• CNN: Change is a feature, not a bug

    The real problem here, and one that few are addressing, is that the old health care system isn’t that good. We wanted to change it. Doing so means that it, well, changes. If we liked our old health care system, we could keep it. But we didn’t, and so at some point we’re going to have to accept a new one.

    Go read my column at CNN.com.

    @aaronecarroll

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    • Some people liked how the system was, some people did not. There is no we.

      • Almost no one “likes” the system. Go read my post from yesterday.

        • I did read the report you posted yesterday. I would say that one survey is not the end of the matter. This Gallup survey (http://www.gallup.com/poll/159455/americans-satisfaction-health-coverage-slips-slightly.aspx) from last year suggest most people had a rosy outlook about the coverage they had. So, according to Gallup, almost everyone liked the system.

          My point, however, was that one should be careful about using the term “we” when making broad statements about political decisions, such “We wanted to change our health care system” or “if we liked it, we wouldn’t change it”. No one would say, if we didn’t want invasive NSA surveillance, we wouldn’t have it, or if we didn’t want the Bush tax cuts, we wouldn’t have them, or if we didn’t want a war in Iraq, we wouldn’t have sent troops.

          • That’s a survey of “health coverage”. Not even close to the same thing. Or of “quality of the healthcare you receive”. Again, not the same.

            Plus, the Gallup poll doesn’t allow for comparisons. It’s asked in a vacuum.

      • You can “like” all sorts of bad, stupid things that are detrimental to yourself, your community, the economy, etc.

        Just because you “like” it doesn’t mean it’s a good thing.

        That elderly Florida woman paying 700$ a year for an “insurance” plan that had a max payout of <300$ a year "liked" her plan too….until she found out how badly she was being scammed.

    • Give people a real choice: buy a new Obamacare plan or keep your old plan but forfeit the right to upgrade to an Obamacare plan if you get sick or injured. As for the forfeiture, it could be for a specific period or with respect to conditions suffered while insured under the old plan (i.e., a pre-existing conditions provision). Is that fair? Is it fair to allow people to keep a cheap, crappy plan as long as they are healthy and then upgrade to a much better Obamacare plan if they get sick or injured? [As a technical matter, by allowing people to keep their old plans, I expect there will be an explosion in the number of cases testing the limits to the exceptions to the open enrollment period. Should the Obama “solution” include a provision that the exceptions to the open enrollment period will not apply to those who choose to keep their old plans?]

      • Good point health insurance should mostly be long term contracts like life insurance. IMO it is only the way it is because it was once a much small expense.

    • Nice summary of why “like it, keep it” could never had been true.

      Unfortunate that we did not have policy wonks explaining that this could not possibly work under the ACA while Obama was saying it. Then we would not have the embarrassing spectacle of trying to retroactively make it less untrue than it was.

      It would have been honest to say “the more you like your policy, the less likely it is that we will let you keep it”.

      To elaborate: “If you are young, healthy, and have a good policy with a low premium that reflects your low risk, then there is no way we are going to let you keep that. We will raise your rates, and use the money to subsidize someone else’s coverage. Then we will take credit for giving them your money”

      The Administration proposal does not address a bug in the ACA, it is an attempt to deflect attention from a prominent feature that it is no longer possible to cover up. The action will not protect those who had good fairly priced policies beyond one year, even assuming the insurance company and the insurance regulators make the option available.

      “buy a new Obamacare plan or keep your old plan but forfeit the right to upgrade to an Obamacare plan if you get sick or injured”

      Interesting proposal, but it would not solve the adverse selection concern.

      There is an alternative: government butt out.

      • > “we did not have policy wonks explaining”

        We very much DID have policy wonks explaining that not everyone could keep their plan. By establishing regulatory minimums, unless EVERYONE always met that minimum, by definition those plans at the very least were going to go away. That’s why don’t get the idea of taking the President’s words literally, at face value. The caveat of “unless your plan is below minimums” is explicit in the law itself. You’d have to be stupid or grossly mis/under-informed to not see that.

        > “It would have been honest to say “the more you like your policy, the less likely it is that we will let you keep it”

        That’s blatantly untrue, illogical, and has no bearing whatsoever on reality.

        > “To elaborate: “If you are young, healthy, [….]”

