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flere-imsaho 10-30-2013 01:36 PM

Quote:

Originally Posted by gstelmack (Post 2869069)
Are their numbers on our overhead, i.e. how much of our health care spending goes to actually collecting and distributing the money, as opposed to directly providing care?


Medical Loss Ratio is what you're looking for.

Arles 10-30-2013 01:47 PM

Quote:

Originally Posted by cartman (Post 2869075)
What we are afraid of is if they elect to only go with the catastrophic plan, and not also one the cheap plans, which is an option you are providing. That changes nothing from how things are today, and part of the reason the ACA mandated minimum coverages for the plans.

People in that option probably have no insurance now, extremely high deductible similar insurance now or feel they can risk having crap coverage (20s, no kids, ...).

There's no magic bullet that will solve all the problems out there. What I proposed was simply a way to get everyone access to catastrophic coverage and go from there. Yes, there will be some people who have crap coverage or no coverage now and join a plan that doesn't promote wellness/prevention. But, what people are essentially doing is answering the old classroom question of "A man offers free college to 10 of 30 kids in a poor area classroom. Do you take it?" with "No, because 20 kids won't get to go to college". Even though this potentially benefits 10 kids and doesn't adversely impact the other 20, we can't do it because it doesn't solve the problem of all 30 going to college.

JonInMiddleGA 10-30-2013 01:47 PM

Quote:

Originally Posted by molson (Post 2869065)
I don't know why death panels get such a bad rap. I say, bring 'em on!


The only bone of contention I have with that is the critera for determining who lives or dies.

The concept itself? Not a big problem for me tbh.

flere-imsaho 10-30-2013 01:49 PM

Quote:

Originally Posted by Arles (Post 2869070)
So, what conditions are we afraid people won't go to the doc for if they elect a cheap private plan with $50-60 doc visits as opposed to $20 ones?


Hold on a sec. You started out by positing a 6K deductible catastrophic plan and did not mention the cost of doc visits, but now you're qualifying that as only a $40 difference in the cost of doc visits? That's moving the goalposts.

Anyway, if we take a catastrophic plan with a 6K deductible and having to pay full costs for doctor's visits (which is what is implicit in your original proposal), I'd bet good money many women wouldn't go to the full suite of prenatal visits usually recommended, because those costs would add up too much. And then, on average, costs for live births would be considerably higher.

Single-payer countries already mitigate this with births by offering more in the way of prenatal visits as it's been shown that more education and care prior to birth will lead to less overall live birth costs when aggregated across the population.

Even U.S. private insurance companies realize this, and offer incentives for pregnant mothers to see their doctors, attend wellness sessions, get screened, etc.... Catching a problem only once you're in labor is far more expensive than getting it in the first trimester.

cartman 10-30-2013 01:49 PM

Quote:

Originally Posted by Arles (Post 2869081)
People in that option probably have no insurance now, extremely high deductible similar insurance now or feel they can risk having crap coverage (20s, no kids, ...).

There's no magic bullet that will solve all the problems out there. What I proposed was simply a way to get everyone access to catastrophic coverage and go from there. Yes, there will be some people who have crap coverage or no coverage now and join a plan that doesn't promote wellness/prevention. But, what people are essentially doing is answering the old classroom question of "A man offers free college to 10 of 30 kids in a poor area classroom. Do you take it?" with "No, because 20 kids won't get to go to college". Even though this potentially benefits 10 kids and doesn't adversely impact the other 20, we can't do it because it doesn't solve the problem of all 30 going to college.


But if you are trying to control costs, then just giving access to catastrophic coverage doesn't do much at all.

flere-imsaho 10-30-2013 01:51 PM

Quote:

Originally Posted by JonInMiddleGA (Post 2869082)
The only bone of contention I have with that is the critera for determining who lives or dies.


The thing is, however, is that in most cases that's not the question.

The question tends to be do we keep you alive for another 4 weeks at a cost of $2.3M, or do we let you die in peace now.

Studies have shown that most people, when presented with the option, including the fact that those extra 4 weeks (or whatever) aren't really great from a quality of life standpoint, will choose the former.

Relevant reading: A Pacemaker Wrecks a Family's Life - NYTimes.com

flere-imsaho 10-30-2013 01:56 PM

Quote:

Originally Posted by Arles (Post 2869081)
There's no magic bullet that will solve all the problems out there.


Sure there is! :D

1. Extend Medicare Advantage to the entire population.

2. Remove state-by-state regulation of health insurance (i.e. allowing plans to be truly nationwide).

Single-payer, aggregated data upon which to make good health policy decisions, and private administration of the system (who tend to do it better) that still allows space for innovation and keeps a market component (with oversight based on good measures) that weeds out the lousy actors. Everyone wins! :D

Blackadar 10-30-2013 01:56 PM

Quote:

Originally Posted by Arles (Post 2869049)
To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. Maybe some higher level private insurances would get you a discount, but you would still be paying for what you use in some capacity (no different than taking your car to the shop and the warranty covers some of the parts while you pay for labor and other parts on a negotiated price). But, we are a LONG way from that point. There's simply too much entitlement in the idea of health care in the US to get there anytime soon.


Your whole post is horribly incorrect...but in the interest of actually trying to educate someone, I'm only going to use your last paragraph to demonstrate why perhaps you need to better understand the issue before commenting or presenting "solutions" that don't work. After all, much of what you have proposed others have commented on and shown why those ideas don't work.

---

Do you know that you can't negotiate directly with doctors and hospitals? Or, more appropriately, they won't negotiate with you because those same "private companies" that you tout won't let them? *shock*

I'll provide an example so it's easy to understand. For whatever reason, Blue Cross decided after 3 years of health payments to not cover my birth of daughter. Yep, they decided to drop the coverage, leaving me high and dry because it was now a preexisting condition for all the other insurance companies. That's not legal now, but that required government regulation to enforce. It was legal then. So instead of a couple of grand, I was facing about $15k in costs.

I have a little money in the bank, so I went to the two hospitals nearby and had the same exact discussion. I offered to pay for the prenatal care and the birth care IN CASH if I could get a discount. Nope. Do you know why? Because the "private companies" - this insurance industry you want people to rely on - had specifically written into their contracts that they could not give Joe Average Cashpayer the same rate that they had pre-negotiated with the doctor & hospital. So while the hospital would only get about $5-$6k for birth of my daughter through the insurance companies, I had to pay full price ($12k) because of the price-fixing that is legal in this industry even if I paid in cash (meaning they had no billing or collection costs).

So simply put your final paragraph demonstrates how little you understand about health care coverage and shows why your opinion is ill-informed and incorrect. It's nothing like taking your car to the shop. There are 20 repair places and they're in competition with each other. The two hospitals nearby are both owned by the same conglomerate.

A defacto monopoly + an inelastic good = free market solutions don't work

Arles 10-30-2013 01:57 PM

Quote:

Originally Posted by flere-imsaho (Post 2869083)
Hold on a sec. You started out by positing a 6K deductible catastrophic plan and did not mention the cost of doc visits, but now you're qualifying that as only a $40 difference in the cost of doc visits? That's moving the goalposts.

Anyway, if we take a catastrophic plan with a 6K deductible and having to pay full costs for doctor's visits (which is what is implicit in your original proposal), I'd bet good money many women wouldn't go to the full suite of prenatal visits usually recommended, because those costs would add up too much. And then, on average, costs for live births would be considerably higher.

Then I would recommend getting either employer-paid coverage or additional private insurance if you plan on having a kid. Makes sense. FYI, a lot of single moms qualify for state access coverage which currently pays for a lot of the expense of having a kid. They do here in Arizona.

Quote:

Even U.S. private insurance companies realize this, and offer incentives for pregnant mothers to see their doctors, attend wellness sessions, get screened, etc.... Catching a problem only once you're in labor is far more expensive than getting it in the first trimester.
Again, how does that change with my proposed plan above:

1. If you or your husband work and get pregnant - you are covered through employer plan.
2. If you are a single mom who doesn't make much or make near the poverty level as a family - you currently can enroll in a program like ACCESS here in AZ.
3. If you are a middleclass family where neither parent has employer coverage but you make more than what is needed to qualify for state programs (maybe self employed), you would have to buy a private plan with better prenatal coverage (just like now). However, you atleast would have cheap access to catastrophic coverage - something you don't have now.

So, again, who is worse off with what I proposed as compared to what's available today?

Arles 10-30-2013 01:58 PM

Quote:

Originally Posted by flere-imsaho (Post 2869088)
Sure there is! :D

1. Extend Medicare Advantage to the entire population.

2. Remove state-by-state regulation of health insurance (i.e. allowing plans to be truly nationwide).

Single-payer, aggregated data upon which to make good health policy decisions, and private administration of the system (who tend to do it better) that still allows space for innovation and keeps a market component (with oversight based on good measures) that weeds out the lousy actors. Everyone wins! :D

And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...

cartman 10-30-2013 02:01 PM

Quote:

Originally Posted by Arles (Post 2869092)
And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...


Well if it is just a matter of what goes to the insurance company now (your contribution + the employer's) + existing Medicare withholdings would instead go to the uber-Medicare, then it is close to a wash.

