2013 Will Be The "Worst" Year For The US [In My Adult Life]

[RuralEngineer]

TripleB, your last few threads have been 100% doom and gloom "the world is ending."  You should probably reign it in a bit.  Nothing is ever as bad (or good) as it seems in the moment.

Would you prefer he post topics about the interesting squirrel he saw yesterday?  Perhaps he could comment on what sunshine tastes like (spoiler alert, the answer is lime skittles).

I've never understood people's desire to be the arbiter of what is "too negative," particularly now.  Things are not great out there.  Is it any wonder that more topics are of a negative nature than a positive one?  Does anyone really think telling someone to "be more positive" is useful or likely to have the desired effect?  It's about like telling someone who's upset to "calm down."  Yep, works every time.

[D1984]

By 2016 we'll realize Obamacare is unfeasible, and if the Dems are in power, they can blame it on the free market and start shifting to Single Payor, but if the Repubs are in power, they will scrap the whole thing and go back to what it was before Obama.

Yeah, because what we had before was oh so sustainable  . 8 to 10% per year cost increases each year (actually, in 2009, the last year before ObamaCare took effect, my employer's health care costs increased by almost 17%...to be fair they increased by just as much AFTER 2010 as well under Obamacare but to say cost increases were't already unsustainable before PPACA is a lie. You can't have healthcare costs increasing at rates above that of GDP growth and inflation combined and expect it to last forever (exponential compounding is a bitch).

With that said, I agree Obamacare will do nothing to truly solve the problem (mainly due to the adverse selection death spiral I mentioned and that you fleshed out the details of in the post about the person with cancer) but any steps that might have fixed this--such as a much tougher insurance purchase mandate with higher fines and real teeth in its enforcement and a system whereby enrollment in the exchanges was only allowed once a year a la open enrollment today and where you had to keep your coverage for at least a year after you bought it--were non starters from the get-go (the mandate--weak as it currently is--was the least popular part of Obamacare to begin with).

What steps exactly do you propose to fix our current employer based insurance system that would:

A. Work better, cheaper, and more efficiently than the PPACA,

B. Would result in less people going without medical care (and less than the 45,000 we currently have die each year due to lack of care or delayed care) and medical insurance,

C. Hold health care cost increases down to perhaps inflation plus maybe one and one half percent (with even moderate GDP growth this should be sustainable),

D. Not link insurance to employment

[D1984]

Isn't that kind of a blessing in disguise? Employer-sponsored health coverage is a big thing tying people to their jobs and keeping them working for firms they don't care for.

This. It makes no sense for employers to provide our health insurance (they don't provide our homeowner's or car insurance and don't generally provide the bulk of our life insurance) but they do because of the leftover effects of a wage/price control policy in WWII and a tax-favorability to employer insurance (vs buying one's own health insurance) that was codified in 1954.

I do admit that employers provide a risk-pooling function but ANY large group could do that (and indeed that's what the health isnurance exchanges are supposed to do).

As it stands now, I have paid (via my employer...I checked with HR during the last open enrollment a month ago) about $43,000 in health insurance premiums over the years (that's ignoring any lost opportunity cost for growth on that money) and have used maybe $3,000 of health care. Almost all the money they paid on my behalf went to subsidizing other employees' health care which is how risk pooling works. The issue is that if I lose my job and then get seriously ill, no one will be there to subsidize ME (since I'd lose COBRA after 18 months...and I'm one of the lucky few--or just the more diligent savers--who could AFFORD to pay for COBRA for 18 months out of pocket...many couldn't in the first place) whereas if I had had the chance to buy my own policy when I first started work I would have bought a high deductible one and squirrled the rest away in an HSA so that if I lost my job I would not only still have coverage (since the policy was bought on my own and not part of a group plan by my employer) AND I'd have $40K+ in an HSA.

