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Obamacare works - Employer based Healthcare is just about dead

Visbek said:
Yeah, not so much.

Without insurance, health care would be unaffordable for the vast majority of Americans. Insurance companies distribute the risks and costs of health care across a big pool, and negotiate prices with insurers and doctors and hospitals.
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We are just going to have to agree to disagree on that. I've seen enough of your posts to know that you are usually reasonable, even if you're not always correct.

Insurance companies make a tidy profit, paying out less in claims that they charge for their policies. And the "discounts" that they negotiate are pretty much bogus. Medical care providers just jack up their prices, so that they can give discounts. I'm uninsured, and I can get the same discount, just by asking for the uninsured rate, I've done it before.

I also am motivated to shop for care based upon price. There was a time when I paid $100+ just to get my blood pressure script renewed, then I started price shopping. The first thing I did was to ask my doc for a discount, and they instantly gave me a 30% discount. Then I started price shopping with other care providers, and found one that was half the cost, for the exact same service (actully, I think it's better service).

When people have these low deductible low copay policies, they have little reason to shop based on price, and their insurance company restricts the docs that they can go to. When customers have little incentive to shop based upon price, then care providers have no incentive to compete based upon price, and little reason to operate efficiently.


continued...
 
Not ironically...the people pleading for the death of employer provided healthcare were likely those that in the past were too irresponsible to secure ANY healthcare. And of COURSE they are clamoring for other peoples provided healthcare...I mean...universal healthcare.
 
Insurance doesn't make health care cheap for the people who have it. What it does is spread the costs out among the ratepayer pools. Most of these procedures would still cost whatever the insurance company gets charged for them, and that would still be well beyond the ability of most people to pay.

For the vast majority of Americans, if they weren't paying into an insurance system, it is highly unlikely they'd set that money aside for a heart attack on a rainy day. Most people would spend it, and not save up money for the all-but-inevitable heart attack or cancer.
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That's exactly why I advocate for individual HSA accounts, so that we can save for health care expenses with pre-tax dollars, and when an HSA is combined with an inexpensive high deductible high copay insurance policy, risk is still spread, but at a very small cost to the patient.

continued...
 
Visbek said:
Yeah, not so much.

Without insurance, health care would be unaffordable for the vast majority of Americans. Insurance companies distribute the risks and costs of health care across a big pool, and negotiate prices with insurers and doctors and hospitals.

Insurance doesn't make health care cheap for the people who have it. What it does is spread the costs out among the ratepayer pools. Most of these procedures would still cost whatever the insurance company gets charged for them, and that would still be well beyond the ability of most people to pay.

For the vast majority of Americans, if they weren't paying into an insurance system, it is highly unlikely they'd set that money aside for a heart attack on a rainy day. Most people would spend it, and not save up money for the all-but-inevitable heart attack or cancer.

I concur that for-profit insurers are causing lots of issues. The problem is that we cannot make health care affordable by wiping out the insurers. The service they provide -- pooling risk -- is still a critical one. Health care is expensive in the US not because we pool risk, but because the profit motive is skewing the way we handle these critical services and needs.

By the way, one of my doctors doesn't take any insurance whatsoever. She's competing against doctors who do take insurance, who charge for the copay (typically $50 these days) and maybe a little extra that insurance doesn't cover, she doesn't have the overhead of dealing with insurers. She charges $350/visit. I see no indication that cutting out that particular middle-man has reduced her costs.



If you have a heart attack or a stroke, you don't exactly have a lot of time to shop around. Maybe you will know in advance what hospital you want to be taken to, but once you're there, your options are limited.

Or: Let's say you have a stroke. Every minute counts. Are you going to give EMTs or relatives a standing order to take you to the hospital that is a 45 minute drive from your house, because they charge 10% less than the one that is 15 minutes from your house?

If you have cancer, are you going to skip on the surgical portion because it's too expensive? Are you going to opt for a different chemo medication because it costs 5% less?

