The Collapse of Obamacare in North Carolina

All of the insurance companies operating in North Carolina except one, Blue Cross/Blue Shield, have dropped out of the Obamacare exchange. And that one company will be increasing its premiums by 25% for 2017. This pushes premiums up to near the $2000 a month level for a family making it the greatest expense for many families not eligible for a subsidy, bigger than the mortgage or the car payment, close to 50% of take home pay for the average family income. And if people decide they can't afford this then they must pay the penalty mandated by law in addition to going without medical insurance.

Many people would under these circumstances opt for a catastrophic health policy, but that's not allowed by the law, which mandates that everyone buy a full policy with all the bells and whistles.

Because insurance companies can't turn down people with pre-existing conditions and healthy people find the premiums less and less affordable the pool of insured is increasingly dominated by sicker people, so that pool of insured costs more on the average. Without government subsidies to insurance companies (and the courts struck down the authority of the Obama administration to hand out those subsidies) premiums cost more and more.

If only someone had warned us that it would turn out like this. Oh, wait ... we DID. We DID warn you. We told you and we told you, and you wouldn't listen. The ACA was passed with NO Republican support. The Republicans said they didn't like it, they didn't want it, they would not support it or fix it. And the ACA was passed by the Democrats anyway because they didn't think they needed any Republican support. They thought they'd be in the majority for 40 years! Yes! They thought that once people saw how great Obamacare is then it would be the end of the Republicans forever! But suffice it to say that the Republicans are not gone, and they haven't changed their minds about the ACA.

Were it left to me I think I'd go with a plan to for catastrophic health insurance, not necessarily through the government, and get rid of the idea of health insurance as something that pays for every little medical expense. You don't rely on car insurance to pay for oil changes. You don't rely on home owner's insurance to pay for house painting. Insurance generally is something used to keep us from falling apart in the case of some disaster. Health insurance should be the same way.

LowDown said:

All of the insurance companies operating in North Carolina except one, Blue Cross/Blue Shield, have dropped out of the Obamacare exchange. And that one company will be increasing its premiums by 25% for 2017. This pushes premiums up to near the $2000 a month level for a family making it the greatest expense for many families not eligible for a subsidy, bigger than the mortgage or the car payment, close to 50% of take home pay for the average family income. And if people decide they can't afford this then they must pay the penalty mandated by law in addition to going without medical insurance.

Many people would under these circumstances opt for a catastrophic health policy, but that's not allowed by the law, which mandates that everyone buy a full policy with all the bells and whistles.

Because insurance companies can't turn down people with pre-existing conditions the pool of insured is increasingly dominated by sicker people, so that pool of insured costs more on the average. Without government subsidies to insurance companies (and the courts struck down the authority of the Obama administration to hand out those subsidies) premiums cost more and more.

If only someone had warned us that it would turn out like this. Oh, wait ... we DID. We DID warn you. We told you and we told you, and you wouldn't listen. The ACA was passed with NO Republican support. The Republicans said they didn't like it, they didn't want it, they would not support it or fix it. And the ACA was passed by the Democrats anyway because they didn't think they needed any Republican support. They thought they'd be in the majority for 40 years! Yes! They thought that once people saw how great Obamacare is then it would be the end of the Republicans forever! But suffice it to say that the Republicans are not gone, and they haven't changed their minds about the ACA.

Were it left to me I think I'd go with a plan to for catastrophic health insurance, not necessarily through the government, and get rid of the idea of health insurance as something that pays for every little medical expense. You don't rely on car insurance to pay for oil changes. You don't rely on home owner's insurance to pay for house painting. Insurance generally is something used to keep us from falling apart in the case of some disaster. Health insurance should be the same way.

Click to expand...

Two of the biggest flaws in PPACA were dropping most actuarial risk factors (by calling them pre-existing conditions) and (as you noted) adding all sorts of "no out of pocket cost'' items to the mix of mandated "standard" policy features. It was interesting that age, a "pre-existing condition" (actuarial risk factor) that one has no control over, was kept (and allowed to cause up to a 300% premium increase) over obesity, which can typically be controlled (prevented?) with diet and exercise.

the half measure ACA was always likely to fail. it's time to expand medicare into single payer. we can transition to that with a public option.

Helix said:

the half measure ACA was always likely to fail. it's time to expand medicare into single payer. we can transition to that with a public option.