Alas, I was unable to do the above because all the money I COULD have used to do it was spent subsidizing the older and sicker people in my risk pool (I wasn't alloweds to decline employer provided coverage unless I had coverage through a spouse's employer and proff of it...and even if I HAD declined coverage the extra money would not have gone to me as wages but went into the general pool that paid for our helath insurance). I don't entirely mind subsidizng them (that's the point of health insurance risk pooling after all; the relatively healthy subsidize the sicker ones) but I do think it's only fair that the risk pool should still be there for me now that I have subsidized everyone else for so long. As it is, I have a personal "catastrophic" policy ($6K max OOP per year) I bought on the open market for $69 a month just so if I lose my job or am laid off I'll still have coverage. I get the "privilege" of paying almost $850 a year (this is in addition to the upwards of $40K extra I would have had as well had it not been spent on employer provided health insurance) for a policy I can't even use (this is in addition to what my employer pays on my behalf towards our group coverage) unless I lose my job but that I had to buy just so I won't have to worry about what happens if I develop any pre-existing conditions between now and any time I may get laid off. Roll on 2014 I say; the exchanges can't come soon enough.

[MachineGhost]

By 2016 we'll realize Obamacare is unfeasible, and if the Dems are in power, they can blame it on the free market and start shifting to Single Payor, but if the Repubs are in power, they will scrap the whole thing and go back to what it was before Obama.

We can't go back to before Obamacare where insurance companies wouldn't cover sick people and actively drop sick people that do have insurance.  It is not ethical.

I don't believe the politicians are so smart they expect the intended consequence to be a single payor system.  That's just asking too much of the bottom of the barrel.  It will be an unintended consequence if we allow it, not a conspiracy.  Obamacare is a huge giveaway to the sickcare industry so they would not want to hasten their own demise.

[TripleB]

By 2016 we'll realize Obamacare is unfeasible, and if the Dems are in power, they can blame it on the free market and start shifting to Single Payor, but if the Repubs are in power, they will scrap the whole thing and go back to what it was before Obama.

Yeah, because what we had before was oh so sustainable  . 8 to 10% per year cost increases each year (actually, in 2009, the last year before ObamaCare took effect, my employer's health care costs increased by almost 17%...to be fair they increased by just as much AFTER 2010 as well under Obamacare but to say cost increases were't already unsustainable before PPACA is a lie. You can't have healthcare costs increasing at rates above that of GDP growth and inflation combined and expect it to last forever (exponential compounding is a bitch).

You raise a great point. As HB would frequently say, this is where the government steps in and says "See! Look at the 10% inflation in healthcare costs. Failure of the free market! We need more government to fix it."

When in fact, it was failed government programs that caused 10% increases in healthcare year after year for the last 40 or so years.

In the 70s, Milton Friedman did an interview with Geraldo Rivera (it's on YouTube and great) where inflation in healthcare had been 10% year after year for several years and an audience member asked him why that was occuring.

He explained that government paid for around 30% of all healthcare expenses in the country. And as long as government artificially drove up demand for healthcare, inflation would continue at 10%.

Now in 2012, goverment pays for over 50% of all healthcare in the country through Medicare, Medicaid and the VA system. It's no wonder we have continued 10% inflation in healthcare costs.

One might counter argue, "but it's good government is paying because there's many people who need it but wouldn't receive it otherwise. Government can't create demand for healthcare, the demand is already there."

To which an economist would say, "demand is unmet desire plus the ability to pay for them. Only consumers with the money to buy a product can influence demand from an economic perspective."

The only way costs for healthcare would stop increasing above inflation is if government got out of the equation.

[BearBones]

The only way costs for healthcare would stop increasing above inflation is if government got out of the equation.

Government, government, government..

I have not read HB's  "...Freedom in an Unfree World," but if there is any wisdom to it, it is that life is inherently NOT free. Never has been, never will be. The only consistent freedom we have is our attitude toward the world and our attitude toward our own lives.

Portfolio declines 30%? Hurray! I'd still rather be living in 2013 and in the US than most other points and places in human history (and I am sure glad I have cash and gold)! Obamacare? Ditto! Gun control? Ditto! And on and on...

Suggestion: How about we focus on our common desire to learn about investing rather than what an evil, dire, and repressive world we live in?

[Bean]

We can't go back to before Obamacare where insurance companies wouldn't cover sick people and actively drop sick people that do have insurance.  It is not ethical.

That could have been legislated without the monster of other craziness they passed.  It doesn't have to be all or nothing.

[Pointedstick]

We can't go back to before Obamacare where insurance companies wouldn't cover sick people and actively drop sick people that do have insurance.  It is not ethical.