Pharmaceuticals also often have a virtual or real monopoly on drugs -- and can charge whatever they want for them. Competition is not a real factor, when there is only one drug on the market. Consider Daraprim, which has been in the news this week. It's a 60+ year old drug, and was produced at $1/pill. The rights were sold, and the new owner increased the price to $13.50 -- nothing about the drug changed, they just arbitrarily increased the price. The rights were sold again, and the new owner jacked up the price to $750 per pill. Again, nothing changed, except the owner decided to gouge everyone, and is banking on the possibility he'll profit before someone makes a generic (which may not happen at all). His claim that he was increasing the price to do research to replace the pill did not convince anyone.

Extortionate pricing for Daraprim has nothing to do with insurance companies. It's all about monopoly power, and eliminating insurers doesn't change that one bit.



Great! So we could buy Daraprim at $735 a pill, instead of $750? Sweet.

The reality is that most health care cannot work that way. You can't order chemo medications or biologics online. You can't get surgery in one hospital, and recover in another one, because one charges less for Tylenol than the other. Competition doesn't affect pricing when a manufacturer abuses its monopoly power. It's not beneficial to put off surgery for 2 months because you think your surgeon will offer a Black Friday deal. Competition does not eliminate the need to pool and distribute risk.

It's quite clear that a single-payer system, while not perfect, is more efficient overall. It generates a pool significantly larger than what any insurer could do. It has far more leverage to negotiate prices. It can decide not to cover drugs or procedures that are unable to demonstrate a sufficient benefit. It has sufficient power to keep a monopoly player in check. It removes the profit motive from enough of the system to restore incentives that work for health care -- e.g. taking care of patients, rather than making money.
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Good post except for the last.. making money is still a motive in single player systems.

The big question is whether the single payer system is or will be better than private insurance. In most countries, the single payer system of insurance is worse than what the average American with healthcare insurance has. Comparable to Medicaid for most countries. Or the VA.
 
VanceMack said:
Not ironically...the people pleading for the death of employer provided healthcare were likely those that in the past were too irresponsible to secure ANY healthcare. And of COURSE they are clamoring for other peoples provided healthcare...I mean...universal healthcare.
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Employer provided healthcare needs to go away.. its a huge problem for portability, for price control etc. that doesn't mean that employers should not be given the opportunity to help with healthcare and get the very big tax advantage for doing so... but the problem is that when I buy a policy for my employees.. Its a one size fits none proposition. for some.. its way more insurance than they need.. for others. its not good enough.

When my business was much smaller.. I calculated what it would cost in healthcare PER PERSON.. if they all had their own policies. It was actually CHEAPER to have individual policies.. as they gouged the heck out of me as a healthcare provider. Oh they said.. "well healthcare workers are more likely to use healthcare".. which is bs.. we are less likely to freak out and demand MRI's for things we know we don;t need surgery for etc. The reality is that insurance providers realized that my employees VALUE healthcare insurance and demand it and that puts pressure on me to provide a good policy and with my profit margin they new they could gouge the heck out of me. That's why when you get big enough you self insure.

What would make sense is a system of a HSA for everyone. No limits and all tax free. No "use it or lose it". The only insurance you need to qualify.. and you must have insurance (insurance mandate) is a catastrophic policy with a 10,000 deductible. However, the insurance should have say 5 free visits a year.. gratis.. for screening and other medical problems so people will come in and get diagnosed and taken care of before they have an expensive problem.

Let employers put in what they want to the HSA. Older employers can take more compensation in more money in the HSA.. and younger employees can have more money in salary.

This would solve the portability problem between jobs.. help small business help their employees get healthcare.. increase competition and thus lower prices in insurance companies.. and over the years as money builds up in the HSA.. this money can be used to supplement medicare.
 
jaeger19 said:
Employer provided healthcare needs to go away.. its a huge problem for portability, for price control etc. that doesn't mean that employers should not be given the opportunity to help with healthcare and get the very big tax advantage for doing so... but the problem is that when I buy a policy for my employees.. Its a one size fits none proposition. for some.. its way more insurance than they need.. for others. its not good enough.

When my business was much smaller.. I calculated what it would cost in healthcare PER PERSON.. if they all had their own policies. It was actually CHEAPER to have individual policies.. as they gouged the heck out of me as a healthcare provider. Oh they said.. "well healthcare workers are more likely to use healthcare".. which is bs.. we are less likely to freak out and demand MRI's for things we know we don;t need surgery for etc. The reality is that insurance providers realized that my employees VALUE healthcare insurance and demand it and that puts pressure on me to provide a good policy and with my profit margin they new they could gouge the heck out of me. That's why when you get big enough you self insure.