Click to expand...

Considering that the problems are much larger than silly solutions like that, it would be a poor choice.

Harry Guerrilla said:

Considering that the problems are much larger than silly solutions like that, it would be a poor choice.

Click to expand...

there will be naysayers, but in a generation, it will be as normal as Medicare for senior citizens is now.

Harry Guerrilla said:

Considering that the problems are much larger than silly solutions like that, it would be a poor choice.

Click to expand...

He doesn't realize the flaw in his logic.

Government can't run healthcare the way that it is so let's charge people 20-30% more tax on their paycheck
Give them VA quality medical care and say all is well.

I seriously think these people do not think about this very well.

Helix said:

there will be naysayers, but in a generation, it will be as normal as Medicare for senior citizens is now.

Click to expand...

You won't get Medicare you will get VA care. Why do you hate you health so much.
Government has proven itself 100% inept at running healthcare.

So why do you ignore facts?

Helix said:

there will be naysayers, but in a generation, it will be as normal as Medicare for senior citizens is now.

Click to expand...

Not if you don't change the entire structure of the rest of the medical delivery and research system.
Single payer is nothing but fallacy of a single cause.

The medical care delivery system is more complex than that.

ludin said:

He doesn't realize the flaw in his logic.

Government can't run healthcare the way that it is so let's charge people 20-30% more tax on their paycheck
Give them VA quality medical care and say all is well.

I seriously think these people do not think about this very well.

Click to expand...

Well we're already facing a problem of having enough doctors, as it is.
We and a lot of the rest of the western world have to import doctors from developing nations.

When you drop the incentive of high pay, but not reforming both the collegiate and specifically the medical doctor parts.
You'll be having an even larger shortage.

ludin said:

You won't get Medicare you will get VA care. Why do you hate you health so much.
Government has proven itself 100% inept at running healthcare.

So why do you ignore facts?

Click to expand...

why do you ignore the 500 threads in which i've already explained this to you?

Harry Guerrilla said:

Not if you don't change the entire structure of the rest of the medical delivery and research system.
Single payer is nothing but fallacy of a single cause.

The medical care delivery system is more complex than that.

Click to expand...

i'm intimately aware of how the research end of it works. if that part of it was so important, sequester cuts to the NIH wouldn't have happened.

as for single payer,

Helix said:

i'm intimately aware of how the research end of it works. if that part of it was so important, sequester cuts to the NIH wouldn't have happened.

as for single payer,

View attachment 67208695

Click to expand...

You need a robust private industry in terms of research.
These private industries, like it or not are driven by profit, not government grants.

Yes, yes again you're making very simplistic arguments.
If all you do is swap quasi private medical insurance for single payer, but don't change anything else.
There likely won't be much of a cost reduction, because of the many aforementioned reasons.

Doctors won't go to school spending near on 100k+ and 10 years, only to earn 50k a year.
Private research will grind to a halt if you impose cost caps on their products.
You have to reform the whole shebang, not just impose single payer.

Harry Guerrilla said:

You need a robust private industry in terms of research.
These private industries, like it or not are driven by profit, not government grants.

Yes, yes again you're making very simplistic arguments.
If all you do is swap quasi private medical insurance for single payer, but don't change anything else.
There likely won't be much of a cost reduction, because of the many aforementioned reasons.

Doctors won't go to school spending near on 100k+ and 10 years, only to earn 50k a year.
Private research will grind to a halt if you impose cost caps on their products.
You have to reform the whole shebang, not just impose single payer.

Click to expand...

have you worked in either public or private research?

Helix said:

the half measure ACA was always likely to fail. it's time to expand medicare into single payer. we can transition to that with a public option.

Click to expand...

Medicare is not "sucessful" because it competes as an "option" - it is "successful" because it sets prices on a take it or leave it basis and mandates "contributions" from all wage earners often for decades before the first benefit is ever paid. Once all prices for each and very medical procedure, device, drug and service are set by the government then many payers could survive (and profit) with lower contribution (premium) rates.

Helix said:

have you worked in either public or private research?

Click to expand...

I don't have to work in it, to know how it's funded.
Private and public research are both integral to medical advancement.

Helix said:

the half measure ACA was always likely to fail. it's time to expand medicare into single payer. we can transition to that with a public option.

Click to expand...