That could have been legislated without the monster of other craziness they passed.  It doesn't have to be all or nothing.

The problem with requiring insurance to cover pre-existing conditions is that it destroys the fiction that it's insurance and transforms it into a kind of cost-sharing program among members. But with no incentive for people to become members until they need service, costs will simply spiral out of control. Even Obama and the Democrats understand that once you require coverage for pre-existing conditions, you need to force everyone to buy the coverage or else the insurers (if you can still even call them that) will quickly go bankrupt.

Insurance only works when it's insuring the risk of financially quantifiable catastrophic loss. Once you start forcing insurers to cover routine expenses that can be shopped for in the marketplace (i.e. anything that's not a life-threatening emergency), the whole house of cards collapses. Imagine if your car insurance were required to cover the cost of gas. What do you suspect that would do to the price of gas and your car insurance premiums?

[TripleB]

Imagine if your car insurance were required to cover the cost of gas. What do you suspect that would do to the price of gas and your car insurance premiums?

That sounds great! I have a lot of free time on my hands lately and I'd love to take several cross-country road trips given that the gas will be "free" - as in there's no marginal increase of my expenses to take them because all the gas I want is already included in my car insurance premium.

I currently drive infrequently and expend reasonable efforts to hold off on running certain errands so I can do them in tandem with others and be efficient and save gas. What a hassle! It would be great if I didn't have to worry about how much gas I was using and could just freely drive all I wanted.

Then again, someone might argue my MORALs are HAZARDous

[D1984]

By 2016 we'll realize Obamacare is unfeasible, and if the Dems are in power, they can blame it on the free market and start shifting to Single Payor, but if the Repubs are in power, they will scrap the whole thing and go back to what it was before Obama.

Yeah, because what we had before was oh so sustainable  . 8 to 10% per year cost increases each year (actually, in 2009, the last year before ObamaCare took effect, my employer's health care costs increased by almost 17%...to be fair they increased by just as much AFTER 2010 as well under Obamacare but to say cost increases were't already unsustainable before PPACA is a lie. You can't have healthcare costs increasing at rates above that of GDP growth and inflation combined and expect it to last forever (exponential compounding is a bitch).

You raise a great point. As HB would frequently say, this is where the government steps in and says "See! Look at the 10% inflation in healthcare costs. Failure of the free market! We need more government to fix it."

When in fact, it was failed government programs that caused 10% increases in healthcare year after year for the last 40 or so years.

In the 70s, Milton Friedman did an interview with Geraldo Rivera (it's on YouTube and great) where inflation in healthcare had been 10% year after year for several years and an audience member asked him why that was occuring.

He explained that government paid for around 30% of all healthcare expenses in the country. And as long as government artificially drove up demand for healthcare, inflation would continue at 10%.

Now in 2012, goverment pays for over 50% of all healthcare in the country through Medicare, Medicaid and the VA system. It's no wonder we have continued 10% inflation in healthcare costs.

One might counter argue, "but it's good government is paying because there's many people who need it but wouldn't receive it otherwise. Government can't create demand for healthcare, the demand is already there."

To which an economist would say, "demand is unmet desire plus the ability to pay for them. Only consumers with the money to buy a product can influence demand from an economic perspective."

The only way costs for healthcare would stop increasing above inflation is if government got out of the equation.

Sorry, I don't buy this. How come costs for Medicare/Medicaid and the VHA have increased slower than private health insurance costs? How come the more government-controlled systems have been better at "holding the line" on health care costs as a percentage of GDP than we have?

The main drivers of are high health care costs are they we simply pay more (in many cases MUCH more) than other countries do on a PPP adjusted basis for doctors' salaries, hospital admissions, drugs, surgeries, pharmaceuticals, medical devices, etc.

Besides, why would someone necessarily demand more health care if the government or private insurers offset the cost more? No one with one broken leg wants a cast on both legs just because Medicare is paying....people don't just drop by the hospital and go "ya know, a triple bypass surgery would really hit the spot right about now and since the government is paying I'll go ahead and get one more than I would have if I had to pay for it myself." Healthcare is at least somewhat unlike any other good in that if most of us had our choice the optimal amount consumed would be zero (no one WANTS to be in a hospital, have to have surgery, get injections, etc) if we could be just as healthy without it whereas with many  goods/services (say the government offered free Corvettes or one-tenth price filet mignon dinners) the optimal amount consumed would NOT be zero for most people.