What would make sense is a system of a HSA for everyone. No limits and all tax free. No "use it or lose it". The only insurance you need to qualify.. and you must have insurance (insurance mandate) is a catastrophic policy with a 10,000 deductible. However, the insurance should have say 5 free visits a year.. gratis.. for screening and other medical problems so people will come in and get diagnosed and taken care of before they have an expensive problem.

Let employers put in what they want to the HSA. Older employers can take more compensation in more money in the HSA.. and younger employees can have more money in salary.

This would solve the portability problem between jobs.. help small business help their employees get healthcare.. increase competition and thus lower prices in insurance companies.. and over the years as money builds up in the HSA.. this money can be used to supplement medicare.
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MANDATED employer provided health care should go away. People should be responsible for their own health care. 80% of the country WAS.
 
imagep said:
What about outlawing insurance and thus forcing medical care providers to compete based upon price? Without price competition, the free market doesn't work right, and the existence of insurance is largely what has eliminated the need for providers to compete on price.
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that is my plan replace insurance with a massive HSA system. the only thing the government does is front load the account with a one time payment/year.
employee's and corporations fill in the rest. with extra incentives for companies that spend 10k a year per employee and only the employee's
that get that get an extra break.

for small businesses it can be 5k per year per employee.
 
imagep said:
You should price shop for new insurance.
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Our company has. We have changed insurance 3 times now and are back with our original provider. Our company pays half and I pay half. I sat down with the boss and he explained not only am I paying twice as much so is the company. The bottom line is the money that normally would have gone towards raises will now go towards health care. Health care has not only taken away our raises but now I have to pay twice as much with less money. Why, so lazy people don't have to pay or get a reduced amount.

imagep said:
And exactly what new taxes are you paying? Unless you are a 1%er, it's highly unlikely that you are paying any more in taxes.
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First they went through and reassessed our homes and property raising the estimated values increasing the amount of taxes I have to pay. With the current housing market I could not get half what they are valuing my house and property for. Then they keep increasing the tax itself so school teachers and such don't have to pay for their health care and get their raises. Then the gambling was supposed to lower our taxes but instead they went up. Now they are going to tax the gas to pay for the school teachers pensions. I will pay for that with higher gas prices because the gas co. will pass it on not pay it. Tolls on the tollways have increased, my tags for the car have gone up, as well as the sales tax I pay as things I buy go up. When you watch your expenses and year after year everything cost more and your pay does not keep up you keep cutting things. The ones really hurting are the ones on Social Security. You need to go out and sit down and listen to these people. It is beyond sad and pathetic. While government workers are crying over making 60 to 90k a year plus benefits these poor people paying their over bloated salaries are deciding between medication and food. It is time the government tightened its belt.
 
PIPEWRENCH said:
Our company has. We have changed insurance 3 times now and are back with our original provider. Our company pays half and I pay half. I sat down with the boss and he explained not only am I paying twice as much so is the company. The bottom line is the money that normally would have gone towards raises will now go towards health care. Health care has not only taken away our raises but now I have to pay twice as much with less money.
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Most people I have talked to had their insurance go up (doesn't it always go up?), but not by that much. Sounds like your company was getting a crazy good deal before, or maybe it has crappy insurance which no longer meets the standard.


First they went through and reassessed our homes and property raising the estimated values increasing the amount of taxes I have to pay. With the current housing market I could not get half what they are valuing my house and property for. Then they keep increasing the tax itself so school teachers and such don't have to pay for their health care and get their raises. Then the gambling was supposed to lower our taxes but instead they went up. Now they are going to tax the gas to pay for the school teachers pensions. I will pay for that with higher gas prices because the gas co. will pass it on not pay it. Tolls on the tollways have increased, my tags for the car have gone up, as well as the sales tax I pay as things I buy go up. When you watch your expenses and year after year everything cost more and your pay does not keep up you keep cutting things. The ones really hurting are the ones on Social Security. You need to go out and sit down and listen to these people. It is beyond sad and pathetic. While government workers are crying over making 60 to 90k a year plus benefits these poor people paying their over bloated salaries are deciding between medication and food. It is time the government tightened its belt.
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That's a state or local level tax hike, it had nothing to do with the federal government, or Obama, or Obamacare. Some states, like Tennessee, don't even have property taxes. Maybe you should move.
 