        Insurance has ALWAYS been about the healthy subsidizing the sick. That’s the entire point of the system! This is not news, nor should it be shocking to anyone!!

        > “There is an alternative: government butt out.”

        Because the private sector has such a bang up job of controlling and lowering prices, while insuring hte uninsured, and getting more medical care to more people, such that our nation is not the worst in every single metric used to rate a nation’s healthcare system?

        Why is this dbh person allowed to contiue trolling?

        • Bob,

          Has it occurred to you that insulting others does not consist of an argument? I realize it is standard fare on the internet, but do you believe that vehemence is persuasive?

          “Why is this dbh person allowed to contiue trolling?”

          Meaning “I cannot refute his points, so I wish he would stop bringing them up”??

          Everyone knew the individual policies were going away? So why weren’t the Democrat members of Congress who are now bailing out on Obama objecting, in public, when he was making those claims?

          Why were there not front page articles calling him out, as there have been in the last few weeks? Why no editorials in the NY Times pointing out that “like it, keep it” was not only wrong, but completely at odds with the law?

          ‘ “the more you like your policy, the less likely it is that we will let you keep it”

          That’s blatantly untrue, illogical, and has no bearing whatsoever on reality.” ‘

          Please explain what is untrue, illogical or has no bearing. The original post makes exactly this point. If you have a policy with a low price and good benefits, then you got that because you were a low risk customer. You cannot be allowed to keep such a policy. If you do, then there is no money in the pool to cover the high risk people.

          In fact, no less an authority than Bob has told us that

          “Insurance has ALWAYS been about the healthy subsidizing the sick”

          Insurance need not subsidize anyone. I pay a low premium for auto insurance because I am a low risk customer. I pay a low premium for life insurance for the same reason. Should this be permitted? Or should the federal government take over and force the low risk purchasers of auto and life insurance to subsidize the high risk people?

    • Let us admit that among people who like you who are well informed on the state of healthcare there is agreement that PPACA is horrible. The supporters though, think that it is clearly better than nothing and that it is unlikely that better laws are attainable at this time. I can certainly understand and respect that position but I think supporters should more bashing the bad aspects of the law and they should bash the dishonest of the politicians that made the law of course always pointing out that the politicians on the other side are just as bad or worse.

      The fact that the PPACA does almost nothing on the supply side is very disappointing. Lower cost/prices would help everyone.

      The employer mandate is a horrible thing the push should be in the other direction. People do not even know what they are spending on healthcare!

      You cannot subsidize the median person so it is an outrage that subsidies go up to $95,000. The politicians are scamming rationally ignorant voters!

      Capping the deductibles at under $7,000 is also very bad policy they should be pushing people above median income in fair health toward much high deductibles.

      The tax on Medical equipment manufacturers is a dishonest underhanded way to tax the people.

      Mandating birth control is a Democrat party give away to an voting block important to them.

      The 3 to 1 cap on old people’s insurance makes no sense but for the fact that old people vote more that young people.

      There is very little evidence that Many of the mandated coverages make medical sense.

      The good aspects of PPACA:

      People with preexisting conditions can get coverage easier and at a lower cost.

      The exchanges have the potential if structured correctly to lower that marginal tax on those people near the medicaid cut off.

      “Death panels”, medicare might stop some care that has not shown net benefit.

      • @ Floccina

        I hear this argument for super-high deductibles all the time. Is there any research backing it? What about actuarial evidence? What’s the actuarial cost of a policy with OOP capped at $1K, $3K, $5K, $7K, $10K or $25K? My bet is moving from $10K to $25K doesn’t net you much reduction in cost. Without the actuarial cost, it’s policy divorced from market or economics.

        For my non-group policy, the move from $1,000 deductible to $2,500 (or since it was a policy for a family of 4, $4,000 to $10,000) didn’t net much of a reduction in premium, certainly not one that made the increased risk worth it. Choosing a deductible of $1,000 was a no-brainer.

        But ultimately, insurance companies are far better equipped to figure out what care and what costs are excessive. If they’ve failed to, why do you think individuals can, with the notoriously opaque pricing system?

