Ding.
Comment by Patterico (89e117) ? 2/1/2013 @ 1:01 pm
I?ll take the penalty/tax, thanks.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:03 pm
You?ll get nothing, and pay for it.
Comment by SarahW (b0e533) ? 2/1/2013 @ 1:04 pm
Exactly and sign up when I get seriously ill.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:06 pm
The high deductible health policy choice offered by my employer (that still protected against catastrophe and risk of an impossibly big outlay for care) which I got for a pittance in premiums was very satisfactory for many years. Under Obamacare that puppy?s no longer an option. Thanks Dems.
Comment by elissa (0a4492) ? 2/1/2013 @ 1:12 pm
?If you like your insurance you can keep it.?
Comment by Patterico (89b580) ? 2/1/2013 @ 1:19 pm
?Under Obamacare that puppy?s no longer an option.?
elissa ? A high deductible cat policy won?t count toward avoiding the penalty/tax under Obamacare, but I?m unclear whether insurance companies will still be permitted to write them.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:22 pm
They might be able to write them, but you?d still pay the penalty/tax.
Comment by Sammy Finkelman (d22d64) ? 2/1/2013 @ 1:26 pm
That cannot be true, Elissa. If you like your insurance, you can keep it. Obama said so.
Comment by JD (b63a52) ? 2/1/2013 @ 1:28 pm
Yes, we were lied to, and yes, we got Obamacare.
But the lies were irrelevant to passing Obamacare. It isn?t as if the public only supported Obamacare because of the lies? as we both know, the public didn?t support Obamacare, period. The public didn?t believe the claims Obamacare supporters were making (a majority of the public felt Obamacare would result in their having to pay more money for less care).
We got Obamacare because the Democrats in Congress decided that it was something they were going to force down our throats. They knew the numbers didn?t work and they didn?t care.
Comment by steve (369bc6) ? 2/1/2013 @ 1:28 pm
If the numbers don?t work now, just wait until we add 12,000,000 more to the rolls.
Comment by JD (b63a52) ? 2/1/2013 @ 1:31 pm
I?m unclear whether insurance companies will still be permitted to write them.
Me too, but my guess is that they?re not going to be allowed to, as Obamacare sets minimum standards that policies have to meet (such as offering ?free? contraceptive coverage) and catastrophic only plans won?t meet that standard.
Comment by steve (369bc6) ? 2/1/2013 @ 1:31 pm
?They might be able to write them, but you?d still pay the penalty/tax.?
Sammy ? I noted that in my comment. My question is whether HHS would prohibit insurers writing policies which allow people to do an end run around Obamacare given the differential between the size of penalty/tax and the anticipated premiums. Early on I heard they were going to prohibit such policies, but I have not heard anything in a couple of years.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:35 pm
daley?yeah, I don?t know either. I think probably not. The beauty of it was that it wasn?t strictly a ?we wash our hands of you until it?s a catastrophe/hospital? deal. You still filtered all dr?s visits, tests and emergency room visits through the plan to get the benefit of any negotiated prices with the provider that were lower than billed amount. They didn?t pay uniil the high dedudctible was reached, but you benefitted from the group rates on services.
Comment by elissa (0a4492) ? 2/1/2013 @ 1:35 pm
For anybody wanting an insurance primer, the cost is going up for four reasons:
1 ? the minimum level of coverage is going up (as everything including the kitchen sink will have to be covered), driving up the cost (you ?get? more, you pay more).
2 ? forcing people with coverage to subsidize the free and below market coverage provided to those without coverage (xx% of your premium pays for ?your? coverage, the balance of your premium dollars pays for someone else to get coverage),
3 ? eliminating waiting periods, prior period exclusions, lifetime caps on coverage and risk-based pricing increases the expectation of outlay, resulting in higher premiums, and
4 ? medical care just costs more every year. There are very few breakthroughs that lowers the cost of providing care.
Comment by steve (369bc6) ? 2/1/2013 @ 1:38 pm
4 ? medical care just costs more every year. There are very few breakthroughs that lowers the cost of providing care.
LASIK
Comment by JD (448fa8) ? 2/1/2013 @ 1:39 pm
Obama bends the health care cost curve down, in his mind, the same place where he splits atoms.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:46 pm
That?s one, can you name a second?