ludin said:
that is my plan replace insurance with a massive HSA system. the only thing the government does is front load the account with a one time payment/year.
employee's and corporations fill in the rest. with extra incentives for companies that spend 10k a year per employee and only the employee's
that get that get an extra break.

for small businesses it can be 5k per year per employee.
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That would be a darned good start towards correcting our healthcare affordability issue. Force, or at least highly incentivize people to save for healthcare needs, and let free market forces keep healthcare cost in check, just like in every other sector of our economy. I'm good with that.
 
VanceMack said:
MANDATED employer provided health care should go away. People should be responsible for their own health care. 80% of the country WAS.
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I agree. I think the next thing to go away is the Health Insurance Companies. It was a great idea that went wrong. Originally people paid in and the extra money was invested and used to pay catastrophic events that no one could save for as an individual. Unfortunately the money paid in now has to support thousands of millionaires and billionaires and their lifestyles instead being invested to pay for our health care needs.
 
VanceMack said:
MANDATED employer provided health care should go away. People should be responsible for their own health care. 80% of the country WAS.
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Lets see.. we don't have mandated employer healthcare.. and people have never really been responsible for their own healthcare for that last 40 years or more.. its been employer based insurance for the vast vast majority.
 
imagep said:
That would be a darned good start towards correcting our healthcare affordability issue. Force, or at least highly incentivize people to save for healthcare needs, and let free market forces keep healthcare cost in check, just like in every other sector of our economy. I'm good with that.
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I wouldn't force anyone. I believe if there is incentive then people will do it.
so if we look at family.

the government at the beginning of the year pumps the account with 10k.
your company decides to take the incentive and give 10k since they will get 2x the deduction at 10k (non-executive packages only). so at the end of the year you have 20k if you didn't spend anything. then there is your contribution. so a family of 4 making 60k a year puts 10% (taken out per check) that is another 6k so at the end of the year they have
26k dollars saved up.

they can use that for any medical need. and since doctors are willing to give 50-90% discounts on upfront cash payments that 100k surgery only costs 20k at an 80% discount.
if you don't want to pay it all out then you can spend part of your 26k paying for a catastrophic plan.
 
VanceMack said:
Employer offered as an incentive to attract higher quality candidates.
As for the 'mandate'...Ima just let you read it. http://www.cigna.com/assets/docs/about-cigna/informed-on-reform/employer-mandate-fact-sheet.pdf
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Maybe you should read it.

and will be phased in during 2015 and 2016 based on employer size.
Employees who work 30 or more hours per week are considered full-time. This chart shows how the employer
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Its been delayed. So we have not HAD a mandate. It only gets phased in this year..for employers 100 or more I believe, and for 50 to 99 until 2016.

those under 50 FTE have no mandate at all.
 
jaeger19 said:
Maybe you should read it.



Its been delayed. So we have not HAD a mandate. It only gets phased in this year..for employers 100 or more I believe, and for 50 to 99 until 2016.

those under 50 FTE have no mandate at all.
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And has the threat of the mandate already had an impact on employee hours, employment, etc? Is an employer mandate stupid beyond words?
 
VanceMack said:
And has the threat of the mandate already had an impact on employee hours, employment, etc? Is an employer mandate stupid beyond words?
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I have not seen the threat of the mandate had much impact on employee hours or employment. However, the employer mandate is stupid beyond words because many of the problems in healthcare insurance like lack of portability, one size fits none, cost etc.. stem from an employer having to purchase a one size fits none policy for all its employees. Its exactly in the wrong direction we need to be heading.
 
imagep said:
Most people I have talked to had their insurance go up (doesn't it always go up?), but not by that much. Sounds like your company was getting a crazy good deal before, or maybe it has crappy insurance which no longer meets the standard.




