Obamacare and rate increases - report your results here

[JohnRoberts]

I won't waste too much time debating what people think about other people, but stirring up enmity is the currency of political rhetoric. 

Big insurance was surely problematic before, and now enticed into partnership with the government thanks to the promise of an expanded customer base they have jumped in with both feet. There is an old saying, "when you go to bed with the government you don't get a restful sleep." 

If we just wanted to execute the wealth transfer you could do it more cheaply by raising taxes on workers directly and gifting the poor, or up to 3x the poverty level beneficiaries under ACA... Note: we are not talking about the global poverty level (something like $1-2/day) but our $11k /annum US definition of poverty. Speaking of world poverty, while it's hard to call $1.25 a day comfortable in 1990 that used to be 43% of the world's population below that level, now it's only 21%. So somebody is benefitting from world's economic growth. [end_veer].

The ACA does not appear like it will actually reduce healthcare costs, and the "affordable" tag, refers to all the people getting assistance to help pay for not very cheap health insurance.  This assistance is coming from the rest of us paying new taxes and more.

I expect how this is received by individuals depends on which group they are in.

There is still a lot that we could have done to reform the healthcare system like tort reform, actual competition for insurance plans (like car insurance) etc. I am ever optimistic but I expect this to get worse before we get the collective will to impose true (free market)  reform.

As usual I hope I am wrong and the ACA magically delivers everything that they promised it would.

HNY

JR

 

[Spiritworks]

Unfortunately, I don't think the collective will will ever be large or strong enough to demand change for the better. The hordes of untamed masses that demand and expect a free ride are spawning exponentially out of control while becoming the largest depository of of bought-for votes by the powers that be. Those of us that know better are being bled dry. It will be interesting to see what will happen when there's no blood left.

 

[JohnRoberts]

Unfortunately, I don't think the collective will will ever be large or strong enough to demand change for the better. The hordes of untamed masses that demand and expect a free ride are spawning exponentially out of control while becoming the largest depository of of bought-for votes by the powers that be. Those of us that know better are being bled dry. It will be interesting to see what will happen when there's no blood left.

I choose to take a more optimistic perspective. Political power tends to swing back and forth like a pendulum around the center, so they must fight gravity to hold it so far left in a basically centrist or center right country.

One party seems to be running the table with promising the moon and creating an entitlement society (Romney got slammed for that observation), i am already seeing some cracks in the "free stuff" mentality. Some federal judges who must approve disability awards are currently under review for rubber stamping unfounded disability claims, the number of people added onto the government teat in the last several years is remarkable and growing. The US average is something between 4-5% of working age adults on disability. This population does not show up in the unemployment numbers. Note: this is not just a recent thing, active programs to move people off welfare after Clinton coincided with increased disability applications.  Sorry I don't want to go too far down this road. Poor people need help, but they need an opportunity to work themselves out of poverty not a tender trap that holds them there.

As Thatcher famously quipped eventually they run out of other peoples money. I don't expect us to get into a full blown sovereign debt crisis, but we have had our debt down graded in recent years, so the trajectory is down not up. We will revisit the borrowing authority again in Mar 2014 and I expect the typical heated political machinations, while as i've mentioned before this is much ado about a spending horse that is long out of the barn, so just more political theater. 

I expect the future to get better... I wish it would hurry up and get here... this current malaise is not a fun ride.

happy new year all....

JR 

 

[Ptownkid]

The part that I truly do not understand in all of this is why the target was insurance as opposed to the absurd cost of healthcare in your country...seems to me that the real problem is what your health care system is allowed to charge.

 

[JohnRoberts]

The part that I truly do not understand in all of this is why the target was insurance as opposed to the absurd cost of healthcare in your country...seems to me that the real problem is what your health care system is allowed to charge.

It is the nature of a free market with competition that sellers of services are free to charge what they want, and customers will use the cheaper vendor. This already happens in competitive markets like lasik eye surgery, and cosmetic surgery. 

We already have experience with what happens when you try to control prices by government mandate. Back during the '70s our government applied price controls to oil/gasoline, and what we got was less supply, long lines and not enough gas. Not unlike your system with longer waits and limited service. In Canada if a dog or cat needs surgery there is no long wait, because it is a competitive free market (of course destitute dogs and cats don't fare as well).

