Affordable Care Act Woes (Obamacare)

[Reub]

To quote the one and only:

"Suzanne Somers: The Affordable Care Act Is a Socialist Ponzi Scheme"

http://blogs.wsj.com/experts/2013/10/28 ... zi-scheme/

She just grows on you every day!

[doodle]

To quote the one and only:

"Suzanne Somers: The Affordable Care Act Is a Socialist Ponzi Scheme"

http://blogs.wsj.com/experts/2013/10/28 ... zi-scheme/

She just grows on you every day!

Isn't all insurance a ponzi scheme of sorts? I mean I've been paying into insurance for ten years now and luckily haven't had anything worse than a cold and havent even bothered to get my free yearly checkup. Then, there are others who are at the doctors every week. One day I might need it, or I might just die in my sleep and never spend a penny.

[WildAboutHarry]

Isn't all insurance a ponzi scheme of sorts?

No.

Neddy doesn't believe in insurance. He considers it a form of gambling.

[doodle]

Isn't all insurance a ponzi scheme of sorts?

No.

Neddy doesn't believe in insurance. He considers it a form of gambling.

It is a form of gambling....but it only works if enough people participate to adequately pool the risk.

It seems similar to a Ponzi scheme in some respects:

A Ponzi scheme is a investment operation that pays returns to its investors (sick people) from their own money or the money paid by subsequent investors (healthy people), rather than from profit earned by the individual or organization running the operation.

[Pointedstick]

It is a form of gambling....but it only works if enough people participate to adequately pool the risk.

It seems similar to a Ponzi scheme in some respects:

A Ponzi scheme is a investment operation that pays returns to its investors (sick people) from their own money or the money paid by subsequent investors (healthy people), rather than from profit earned by the individual or organization running the operation.

Most insurance programs need to convince people that they offer more risk mitigation value than they cost in premiums, deductibles, etc. For example, nobody would voluntarily buy a car insurance policy that cost $5,000 a month because it would be patently obvious that such a high cost could simply be saved and used to pay for the cost of any disasters in cash.

The problem with the medical insurance industry is that it's been so highly manipulated that it's barely insurance anymore. It's more like membership in a weird cost-sharing health club. And through government meddling, the price of membership (to say nothing of the underlying costs that membership pays for) has risen so high that many people have decided that it's not worth it anymore.

And in typical government fashion, instead of making it worth it, it simply forces people to buy it anyway, adds additional service mandates that the people who didn't buy it before still don't feel like they need, then then it declares that it's made it worth it.

[Kshartle]

but I still hear the generic "it..it's just different, it's health care" response. Maybe they are right.

There is not a chance they're right.

I hear "health care is a right because you need it to live"

You need food, water, shelter and clothing more. Are those a right too?

[Pointedstick]

You need food, water, shelter and clothing more. Are those a right too?

Rights are politically-created ideas. The government can declare anything it wants a right. If food, water, shelter, or clothing ever became too expensive for many people to afford, you bet the government would declare access to them rights and then bungle up those markets as well.

[iwealth]

but I still hear the generic "it..it's just different, it's health care" response. Maybe they are right.

There is not a chance they're right.

I hear "health care is a right because you need it to live"

You need food, water, shelter and clothing more. Are those a right too?

Would government controlled clothing be weird?

There's a reasonable standard of clothing every American should wear. It's been determined to be irresponsible to wear certain types of clothing if the outside temperature is above or below a certain threshold. If your clothing does not currently meet those standards, you must discard that clothing and get new clothing meeting the government imposed minimum standards. Any clothing purchased prior to March 2010 is grandfathered in and still wearable. Of course anyone that can't afford the minimally required government standard clothing will receive subsidies to ensure they are able to purchase and wear that clothing.

Yeah I guess that would be weird.

[Kshartle]

You need food, water, shelter and clothing more. Are those a right too?

Rights are politically-created ideas. The government can declare anything it wants a right. If food, water, shelter, or clothing ever became too expensive for many people to afford, you bet the government would declare access to them rights and then bungle up those markets as well.

If the government declares gravity doesn't exist will it stop existing?

I know your point is different....I just want to point out that the government can't overrule reality. If it's not a right the government can't make it one. It can only pretend it is and steal from some and give to others.

It's like saying Obamacare makes previously uninsurable people insurable. It doesn't. They're still uninsurable. It's just a welfare program taking from some to give to others.

[WildAboutHarry]

A Ponzi scheme is a investment operation that pays returns to its investors (sick people) from their own money or the money paid by subsequent investors (healthy people), rather than from profit earned by the individual or organization running the operation.

Insurance "schemes" (e.g. Social Security) sponsored by the government are often very much like a Ponzi scheme.  Private-sector insurance plans, not so much.

[Kshartle]

A Ponzi scheme is a investment operation that pays returns to its investors (sick people) from their own money or the money paid by subsequent investors (healthy people), rather than from profit earned by the individual or organization running the operation.