        • SAO I can find no empirical study the belief is based mostly on theory but..
          The Rand health insurance experiment is shows that when people have to pay they spend much less..
          The Amish go to Mexico for cheaper care shopping for price.
          My hope based on theory is that the pricing system is so opaque because the great majority of payment is from Government and insurance companies and nobody cares about over spending Government or insurance company money.
          Cosmetic care is less opaque in pricing and is cheaper.
          Also it has been my personal experience that doctors find cheaper care when they know the patient is paying.
          I have heard of stories where people opt for worse and more expensive nursing home care when a family member could do it for much cheaper because insurance companies and Government will not pay the familiy members.
          Most spending in a single year is on small percent of patients so the deductibles need to very high to get people to act.

    • > “Let us admit that among people who like you who are well informed on the state of healthcare there is agreement that PPACA is horrible.”

      No, let us not admit that, because there is no such agreement amongst the well informed.

      The well informed agree the bill is not perfect, and has many flaws. But they do NOT agree that the bill is “horrible”. Horrible would imply more bad that good, which is the exact opposite of the general consensus of the well informed and knowledgeable.

      The consensus is that the previous state of healthcare was horrible.
      The consensus is that the PPACA does more good than bad.
      That cannot be equated to horrible unless your dictionary is severaly flawed.

      > “The tax on Medical equipment manufacturers is a dishonest underhanded way to tax the people. ”

      No, and the average person wont even notice it’s impact on their bills. This has always been talked about on this blog. Your statement is patently absurd.

      > “Mandating birth control is a Democrat party give away to an voting block important to them.”

      Firstly, there is no mandated birth control. There IS mandated coverage for birth control, but that’s NOT a give away to some voting block, unless the block you mean is “90% of the country”.

      Because in case you havent been paying attention, the majority of the country, right or left, democrat or republican, who is active sexually, including married couples, uses birth control.

      Why ???? Because “an ounce of prevention is worth a pound of cure”.

      Or stated another way: because kids are damned expensive, and if I dont want or cant afford another, I aint gonna get another. And its far easier and simpler, by any metric – ethically, economically, medically, religuosly, etc etc – to simply never let the little swimmers make it to the goal.

      > “You cannot subsidize the median person so it is an outrage that subsidies go up to $95,000. The politicians are scamming rationally ignorant voters!”

      First off, your numbers are wrong. It’s no where near up to 95k. Secondly, “Rational” and “ignorant” are mutually exclusive. There is no such thing as “rational ignorance”.

      Again: your statement is misinformed and patently absurd.

      > ““Death panels”, medicare might stop some care that has not shown net benefit.”

      Huh?
      W.T.F.?
      Are you saying you think there are death panels?
      Still???

      Much like dbh, your post makes little sense and is flatly at odds with reality. How can you have a rational discussion when your basis of thought has no basis in reality?

    • Wasn’t the logic of the medical device tax that the ACA would bring in more customers, by increasing the number of people who could afford medical care? This would increase the demand for medical devices. Thus, device makers that were profitable at current levels of sales should see a profit increase as their sales went up. The device tax was then expected to capture some of that increased revenue and return in to the government to help pay for the higher overall costs of the subsidies and Medicaid expansion? In other words, give to the device manufacturers through broader coverage and take away in the form of a tax. Not obvious whether the manufacturers would be better or worse off.

      They are reacting as if they are losing. This may mean they are less convinced about the increased demand part of the equation.

      The rationale for paying for things with insurance is that people might not buy them otherwise. In some cases this may be because they really cannot afford them -$100,000 cancer treatment.

      In other cases, it might be POSSIBLE to pay for, say birth control or preventative care, but when choosing how to allocate a limited budget, people might not do it. Then insurance pays for the avoidable pregnancy or the advanced medical problem that could have been prevented. It might make a lot of sense to cover the cheap expense with insurance to save the big expenses later. Healthcare dollars aside, you get a healthier population.

      These costs might seem minor to those at the top of the income range, but when you are living just above Medicaid eligibility, there is no such thing as a “small” expense.

    • I’ve been a periodic visitor to TIE for a few years and have found the reader comments often to be interesting and informative. Disagreements between the commenters and blog authors and between different commenters are not unusual, but these disagreements are generally expressed rationally and respectfully. At some point (a couple of years ago?) the TIE management began moderating comments. I encourage them to renew their efforts to disallow intemperate and abusive comments.