Arles 10-30-2013 02:05 PM

Quote:

Originally Posted by Blackadar (Post 2869089)
Your whole post is so absurdly misguided it's laughable. But I'm going to only pick on your last paragraph to demonstrate why you need to understand the issue better before commenting.

First, you obviously didn't read my post as this paragraph was simply a sidebar on how to reduce costs if that was your main objective. My comment "To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. " is true. But, it won't happen anytime soon because that's too drastic a change for what people expect from health insurance.

Quote:

I'll provide an example so it's easy to understand. For whatever reason, Blue Cross decided after 3 years of health payments to not cover my birth of daughter. Yep, they decided to drop the coverage, leaving me high and dry because it was now a preexisting condition for all the other insurance companies. That's not legal now, but that required (OMG!) government regulation to enforce. It was legal then. So instead of a couple of grand, I was facing about 15k in costs.
So, you were with BC for 3 years and then they dropped you because your wife got pregnant? Was it a 3-year pregnancy? Otherwise, I can't see how that would be a pre-existing condition. I've worked directly with Blue Cross on the employer-provided, self-employed and private side and in no situation on any plan does it drop someone who is paying their premiums on a plan that covers prenatal care when they have a child. Your post simply doesn't make any sense.

Marc Vaughan 10-30-2013 02:05 PM

Quote:

Originally Posted by molson (Post 2869065)
I don't know why death panels get such a bad rap. I say, bring 'em on!


The concept of 'death panels' was impressing PR/marketing from the anti-ACA crowd tbh ... especially so when you consider most private policies I've seen in the US have 'maximum' amounts which are covered in most areas, effectively being exactly the sort of thing they decried.

Arles 10-30-2013 02:06 PM

Quote:

Originally Posted by cartman (Post 2869093)
Well if it is just a matter of what goes to the insurance company now (your contribution + the employer's) + existing Medicare withholdings would instead go to the uber-Medicare, then it is close to a wash.

It's not a wash. Look at how much a normal family pays for health insurance and that number will be well below that.

Blackadar 10-30-2013 02:07 PM

Quote:

Originally Posted by Arles (Post 2869092)
And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...


Actually, most everyone does win, except the insurance companies who rake in the premiums hand over fist.

From a GDP standpoint, the USA spends 50% more than any other industrialized nation in the world. The US spends 17.7% of its GDP on healthcare, whereas every other nation is 12% or less. Per capita, the US spends about $7,500k on healthcare while the next closest country (Norway) is at about $5,000. In the UK and Switzerland, that number is closer to $3k.

Simply put, raising taxes $5k/yr isn't a problem for me if I don't have to spend $8k/yr on health care. I still come out with $3k more in my pocket. So yeah, most everyone does win.

Arles 10-30-2013 02:11 PM

At the end of the day, no one would even consider what I proposed because it doesn't fit the agenda of the democrats (full government provided single payer system) or the republicans (no government interference at all). So, we end up with this Obamacare option that will probably end up doing more damage to quality of coverage and overall cost than just staying put. Either way, time will tell.

Arles 10-30-2013 02:13 PM

Quote:

Originally Posted by Blackadar (Post 2869098)
Actually, most everyone does win, except the insurance companies who rake in the premiums hand over fist.

From a GDP standpoint, the USA spends 50% more than any other industrialized nation in the world. The US spends 17.7% of its GDP on healthcare, whereas every other nation is 12% or less. Per capita, the US spends about $7,500k on healthcare while the next closest country (Norway) is at about $5,000. In the UK and Switzerland, that number is closer to $3k.

Simply put, raising taxes $5k/yr isn't a problem for me if I don't have to spend $8k/yr on health care. I still come out with $3k more in my pocket. So yeah, most everyone does win.

Glad it works for you. For the employed crowd and much of the self employed, this would be a massive cost increase with no guarantees of the system being any better long term and the risk of worse coverage.

Blackadar 10-30-2013 02:14 PM

Quote:

Originally Posted by Arles (Post 2869095)
First, you obviously didn't read my post as this paragraph was simply a sidebar on how to reduce costs if that was your main objective. My comment "To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. " is true. But, it won't happen anytime soon because that's too drastic a change for what people expect from health insurance.


No, it won't happen because Big Insurance doesn't allow it.


Quote:

Originally Posted by Arles (Post 2869095)

So, you were with BC for 3 years and then they dropped you because your wife got pregnant? Was it a 3-year pregnancy? Otherwise, I can't see how that would be a pre-existing condition. I've worked directly with Blue Cross on the employer-provided, self-employed and private side and in no situation on any plan does it drop someone who is paying their premiums on a plan that covers prenatal care when they have a child. Your post simply doesn't make any sense.


Yep, they did. Or more precisely, they refused to pay for her pregnancy even though I had the paperwork that showed we checked the appropriate box and all the documentation they sent talked about maternity coverage. They claimed we hadn't been paying for it (we fully paid the premium every month) and flat out refused to cover the pregnancy. We appealed and providedthe documentation. They refused again. We sent it to the insurance commissioner of NC. Blue Cross dropped us. The NCDOI did diddly squat for almost a year, by which time my daughter was already born and we had found other coverage. Since we no longer had coverage with Blue Cross, the insurance commission's inquiries went nowhere. Meanwhile, I got stuck paying the bill. Thank you very much.

Blackadar 10-30-2013 02:19 PM

Quote:

Originally Posted by Arles (Post 2869100)
Glad it works for you. For the employed crowd and much of the self employed, this would be a massive cost increase with no guarantees of the system being any better long term and the risk of worse coverage.


I am employed, you pompous asshole. I've been working for 30 fucking years now. Don't be a jackass.

And the math is simply the math. Overall costs will be reduced in a single payer system. There's no logical way to deny it, there's no historical way to refute it. The math is the math. Due to this very simple fact, there will be far more winners in a single payer solution than losers. In fact, the self employed would be some of the biggest winners because their premiums are so damned high. It's the self-insured that would likely be "losers", but the single biggest loser would be Big Insurance. Sorry if I don't cry over that.

flere-imsaho 10-30-2013 02:38 PM

Quote:

Originally Posted by Arles (Post 2869091)
Then I would recommend getting either employer-paid coverage or additional private insurance if you plan on having a kid. Makes sense. FYI, a lot of single moms qualify for state access coverage which currently pays for a lot of the expense of having a kid. They do here in Arizona.


You were positing a system where people were given a 6K deductible catastrophic plan. Now you're changing the context, or, simply put, moving the goalposts.

It's very difficult to have a meaningful discussion with you if you keep changing the rules of the conversation.


Quote:

Again, how does that change with my proposed plan above:

1. If you or your husband work and get pregnant - you are covered through employer plan.
2. If you are a single mom who doesn't make much or make near the poverty level as a family - you currently can enroll in a program like ACCESS here in AZ.
3. If you are a middleclass family where neither parent has employer coverage but you make more than what is needed to qualify for state programs (maybe self employed), you would have to buy a private plan with better prenatal coverage (just like now). However, you atleast would have cheap access to catastrophic coverage - something you don't have now.

So, again, who is worse off with what I proposed as compared to what's available today?

Um, that is what's available now, due to the ACA. #1 is employer-provided coverage, #2 is Medicaid, and #3 is an Exchange plan. Prior to the ACA, #3 didn't exist.

flere-imsaho 10-30-2013 02:40 PM

Quote:

Originally Posted by Arles (Post 2869092)
And increase all of our taxes by 20+% ( and probably more). Sounds like everyone wins to me...


Not really. Medicare Advantage reimburses at close to (sometimes above, sometimes below) Medicare A & B rates, with bonuses and penalties for plans with good and bad quality ratings, respectively.

I haven't (and probably can't) run the numbers, but it probably saves money overall, from a system-perspective.

But it also makes it far easier to control costs in the future, and also moves the entire system, through use of incentives and penalties, to outcome-based care, which really should be our overall objective.

flere-imsaho 10-30-2013 02:44 PM

Quote:

Originally Posted by Arles (Post 2869100)
Glad it works for you. For the employed crowd and much of the self employed, this would be a massive cost increase with no guarantees of the system being any better long term and the risk of worse coverage.


Huh? If I'm employed and spend $8K on health care (premiums, co-pays, deductible, etc...) and the government comes along and says I can have single-payer care for an extra $5K in taxes, meaning I no longer have to pay $8K on health care, I'm taking that deal.

Arles 10-30-2013 02:49 PM

I think I've figured out this thread after a long period of posting:

1. Someone comes out with an idea that isn't equal to "single payer"
2. 80% of the readers tar and feather that idea because it isn't single payer.
3. Rinse and repeat

I doubt we will ever see a single payer plan anytime soon because of:

1. The hold of the insurance companies on both sides of congress
2. The increased cost and decreased coverage to people who currently have employer based coverage
3. The fact that a sizeable percentage (maybe 25-30%?) don't want a government managed health care system in the US.

Hate to be realist, but that is the situation we are in.

cartman 10-30-2013 02:51 PM

Quote:

Originally Posted by Arles (Post 2869097)
It's not a wash. Look at how much a normal family pays for health insurance and that number will be well below that.


Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee. Medicare's tax rate is 1.9%. Average income last year was $50,054 per household.

Take the $16,351 plus the 1.9% Medicare tax, and it sure looks like it would come out to a wash, probably even less than the 20% hike you predict. To the employee, the $4,565 (~9%) would turn into a tax.

flere-imsaho 10-30-2013 02:52 PM

Quote:

Originally Posted by Arles (Post 2869097)
It's not a wash. Look at how much a normal family pays for health insurance and that number will be well below that.


Well, a normal family with an employer-sponsored plan pays ~$9,000/year for health insurance, while their employer picks up ~$12,000.

So take what that family pays in tax for Medicare, plus $9,000, and keep the new taxes below that. Ta-da! And since every single other single-payer system actually costs less on a per capita basis, this seems likely.

And that's not even discussing the money the employer gets back for not having to pay the other part of the premium. How to pro-business Republicans not like that?

:D

Data from here: Annual Healthcare Costs For Family Of 4 Now At $22,030 - Forbes

Arles 10-30-2013 02:54 PM

Quote:

Originally Posted by cartman (Post 2869112)
Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee. Medicare's tax rate is 1.9%. Average income last year was $50,054 per household.

So, your assumption is that if employers no longer had to pay a premium, employees would immediately get an across the board $12,000 raise? As someone who helps control hiring for a major international company with thousands of US employees - I can say with 100% certainty that would not happen at my company. But, maybe we are an outlier...

molson 10-30-2013 02:54 PM

Since when has the government ever felt the need to increase taxes to pay for stuff?

cartman 10-30-2013 02:55 PM

Quote:

Originally Posted by Arles (Post 2869114)
So, your assumption is that if employers no longer had to pay a premium, employees would immediately get an across the board $12,000 raise? As someone who helps control hiring for a major international company with thousands of US employees - I can say with 100% certainty that would not happen at my company. But, maybe we are an outlier...


No, I'm saying that would be a tax, not a premium payment.

flere-imsaho 10-30-2013 02:57 PM

Quote:

Originally Posted by Arles (Post 2869111)
I doubt we will ever see a single payer plan anytime soon


Well, over 100M Americans get their insurance from a single-payer entity, i.e. the government, now (Medicare, Medicaid, VA). So there's that.

Quote:

Hate to be realist, but that is the situation we are in.

I know, right?

Arles 10-30-2013 03:00 PM

Quote:

Originally Posted by flere-imsaho (Post 2869113)
Well, a normal family with an employer-sponsored plan pays ~$9,000/year for health insurance, while their employer picks up ~$12,000.

Quote:

Originally Posted by cartman (Post 2869112)
Last year the average premium for employer-provided coverage was $16,351, of which $4,565 was paid by the employee.

You guys might want to get your numbers right. Here's an FYI, the average worker at our plan pays $300 a month for a very good plan ($500 deduct). So, that means that they pay around $3,600 for premiums. But let's go with the 5K number. You still have to pickup that extra $12K and I can tell you we aren't giving a $30-50K a year guy a $12K raise if we drop benefits.

cartman 10-30-2013 03:02 PM

Quote:

Originally Posted by Arles (Post 2869118)
You guys might want to get your numbers right. Here's an FYI, the average worker at our plan pays $300 a month for a very good plan ($500 deduct). So, that means that they pay around $3,600 for premiums. But let's go with the 5K number. You still have to pickup that extra $12K and I can tell you we aren't giving a $30-50K a year guy a $12K raise if we drop benefits.


WE AREN'T SAYING THAT

You take a line from the OpEx budget for insurance premiums, and that exact same amount moves to the increased Medicare tax. Yes, the amount paid in taxes goes up, but the amount paid by the company for insurance payments would go away. You seem to be saying that a single-payer plan would only be funded by what employees were contributing, and the amount that companies paid doesn't count.

BTW, here is where I got my figures for premiums: http://www.ncsl.org/research/health/...-premiums.aspx

Arles 10-30-2013 03:02 PM

Quote:

Originally Posted by flere-imsaho (Post 2869117)
Well, over 100M Americans get their insurance from a single-payer entity, i.e. the government, now (Medicare, Medicaid, VA). So there's that.



I know, right?

If it's such a great idea, why is public sentiment like this?
46% Oppose Single-Payer Health Care System - Rasmussen Reports™

38% in favor
46% oppose
16% not sure

You would need well over 60% support to override the big business aspect of health care and get close to a single payer across the board. Ain't happenen.

Blackadar 10-30-2013 03:11 PM

Quote:

Originally Posted by Arles (Post 2869111)
I think I've figured out this thread after a long period of posting:

1. Someone comes out with an idea that isn't equal to "single payer"
2. 80% of the readers tar and feather that idea because it isn't single payer.
3. Rinse and repeat


Thank you for that wonderful example of Ad Hominem!

I imagine that if you ever have an idea that is at least equal to single payer, you'll find people more receptive. When your ideas are ill-conceived and illogical, I think you'll find that people aren't receptive to them. Also, insults don't work well either.

Quote:

Originally Posted by Arles (Post 2869111)
I doubt we will ever see a single payer plan anytime soon because of:

1. The hold of the insurance companies on both sides of congress
2. The increased cost and decreased coverage to people who currently have employer based coverage
3. The fact that a sizeable percentage (maybe 25-30%?) don't want a government managed health care system in the US.

Hate to be realist, but that is the situation we are in.


#1 = True.
#2 = False. This was already addressed above.
#3 = True, because they have a vested interest in keeping the current system or they're too ill-informed to know any better.

Blackadar 10-30-2013 03:12 PM

Quote:

Originally Posted by Arles (Post 2869120)
If it's such a great idea, why is public sentiment like this?
46% Oppose Single-Payer Health Care System - Rasmussen Reports™

38% in favor
46% oppose
16% not sure

You would need well over 60% support to override the big business aspect of health care and get close to a single payer across the board. Ain't happenen.


Yeah, and look at the numbers on gay marriage a few years ago.

JonInMiddleGA 10-30-2013 03:55 PM

Quote:

Originally Posted by Blackadar (Post 2869122)
#3 = True, because they have a vested interest in keeping the current system or they're too ill-informed to know any better.


Gosh, wouldn't want it to be because we don't believe that's an area where government involvement should be increased.

flere-imsaho 10-30-2013 06:24 PM

Quote:

Originally Posted by Arles (Post 2869118)
You guys might want to get your numbers right.


I cited a respected annual study for my numbers and provided a link.

It is you who should get your numbers right.

Pull it together Arles.

flere-imsaho 10-30-2013 06:32 PM

Quote:

Originally Posted by Arles (Post 2869120)
If it's such a great idea, why is public sentiment like this?


You mean Medicare's 60 to 70% approval rating?

Who's Afraid Of Public Insurance? - NationalJournal.com

Americans love single-payer healthcare... except when it's called single-payer, universal, or Obamacare.

lighthousekeeper 10-31-2013 09:51 AM

Regarding healthcare.gov, having a not-ready-for-primetime website is one thing, but a bigger issue is how prices are hidden. I still haven't been able to figure out what the marketplace prices are. Is there some complexity I am missing - shouldn't a spreadsheet be posted somewhere that lists all possible prices based on a combination of factors? How many factors go into determining price?

And their online live chat assistance makes Comcast support look awesome:

Spoiler

Arles 10-31-2013 11:31 AM

Pretty good article on CNN about the launch:

What else could go wrong with Obamacare? - CNN.com

Quote:

"Young invincibles" are key. They are the young and the healthy. If they don't purchase health insurance, the program is at risk.

If too many exchange consumers are older or unhealthy, then monthly premiums will likely skyrocket in 2015 and this could cause the exchanges to topple. If that occurs, one of the highest-profile parts of the law will be viewed as a failure.

To pass this test, the administration figures roughly 40% of exchange consumers -- 2.7 million if the Congressional Budget Office's estimates are correct -- need to be between the ages of 18 and 35.

Younger and healthier premium pools will keep overall costs lower and ease the financial hit to the program when it does pay benefits.
This is where the numbers start posing a problem. Many young people in that range get employer provided coverage and have no reason to pay for more expensive exchanges. My fear is that the only way this system will survive is if "healthy" people with employer-provided coverage are somehow forced on to the exchanges (where they will get worse coverage at higher costs to them).
Quote:

While the President has said that "You can keep your health care plan" if you like it, that's not necessarily true.

That's because the law now mandates that insurance plans cover certain services. So regardless of which plan you choose, whether it's the low-cost, high-deductible bronze plan or the most expensive, low-deductible platinum plan, they all have to provide basic services. Those services include immunizations, ambulatory care, prenatal care, newborn care, mental health and substance abuse services.

The Kaiser Family Foundation wrote in February that unsubsidized premiums for individuals and families "will be somewhat higher under reform than they are today."

Kaiser said many reasons are to blame for higher monthly out-of-pocket costs, including higher quality coverage due to minimum coverage requirements, prohibition on preexisting conditions and caps on out-of-pocket costs.