Unlike the segments of the US healthcare markets (cosmetic, eye, etc) where competition has kept prices down, the larger general delivery of healthcare here was already monopolized by big insurance in partnership with big hospitals. Now that they have joined up with big government we are well on our way to the limited service options many other countries already enjoy.

I do not pretend that there is an easy answer to this. I have been writing about this for years. We have a demographic bomb with aging population and increasing end of life and late life health care costs (for people who don't manage their weight, diet and exercise, which is most people. ) There isn't enough wealth to magically give every single person the best SOTA health care.  In my judgement competition and free markets where individuals manage their own healthcare spending would generate the stimulus for innovation and cost reduction in the industry. Government mandates to lower costs historically do not work very well. A safety net for the poorest among us is a separate issue that could be handled without taking over 1/6th of the private economy.

This is nothing new, I've been watching this slow motion train wreck for the last few years.  I wish I was wrong. Really.

JR

 

[emrr]

I re-upped my old plan that had been cancelled in Oct.  I can't find anything competitive in the new market.  Should I get a divorce, I could get a nice large subsidy that would make it competitive, but not with joint income. 

If I didn't say it already, check out the nutballs subsidy calculator for two people.  You get the full subsidy up to $62K (for two about $1959), and between there and $62,040 it barely changes.  At $62,041 it becomes $0.00.   

 

[lassoharp]

The part that I truly do not understand in all of this is why the target was insurance as opposed to the absurd cost of healthcare in your country...seems to me that the real problem is what your health care system is allowed to charge.

To fully convert to a tax payer based system, "socialized medicine" was apparently too big a step for anyone to tackle.  The charge rates have been too high for too long and it's hard to see anything far beyond the fact that to bring base costs down would mean less profit for hospitals, providers of med technology, pharma companies, and insurance companies who supposedly would be largely out of the picture in a fully socialized model.  The political climate for that change is very hostile for a large sector of the population.  Lots of irrational fears about "Socialism" and many health care professionals, nurses, administrators and managers who will simply shake their head calmly and tell you "Socialized medicine will not work in America".

There is still a lot of anxiety that our health care system will become "inferior" under a different system and it's no secret where they got their ideas from.  Sometimes people who have believed one thing for most of their lives has an experience that changes that.  I met a plumber who was working in Afghanistan for the civilian corps.  They work inside the military compound there. up to 90K a year, tax free $.  He was in Thailand during his leave time and had an appendicitus. He had to go to a hospital in Thailand.  He said he was worried because of what he'd heard.  He said the hospital was as  nice as any hospital he'd ever been in in America.  He was still worried about the bill.  He was there 4 days for the surgery and follow up.  He did not know if they would take his military insurance card.  He went to give it to the receptionist at check out.  They alughed and told him he did not need that.  He looked at the bill.  Just under $400 total, which he had in hand.  In America that would likely have 5 or 10 thousand dollars or more - easily.

My optimism is that eventually there will be enough people who understand and believe that a different system will work and will demand it.

Still a long long ways to go it seems.  ACA is and will be blamed for as much as it can be blamed for likely a long time. Even if there had never been ACA we were already heading well in the opposite direction.  There's an article a medical doctor posted a link to earlier in this thread that highlights the trend.  Nothing new and simple in overall picture.  Hospitals want more profit and the first thing they do is look for ways to cut labor costs.  Easy enough for non professional or low level professional staff members.  But that is apparently not enough and they are going after the doctors now and the plan seems to be working well.  Why would their long term goals not be to eventually have every doctor in town shut out of private practice and working for them for what will amount to 30K a year net salary vs 100-200K a year?  Kind of ironic since one of the points people often argue on  socialized medicine is not being able to pay doctors a decent salary under a tax payer based system. 