[D1984]

Insurance only works when it's insuring the risk of financially quantifiable catastrophic loss. Once you start forcing insurers to cover routine expenses that can be shopped for in the marketplace (i.e. anything that's not a life-threatening emergency), the whole house of cards collapses. Imagine if your car insurance were required to cover the cost of gas. What do you suspect that would do to the price of gas and your car insurance premiums?

I'm not sure how much effect increasing deductibles so that "routine expenses that can be shopped in the marketplace aren't covered" would have on bending the cost curve. According to the MEPS (Medical Expenditure Panel Survey) almost 50% of healthcare was consumed by the top 5% of healthcare users (22% was consumed by the top 1% of healthcare users; roughly 2/3 was consumed by the top 10%; 80% was consumed by the top 20%). The cutoffs to even be in the 1%, 5%, 10%, and 20% respectively were (in 2002 dollars so they'd be much higher now given health care inflation over the last ten years):

1% = $35,543
5% = $11,487
10% = $6,444
20% = $3,219

Most health expenditures are incurred by the top 20% (and most of those by the top 5% ) of health care consumers. These people are going to blow right through a $3,000 or even $5,000 deductible (and most will do it EVERY year as many of the ones in the top 5% are those with expensive chronic conditions). Even if the bottom 80% of us health care spending-wise were so incentivized by consumer driven health care that we spent NOTHING on health care that wouldn't even touch 80% of the problem.

Plus, there's the minor matter of "shopping in the marketplace" to begin with. Read Uwe Reinhardt's (healthcare economist at Princeton) paper "The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy" and tell me how someone is supposed to shop for more cost effective care when hospitals in most states (California is an exception and the WSJ had a story a few years back about how prices the uninsured were expected to pay varied as much as seventeenfold between hospitals) aren't even required to disclose prices or give an estimate until AFTER treatment (when you or your insurer gets the bill). The entire health care market is nearly opaque (and designed that way so hospitals, doctors, drug companies etc can extract rentier's profts that they couldn't easily sustain in either a true free market or an outright single payer system) from square one.

[Gumby]

TripleB, your last few threads have been 100% doom and gloom "the world is ending."  You should probably reign it in a bit.  Nothing is ever as bad (or good) as it seems in the moment.

Would you prefer he post topics about the interesting squirrel he saw yesterday?  Perhaps he could comment on what sunshine tastes like (spoiler alert, the answer is lime skittles).

I've never understood people's desire to be the arbiter of what is "too negative," particularly now.  Things are not great out there.  Is it any wonder that more topics are of a negative nature than a positive one?  Does anyone really think telling someone to "be more positive" is useful or likely to have the desired effect?  It's about like telling someone who's upset to "calm down."  Yep, works every time.

Meh. The whole "2013 Will Be The 'Worst' Year For The US [In My Adult Life]" prediction is almost certainly wrong. Predictions rarely ever work out. It sounds like something from Fox News, designed to get people scared about things that they really don't need to waste their time worrying about. What's next? Christmas 2013 is going to get attacked by atheists?

[Gumby]

It's also worth pointing out that high inflation is extremely unlikely while unemployment is high and taxes are high. If unemployment were to drop significantly it certainly wouldn't be the "worst" year for the US by a long shot. So, it's often just illogical fear mongering when people start only seeing negatives everywhere they look.

[Benko]

Besides, why would someone necessarily demand more health care if the government or private insurers offset the cost more?

My throat hurts, my back hurts, I scraped my arm could you look at it....

The demand for a free good tends toward infinity.

[D1984]

Besides, why would someone necessarily demand more health care if the government or private insurers offset the cost more?

My throat hurts, my back hurts, I scraped my arm could you look at it....

The demand for a free good tends toward infinity.

Do minor things like what you mentioned above (which sounds like something an NP or PA would usually address; maybe a family practioner....not something that's going to run into the tens of thousands per year) really contribute that much to overall health care expenditures vs the major spending by the chronically ill mentioned above in my MEPS reference.