In addition to higher premiums, plans, especially the lower cost bronze and silver plans, include high deductibles. For instance, in Washington, D.C., deductibles for a family of three run up to $12,000.

While high premiums might prohibit people from being able to afford the monthly cost, high deductibles mean some may not be able to afford getting sick.
Quote:

An estimated 4.8 million low-income people are likely to fall into what is called the insurance "gap." They are the people who make too much to qualify for Medicaid in their state but too little to qualify for federal subsidies for the insurance marketplace.

That's because subsidies for health insurance are available for people who make 138% of the poverty level, or about $31,300 for a family of four.

To accommodate the individuals and families who don't make that much, the federal government is paying for states money to expand Medicaid, but 25 states opted to not take the federal government's money and not expand Medicaid.

So many wage-earners, including most workers who earn a minimum wage, make too much to qualify for Medicaid but are too poor to receive federal subsidies. Purchasing insurance without subsidies is likely to be cost prohibitive for most in this category.
I don't know that this is a bad thing long term. But, people will be paying more than what they expect for coverage not much better than what they had.

JPhillips 10-31-2013 12:15 PM

I know I've seen polls where support for ACA is highest among the youngest age group and drops as age goes up. That doesn't necessarily translate into enrollments, but there is reason to believe the young want health insurance.

flere-imsaho 10-31-2013 12:27 PM

Quote:

Originally Posted by Arles (Post 2869367)
This is where the numbers start posing a problem. Many young people in that range get employer provided coverage and have no reason to pay for more expensive exchanges.


Almost 30% of those aged 18-35 are uninsured. (Source) Assuming a general population of 300 million, that's 90 million young people who will likely be going to the Exchange or Medicaid.

The risk you raise is a real one, of course, but it is also very easy to overstate.

Quote:

My fear is that the only way this system will survive is if "healthy" people with employer-provided coverage are somehow forced on to the exchanges (where they will get worse coverage at higher costs to them).

You're still making the assumption that the Exchange plans are, on average, worse in terms of cost & benefits to employer-provided coverage.

Quote:

I don't know that this is a bad thing long term. But, people will be paying more than what they expect for coverage not much better than what they had.

As I linked before, the average family of four pays over $9,000/year for their employer-sponsored plan. Which means some are far worse than that.

Again, it's a concern, but it's an easily-overstated concern.

Arles 10-31-2013 01:25 PM

Quote:

Originally Posted by flere-imsaho (Post 2869392)
You're still making the assumption that the Exchange plans are, on average, worse in terms of cost & benefits to employer-provided coverage.



As I linked before, the average family of four pays over $9,000/year for their employer-sponsored plan. Which means some are far worse than that.

Again, it's a concern, but it's an easily-overstated concern.

They are. In Arizona, coverage costs $300 a month ($3600 a year) for a family plan with a $500 deductible at our plant. Intel, Motorola, On Semi and most other manufacturing plants in Phoenix have the same cost as we are all part of the same network for coverage under BCBSAZ. To get an exchange plan with a $1000 deductible for a family under BCBSAZ, it costs $775 a month. That's an increase of $5700 a year for a worse plan.

Most of the factory workers also make more than 40K, so they wouldn't qualify for a subsidy. Now, I know everyone is going to say "Well, they are only paying $300 a month and the company is paying the remaining $700." That is correct, but we are not giving every worker a 5K raise if we cut benefits. There are tax benefits to our company of covering workers and if those go away or we decide to drop coverage because of financial reasons with exchanges, those employees will be forced to eat that $5700 a year. That's reality and that's what no one is saying. Just like these other "unintended consequences" we are seeing now where it's obvious the "you can keep the plan you had" line was a farce - you will see companies start dropping coverage in 2015 and most employees aren't going to get a $5K raise to makeup the difference.

Finally, the plans on the exchange have double the deductible as the lowest deductible you can get on the exchange is a $1K/2K. You couldn't even get the plan subsidized by our employer if you went to an exchange.

So, here's what we are going to see over the next 2-3 years:
(2010) "Hey, if you like your plan, you can keep it"
(2012) "Hey, if you lose your plan, there's a similar one on an exchange"
(2014) "Hey if you lose your plan, there's one on an exchange that costs $5-7K more a year with a deductible twice as high as you had"

I'm scared at what this will morph into in 2015+. A lot of people making between $40K and $80K are going to take it in the shorts if/when exchanges start replacing employer coverage.

lighthousekeeper 10-31-2013 02:36 PM

Quote:

Originally Posted by Arles (Post 2869427)
They are. In Arizona, coverage costs $300 a month ($3600 a year) for a family plan with a $500 deductible at our plant. Intel, Motorola, On Semi and most other manufacturing plants in Phoenix have the same cost as we are all part of the same network for coverage under BCBSAZ. To get an exchange plan with a $1000 deductible for a family under BCBSAZ, it costs $775 a month. That's an increase of $5700 a year for a worse plan.

Most of the factory workers also make more than 40K, so they wouldn't qualify for a subsidy. Now, I know everyone is going to say "Well, they are only paying $300 a month and the company is paying the remaining $700." That is correct, but we are not giving every worker a 5K raise if we cut benefits. There are tax benefits to our company of covering workers and if those go away or we decide to drop coverage because of financial reasons with exchanges, those employees will be forced to eat that $5700 a year. That's reality and that's what no one is saying. Just like these other "unintended consequences" we are seeing now where it's obvious the "you can keep the plan you had" line was a farce - you will see companies start dropping coverage in 2015 and most employees aren't going to get a $5K raise to makeup the difference.


Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side? The dire scenario you paint is one where employers drop benefits and don't give raises (thus saving ($8,400-tax savings)/employee) and lament how this will be worse for employees. Of course, in that worst-case scenario.

This scenario really avoid the big picture, which is overall costs (who cares how it is split out between employees and employers - capitalism should help shake that out).

DaddyTorgo 10-31-2013 02:59 PM

Quote:

Originally Posted by lighthousekeeper (Post 2869461)
Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side?


Because he's fear-mongering.

Arles 10-31-2013 03:11 PM

Quote:

Originally Posted by lighthousekeeper (Post 2869461)
Haven't really followed the debate here closely, but this post seems to have some flaws in reasoning. Why bring up the tax savings benefits for employers while not accounting for them on the employee side? The dire scenario you paint is one where employers drop benefits and don't give raises (thus saving ($8,400-tax savings)/employee) and lament how this will be worse for employees. Of course, in that worst-case scenario.

I just think that will be more the norm. I can't see a bunch of $15-20 an hour jobs getting $5K raises the moment a company drops coverage. They will say how employees are welcome to check out the exchanges and similar plans will be there and leave it at that. Maybe they get a 2-3% raise, but you are still looking at a gap of around $500 a month for people in this situation.

Quote:

This scenario really avoid the big picture, which is overall costs (who cares how it is split out between employees and employers - capitalism should help shake that out).
All I'm trying to say is that there will be a ton of pain felt by the middle class as more companies remove benefits and people get tossed to exchanges. In the long term is that better? Maybe. But it's going to be tough in the short term for many middle class working families - most who will be blindsided by this as no one ever told them that Obamacare could hurt them in the short term. We were always sold the line that if we like our current plan, we can keep it. And, as we get closer to 2015, that will be far from the truth for many people.

Edward64 11-01-2013 06:37 PM

A legit #2.

Leader of Pakistan Taliban killed in US drone strike, US, Pakistani officials say - Investigations
Quote:

The leader of the Pakistan Taliban was killed Friday in a U.S. drone strike in Northwest Pakistan, U.S. and Pakistani officials tell NBC News.
A U.S. official, speaking on condition of anonymity, confirmed the death of Hakimullah Mehsud, head of the Tehrik-i-Taliban Pakistan (TTP), in a CIA drone strike.

A Pakistani security official, also speaking on condition of anonymity, told NBC News earlier that Mehsud was killed earlier in the day in Danday Darpakhel village of North Waziristan.

A senior member of the Pakistani Taliban, who also spoke on condition of anonymity, confirmed the death.

"It is very painful to announce that our dearest, brave and sincere leader Hakimullah Mehsud died in drone attack," he said.


DaddyTorgo 11-01-2013 09:45 PM

Good hit.

Hakimullah was a legit baddie.

Mizzou B-ball fan 11-01-2013 09:59 PM

More discussion on the new 5%.....

Health Care Shoppers Aren’t as Dumb as Obama Thinks - Yahoo Finance

larrymcg421 11-01-2013 10:15 PM

Quote:

Originally Posted by Mizzou B-ball fan (Post 2869862)


I love that in all the anecdotal examples in that article, they don't mention what the specific coverages are for these new more expensive plans or what the coverage was under the current plan these people have. That comparison would seem to be necessary, especially if you're going to use terms like "with coverage that’s more or less the same as far as he’s concerned".

flere-imsaho 11-02-2013 09:44 PM

All three of those people are trying to replace their individual plans with new individual plans from their current insurer, as opposed to shopping the marketplace for a new plan. So what they're seeing is their current insurer's non-Exchange plan that their current insurer would like to keep them on (as the premiums are higher).

lynchjm24 11-03-2013 06:01 PM

I'll probably regret chiming in here - but
you can't compare Medicare and Medicaid costs to employer sponsored premiums.