That's a state or local level tax hike, it had nothing to do with the federal government, or Obama, or Obamacare. Some states, like Tennessee, don't even have property taxes. Maybe you should move.
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Obama care the reason my insurance became unfordable. I had received reductions from my health care insurance prior to Obama and the disaster called the affordable care act. I worked out, lost weight, quit smoking, ate healthier, and reduced my health care cost. The 10 years leading up to 2008 most years my insurance went down or stayed the same. My insurance was rewarding good behavior with lowered insurance rates. Then came Obama care and everything I worked for went down the drain. All the reductions for doing the right things are now offset by the I don't give a $hit people the insurance companies are forced to insure. The reward the lazy and punish the hard working theory.

Then your advice is I should move. No I think I will stay and fight our over bloated government and the 3rd generation welfare recipients it has created.
 
jaeger19 said:
I have not seen the threat of the mandate had much impact on employee hours or employment. However, the employer mandate is stupid beyond words because many of the problems in healthcare insurance like lack of portability, one size fits none, cost etc.. stem from an employer having to purchase a one size fits none policy for all its employees. Its exactly in the wrong direction we need to be heading.
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Yup, yup, and yup.
 
PIPEWRENCH said:
Obama care the reason my insurance became unfordable. I had received reductions from my health care insurance prior to Obama and the disaster called the affordable care act. I worked out, lost weight, quit smoking, ate healthier, and reduced my health care cost. The 10 years leading up to 2008 most years my insurance went down or stayed the same. My insurance was rewarding good behavior with lowered insurance rates. Then came Obama care and everything I worked for went down the drain. All the reductions for doing the right things are now offset by the I don't give a $hit people the insurance companies are forced to insure. The reward the lazy and punish the hard working theory.

Then your advice is I should move. No I think I will stay and fight our over bloated government and the 3rd generation welfare recipients it has created.
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I've never heard of insurance going down, unless someone downgraded their policy or did some serious price shopping.

I'm totally against means tested welfare also, but it's not nearly as big of a problem as most people think it is. The welfare queen type person pretty much went away when we reformed and put time limits on welfare back in the 1990's, although people still imagine that people on welfare are all slackers and are making huge amounts of money on welfare.

I chatted with a young lady on facebook yesterday, the daugher of a friend of mine, she's 22 years old, a single mom, works 25 hours a week, does not qualify for WIC and does not qualify for government provided daycare for her two year old (because she doesn't work enough hours). She gets medicaid and $100 a month in food stamps, that's all.
 
imagep said:
Insurance companies make a tidy profit, paying out less in claims that they charge for their policies. And the "discounts" that they negotiate are pretty much bogus. Medical care providers just jack up their prices, so that they can give discounts. I'm uninsured, and I can get the same discount, just by asking for the uninsured rate, I've done it before.
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I think if you re-read your analysis, you may see the flaw in it.

Providers start with very high rates, specifically because they know it's a starting point for negotiations with the insurers. It's no different than car dealers asking a high price, knowing full well that buyers will haggle, just more extreme. As you noted, the insurer's own profits are at stake; every dollar they spend on a drug, is a dollar taken away from their own profit margins. They have a substantial financial incentive to knock those prices down as low as possible.

The insurers are doing the exact same thing you are doing as an individual -- they are negotiating prices with the providers. The difference is they have a lot more leverage than you, and can extract better pricing. Sometimes an individual can negotiate a good price on health care... but it's not that common. That often involves pleading poverty, which can be demoralizing. Especially if you're not actually poor.

Single-payer systems are much more efficient at taming costs because they have an incredibly powerful negotiating position. They are not beholden to pharmaceuticals, who put out minor variations of existing drugs to maintain patent-based monopolies. Doctors working within the system can be paid a flat rate, and don't have financial incentives to jam in too many patients a day, or order unnecessary tests, or prescribe new drugs that work just as well as the old ones.

Thus, the problem isn't a lack of negotiation, or a lack of pricing pressure, or a lack of competition. These elements are already features of the private-sector system. The better fix is to recognize that profit motives are a bad fit for many elements of health care.
 
PIPEWRENCH said:
Obama care the reason my insurance became unfordable. I had received reductions from my health care insurance prior to Obama and the disaster called the affordable care act. I worked out, lost weight, quit smoking, ate healthier, and reduced my health care cost. The 10 years leading up to 2008 most years my insurance went down or stayed the same. My insurance was rewarding good behavior with lowered insurance rates.
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I call shenanigans.