The demand for a free good tends toward infinity if the good is inherently desirable in the first place (i.e. the perceived benefits outweigh the costs); I bet if I set up a stand offering friend manure pies I couldn't GIVE them away for free...for that matter, if a health plan offered, say,  free colonoscopies everyday I don't think they'd find many takers after the first two or three colonoscopies per person per year (if that).

Do members of the Forbes 400 try to maximize their use of health care every year (when you have a billion or more in wealth and presumably very good insurance health care is all but free by your perception) just because it is practically "free" top them or do they use what they need to be healthy and then don't deliberately go out and consume more basically "free" health care?

If I manage (say I had a major auto accident or something) to max out my deductible and coinsurance next year then every bit of care I consume is "free" from that point (my employer's plan waives copayments once the OOP max is met) on but I'm not going to go to the doctor every week just because it's free UNLESS I happen to be sick or injured in the first place.

If what you are saying is 100% true then the only real solution is to abolish all insurance (or maybe put in place maybe $20,000--or higher--deductibles which is tatamount to abolishing insurance anyway for most middle class and poorer individuals since for them $20K in medical costs before the insurer picks up a dime is a one way ticket to bankruptcy court) and just make everyone pay eveything out of pocket because the vast majority of health care ($$$ wise) is consumed by those who are way past their deductibles/coinsurance levels anyhow.

[TripleB]

Whoever disagrees with my statement that healthcare will be overused should volunteer for a few hours in any Emergency Department in the country, where, due to EMTALA, all patients must be seen by a provider (which could be an NP or PA depending on the state, although an MD/DO "Physician" is still required to sign off on the chart).

90 out of 100 patients are completely ridiculous (to include drug-seeking patients who want opiates because the war on drugs has made heroin expensive)

9 out of 100 patients are legit but should be seen by a PCP, which the patient doesn't have, so they use the ED.

1 out of 100 patients is legit and belongs in the ED.

An average medium sized ED in an urban area has a daily census of between 100 and 200 patients per day. 1 to 2 of them actually belong in the ED.

Now imagine that nonsense occurring in every levels of healthcare because it's all free everywhere.

[Benko]

A large percentage of ER visits are for people who use the ER as their primary care provider.  If you make it free you will increase the number of people who e.g. go to the doc/er just in case.  This will apply to well people and people with chronic illnesses.  HUman nature is human nature.  Giving an example of a good to which people are adverse to is not relevant. 

"Do members of the Forbes 400"
I suspect many members of the Forbes 400 had to work for what they have. So I would suspect they are less likely to abuse the system. 

but I'm not going to go to the doctor every week just because it's free"
You wouldn't abuse e.g. the welfare system eighter should you ever need it, but you are not the people we are talking about.  I work for the gov't and see hard working people but also people who game the system. 

"If what you are saying is 100% true then the only real solution is to abolish all insurance"
I have no idea where that straw man came from.

[Pointedstick]

Whenever people wonder why health care is too expensive, I like to pull out this website, written by a doctor who desperately tries to find out what things cost:

http://www.truecostofhealthcare.org/

The TL;DR summary is that nobody has any idea what anything in medicine costs anymore, and nobody pays for their own services, so it's devolved into a game of providers trying to jack prices up as high as they can, with the ultimate payers (insurers) having to pass those costs onto subscribers, resulting in ever-rising premiums. But none of the providers truly profit from this since the internal lack of consistent prices on services causes whatever vast sums change hands to be squandered out of ignorance and departmental politics, or spent on labor and services to sort the mess out (e.g. huge billing departments).

There are many reasons why this state of affairs came about, but that's where we're at right now. Health care is basically a sector of the market where market features such as prices and competition are absent, transforming it into a chaotic, disorganized, inefficient, extractive, free-for-all.

[D1984]

A large percentage of ER visits are for people who use the ER as their primary care provider.  If you make it free you will increase the number of people who e.g. go to the doc/er just in case.  This will apply to well people and people with chronic illnesses.  HUman nature is human nature.  Giving an example of a good to which people are adverse to is not relevant. 