Hospitals and providers lose money on Medicare reimbursements - the costs are artificially low because they are subsidized by employers and insurers.

If you tried to apply Medicare reimbursements across the board, 90% of providers would be bankrupt by March.

There is huge debt and consolidation across the hospital industry for a reason.

JonInMiddleGA 11-03-2013 06:05 PM

Quote:

Originally Posted by Arles (Post 2869474)
We were always sold the line that if we like our current plan, we can keep it.


anybody who bought that line, well ...

DaddyTorgo 11-03-2013 06:32 PM

Quote:

Originally Posted by JonInMiddleGA (Post 2870247)
anybody who bought that line, well ...


You realize that it's PRIVATE COMPANIES that are CHOOSING not to offer these plans anymore BASED ON THEIR CAPITALIST MOTIVES right?

Or are you saying you want the government in the business of compelling these private companies to lose money by offering these plans that they don't want to offer anymore??

This is the same thing that's been going on for years - the insurance company decides to discontinue a plan - sometimes because it's not profitable, sometimes because they can make more money by getting those customers to switch to a new plan and start a new round of raising rates on it, or for any of a number of other reasons.

It's not like this just started happening this year because of ACA.

JonInMiddleGA 11-03-2013 06:34 PM

Quote:

Originally Posted by DaddyTorgo (Post 2870254)
It's not like this just started happening this year because of ACA.


More market interference from an unconscionable piece of garbage legislation.

There's not a pit in hell warm enough for any SOB who voted for it afaic.

Desnudo 11-04-2013 11:48 AM

Quote:

Originally Posted by Arles (Post 2869118)
You guys might want to get your numbers right. Here's an FYI, the average worker at our plan pays $300 a month for a very good plan ($500 deduct). So, that means that they pay around $3,600 for premiums. But let's go with the 5K number. You still have to pickup that extra $12K and I can tell you we aren't giving a $30-50K a year guy a $12K raise if we drop benefits.


I pay 300 a month for a good, not great plan. That is increasing 10% due to Obamacare. Although we now also have a high deductible option @200/month + hsa that I will be switching to.

molson 11-05-2013 10:19 AM

Quote:

Originally Posted by DaddyTorgo (Post 2870254)
You realize that it's PRIVATE COMPANIES that are CHOOSING not to offer these plans anymore BASED ON THEIR CAPITALIST MOTIVES right?


It feel like we've had this debate here a lot and people have gotten really mad at me for making this point, but I still don't understand why people think government-implemented policy is supposed to just assume that everyone in America will act in policy's best interest at all times. Did nobody know that private companies and capitalism would exist after the ACA? Isn't that something that should have been accounted for when selling the policy to the public? Maybe ACA is still worthwhile even if a few people have to pay a little more, but in general, I think policy should be judged on how well it actually works, not how well it theoretically works if everyone acted in the way we wish they would. I mean, I could come up with some great plans to make inner-cities safer, as long as I can assume that nobody will commit crimes to screw up my great policy.

Galaxy 11-05-2013 01:36 PM

Quote:

Originally Posted by lynchjm24 (Post 2870244)
I'll probably regret chiming in here - but
you can't compare Medicare and Medicaid costs to employer sponsored premiums.

Hospitals and providers lose money on Medicare reimbursements - the costs are artificially low because they are subsidized by employers and insurers.

If you tried to apply Medicare reimbursements across the board, 90% of providers would be bankrupt by March.

There is huge debt and consolidation across the hospital industry for a reason.


Medicare is a major problem...For every $1 that a person pays in, it will cost $3 per person in spending.

larrymcg421 11-05-2013 01:44 PM

Quote:

Originally Posted by molson (Post 2870655)
It feel like we've had this debate here a lot and people have gotten really mad at me for making this point, but I still don't understand why people think government-implemented policy is supposed to just assume that everyone in America will act in policy's best interest at all times. Did nobody know that private companies and capitalism would exist after the ACA? Isn't that something that should have been accounted for when selling the policy to the public? Maybe ACA is still worthwhile even if a few people have to pay a little more, but in general, I think policy should be judged on how well it actually works, not how well it theoretically works if everyone acted in the way we wish they would. I mean, I could come up with some great plans to make inner-cities safer, as long as I can assume that nobody will commit crimes to screw up my great policy.


Well it is an important distinction in the context of Obama's "lie" about being able to keep your plan. And whether you consider it beforehand or not, it is important to draw that distinction so people know why the change is taking place.

molson 11-05-2013 02:01 PM

Quote:

Originally Posted by larrymcg421 (Post 2870722)
Well it is an important distinction in the context of Obama's "lie" about being able to keep your plan. And whether you consider it beforehand or not, it is important to draw that distinction so people know why the change is taking place.


And if the Republicans really managed to prevent the debt limit deal, any consequences wouldn't really be their fault, because it would be the credit agencies and the debt holders who would be directly responsible.

And it was really the Iraqi insurgents that dragged out the Iraq war, not the U.S. military. If the insurgents didn't shoot at the military and stuff, then the job would have been done a lot faster.

This mindset kind of fills me with pessimism, the idea that the ACA will be great, as long as everyone, including its opponents, cooperate with it fully and always act in the policy's best interest. I'm actually going to just decide to assume that the brains behind the ACA don't share that mindset and actually did think it was worthwhile to consider concepts like capitalism and private industry, and possibly even the impact of entities that might not act so friendly to the plan.

Ben E Lou 11-05-2013 02:09 PM

The behavior of the private companies in a capitalistic system should have been at least somewhat predictable. It comes across as more of a complete failure of the President and his advisors in creating the policy to take into account market reaction than anything else. I find it hard to believe that they thought that big bidness would just set aside its attempts to maximize profits to help make this thing work. But I find it even harder to believe that they accounted for it and just wanted to be branded as either incompetent or liars. The whole thing has me just....puzzled.

Passacaglia 11-05-2013 02:16 PM

Quote:

Originally Posted by larrymcg421 (Post 2870722)
Well it is an important distinction in the context of Obama's "lie" about being able to keep your plan. And whether you consider it beforehand or not, it is important to draw that distinction so people know why the change is taking place.


Based on the way you put it in quotes, it sounds like you don't really think it's a lie.

cartman 11-05-2013 02:21 PM

But insurance companies just can't take certain steps arbitrarily. There are numerous investigations going on by state insurance regulatory agencies into the practices of the insurance companies with regards to how they've been handling the switch in the individual plans.

edit: to clarify, even with the PPACA, the burden of monitoring insurance company behavior is a state level function, there is not much federal oversight.

ISiddiqui 11-05-2013 02:24 PM

Quote:

Originally Posted by Ben E Lou (Post 2870732)
The behavior of the private companies in a capitalistic system should have been at least somewhat predictable. It comes across as more of a complete failure of the President and his advisors in creating the policy to take into account market reaction than anything else. I find it hard to believe that they thought that big bidness would just set aside its attempts to maximize profits to help make this thing work. But I find it even harder to believe that they accounted for it and just wanted to be branded as either incompetent or liars. The whole thing has me just....puzzled.


If it helps, the implementation of the policy in 2014 seems to indicate that it may have been as the greater good to be seen as incompetent if they could just get the bill passed.

Coffee Warlord 11-05-2013 02:29 PM

Quote:

Originally Posted by Ben E Lou (Post 2870732)
But I find it even harder to believe that they accounted for it and just wanted to be branded as either incompetent or liars. The whole thing has me just....puzzled.


It however, fits if you assume that passing a bill (winning you re-election points) was the goal, not necessarily making it work. If Obama didn't get ANYTHING passed, he'd come off as weak & unable to get his agenda moved, making him vulnerable for re-election.

larrymcg421 11-05-2013 02:30 PM

Quote:

Originally Posted by molson (Post 2870730)
This mindset kind of fills me with pessimism, the idea that the ACA will be great, as long as everyone, including its opponents, cooperate with it fully and always act in the policy's best interest. I'm actually going to just decide to assume that the brains behind the ACA don't share that mindset and actually did think it was worthwhile to consider concepts like capitalism and private industry, and possibly even the impact of entities that might not act so friendly to the plan.


Don't get me wrong. I think they did predict it, and I think they (correctly) thought it was a good thing that these substandard plans would get cancelled. My point is that it's important for them to point out the difference between what the ACA is mandating to be done and what the insurance companies are deciding to do as a reaction to the ACA.

flere-imsaho 11-05-2013 02:42 PM

Quote:

Originally Posted by larrymcg421 (Post 2870745)
Don't get me wrong. I think they did predict it, and I think they (correctly) thought it was a good thing that these substandard plans would get cancelled. My point is that it's important for them to point out the difference between what the ACA is mandating to be done and what the insurance companies are deciding to do as a reaction to the ACA.


:+1:

Solecismic 11-05-2013 02:58 PM

Quote:

Originally Posted by larrymcg421 (Post 2870745)
Don't get me wrong. I think they did predict it, and I think they (correctly) thought it was a good thing that these substandard plans would get cancelled. My point is that it's important for them to point out the difference between what the ACA is mandating to be done and what the insurance companies are deciding to do as a reaction to the ACA.