Under the ACA, insurers can still charge extra for smokers. The difference now is they can only charge a maximum of 50% more than nonsmokers. Wellness programs are maintained under the ACA, and even expands them.

It is highly unlikely that your insurance premiums dropped for 10 years in a row. Between 1998 and 2008, insurance premiums increased roughly 130%. Beating those costs every year by quitting smoking and losing weight doesn't add up.

It also doesn't make any sense that they only started changing in 2008. That's years before the ACA took effect. Premium growth also slowed starting around 2009.

If you had employer-based care, there is no way to know how much your employer paid. If you had individual care, you either were paying out the wazoo, or had a high-deductible plan that covered so little that it was nearly worthless. You haven't specified the changes in your coverage, either.

We don't know how much you paid. We don't know key facts. We don't even know if you are telling the truth. Neither statistical data nor evidence supports your narrative. This is why anecdotes are not an acceptable form of evidence in a debate like this.
 
jaeger19 said:
I have not seen the threat of the mandate had much impact on employee hours or employment. However, the employer mandate is stupid beyond words because many of the problems in healthcare insurance like lack of portability, one size fits none, cost etc.. stem from an employer having to purchase a one size fits none policy for all its employees. Its exactly in the wrong direction we need to be heading.
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Employers ABSOLUTELY have been cutting back in fear of the employee mandate...the one that IS on the books and IS slated to kick in and that you AGREE is a disaster...

so tell em why we are having this discussion again?
 
VanceMack said:
Employers ABSOLUTELY have been cutting back in fear of the employee mandate...
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The evidence suggests otherwise.

On the most basic level, the unemployment rate has steadily improved, while labor force participation is starting to flatten out. We should note that LFPR started falling in 2001, so it's not like we can look at LFPR exclusively since 2009 and say "that's because of the ACA!" We certainly do not see the disasters predicted by critics in 2009.

The number of part-timers doesn't bear out the fears either. What we see is that when the recession kicked in, the number of full-timers dropped and part-timers rose. The number of full-timers slowly started to recover in 2010, as in after the ACA was passed. This is not what we'd see if employers were trying in large numbers to evade the insurance requirement.

Oh, and pay careful attention to the scales on the following graph. Full time employment is usually around 83% of the workforce, and is now around 82%; part-time is usually around 17%, and is currently 18%. The recession distorted this, but a) the trends are clear, and b) we're not too far off of pre-recession levels.

Full-Time-vs-Part-time-16-plus-since-2000.gif


So no, it is ABSOLUTELY NOT evident that employers are firing people or busting them down to part-time in preparation of the employer mandate of the ACA.
 
Visbek said:
The evidence suggests otherwise.

On the most basic level, the unemployment rate has steadily improved, while labor force participation is starting to flatten out. We should note that LFPR started falling in 2001, so it's not like we can look at LFPR exclusively since 2009 and say "that's because of the ACA!" We certainly do not see the disasters predicted by critics in 2009.

The number of part-timers doesn't bear out the fears either. What we see is that when the recession kicked in, the number of full-timers dropped and part-timers rose. The number of full-timers slowly started to recover in 2010, as in after the ACA was passed. This is not what we'd see if employers were trying in large numbers to evade the insurance requirement.

Oh, and pay careful attention to the scales on the following graph. Full time employment is usually around 83% of the workforce, and is now around 82%; part-time is usually around 17%, and is currently 18%. The recession distorted this, but a) the trends are clear, and b) we're not too far off of pre-recession levels.

Full-Time-vs-Part-time-16-plus-since-2000.gif


So no, it is ABSOLUTELY NOT evident that employers are firing people or busting them down to part-time in preparation of the employer mandate of the ACA.
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ObamaCare Employer Mandate: A List Of Cuts To Work Hours, Jobs - Investors.com
Forbes Welcome
CEO of Carl's Jr. says 'Obamacare has caused millions of full-time jobs to become part-time' | PolitiFact
Businesses report cutting jobs due to ObamaCare | Fox News
Obamacare's biggest impacts: Americans losing hours, losing coverage | The Daily Caller


See...thats the problem with your cherry picking a slide to try to make it say what you want it to say.
 
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