a moment and do some actual research on it. It will be more beneficial than retorting to my beliefs above and maybe, just maybe, it will get you to write a letter to the candidates/leader of your country (@non-US citizens) and ask if they will join this and "what implications it will have on the country?"

.10,
Jesse

quote:

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Originally posted by Volcanon:

If Americans were serious about not raising taxes there's plenty of fat to cut. In my opinion, paying some more taxes and doing things that are generally painless for 99% of people, like closing tax loopholes, is probably better, but hey.

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quote:

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Originally posted by speechjew:
#occupyMOTL

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quote:

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Originally posted by ogre:
I'm opposed to the bill too for a simple reason, it's size.

"How many other areas beyond health-care (ie. student loans, mortgages, other areas unknown to myself at this time) does it branch into?"

The root of my frustations w/ it are that:

- No one who voted for/against the bill read it
- Who that has read the bill could fully understand it?

The US government is loaded w/ a bunch of people who collectively have enough manual dexterity to make a sandwich and yet there making decisions that will affect the future the country. IMO, priority #1 should be, and should have been since Jan 2009, to get people working in this country again; America needs to encourage companies to keep their investments here and to employ Americans to make their products, not encourage them to move overseas for cheap labor and ship it back to sell. This won't happen unless our trade policy is changed and that is something that has been deemed taboo by both parties and more importantly the media, all the media!

I'll ask a question, how many of you reading this have ever heard of the Trans-Pacific Partnership? If you haven't then I advise you to take a moment, do some searching and get educated. As a matter of fact take more than a moment and do some actual research on it. It will be more beneficial than retorting to my beliefs above and maybe, just maybe, it will get you to write a letter to the candidates/leader of your country (@non-US citizens) and ask if they will join this and "what implications it will have on the country?"

.10,
Jesse

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@Your argument - the exact same concerns were brought up before Social Security was implemented. It kills me that people are reacting as if universal health care has never been done before. Not only do we have existing examples in multiple countries (most of europe, canada, etc.), but we have states that have successfully run a universal health care program. This is the last time I'm going to say this - Universal health care's legality is a political football, nothing more.

quote:

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Originally posted by coasterdude84:

@hilikuS: I honestly couldn't care less about the well being of the insurance companies, as they've screwed me a number of times. However, I suppose I do care somewhat because I know they will be quick as hell to pass those costs onto me. And I agree, everyone should have insurance, it just makes financial sense. However, it should not be mandated. If you don't have insurance and get hurt, well, I guess you've managed to screw yourself then, haven't you? No one else should be paying for your mistake. Sounds kinda heartless, I know, but we need people to take a little responsibility for themselves.

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Oh don't get me wrong. I shed no tears if an insurance company goes down in flames. The problem with that is all of their clients have a problem at that point. Not only that, but when the company is ready to go down, guess who's probably going to foot the bill. Sounds like a bail out situation to me!

The thing is, while these people should be responsible for themselves. If they don't have the insurance, they rack up the huge bills. Someone always pays. If the person who racked up the bills can't pay, the hospital is out the money. That affects their service as all of the resources, and person hours you spent are lost. I'm not saying it'll close down the hospital, but yeah. I guess it's just one of those things that really annoys me, because it's a decision someone else made, that negatively affects me for no reason.

Technically nothing is mandated under the Act. You aren't forced to have any health care, you just pay a tax if you don't. I mean, logically they're forced, but not technically. If you had to pay $500 for insurance premiums, or $350 in taxes to get nothing...

There's definitely flaws with the Act, but I love it. It allows for health care for everyone, without burdening the government with the cost of it. I couldn't support public health care because this country is super broke. So to me it was a matter of somehow getting America's finances in order, and then trying to work health care in. This idea sort of avoids that whole situation, and gives it anyway.

Here everybody pays tax, thru that they get free health care. Have been like that for 60yrs or so. Its simply a matter of priorities. You cant have free health care for everybody if you are spending 20-40% of bnp on killing people overseas. Makes good sense to me.

quote:

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Originally posted by KBmaster:
Interesting discussion.

Here everybody pays tax, thru that they get free health care. Have been like that for 60yrs or so. Its simply a matter of priorities. You cant have free health care for everybody if you are spending 20-40% of bnp on killing people overseas. Makes good sense to me.

But its very hard to stray from this concept when you dont have a democracy like in the US. Greed seems to be the way to go over there. Very sad.