Also, Lasik isn?t usually covered by insurance, so allow me to modify my point to say that there is very little that lowers the cost of what is covered by insurance. And where the cost for a given procedure or drug does go down, it is usually because it was replaced by a more expensive drug or procedure.
Unfortunately, medical care isn?t like computers, where we can expect to get a better machine for relatively less money than the year before.
Comment by steve (369bc6) ? 2/1/2013 @ 1:48 pm
The cost of routine care would go down if the market weren?t distorted by price-fixing, and this distortion protected by removal of the true consumer from the cost of care.
Prudential planning should be rewarded with tax breaks that employers get now ? employers should pay you a wage. You decide how to allocate. Your insurance costs should be fully deductible. HSA?s grow tax free with contributions also deductible.
The insurance market is then regulated by the states to make sure it provides what it promises.
The truly indigent or disabled are covered in part or whole by programs that CANNOT dictate other fee arrangements and insurers are also forbidden to collude or prevent negotiation of individual treatment.
Comment by SarahW (b0e533) ? 2/1/2013 @ 1:52 pm
Steve ? the costs for many diagnostic and surgical services go WAY down when self-pay when the provider is not forbidden from a cash-schedule or direct negotiation. MRI, ultra-sound, etc. Plain old tort liability and professional standards still apply, so quality is uncompromised.
Comment by SarahW (b0e533) ? 2/1/2013 @ 1:54 pm
?And where the cost for a given procedure or drug does go down, it is usually because it was replaced by a more expensive drug or procedure.?
steve ? I think the movement of many surgical procedure away from hospital settings to specialized clinics or outpatient facilities has had an impact on costs, but that would have to be confirmed by some of the docs on the board. The Obama Admin. does not particularly support physician owned hospitals or surgery centers based on my understanding.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:55 pm
the costs for many diagnostic and surgical services go WAY down when self-pay when the provider is not forbidden from a cash-schedule or direct negotiation. MRI, ultra-sound, etc.
I make a distinction between the cost of the service and the amount you have to pay ? defining ?cost? in two different ways, and my referring to ?cost? refers to the cost incurred by the provider in providing that service. Negotiating a price break doesn?t result in a lower cost of providing the service, it merely shifts the costs to someone else?s pocket. It?s the flip side of Obamacare mandating that coverage for X or Y is ?free?? not charging someone for that specific coverage doesn?t mean it doesn?t cost the provider to provide that service.
The same may apply to the ?cost? of outpatient surgery. While the insurance company may not pay as much, I don?t know if the actual cost of providing the service is any less in a different environment. (I think it?s being done because the surgeons can have a stake in the facility and thus can make more for themselves).
Comment by steve (369bc6) ? 2/1/2013 @ 2:05 pm
?And where the cost for a given procedure or drug does go down, it is usually because it was replaced by a more expensive drug or procedure.?
steve ? How about laparoscopic surgery which has become so common for many surgeries over time. While it may involve a higher technology investment than more invasive surgery, how does the shorter recovery time/hospital stay affect overall cost?
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 2:06 pm
Based on this report http://ehbs.kff.org/pdf/2012/8345.pdf
the average cost for a family plan with employeer provided coverage is 15,700$ for 2012. If i assume 3% inflation it goes up to 17,1000 for 2015. This is for an employeer plan, I assume that buying a plan for an individual family is more expensive but I have no idea how much. It doesn?t really look like this is too far off from what we?re currently paying.
Comment by time123 (066362) ? 2/1/2013 @ 2:10 pm
?I make a distinction between the cost of the service and the amount you have to pay?
steve ? I thought you were trying to make an analogy to a manufacturing type business, that the ?cost of goods sold? in the health care industry only moves in one direction due to technology or research advances. What people actually pay, negotiate to pay, or the government pays for the goods and services are separate questions.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 2:12 pm
Time ? the employer gets a tax break, and gets to play an employee with that plan and keep him. The self-purchase family plan ? NO BREAK AT ALL, except you don?t pay the fine.
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:14 pm
Steve, the better way is to remove as much market distortion as possible, preserve liberty and reward private prudence.
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:15 pm
It doesn?t really look like this is too far off from what we?re currently paying.
Raise your hand if you are paying this much.