Insurance "schemes" (e.g. Social Security) sponsored by the government are often very much like a Ponzi scheme.  Private-sector insurance plans, not so much.

Except ponzi schemes are completely voluntary. Calling a government program a ponzi scheme is insulting to ponzi schemes.

[Kshartle]

Current Post on Yahoo Finance:


If you're 26 or older and your health insurance is about to double because you're not insured through your job, what would you do?
Take the penalty (10271) - your vote
  45%
Buy insurance now anyway (3996)
  18%
Wait until I got sick to buy (8351)
  37%

[Kshartle]

I don't know what the difference is between taking the penalty and waiting until I'm sick to buy. I'm going to wait until I'm sick and try to avoid the penalty by not expecting a return.

[Xan]

Even with the pre-existing condition thing, there's still a lot of risk in just planning to buy insurance after you get sick.  Something could happen suddenly, where you need expensive, emergency treatment, and I think you'd be on the hook for that.

The example I can think of is a car wreck where you spend a month in the ICU.  Although I wonder if somebody with your power of attorney could sign you up for health insurance on the way to the hospital (or on day 1 out of 30).

[Kshartle]

Even with the pre-existing condition thing, there's still a lot of risk in just planning to buy insurance after you get sick.  Something could happen suddenly, where you need expensive, emergency treatment, and I think you'd be on the hook for that.

The example I can think of is a car wreck where you spend a month in the ICU.  Although I wonder if somebody with your power of attorney could sign you up for health insurance on the way to the hospital (or on day 1 out of 30).

Doesn't my car insurance cover me for an emergency car wreck? I think I'm required to carry something like 40k of personal injury.

If you're talking about some other emergency like an arm break....well I'll just pay the bill.

I only want insurance for big things that will really harm my wealth like cancer or a brain transplant etc.

[iwealth]

Even with the pre-existing condition thing, there's still a lot of risk in just planning to buy insurance after you get sick.  Something could happen suddenly, where you need expensive, emergency treatment, and I think you'd be on the hook for that.

The example I can think of is a car wreck where you spend a month in the ICU.  Although I wonder if somebody with your power of attorney could sign you up for health insurance on the way to the hospital (or on day 1 out of 30).

Or perhaps carry the less expensive catastrophic coverage until something happens and then switch.

[moda0306]

I believe the "penalty" goes up significantly over the next few years. 

[Pointedstick]

I believe the "penalty" goes up significantly over the next few years.

I hear there are also going to be a few elections in the coming years as well.

In a representative republic, you can only piss off so many people for so long.

[Kshartle]

Even with the pre-existing condition thing, there's still a lot of risk in just planning to buy insurance after you get sick.  Something could happen suddenly, where you need expensive, emergency treatment, and I think you'd be on the hook for that.

The example I can think of is a car wreck where you spend a month in the ICU.  Although I wonder if somebody with your power of attorney could sign you up for health insurance on the way to the hospital (or on day 1 out of 30).

Doesn't my car insurance cover me for an emergency car wreck? I think I'm required to carry something like 40k of personal injury.

If you're talking about some other emergency like an arm break....well I'll just pay the bill.

I only want insurance for big things that will really harm my wealth like cancer or a brain transplant etc.

What if you need emergency surgery for a burst appendix that left you in the hospital for a week? Could you self insure that?

Yes

[WiseOne]

Sincere question: has anyone here been positively affected by Obamacare or know anyone who has? Anyone with a pre-existing condition who's now insurable? Anyone under 26 without much money who's been able to stay on their parent's insurance? Anyone gotten a rebate check from their insurer that wasn't dwarfed by premium increases? Anyone who previously couldn't afford health insurance and now can?

In my extended social network, the only two people I know who have benefited from Obamacare are two starving artists who've been able to stay on their parents' insurance. That's it. Several very liberal uninsured relatives have remarked that insurance is not only still too expensive for them, but more expensive than it was the last time they checked.

If only a very very small number of people are actually benefiting from this thing and everybody else is getting reamed, where's the political will to defend it coming from? I mean, we live in a representative republic. A law that helps 5% of people (generously) and shafts the other 95% should be the most unpopular thing ever and legislators should be falling all over themselves to repeal it, deluged by angry letters from their constituents... right? What am I missing? Am I living in a weird bubble? Does my network simply not include enough people too sick to previously be eligible for health insurance, but wealthy enough to afford it now that it has to be issued to them?

Well, I have two nieces with a genetic syndrome that would have left them in a very difficult situation as adults.  They're likely going to be fully capable of holding a job with flexible hours (they're both very smart), but without the ACA they'd have probably been forced onto Medicaid which would have effectively banned them from entering the work force.  Now they have nothing to worry about except a wholesale repeal of the ACA.

You could probably also count in the legions of early retirees (low incomes by definition, thus qualifying for premium subsidies - see recent Mr. MMM column) as well as anyone who has ever had a hangnail or yeast infection who has been wanting to quit Gigantic Corp, Inc. to become self-employed.