Why substandard? My plan did what I wanted it to do. There's no evidence BCBS would simply fail to honor it. Nor is there evidence that it will fail to honor it next year under similar circumstances. I was also free to simply pay for the health care I consumed - no insurance at all.

Let's not pretend that Obamacare does anything for healthy self-employed people other than force us to pay more - some for services we should have the ability to opt out of, and some so that the same offer can be extended to older and/or sicker people. And complaining about that point seems kind of weird - it's like complaining that it's unfair for McDonald's to charge more for six Big Macs, five large orders of fries and a smoothie than it charges for a side salad and a coffee.

Those who are working for companies with more than 50 people and have insurance through these companies are largely insulated from this extra taxation - and let's not pretend, as well, that this isn't a form of taxation.

I realize there are a lot of proponents of Obamacare out there. It's hard to turn down something that's essentially free. It's also hard to feel negatively toward something that could benefit the poor when it doesn't impact you at all (those who already have insurance through an employer). But when the entire burden is placed on a smaller group, it's not too pleasant.

This was cleverly implemented for those of you who wanted it politically. Very few pieces of the law were brought in at first - so that only people with this "substandard" insurance were affected. Then in late 2013 - after Obama was safely re-elected, the bigger stuff hit. And, finally, after the midterms next year, at the start of 2015, the adjustments will hit and many of the grandfathered plans will be eliminated. I would not want to be a Democrat running in 2016.

ISiddiqui 11-05-2013 03:01 PM

Quote:

Originally Posted by Solecismic (Post 2870768)
Those who are working for companies with more than 50 people and have insurance through these companies are largely insulated from this extra taxation - and let's not pretend, as well, that this isn't a form of taxation.


Considering that the Supreme Court's argument - who is denying that it isn't taxation?

Arles 11-05-2013 05:12 PM

Quote:

Originally Posted by molson (Post 2870730)
And if the Republicans really managed to prevent the debt limit deal, any consequences wouldn't really be their fault, because it would be the credit agencies and the debt holders who would be directly responsible.

And it was really the Iraqi insurgents that dragged out the Iraq war, not the U.S. military. If the insurgents didn't shoot at the military and stuff, then the job would have been done a lot faster.

This mindset kind of fills me with pessimism, the idea that the ACA will be great, as long as everyone, including its opponents, cooperate with it fully and always act in the policy's best interest. I'm actually going to just decide to assume that the brains behind the ACA don't share that mindset and actually did think it was worthwhile to consider concepts like capitalism and private industry, and possibly even the impact of entities that might not act so friendly to the plan.

I expect a similar Gomer Pyle-esque "Aww shucks, who could have anticipated that?" response when, after 2015, companies start kicking employees to the exchanges without giving them raises to makeup for their employer paid portion of benefits.

I see it now: "How were we supposed to know that employers weren't going to give $20 an hour factory workers a $9K per year raise to cover their $700 a month portion. I mean, that's just unfair that these people go from paying $300 a month out of pocket to now facing a $900 a month bill for similar coverage through the exchanges. But, no one could see this coming..."

cartman 11-05-2013 05:49 PM

Quote:

Originally Posted by Arles (Post 2870807)
I expect a similar Gomer Pyle-esque "Aww shucks, who could have anticipated that?" response when, after 2015, companies start kicking employees to the exchanges without giving them raises to makeup for their employer paid portion of benefits.

I see it now: "How were we supposed to know that employers weren't going to give $20 an hour factory workers a $9K per year raise to cover their $700 a month portion. I mean, that's just unfair that these people go from paying $300 a month out of pocket to now facing a $900 a month bill for similar coverage through the exchanges. But, no one could see this coming..."


You are aware then that the company would be missing out on a big tax break. The per-employee fine for not providing insurance is not tax deductible, but any employer contributions to an insurance premium are deductible.

Insurance companies don't want to lose clients either, so they will have more of an incentive to work with larger employers to keep them as clients.

ISiddiqui 11-05-2013 06:26 PM

Stop deflecting knee jerk talking points with facts!! :mad:

molson 11-05-2013 06:30 PM

Quote:

Originally Posted by cartman (Post 2870809)

Insurance companies don't want to lose clients either, so they will have more of an incentive to work with larger employers to keep them as clients.


You might be right, but these predictions don't carry a lot of weight because if they're wrong, capitalism was to blame, not the ACA.

Arles 11-05-2013 06:40 PM

Quote:

Originally Posted by cartman (Post 2870809)
You are aware then that the company would be missing out on a big tax break. The per-employee fine for not providing insurance is not tax deductible, but any employer contributions to an insurance premium are deductible.

Insurance companies don't want to lose clients either, so they will have more of an incentive to work with larger employers to keep them as clients.


Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare - Forbes
Quote:

“The Departments’ mid-range estimate is that 66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013,” wrote the administration on page 34552. All in all, more than half of employer-sponsored plans will lose their “grandfather status” and get canceled. According to the Congressional Budget Office, 156 million Americans—more than half the population—was covered by employer-sponsored insurance in 2013.

Another 25 million people, according to the CBO, have “nongroup and other” forms of insurance; that is to say, they participate in the market for individually-purchased insurance. In this market, the administration projected that “40 to 67 percent” of individually-purchased plans would lose their Obamacare-sanctioned “grandfather status” and get canceled, solely due to the fact that there is a high turnover of participants and insurance arrangements in this market. (Plans purchased after March 23, 2010 do not benefit from the “grandfather” clause.) The real turnover rate would be higher, because plans can lose their grandfather status for a number of other reasons.

How many people are exposed to these problems? 60 percent of Americans have private-sector health insurance—precisely the number that Jay Carney dismissed. As to the number of people facing cancellations, 51 percent of the employer-based market plus 53.5 percent of the non-group market (the middle of the administration’s range) amounts to 93 million Americans.

Companies sweating Obamacare tax—and acting on it: Study
Quote:

Mid- and large-sized companies overwhelmingly expect health-care costs to increase under Obamacare—and most are eyeing possible changes to their health insurance offerings because of a looming excise tax for pricier plans under the health-care reform law, a new survey of employers finds.

In fact, 40 percent of 420 companies surveyed by Towers Watson said they will be changing their insurance plans' designs in 2014 in light of the coming excise tax as well as to control employee-related health costs.

And nearly 60 percent of the companies view private health insurance exchanges as a possible way to control their health-care and administrative costs by shifting the work of insuring their workers off to those exchanges in the future.
Not all companies need all those tax breaks. Companies have been looking for a way to get out of the healthcare game for decades and these exchanges offer them cover to do so - esp when it's only a $2000 per worker a year fine to drop them. For most companies, that's about the cost of covering a worker for 2-3 months.

Employees (esp middle class) are going to be moving from their nice $300-$400 a month out-of-pocket plans they have now to exchanges that will cost around $800-$1200 a month for the same coverage. This is going to be devastating for many middle income families when it happens.

ISiddiqui 11-05-2013 06:47 PM

Sorry, I don't buy it. Most companies started offering health insurance, even though it cost them money to entice better employees. They may bluster about dropping employees to the exchanges, but they realize they'll have a competitive disadvantage to hiring workers.

And Employer Sponsored Plans have been losing their grandfathered status for 2 years now. This isn't something that just happened.

Arles 11-05-2013 06:53 PM

Quote:

Originally Posted by ISiddiqui (Post 2870812)
Stop deflecting knee jerk talking points with facts!! :mad:

I don't think anyone knows any "facts" moving forward. A lot of the facts we were told at the start have been false. The reality is that providing insurance to employees was a necessary evil for most major companies as many companies had just been doing it and you needed to provide them to "keep up with the Jones'" and retain people.

However, esp on the lower skilled jobs, it would be very attractive to pull coverage as it would save companies a ton of money and if enough companies did this they would still have access to a strong labor pull. I think higher paid jobs will keep coverage for a bit, but even those could eventually lose it. Remember, it's not just the cost - it's the cost of insuring with a plan that the ACA deems sufficient. I don't think people really understand the "unforseen consequences" that could be down the road because of this.

Arles 11-05-2013 06:59 PM

Quote:

Originally Posted by ISiddiqui (Post 2870816)
And Employer Sponsored Plans have been losing their grandfathered status for 2 years now. This isn't something that just happened.

But exchanges weren't an option 2 years ago. By providing companies an out to drop coverage, exchanges may end up costing a lot of people a lot of money. The key is if enough companies take the gamble on being able to find good workers without offering good insurance plans. I think that number is going to rise in 2014 and get even higher in 2015-16. Eventually, enough companies will decide to pay the fine and save the 7K+ per employee on providing good health coverage to make it not required to land good people.

One more key point often missed is that this is exactly what the ACA proponents want. The only way for this system to survive over time is if enough healthy people between the ages of 25 and 45 join up in these exchanges to defray the cost. If it's just people with pre-existing conditions, high risk applicants and lower income - the costs will be enormous. If the ACA proponents were honest, they would say that they hope all employee-provided coverage would go away to help lower the cost on the exchanges. In fact, I wouldn't be surprised to see legislation down the road to reduce the tax benefits companies get for covering employees.