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For those of you focusing on increased costs, and / or trying to claim Obama-care is the “biggest tax increase ever”, or trying to bash the legislation as “the biggest intrusion on personal freedoms” ever; you are beautifully describing the Republican Party’s current talking points. But you are not at all addressing the reality of health insurance in the US; the benefits of Obama-care to normal citizens; and you are certainly not proposing any viable alternative to the health crisis in our country.

The harsh reality is that health care in America, without Obama-care, is an increasingly broken system. Fewer Americans each year are covered; the price of coverage is increasing rapidly (pre-Obama-care); and the coverage has become much more porous because of loopholes and limits (again, pre-Obam-care). The primary reason Obama-care is unpopular among the general population is the quarter-billion-dollar Ad blitz against it by the Republican Party, Conservative PACs, and the Health Insurance Industry, each for their own partisan reasons.

The Supreme Court ruled that the individual mandate is constitutional because the government has a right to assess a tax on those who refuse to buy health insurance. I have no illusion that this isn’t a tax. To quote an old John Flynn song, if something "looks like a duck and quacks like a duck .... it ain't no armadillo". It was not called a tax in deference to unelected power brokers like Grover Norquist, whose word is apparently law among spineless Republicans.

When you look at the mechanics it is definitely a tax. The fine, or penalty, or whatever you call it, will be administered by the IRS, and payment is required by April 15th. Those are the same terms that apply to me when I fill out my annual TAX return.

Think of it like taxes on tobacco; it is a payment to society for actions (or in this case inaction) that will cost society as a whole at some later time. There is no doubt that a large number of those who shirk their responsibility of obtaining health insurance will need health care. And every year the rest of us pick up the tab for those who don’t have health insurance. Billions are currently paid in higher health insurance premiums. Billions more are currently paid directly by the government to keep hospitals from going bankrupt. As noted below, hospitals take the biggest hit for treating the uninsured.

The “facts” about the current state of health care in the US are as follows:

Our nation was founded on competition. Unfortunately (and despite Republican claims to the contrary), healthcare insurance, like much of the healthcare industry, is not competitive. And the current system cannot become more competitive without some sort of government intervention. There are huge medical and financial barriers to entry. I’m not talking at the local broker level. The local brokers are simply getting wholesale quotes from a few large companies, and adding a sales commission. I’m talking at the wholesale level. The market forces for increasing costs (and profits) have overwhelmed every attempt at cost control. As an example, no medicine or medical procedure will be approved by the FDA simply because it is cheaper. At the State and Federal level, for too many years health industry lobbyists have been ghost writing most legislation. And too many political figures get the bulk of their political funding from health care and health insurance companies. As a result, the United States, by a huge margin, pays the highest per-capita cost for health care in the World. This isn’t even close. We pay between 50% and 100% more than other industrialized nations.

For that enormous healthcare cost we get mediocre care. By virtually every major metric, Americans collectively get short-changed in healthcare. Life expectancy has actually been decreasing in many parts of the country, despite the fact that we already trail most other developed countries. An increasingly higher percentage of our population has no health insurance. And these trends are getting worse every single year. These long term trends have nothing to do with Obama-care. In fact, they are problems Obama-care attempts to addresses.

Getting back to costs; claiming that Obama-care is raising healthcare costs is ridiculous. Against what standard is this claim being made? Healthcare costs have been out of control for the past 50 years. In all that time Democratic attempts, when they held power, to attack the problem have been stymied by Republicans. In all that time, Republicans, when in power, have failed to come up with even one comprehensive plan to address the problem. Put another way, for all the talk about paying too much in Federal taxes, health care costs have risen so rapidly that as a nation we now pay more in health care costs than we do in Federal taxes.

Since Obama took office, the rise in healthcare costs is actually slowing. To quote the Bureau of Public Statistics:

“U.S. health care spending grew 3.9 percent in 2010 following record slow growth of 3.8 percent in 2009; the two slowest rates of growth in the fifty-one year history of the National Health Expenditure Accounts. Total health expenditures reached $2.6 trillion, which translates to $8,402 per person or 17.9 percent of the nation’s Gross Domestic Product (GDP).”

(source: http://www.cms.gov/Research-Statistics -Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf)

Part of the reason is that there are enormous cost reductions built into the new plan. 50 years ago health insurers were quite profitable while spending 90% to 95% of all the premiums they collected on actual heath care for the members they insured. Wall Street’s excesses, including the hedge fund / venture capital mindset, hit the health insurers particularly hard. In a field of gross excesses, health insurance and healthcare company CEO's have been some of the most highly compensated executives. This was accomplished by diverting a higher and higher percentage of health insurance premiums from actual health care services to things like executive and investor compensation. This lowered the amount of premiums spent on health care to 80% and less at many (most?) health insurance companies.