There is no political support for paying the kind of taxes that single payer would require. Ask the governor of Vermont about that.

Helix said:

there will be naysayers, but in a generation, it will be as normal as Medicare for senior citizens is now.

Click to expand...

Medicare is not an option - all wage earners and their employers must make Medicare "contributions".

ttwtt78640 said:

Medicare is not an option - all wage earners and their employers must make Medicare "contributions".

Click to expand...

A hybrid system is more likely, something like what cpwill has proposed or maybe a HDHP with a government catastrophic and optional supplementary.
However, no one wants that. :lol:

LowDown said:

There is no political support for paying the kind of taxes that single payer would require. Ask the governor of Vermont about that.

Click to expand...

That (bolded above) is not true. If the kind of tax used is progressive enough then there easily could be more voters getting a better deal than the fewer voters being forced to finance that better deal.

That is the very basis for Bernie's "free" and Hillary's "debt free" college plans - promise the majority a new benefit to be paid for by taxing a minority. In Hillary's case, those making up to $125K (83%?) would get the proposed "debt free" college benefit and the rest (17%?) would be forced to fund its cost.

Harry Guerrilla said:

A hybrid system is more likely, something like what cpwill has proposed or maybe a HDHP with a government catastrophic and optional supplementary.
However, no one wants that. :lol:

Click to expand...

One only need look at current US public education (K-12 or college) costs (compared to other nations) to see the likely outcome.

ttwtt78640 said:

One only need look at current US public education (K-12 or college) costs (compared to other nations) to see the likely outcome.

Click to expand...

There are a lot of things that need reform and very little will to reform them the right way.
Invested interests don't like change, unless the change is inherently beneficial to them.

I think we have a much bigger problem here to deal with.

Because ACA itself is such a political lightning rod and so is the subject of moving to something single payer (or some other completely socialized system) we may be stuck with the implications of ACA failures well beyond any political will to do something about.

It does not seem likely that Republicans will win the White House and control Congress at the same time anytime soon, and it does not seem likely that Democrats will win the White House and control Congress at the same time either. At long as we have split governance between ole 'D and 'R there is no real reason to conclude something will get done. ACA is not going anywhere even if more exchanges have one payer participation or outright fail. And it is a very large jump with all sorts of complications to see single payer installed onto the market. Worse, even if Republicans pull off a miracle and remove ACA somehow there is nothing really in the works to replace it with something meaningful.

My concern is the same, since there is no opportunity to correct ACA we will see people continue to be harmed by the system. Too many are going to end up in financial complication not just because ACA is showing problems in practice but also because no one will be able to do much about it.

Harry Guerrilla said:

There are a lot of things that need reform and very little will to reform them the right way.
Invested interests don't like change, unless the change is inherently beneficial to them.

Click to expand...

The problem is that we are discussing insurance (premium, deducible and co-pay) costs instead of the underlying medical care costs which that insurance must cover.

A clearer way to think about this is profits -- and insurers aren’t where the big profits in the health-care system go. In 2009, Forbes ranked health insurance as the 35th most profitable industry, with an anemic 2.2 percent return on revenue. To understand why the U.S. health-care system is so expensive, you need to travel higher up the Forbes list. The pharmaceutical industry was in third place, with a 19.9 percent return, and the medical products and equipment industry was right behind it, with a 16.3 percent return. Meanwhile, doctors are more likely than members of any other profession to have incomes in the top 1 percent.

Click to expand...

https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/

ttwtt78640 said:

The problem is that we are discussing insurance (premium, deducible and co-pay) costs instead of the underlying medical care costs which that insurance must cover.



https://www.washingtonpost.com/news/wonk/wp/2014/01/13/what-liberals-get-wrong-about-single-payer/

Click to expand...

Ohh I agree.
Someone simply waving a magic wand and giving us single payer won't fix all the down stream issues.
It would cause a great many to fall apart.

Whether or not people like to hear it, the pharma industry is costly because we supply a lot of the worlds medical research in that regard.
Maybe if other countries allow for greater cost sharing, we could bring ours down.

Helix said:

the half measure ACA was always likely to fail. it's time to expand medicare into single payer. we can transition to that with a public option.

Click to expand...

Wait, the government did such a bang up job screwing up the ACA, let's give them another crack at it. Only this time, let's give them the whole shebang. How about no.