"Do members of the Forbes 400"
I suspect many members of the Forbes 400 had to work for what they have. So I would suspect they are less likely to abuse the system. 

but I'm not going to go to the doctor every week just because it's free"
You wouldn't abuse e.g. the welfare system eighter should you ever need it, but you are not the people we are talking about.  I work for the gov't and see hard working people but also people who game the system. 

Aren't many who use the ER as their PCP there because they have no choice i.e.they are on Medicaid but it pays so little that no doc will see them so they go to the ER because under EMTALA the ER has to accept Medicaid patients?

As regards the Forbes 400 - Once you're at a billion or more I fail to see how having "worked for it" makes much difference as far as willingness to spend goes. At that point it's money to burn regardless (you could spend $60,000,000 per year on health care or anything else and still wind up the year richjer than you started assuming you are invested properly); still, if you think the Forbes 400 is a bad sample set how about only those of the400 who inherited most of their money, or how about lottery winners? Do they try to consume infinitely more medical care just because they can.?

As regards to "a good to which most people are averse to" - Health care isn't exactly a pleasurable good to consume, opiates or cocaine aside...and those are only expensive because the War on Drugs makes them that way; who has triple bypasses, organ transplants, or expensive chemotherapy just for the fun of it? No one without Munchausen's (I hope); people who do consume a lot of these (expensive) services are typically rather ill and consume them because a doctor advised doing so to get them well, not because they derive pleasure from consuming them. heck, even for something minor like twice yearly dental cleanings....many insurance plans (Delta Dental is our provider and they offer this) offer no out of pocket cost cleanings...but how many people do you think maximize use of this benefit? Ask your dentist but I'd be surprised if even half do. Going to the dentist is not most people's idea of an enjoyable way to spend time so even if it's "free" (and even though they know they probably should) many will choose to avoid the cleanings anyway.

"If what you are saying is 100% true then the only real solution is to abolish all insurance"
I have no idea where that straw man came from.

You seem to be saying that what is driving medical cost inflation is people overusing/overdemanding medical care because it it too cheaply priced. Given the following premises:

A. Most consumption of medical care is heavily tilted towards the most expensive patients (the top 20% of insured patients by cost are responsible for 80% of healthcare dollars spent; the bottom 50% of insured patients are responsible for 3-4% of health care costs),

B. That to be in said 20% you have to have spent probably nearly $5,000 that year on health care (that's not the average; that's the threshold),

C. Most deductibles and max OOP are currently lower than that so these patients have already blown past the deductible/OOP max and are thus essentially getting "free" medical services (from an OOP standpoint) until the next calendar year;

D. People will consume a more than ordinate/necessary amount of care if it's "free" to them because they won't be disciplined by market prices to wisely spend

Then it logically follows to introduce more "price discipline" or cost consciousness at these levels (either by making them pay everything out of pocket or by increasing deductibles to a level where they still have to make huge out of pocket contributions) so that people won't choose to spend so much since it wouldn't seem "free" to them any more.

[Benko]

D1984

"As regards the Forbes 400 - Once you're at a billion or more I fail to see how having "worked for it" makes much difference "

I can belive that.  What you need it a grasp on human nature and how actual people behave, not any more facts of insurance.

Watch videos of what human behavior went on during katrina. 

[D1984]

D1984

"As regards the Forbes 400 - Once you're at a billion or more I fail to see how having "worked for it" makes much difference "

I can belive that.  What you need it a grasp on human nature and how actual people behave, not any more facts of insurance.

Watch videos of what human behavior went on during katrina.

Perhaps I should have been more precise or clarified better what I meant by "makes much difference." I was making a point that once you have enough money that health care is essentially not a scarcity limited good to you anymore (please tell me how one is going to spend several dozen million on healthcare every year) if healthcare is what you truly want to consume and given that that restraint is gone for you it is at that point moot how you got the money (a dollar worked for is a valuable to buy something as any other dollar...I've never seen a hospital--or any other business-charge a higher price list simply because the money wasn't worked for or because it was).

I have no doubt there were looters after Katrina....but how many people DIDN'T loot? Did everyone loot? Did almost everyone loot? For that matter, looters stole (or forcibly took) guns, TVs, clothing, shoes, jewlery, etc but these are goods that are in and of themselves desirable.