The way many insurers accomplished this (while keeping premiums somewhat competitive) was to seem like they covered everyone while finding more and more technical loopholes to get rid of costly participants. Of course, they wouldn’t tell the participant until an emergency actually occurred, and health insurance was actually needed. The most notorious of these practices was to find a reason to deny coverage when a long-term participant developed a serious (i.e. expensive) medical condition, after the person had been treated. Most, if not all, of these loopholes are closed by Obama-care.

Obama-care requires that a minimum of 80% or more of collected premiums be spent on actual health care, so there is an immediate cost savings to consumers. If an insurer spends less on actual health care, they must reimburse premiums for the difference to all their policyholders. Health Insurers are now held accountable to at least a minimum standard of service (like virtually all other insurers). If they want to play risky and / or lucrative financial games, they cannot do so at the expense of their insured.

Obama-care also requires insurers to eliminate most “loopholes”, including lifetime maximums and pre-existing condition exclusions, which allowed the companies to get rid of sick individuals. It turns out it is much less costly to society as a whole, when individuals receive regular treatment. It turns out less costly to society as a whole when a single medical emergency doesn’t bankrupt a family.

Huge cost savings result when everyone is insured. Our society is driven by the expectation that if you are seriously ill or injured, you will receive treatment. And hospitals are not ready to deny a person actual emergency care simply because they can’t immediately prove they have insurance. That is not the way our society works. If you are brought to a hospital, clinging to life, they will act to try and save you. [I won’t go into how ridiculous it would be to try and change this at the hospital level.]

Unfortunately, emergency treatment is very expensive. Treatment in an emergency room costs at least 5 to 10 times as much as the same treatment in a doctor’s office or other non-emergency facility. And many who do not have insurance utilize emergency services as their first medical stop. Some of these individuals are forced to do so because they can’t get health insurance at any price. Some of these individuals can afford health insurance, but simply decide to game the system. And some don’t have insurance because they can’t pay the cost. Obama-care begins to address all these problems.

Regardless of their reasons, the uninsured groups described above have an enormous impact on health costs. Right now, if you have health insurance, between 10% and 20% of your total insurance premium ultimately pays for services that go to these uninsured individuals. It’s the equivalent to uninsured motorist coverage on your automobile insurance. As more Americans get priced out or otherwise excluded from health insurance, this “uninsured” premium is escalating.

Obama-care tries to address all of these issues, while leaving the basics of our health care system intact. As more people become insured your cost to cover the uninsured diminishes. And if everyone is insured, individuals don’t need to wait until a medical problem becomes a medical emergency. They can go to a doctor or clinic and get cost-effective treatment, often at an earlier time, thereby reducing overall medical costs.

If you are insured, there are financial incentives for this kind of behavior. Well visits are covered at no charge, and regular clinic or doctor visits at reasonable charge. Consider that for those of us that already have health insurance, we pay a huge deductible if we go to a hospital emergency room for what turns out to be a non-serious condition. Now consider those without insurance. They wait until they believe their problem is an emergency. They then go to a hospital emergency room. Those of us with health insurance (and the Federal and State governments) are still paying for all the uninsured individuals who don’t have that cost constraint, and can’t pay the bill, because someone needs to pay that bill.

The Federal financial support for those too poor to buy insurance comes, in large part, from the current reimbursements and grants to medical facilities that treat the uninsured. It also comes from savings due to reductions in the health insurance premiums for government workers. And some of it comes from the “taxes” on those who refuse to buy any health insurance, which I believe are limited to a maximum of 2.5% of gross income.

Another area of cost containment is that Obama-care finally allows is a stepped up, coordinated response to waste and fraud in programs like Medicare and Medicaid. Most estimates have the amount of fraud at between $40 billion and $50 billion each year, and growing rapidly. I never understood why Republicans were so resistant to letting the government go after waste and abuse in these programs (perhaps they wanted these programs to collapse from within?). Until Obama, the Medicare and Medicaid programs were “honor” programs, requiring the government to pay all billings quickly, and banning the programs from policing anyone. Obama-care changes this. Payments can be withheld from suspicious service providers until the providers can prove they are legitimate. And these programs can initiate their own investigations, rather than waiting for a lull in the war on terror (since the same Homeland Security resources were the ones that would look into Medicare and Medicaid fraud).

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Originally posted by Nitelite:
Hammr7, that was an excellent post. Thanks for taking the time.

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