Comment by JD (448fa8) ? 2/1/2013 @ 2:17 pm
according to my W2 the cost of my health care package is 11K to my employeer. My monthly is sums up to about 2,500 so i?m at 13,5 total.
Comment by time123 (066362) ? 2/1/2013 @ 2:23 pm
LASIK is different because it is not covered so competition lowers prices. I believe all health are would be like that but for government subsidies.
Comment by Patterico (399c43) ? 2/1/2013 @ 2:29 pm
standard healthcare pricing reflects the fact that many, if not all, non-capitated payors discount their payments, such as only paying 80% of the total charges?
capitiated payors, of course, pay a flat rate, no matter what.
that is why you, if you are going to purchase treatment yourself, can negotiate a lower price. it?s also why you will often get a bill from a provider after receiving care, demanding that you pay the difference between what they charged and what they were paid by your insurer.
Comment by redc1c4 (403dff) ? 2/1/2013 @ 2:33 pm
It?s good to know that you?re content and sanguine about all this, time123, and that you believe you are not negatively affected by ACA as so many of us already know we are. Maybe out there some where you can find a few more pipple who are happy, too, and start a little Omamacare fan club. I don?t think you?re going to need a very big meeting room, though.
Comment by elissa (0a4492) ? 2/1/2013 @ 2:34 pm
about your EMR?s as mandated by Obamacare
yeah, the DEA thinks they are entitled to them without a warrant demonstrating probable cause?
Comment by redc1c4 (403dff) ? 2/1/2013 @ 2:36 pm
The ideal is that the entire population will be attended to under the VA.
It is bound to cut SocSec costs.
Comment by askeptic (b8ab92) ? 2/1/2013 @ 2:48 pm
My turnip has no blood.
Comment by mg (31009b) ? 2/1/2013 @ 2:50 pm
Redc1c4 its worse than that, really. Medicare not only drives pricing, and distorts insurance payouts, but insurers actually forbid free negotiation or cash-for-service pricing that is better that their contract reimbursement. Moreover 3rd party reimbursements are nororiously shell games with real cost often disconnected from reimbursement.
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:51 pm
Why is it that the more we discover about the PPACA, the more that out-of-pocket, first-party, CASH is the solution to spriraling out-of-control health-insurance (and care) costs?
This is a problem created seventy years ago that is finally bearing bitter fruit.
Comment by askeptic (b8ab92) ? 2/1/2013 @ 2:54 pm
An extra 7000 out of the family budget? What difference does it make?
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:59 pm
The bullet train of single payer is up and speeding towards the station!
Comment by Patricia (be0117) ? 2/1/2013 @ 3:00 pm
Patterico ? exactly why I picked that example.
Comment by JD (448fa8) ? 2/1/2013 @ 3:01 pm
Ditto 10. and 38.
Comment by Joseph D (ece5cb) ? 2/1/2013 @ 3:09 pm
i was keeping it simple for the non-hc readers.
Comment by redc1c4 (403dff) ? 2/1/2013 @ 3:19 pm
SarahW ? if it?s true that health insurance purchased on the open market isn?t tax deductable, it seems like that?s something which should be fixed. (I don?t know, as I?ve always gotten insurance through an employer, so I?ve never had to find out.)
Comment by aphrael (009f82) ? 2/1/2013 @ 3:33 pm
I think our uruk hai is riffing off this;
http://www.motherjones.com/kevin-drum/2013/02/conservatives-shocked-discover-healthcare-america-really-expensive
Comment by narciso (3fec35) ? 2/1/2013 @ 4:11 pm
This is further proof, liberals think mathematics is a theory.
Comment by Kevin P. (1df29c) ? 2/1/2013 @ 4:48 pm
aphrael, you?re not getting the point. Obamacare was never meant to make health insurance more affordable.
Obamacare was meant to sabotage the last vestiges of whatever remains of the freemarket that hasn?t been killed off by all the other federal health insurance regulations since FDR?s new deal.
Obama and the Democrats intended this to fail so that they can get the single-payer system they always wanted.
It wasn?t intended to fix anything.
Barney Frank gives away the game. ?Saying we?ll do nothing until we get single-payer is a sure way never to get it.?
Yes, he says the best way to get single-payer is a ?strong public option.? But that doesn?t mean it?s the only way, as we are seeing.
Comment by Steve57 (104863) ? 2/1/2013 @ 4:50 pm
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