ISiddiqui 11-05-2013 11:14 PM

Quote:

Originally Posted by Arles (Post 2870818)
I don't think people really understand the "unforseen consequences" that could be down the road because of this.


And on the other hand, you are making up unforseen consequences.

Arles 11-05-2013 11:51 PM

I guess we will see what happens going up to 2015. We have a few years before anything substantial happens either way.

flere-imsaho 11-06-2013 07:43 AM

Uh, the elimination of the pre-existing condition problem, and the ability to cover your kids up to age 26 were pretty substantial for a lot of people.

Buccaneer 11-06-2013 08:40 AM

Typical result in last night's election for a marginally Blue state. With a Democratic legislature and governor, the Dems crafted a very bad bill to fund education within an increase in income taxes. It wasn't so much how they proposed funding but the details of the bill were scary. Fortunately, the voters of the state overwhelmingly voted against it. In very blue Denver and Bounder counties, it was nearly split 50/50 (and trounced everywhere else). So most people saw through the Dems' charade of "it's for the kids". The Republicans are rightly seen as obstructionist do-nothings but it is much better to do nothing than to put a bad legislation into law.

DaddyTorgo 11-06-2013 08:43 AM

What was bad about the bill Bucc?

//genuinely curious - don't follow local ballot initiatives that closely

ISiddiqui 11-06-2013 08:49 AM

This is what I found:

Colorado bill vows education overhaul, but will voters raise taxes to fund it? - CSMonitor.com

Quote:

Voters are being asked to approve a nearly $1 billion income tax increase that would fund a sweeping overhaul of public education in the state. Among other things, it would raise the per-pupil spending in the state, direct more money to districts with more at-risk students, expand preschool for at-risk kids and full-day kindergarten, give funding equity to charter schools, set aside $100 million for an innovation fund, and establish more transparency and accountability for how education dollars are spent.

It has attracted national attention and support from teachers unions, the US education secretary, the Bill and Melinda Gates Foundation, and New York Mayor Michael Bloomberg, as well as vocal opposition from Colorado Republicans and some groups who see it as an unnecessary and expensive new tax that won’t necessarily improve education.

Quote:

One challenge for proponents of Amendment 66: It’s incredibly complex. The Colorado bill that it funds has actually already been passed by both houses of the Colorado legislature, and Gov. John Hickenlooper (D) has signed it, but the law will only take effect if voters also approve the ballot initiative on Tuesday. It would replace the state’s current flat-rate income tax with a new two-tiered system: The flat rate on taxable income below $75,000 would increase from 4.6 percent to 5 percent, and to 5.9 percent for taxable income above $75,000.

“The heart of it is that voters are agreeing to commit more of their income toward education,” says Dan Thatcher, senior policy specialist at the National Conference of State Legislatures in Denver. “But they’re also agreeing to this 141-page piece of legislation that enacts new school funding formulas. [Those formulas] have never had life breathed into them in this way…. This is unique that voters are voting statewide on what’s one of the most complicated components of state law.”

In most states, Mr. Thatcher notes, any school funding reform is usually accompanied by an infusion of new money, so that no districts lose money as a result of the new formula. But in Colorado, the state has to get voter approval, because of the restrictions that the state’s unusual Taxpayer Bill of Rights (TABOR) imposes on the legislature’s ability to raise revenue.

Quote:

But Caldara and other critics also say that the measure doesn’t really deliver on the reforms it claims to promise, and say they aren’t convinced that the extra money will really go toward restoring art or gym classes rather than just backfilling the pension system.

“There’s nothing here that’s truly a reform,” says Caldara. “It’s just a billion-dollar tax increase every year, which is largely unaccountable.”

Proponents of Amendment 66 say that objection leaves them baffled, since the new law would give taxpayers more transparency, and assurances that money would actually go to education, than they’ve ever had before.

“If that’s their concern, they should be the strongest advocates for Amendment 66,” says Johnston. “If they defeat it, we go back to the old system that has no transparency, or accountability, or requirement that dollars be spent on education."

Under the new law there are much stricter controls that ensure that dollars follow students to the classroom and not just fill holes elsewhere in the budget.

It does seem to be complex, but I don't see anything in it that is really all that objectionable.

Coffee Warlord 11-06-2013 08:56 AM

Quote:

and establish more transparency and accountability for how education dollars are spent.

How about you you do that FIRST, and see where the current tax dollars are going, before you try and get more out of people?

DaddyTorgo 11-06-2013 08:59 AM

Funding equity to charter schools sounds objectionable to me. Especially in a state like CO - I can see wacky cultish charter schools and shit popping up. Or Pentacostalist or stuff.

ISiddiqui 11-06-2013 09:24 AM

Pentecostalism is a perfectly legitimate church, FWIW.

Also, charter schools are created by the state - no religious charter schools could exist, IIRC.

DaddyTorgo 11-06-2013 09:42 AM

Quote:

Originally Posted by ISiddiqui (Post 2870904)
Pentecostalism is a perfectly legitimate church, FWIW.

Also, charter schools are created by the state - no religious charter schools could exist, IIRC.


Isn't it pentecostalism where they do the whole "speaking in tongues" rapture thing? If so, I stand by my characterization.

There have definitely been problems in other states with charter schools veering towards religious education - not sure if CO law protects better on that.

Above and beyond that though - charter schools are sketchy to me. I think there are good ones with altruistic motives, and then there others which are ways for the heads to line their own pockets. I don't think they should be funded by my tax dollars unless they're held to the same accountability standards (education & transparency wise) as public schools (which I think should be held to a higher standard than they are in this regard too by the way).

ISiddiqui 11-06-2013 09:49 AM

Quote:

Originally Posted by DaddyTorgo (Post 2870908)
Isn't it pentecostalism where they do the whole "speaking in tongues" rapture thing? If so, I stand by my characterization.


Which millions and millions of adherents in the US and around the globe. Your ignorance is showing.

Quote:

Above and beyond that though - charter schools are sketchy to me. I think there are good ones with altruistic motives, and then there others which are ways for the heads to line their own pockets. I don't think they should be funded by my tax dollars unless they're held to the same accountability standards (education & transparency wise) as public schools (which I think should be held to a higher standard than they are in this regard too by the way).

There is a reason why Democratic mayors like Cory Booker have been such avid supporters of charter schools. Its because they have revitalized education in inner cities when the public schools had been failing for so long.

DaddyTorgo 11-06-2013 10:01 AM

Quote:

Originally Posted by ISiddiqui (Post 2870909)
Which millions and millions of adherents in the US and around the globe. Your ignorance is showing.



I'm not ignorant. Far from it. Just because there are millions of adherents doesn't mean it's not on the fringe. You know there's millions of Moonies too right? Doesn't make them less weird. I know you've become pretty religious since your conversion, but it's okay to admit that there are "fringier" groups under your religious umbrella.

Quote:

Originally Posted by ISiddiqui (Post 2870909)
There is a reason why Democratic mayors like Cory Booker have been such avid supporters of charter schools. Its because they have revitalized education in inner cities when the public schools had been failing for so long.


I'm not saying I'm against all charter schools. I said there are good ones and there are bad ones, but the lack of accountability and some of the higher-profile cases of charter schools skimping on educational funds while administrators line their own pockets worries me, and I want there to be more stringent oversight and accountability for my tax dollars (in both public and charter schools I said). OMG...I'm a Democrat arguing for more stringent oversight - yes I am.

ISiddiqui 11-06-2013 10:16 AM

Quote:

Originally Posted by DaddyTorgo (Post 2870912)
I'm not ignorant. Far from it. Just because there are millions of adherents doesn't mean it's not on the fringe. You know there's millions of Moonies too right? Doesn't make them less weird. I know you've become pretty religious since your conversion, but it's okay to admit that there are "fringier" groups under your religious umbrella.


270+ million worldwide. One of the fastest growing denominations in the world. 13 million in the US - second largest Protestant denomination in the country after Baptists. Like I said, it is speaking from ignorance if you consider a denomination that is so large and influential to be a "fringe" faith.

FTR, I don't consider speaking in tongues to be strange and I engage in the practice myself. It not exactly a surprising thing down in these red states (or even religious folk in your blue state).

DaddyTorgo 11-06-2013 10:28 AM

Quote:

Originally Posted by ISiddiqui (Post 2870916)
270+ million worldwide. One of the fastest growing denominations in the world. 13 million in the US - second largest Protestant denomination in the country after Baptists. Like I said, it is speaking from ignorance if you consider a denomination that is so large and influential to be a "fringe" faith.

FTR, I don't consider speaking in tongues to be strange and I engage in the practice myself. It not exactly a surprising thing down in these red states (or even religious folk in your blue state).


I consider it strange. I didn't realize you were a Pentacostalist though and it would hit so close to home for you. I'm sorry if I offended you. Obviously we feel differently about it, let's just leave it at that and save the "religion talk" for one of the periodic "religion" threads that pops up.