The requirement of this law for every Joe Bob Citizen to take some kind of positive action is going to be really hilarious to watch.  Joe Bob C. can barely tie his own shoes on a good day, let alone navigate a complicated website to sign up for an even more complicated insurance scheme.  I can't wait to find out what exactly the administration & IRS plan to do about those penalties.  I bet they'll be deferred every year by a Senate/House vote that will go down the wire and create lots of drama, just like the Medicare physician reimbursement cuts.

[MediumTex]

In response to the anticipated flood of new insured patients looking for appointments with the same number of doctors, my doctor decided to set up a $2,000 annual paywall if you would like to continue seeing him.

Since I only go to the doctor once or twice a year, the $2,000 fee was a nonstarter for me, so I am now looking for a new doctor.

Expect to see more and more doctors going to this "concierge" practice model.  The paywall for many doctors will probably be whatever fee is necessary to maintain his/her current patient population (some might just be in the $200-$500 range).  A nice by-product for these doctors will be that they will be able to make more money.

[Benko]

1.  http://nypost.com/2013/10/29/docs-resisting-obamacare/
Docs resisting Obamacare. 

2.

In a representative republic, you can only piss off so many people for so long.

One would think so, but it seems more likely that Obamacare will die a relatively quick death due to a. incompetence of implementation, b. young people not signing up and c. doctors wanting no part of it.

3. "I can't wait to find out what exactly the administration & IRS plan to do about those penalties. "

Apparently if you arrange your taxes so that you get no refund, the IRS cannot collect the "mandate"
from you (if you get a refund, they can just deduce it from your refund).

[smurff]

In response to the anticipated flood of new insured patients looking for appointments with the same number of doctors, my doctor decided to set up a $2,000 annual paywall if you would like to continue seeing him.

Since I only go to the doctor once or twice a year, the $2,000 fee was a nonstarter for me, so I am now looking for a new doctor.

Expect to see more and more doctors going to this "concierge" practice model.  The paywall for many doctors will probably be whatever fee is necessary to maintain his/her current patient population (some might just be in the $200-$500 range).  A nice by-product for these doctors will be that they will be able to make more money.

They will probably come up with a couple of new laws. 

First,  any health care provider (doctor, nurse, physician assistant, nurse practitioner, etc.) who received education and/or training under a government subsidy (federal student loan, grant, or fellowship) or in a government supported facility (Medicare pays for residency training in teaching hospitals, etc.) will be prohibited from turning away patients because of the type of insurance they have.  The new law would forbid putting up barriers like "concierge" services unless such services are part of an actual health care plan open to all in that market.

Second, a federal law will go beyond state laws and allow a variety of practitioners to have legitimate practices (covered by health care plans) without mandatory supervision by M.D. or D.O. physicians. They will be able to admit to hospitals, write prescriptions, develop treatment plans, write referrals to other professionals (physical therapy, nutritionists, etc.) sign disability and workers comp documents, etc. 

Third, they might come up with a new professional designation intermediate between B.S. nurse/physicians assistant and M.D. physician/surgeon, especially if doctors start rioting over nurses taking away their work.  The new designation might require a 2-year Master's degree (beyond the Bachelors) instead of a 4-year Doctorate.  Or they might borrow from other countries (like the UK) where physicians entered university as freshman specifically to study medicine, and graduated with a medical degree after 4-6 years at the Bachelor's level.

Otherwise I don't see how there will be enough doctors for all the people Obamacare will have brought into the system.

[smurff]

Apparently if you arrange your taxes so that you get no refund, the IRS cannot collect the "mandate"
from you (if you get a refund, they can just deduce it from your refund).

They'll fix this right away, before anybody can actually game the system like that. 

The US government is lax and lazy about a lot of things, but not when it comes to using the IRS to collect money.

[D1984]

Apparently if you arrange your taxes so that you get no refund, the IRS cannot collect the "mandate"
from you (if you get a refund, they can just deduce it from your refund).

They'll fix this right away, before anybody can actually game the system like that. 

The US government is lax and lazy about a lot of things, but not when it comes to using the IRS to collect money.

Fix it how? If it required a law to put the mandate itself in then logically it would require a law modifying it so that wages could be garnished, assets liened, property seized, etc. Good luck getting that sort of law through as long as the Rs control at least one house of Congress

For that matter, even if the Ds did win the House in 2014 (and I'd guess there's less than a 50% chance of that happening) there's no guarantee that they could pass a bill making the mandate penalties actual enforceable sanctions. Remember, the mandate is the "green vegetables" that people supposedly have to eat if they want the "dessert" of guaranteed issue, community rating, and no-preexisting conditions i.e. the mandate is the part of Obamacare that NOBODY (besides maybe health wonks like Gruber and Reinhardt and Obama fanbois like....well....whoever still likes him as President about right now) actually likes. Press too hard to have it strengthened and find yourself out of a job come the next election.