 

[JohnRoberts]

Still a long long ways to go it seems.  ACA is and will be blamed for as much as it can be blamed for likely a long time. Even if there had never been ACA we were already heading well in the opposite direction.  There's an article a medical doctor posted a link to earlier in this thread that highlights the trend.  Nothing new and simple in overall picture.  Hospitals want more profit and the first thing they do is look for ways to cut labor costs.  Easy enough for non professional or low level professional staff members.  But that is apparently not enough and they are going after the doctors now and the plan seems to be working well.  Why would their long term goals not be to eventually have every doctor in town shut out of private practice and working for them for what will amount to 30K a year net salary vs 100-200K a year?  Kind of ironic since one of the points people often argue on  socialized medicine is not being able to pay doctors a decent salary under a tax payer based system.

There are a few aspects of the ACA that are actually reform minded (so good), but en masse there is far more wrong than right with the legislation IMO.  I have been saying for years that the healthcare system was broken. Bringing big government into the tent with big insurance and big hospitals, is not my idea of a productive fix.

We'll see...

Happy new year all...  2014 should be pretty interesting as this plays out.

JR

PS Healthcare tourism is not a new concept. Many travel to India for budget surgery. I suspect they don't have all the ambulance chasing lawyers over there that we do. FWIW with the WWW and robot surgery, we could just about use Indian doctors in near real time. But doing the actual work is not the actual problem, it's paying $100 for an aspirin and the like. 

 

[pucho812]

latest Obamacare update for me and refresh of old

Originally started porivate insurance when i was laid off from my previous employer in August... from there saw a steady rate increase of 33% and was met with due  to the obamacare mandate we are dropping you at the end of the year or we can move you into another plan. Then got a letter saying due to the government not making up their minds we are keeping you in the same plan. Then come to the top of the year to see I am still covered and the current rate is double what I started at. I thought this whole Obamacare was supposed to be affordable or are they just trying to out price the private plans  in favor of the government run debacle?

 

[riggler]

Nail on the head Pucho.

 

[JohnRoberts]

While they are doing parade laps already claiming they reduced the rate of cost increase. The plan just went into effect a couple weeks ago so taking credit now a little premature IMO.

I am not optimistic that without serious reform this will survive. Likewise I am not optimistic that we will get a clean do-over so I predict messy times ahead.

The old you break it you own it theory... the old healthcare system while flawed has been severely disrupted, and I won't give the pukes credit for engineering an insurance system collapse on purpose to gain even more control, but how can big insurance emerge from massive bailouts without being even more beholding to big government?

To be generous this is classic passing legislature in broad strokes ignoring reality and human nature, leaving the details to other people, but the math does not compute. They could pass a law outlawing the vacuum in space, or gravity, but it won't change the laws of physics, that trump the laws of man. 

JR

PS: The nominal Affordable terminology refers to the cost to consumers "after" they get federal payment support. The arm waving about bending the price curve is not credible in my judgement. Doctors and private practices are abandoning the system like rats off a sinking ship.. It will be interesting to see where all these new policy holders get care in the future. Anyone here studying medicine to become a doctor?   

 

[gltech]

$177/mo to $289/mo, and $2000 deductible to $13000 BCBS Georgia. Yes, thirteen thousand. My letter said "Yippee, you can keep your current plan, but your monthly and deductible will..." Imagine my surprise.

I won't give the pukes credit for engineering an insurance system collapse on purpose to gain even more control

You can bet your arse on it.

 

[Spiritworks]

latest Obamacare update for me and refresh of old

Originally started porivate insurance when i was laid off from my previous employer in August... from there saw a steady rate increase of 33% and was met with due  to the obamacare mandate we are dropping you at the end of the year or we can move you into another plan. Then got a letter saying due to the government not making up their minds we are keeping you in the same plan. Then come to the top of the year to see I am still covered and the current rate is double what I started at. I thought this whole Obamacare was supposed to be affordable or are they just trying to out price the private plans  in favor of the government run debacle?

This is the very same thing I am hearing over and over in my ( lower ) middle class, blue collar socio-economic group. My story also.

 

[Phrazemaster]

$177/mo to $289/mo, and $2000 deductible to $13000 BCBS Georgia. Yes, thirteen thousand. My letter said "Yippee, you can keep your current plan, but your monthly and deductible will..." Imagine my surprise.

I won't give the pukes credit for engineering an insurance system collapse on purpose to gain even more control

You can bet your arse on it.