Despite the fact that they were stealing everything else, I don't recall any looters trying to force doctors at gunpoint to treat them in order to get "free" medical care 

[Storm]

TripleB, your last few threads have been 100% doom and gloom "the world is ending."  You should probably reign it in a bit.  Nothing is ever as bad (or good) as it seems in the moment.

Would you prefer he post topics about the interesting squirrel he saw yesterday?  Perhaps he could comment on what sunshine tastes like (spoiler alert, the answer is lime skittles).

I've never understood people's desire to be the arbiter of what is "too negative," particularly now.  Things are not great out there.  Is it any wonder that more topics are of a negative nature than a positive one?  Does anyone really think telling someone to "be more positive" is useful or likely to have the desired effect?  It's about like telling someone who's upset to "calm down."  Yep, works every time.

I'm not saying he shouldn't post negative threads; I'm just trying to give the "glass half full" side of argument.  Things rarely turn out as badly as you think they are going to.  This is something PP-like, if you think about it.

[Storm]

By 2016 we'll realize Obamacare is unfeasible, and if the Dems are in power, they can blame it on the free market and start shifting to Single Payor, but if the Repubs are in power, they will scrap the whole thing and go back to what it was before Obama.

We can't go back to before Obamacare where insurance companies wouldn't cover sick people and actively drop sick people that do have insurance.  It is not ethical.

I don't believe the politicians are so smart they expect the intended consequence to be a single payor system.  That's just asking too much of the bottom of the barrel.  It will be an unintended consequence if we allow it, not a conspiracy.  Obamacare is a huge giveaway to the sickcare industry so they would not want to hasten their own demise.

+1.  I believe Obamacare is actually beneficial to healthcare as an industry.  You can easily see this because when the supreme court upheld the legislation, healthcare stocks got a nice bump.  The smart money would not be investing in healthcare stocks if Obamacare was detrimental to the sector.

Even those of us in healthcare (I work in the industry, on the payer side) know that 8-10% inflation is unsustainable.  If we allow it to continue for 25 years either every person on the planet would be employed in healthcare or the bubble would burst.  Perhaps it is self preservation to be logical and work for sustainable growth of the sector, on the order of 3-5% annually.

Administrative cost caps are beneficial because they shake out a lot of the scummy smaller payers that target flyover states with no other health insurance available and charge them ridiculous premiums, pocketing 50% of them and denying claims whenever possible.  The large payers like Aetna, Wellpoint, etc, don't need to resort to these unethical behaviors because they have built efficient businesses that can run within the 3% administrative expense allowed by Obamacare.

I'm curious, TripleB.  What part of the healthcare industry do you work in, and how do you have such knowledge that Obamacare is the disaster that it is?

[Storm]

The problem with requiring insurance to cover pre-existing conditions is that it destroys the fiction that it's insurance and transforms it into a kind of cost-sharing program among members. But with no incentive for people to become members until they need service, costs will simply spiral out of control. Even Obama and the Democrats understand that once you require coverage for pre-existing conditions, you need to force everyone to buy the coverage or else the insurers (if you can still even call them that) will quickly go bankrupt.

There's a hell of a large incentive to get insurance.  It's called the individual mandate, and if you don't get it, you're effectively taxed the same as your premiums, so why would anyone go uninsured just to try and game the system?  It doesn't make sense!

[Pointedstick]

The problem with requiring insurance to cover pre-existing conditions is that it destroys the fiction that it's insurance and transforms it into a kind of cost-sharing program among members. But with no incentive for people to become members until they need service, costs will simply spiral out of control. Even Obama and the Democrats understand that once you require coverage for pre-existing conditions, you need to force everyone to buy the coverage or else the insurers (if you can still even call them that) will quickly go bankrupt.

There's a hell of a large incentive to get insurance.  It's called the individual mandate, and if you don't get it, you're effectively taxed the same as your premiums, so why would anyone go uninsured just to try and game the system?  It doesn't make sense!

That was my point. The individual mandate is required for this policy to work. But understand that it's transforming insurance into something very different. What you have is not so much health insurance but membership into a "health club" that agrees to pay such-and-such percent of such-and-such expenses, some determined by the plan, some mandated by law.