Affordable Care Act

[rah]

MH, while I agree 100% it will be easier politically to do it through the private insurers since they have most of the politicians sucking at that teet.

 

[Sommerswerd]

This is really the key. For the ACA to work optimally, you essentially need to force everyone to pay into the system. But that's functionally no different from single-payer, except you have private insurers taking their profits out of the system. So at that point, if you're forcing everyone to buy in, you might as well just do the more efficient thing and create a single-payer system, forcing everyone to pay in via taxation.

Remember that one of the backdrops of the original ACA fight was that the proponents realized that if Big-daddy-Health-Insurance was full-bore opposed to the ACA, that they would obviously drown their efforts in negative ad money. So they had to come up with something that would bring Health Insurers along, and make them into an ally rather than opponent-with-unlimited-resources. It was a Faustian bargain... but that's politics, that was the only way to move the ball forward... and even that was almost sabotaged... it was literally an 11th hour, skin-of-teeth deal with ZERO support from the opposition.

The Democrats really gave the country a clinic on the sausage-making of national legislation... and we we're frankly kidding ourselves to think for one second that the Republican incompetencepalloza, led by the twitter-troller-in-chief was going to be able to duplicate that feat. Its unthinkable in retrospect. It was literally the blind leading the blind.

 

[metalhead]

And, it really did change the national outlook on the government's role in health care. There is plenty to attack the ACA on from the left, but we are markedly closer to single payer now than we were at the start of the decade. The Rs get an assist on that, by putting into focus how insane it now seems to want to take that coverage away from people.

 

[JollyRoger]

Just have the government buy up all the shares of the big health insurers and be done with it.

 

[onejayhawk]

Just have the government buy up all the shares of the big health insurers and be done with it.

Isn't this the same a nationalizing?

J

 

[onejayhawk]

Translation: "No, I can't, because I don't understand the issue." If you'd explained anything in detail, we wouldn't have to have gone on for half a page about what everybody thinks you might be trying to say.

If you say so. I used to be in risk assessment and reserves, which is basically insurance in a non-medical area. I also tried more technical but you got lost fast.

This is like election polling. I'm not Nate Silver, but I was a long way ahead your crowd. How'd that 10% margin work out for you.

J

 

[onejayhawk]

I mean, doing anything else is basically accepting institutionalized robbery as the status quo. But when has institutionalized robbery not been the status quo?

Isn't this the taxes are institutionalized robbery argument?

I dunno, his constant refrain "that's not how insurance works" makes me think it actually is.

metalhead is the one that keeps saying that.

J

 

[Perfection]

As if I haven't already.

Here is an allegory. You have a rubberband powered toy plane. The distance it must fly is increasing, so you wind the rubberband tighter. Eventually you get catastrophic failure. In the ACA, the rubberband is the insurance reserves and the increasing distance is the line of high risk applicants. The system was created in such a way that this is inevitable.

J

the solution isn't to tell high risk people to go die

 

[onejayhawk]

the solution isn't to tell high risk people to go die

Hospitals and first responders do it all the time. It's called triage.

You have to tell everyone that there is something they cannot have, even if their life depends on it. The question is where to draw the lines. The second question is how to keep the lines from moving.

J

 

[metalhead]

If you say so. I used to be in risk assessment and reserves,

J

Those who can't, teach

It's funny, because you think you're being technical and we aren't understanding you, but the problem is that you're explaining things that are irrelevant to the conversation because you don't understand how health insurance works. It's like how my dad swore for 30 years that solar would never be feasible because he worked on a solar project 30 years ago and it wasn't feasible to scale up to real-world applications back then.

This is painfully obvious every time you try to say that you can't insure against a pre-existing condition, which is blatantly false because insurance companies insure millions of new people with pre-existing conditions every year through employer-based plans, when people either switch plans in open season, or change their coverage due to a life event. So when you say things that are easily demonstrated to be false, and you try to claim we're the ones that aren't understanding you, the only conclusion is that you are in the worst of all places - you have no clue what you're talking about but believe you know better than everyone else.