Sickening! I'm sure this is not an isolated story. I feel so helpless. The "political process" is supposed to allow the people's voices to be heard and the will of the people done. Clearly this kind of chicanery and outright robbery is NOT the will of the people. But how can we change this atrocious legislation? I'm sickened to the core.

 

[bruno2000]

$177/mo to $289/mo, and $2000 deductible to $13000 BCBS Georgia. Yes, thirteen thousand. My letter said "Yippee, you can keep your current plan, but your monthly and deductible will..." Imagine my surprise.

I won't give the pukes credit for engineering an insurance system collapse on purpose to gain even more control

You can bet your arse on it.

Sickening! I'm sure this is not an isolated story. I feel so helpless. The "political process" is supposed to allow the people's voices to be heard and the will of the people done. Clearly this kind of chicanery and outright robbery is NOT the will of the people. But how can we change this atrocious legislation? I'm sickened to the core.

Peoples' voices were heard.  They voted for Democrats, and the Democrats wrote and voted for ACA.
Best,
Bruno2000

 

[Phrazemaster]

Don't get me started on the voting process...if voting was supposed to express the will of the people there are far better voting methodologies than we employ. And let's not even talk about voting fraud with electronic software based voting machines such as Dieboldt provides....

And when poles show most Americans are against ACA, how can it be claimed the will of the people is being expressed? I know one guy who is all for ACA in my personal life, and everyone else sees it for the steaming pile it is...

 

[bruno2000]

Poles show NOW that most folks are not happy with ACA, but during the last election, not so much.........
Best,
Bruno2000

 

[Phrazemaster]

Poles show NOW that most folks are not happy with ACA, but during the last election, not so much.........
Best,
Bruno2000

You may well be correct Bruno. But then again they were basing their beliefs on the lies spun at the time. There seems to be no accountability in government. How can they say X and deliver Y, yet continue? There must be a way to stop this David (in this scenario we are the Goliaths, although appearances might indicate otherwise...)

 

[bruno2000]

It was obvious to me from the start that the math didn't work, regardless of what was said.  The only way to change it is via the ballot box.
Best,
Bruno2000

 

[JohnRoberts]

The pendulum will swing back toward center, but a great deal of damage has been done, and still to occur. I remain in denial  about how slow the voters are about understanding what is really going on. "You can't fool all the people all the time."

This is the kind of legislation you can get when one party, either party, has a lopsided majority. Our founders went to great lengths to make it difficult to force through legislation for exactly this reason. A federal government with too much power diminishes individual liberty. The recent nuclear option rules change in the Senate makes it easier to force partisan decisions.

Instead of fully addressing the economy's problems (only 70k new jobs this month and 400k dropped out of the job market), the democrats used their super-majority to force through this landmark Healthcare legislation (remember Hillary-care?) that they have lusted after for decades. Unfortunately in all that time dreaming about it, they did not work out practical ways to accomplish it. A recent study of the MA system reveals something like 33% waste. During the debate and crafting of the ACA conservative ideas were largely ignored or given lip service (we'll study that). Before the legislation was finalized they lost the super majority in the senate so had to amend the early version using a budget reconciliation gimmick. I don't know about bending the cost curve, but bending the rules is acceptable practice.

It seems politics is getting overly contentious. It has always been dirty, and disingenuous (yes virginia politicians lie), but there used to be a civility and professionalism about doing the people's business.

It is maddening to pay too close attention to politics because it amplifies our individual sense of powerlessness (only 1 vote), but collectively so many are getting screwed over that this won't go on forever. Another example of wealth/cost shifting in ACA the law mandates a maximum 3:1 range of plan prices, so in the past a more expensive to service old customer could be charged 5x the young healthy customer, now that ratio is 3:1. So the young customers rates will increase to carry the older customers who don't pay their way. One elephant in the room about ACA performance is how many young people are actually signed up, the admin declines to release numbers. If they don't get the numbers of young people they need to cover the costs, insurance companies will need to get bailed out and rates will rise again next year.

The question is how to get from here to a good place. We should definitely keep the things that are good about the ACA, but be real world practical about how to accomplish this. Sorry, I still see more bumps in the road for the near future.  Pretty soon we will get to revisit the debt celling again. A political event full of sound and fury with absolutely no real significance (spending was already authorized). Enjoy the political theater.

JR