Arles 11-06-2013 10:42 AM

Quote:

Originally Posted by ISiddiqui (Post 2870895)
This is what I found:
It does seem to be complex, but I don't see anything in it that is really all that objectionable.

The problem is that its the same old education solution in this country: Throw more and more money into it without any kind of plan or accountability. There's a reason private schools educate kids to a better level and to half the cost of public schools - it's because they have accountability. A parent isn't going to keep paying to send a kid to a crap private school.

Come up with a plan and explain why you need the money. Heck, come up with the plan, pass it and then try to get incremental funding as you work through the steps in it. A lot of the initial reforms most states need don't cost a dime.

ISiddiqui 11-06-2013 10:49 AM

Quote:

Originally Posted by Arles (Post 2870929)
The problem is that its the same old education solution in this country: Throw more and more money into it without any kind of plan or accountability. There's a reason private schools educate kids to a better level and to half the cost of public schools - it's because they have accountability. A parent isn't going to keep paying to send a kid to a crap private school.

Come up with a plan and explain why you need the money. Heck, come up with the plan, pass it and then try to get incremental funding as you work through the steps in it. A lot of the initial reforms most states need don't cost a dime.


WTF?! The main problem it seems with the bill is that the PLAN is complex.

ISiddiqui 11-06-2013 10:51 AM

Quote:

Originally Posted by DaddyTorgo (Post 2870921)
I consider it strange. I didn't realize you were a Pentacostalist though and it would hit so close to home for you. I'm sorry if I offended you. Obviously we feel differently about it, let's just leave it at that and save the "religion talk" for one of the periodic "religion" threads that pops up.


I consider myself Charismatic. However, it isn't due to my status that I was taken aback, it was the suggestion that something is a fringe belief when it is so prevalent. One of the things that tends to bother me is that sometimes atheists or mainline Protestants (of which I am one) don't seem to realize that some of the stuff they call 'fringe' has more adherents or people believing it than some of the stuff they consider mainstream.

Arles 11-06-2013 10:56 AM

Quote:

Originally Posted by ISiddiqui (Post 2870931)
WTF?! The main problem it seems with the bill is that the PLAN is complex.

It's complex in how it is drawn, but there isn't a clear path to results. Just because something is complex doesn't mean it has a good plan. Increasing the spending per pupil isn't the solution. Break it up into multiple phases beginning with the last piece in the bill "establish more transparency and accountability for how education dollars are spent".

Maybe after you see how money is spent, the solution might not be to just bump up the spending - it could be to completely change the spending paradigm altogether.

It's like a business going to a bank and saying "Well, I'm not sure what product I will make, how I will make it or how much I will sell it for. But can I have a low interest loan for $1 million to see if I can do it?" I don't fault the Colorado voters at all for voting that down. It's the job of the bill to convince people as to why they need $1 billion - not to just demand and say we are all anti-education if we don't agree.

cartman 11-06-2013 10:58 AM

Quote:

Originally Posted by Arles (Post 2870929)
The problem is that its the same old education solution in this country: Throw more and more money into it without any kind of plan or accountability. There's a reason private schools educate kids to a better level and to half the cost of public schools - it's because they have accountability. A parent isn't going to keep paying to send a kid to a crap private school.

Come up with a plan and explain why you need the money. Heck, come up with the plan, pass it and then try to get incremental funding as you work through the steps in it. A lot of the initial reforms most states need don't cost a dime.


Care to back this spending claim up? I can't find any references to private schools spending half the per-student amount of public schools.

Here's some figures I saw (this report seems to be widely referenced):

http://www.greatlakescenter.org/docs...PvtFinance.pdf

Quote:

Public schools spend, in dollars adjusted for both region and inflation, more than
Christian Association Schools (CAS) and Catholic schools, but less than Hebrew
or independent day schools: nearly $15,000 per pupil for independent schools,
over $12,000 for Hebrew schools, $7,743 for Catholic schools, and approximately
$5,727 for CAS. For public schools, the comparable average spending figure was
$8,402.

DaddyTorgo 11-06-2013 11:00 AM

Quote:

Originally Posted by ISiddiqui (Post 2870932)
I consider myself Charismatic. However, it isn't due to my status that I was taken aback, it was the suggestion that something is a fringe belief when it is so prevalent. One of the things that tends to bother me is that sometimes atheists or mainline Protestants (of which I am one) don't seem to realize that some of the stuff they call 'fringe' has more adherents or people believing it than some of the stuff they consider mainstream.


This is a discussion for another thread, so I'll not address it here.

ISiddiqui 11-06-2013 11:00 AM

Arles: I'm sorry, you said:

Quote:

Throw more and more money into it without any kind of plan or accountability.

There is a Plan. Now you are shifting goalposts and saying it isn't a "good plan". I'm not sure you know what the exact plan is.

From the CS Monitor article:
Quote:

Among other things, it would raise the per-pupil spending in the state, direct more money to districts with more at-risk students, expand preschool for at-risk kids and full-day kindergarten, give funding equity to charter schools, set aside $100 million for an innovation fund, and establish more transparency and accountability for how education dollars are spent.

That seems like a good outline of a plan to me. I'm sure the pages and pages of the bill go into more detail about it.

DaddyTorgo 11-06-2013 11:01 AM

Quote:

Originally Posted by cartman (Post 2870936)
Care to back this spending claim up? I can't find any references to private schools spending half the per-student amount of public schools.

Here's some figures I saw (this report seems to be widely referenced):

http://www.greatlakescenter.org/docs...PvtFinance.pdf


I think by half he meant "nearly double." It's Arles-math again.

Marc Vaughan 11-06-2013 11:03 AM

Quote:

Originally Posted by cartman (Post 2870936)
Care to back this spending claim up? I can't find any references to private schools spending half the per-student amount of public schools.


Its also worth looking above just raw 'spending' and looking at the quality of education provided etc. - I know some 'private' schools in Florida which don't have many particularly qualified teachers at all and I'm sure their spending is 'cheap' in comparison to the public schools ... but I wouldn't send my kids there.

(as with Healthcare I think education is something its vital to invest money into for the good of society as a whole, it shouldn't be driven by a 'profit motive' in my opinion - not least because the entire concept of 'money' and 'profit' is a human created illusion .... yeah I know I'm a socialist hippy ;) )

Arles 11-06-2013 11:26 AM

Quote:

Originally Posted by cartman (Post 2870936)
Care to back this spending claim up? I can't find any references to private schools spending half the per-student amount of public schools.

Here's some figures I saw (this report seems to be widely referenced):

http://www.greatlakescenter.org/docs...PvtFinance.pdf

There was a great article in the Washington Post a few years back that debunked this number:

Quote:

We're often told that public schools are underfunded. In the District, the spending figure cited most commonly is $8,322 per child, but total spending is close to $25,000 per child -- on par with tuition at Sidwell Friends, the private school Chelsea Clinton attended in the 1990s.

What accounts for the nearly threefold difference in these numbers? The commonly cited figure counts only part of the local operating budget. To calculate total spending, we have to add up all sources of funding for education from kindergarten through 12th grade, excluding spending on charter schools and higher education. For the current school year, the local operating budget is $831 million, including relevant expenses such as the teacher retirement fund. The capital budget is $218 million. The District receives about $85.5 million in federal funding. And the D.C. Council contributes an extra $81 million. Divide all that by the 49,422 students enrolled (for the 2007-08 year) and you end up with about $24,600 per child.

For comparison, total per pupil spending at D.C. area private schools -- among the most upscale in the nation -- averages about $10,000 less. For most private schools, the difference is even greater.

The Real Cost Of Public Schools - Washington Post

Here's another well-written breakdown of the real costs:
Quote:

Real spending per pupil ranges from a low of nearly $12,000 in the Phoenix area schools to a high of nearly $27,000 in the New York metro area. The gap between real and reported per-pupil spending ranges from a low of 23 percent in the Chicago area to a high of 90 percent in the Los Angeles metro region.

To put public school spending in perspective, we compare it to estimated total expenditures in local private schools. We find that, in the areas studied, public schools are spending 93 percent more than the estimated median private school. Citizens drastically underestimate current per-student spending and are misled by official figures. Taxpayers cannot make informed decisions about public school funding unless they know how much districts currently spend. And with state budgets stretched thin, it is more crucial than ever to carefully allocate every tax dollar.

This paper therefore presents model legislation that would bring transparency to school district budgets and enable citizens and legislators to hold the K–12 public education system accountable.

http://object.cato.org/sites/cato.or.../pdf/pa662.pdf

There was an actual study done here in Phoenix on this. They looked at three different districts (city, high and low income) and compared the actual costs for both public and private with the stated costs. Here's what they found:

Paradise Valley (City district): Actual Public - $12,312; Stated Public - $9,883; Actual Private - $6,770

Cave Creek (high income): Actual Public - $13,929; Stated Public - $9,024; Actual Private - $6,770

Deer Valley (City district): Actual Public - $9,365; Stated Public - $8,323; Actual Private - $6,770

So, on average, the cost to educate a child in the public school is about double what it costs for a private school. Also, Charter schools tend to be much better than public schools - I want to make that distinction clear as well.


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