 

[rah]

Hey, I worked at an insurance company for almost 15 years. I still wouldn't consider myself an expert on insurance. But I do have some industry certifications. They probably count for something, but not much.

 

[Gori the Grey]

you have no clue what you're talking about but believe you know better than everyone else.

Hey, that kind of thing can get one elected president!

 

[Sommerswerd]

Isn't this the same a nationalizing?

I think that is the point. Even you take the position that ACA was intended to lead to single payer eventually.

Isn't this the taxes are institutionalized robbery argument?

I think Lex's point is that the "for-profit" aspect is essentially superfluous and little more than a government sponsored skim-racket designed purely for the benefit of the insurance companies.

 

[Perfection]

Hospitals and first responders do it all the time. It's called triage.

You have to tell everyone that there is something they cannot have, even if their life depends on it. The question is where to draw the lines. The second question is how to keep the lines from moving.

J

"Sorry, you can't have life saving cancer treatment because you're low income, we decided building tax cuts for the rich and increasing our ability to kill brown people is more important"

Yup sounds like what a triage nurse would say.

Also you say the line shouldn't move, why the heck not? Shouldn't it change to keep pace with technology?

 

[Gori the Grey]

^^Mark Cuban put it interestingly in an interview I saw recently.

He said the arbitrage (I don't really know what that means, but that's the word he used) is between the profits health insurance companies presently realize (which he put at 20%; don't know if he was just whipping a random number out of his ass or if that's the real number) and bureaucratic inefficiency. He said that, should we be able to get that latter number down below the insurance company profits, then single payer is a net gain for our country.

 

[JollyRoger]

There is already bureaucratic inefficiency that diverts from healthcare to profits, but I am sure the profit makers see that as bureaucratic efficiency.

 

[Sommerswerd]

The whole profitssssss focus... while understandable from the perspective of a corporation (like an insurance company) seems a little counter productive in this context to the goal.

 

[Broken_Erika]

Profit is the only goal that matters.

 

[onejayhawk]

Those who can't, teach

It's funny, because you think you're being technical and we aren't understanding you, but the problem is that you're explaining things that are irrelevant to the conversation because you don't understand how health insurance works. It's like how my dad swore for 30 years that solar would never be feasible because he worked on a solar project 30 years ago and it wasn't feasible to scale up to real-world applications back then.

This is painfully obvious every time you try to say that you can't insure against a pre-existing condition, which is blatantly false because insurance companies insure millions of new people with pre-existing conditions every year through employer-based plans, when people either switch plans in open season, or change their coverage due to a life event. So when you say things that are easily demonstrated to be false, and you try to claim we're the ones that aren't understanding you, the only conclusion is that you are in the worst of all places - you have no clue what you're talking about but believe you know better than everyone else.

The teacher can never make the student learn. For example, you should no better than to mix terms of art, but continually do anyway.

Pre-existing conditions are not insurable. Never were. The distinction you continually skip over is that the condition is a risk factor for other issues. For example, coverage is denied for heart issues because of pre-existing diabetes. This is a completely different conversation from a person with a heart condition applying for coverage of his heart condition.

It is painfully obvious you gloss over details. Try, this once, to get it right.

Rule #1: You can insure risk.
Rule #2: You cannot insure expenses.

In the first case, coverage might be granted with a higher premium, a coverage exclusion or a policy rider. Compare, in life insurance to smoker rates or in casualty insurance to DUI rates. In neither case is there to coverage of the diabetes. In the second case, the risk has become certainty. No insurance is possible (the house is burning situation).

When you figure out the distinction between risk and expense, rephrase so I can tell if you figured it out.

J

 

[onejayhawk]

"Sorry, you can't have life saving cancer treatment because you're low income, we decided building tax cuts for the rich and increasing our ability to kill brown people is more important"

Yup sounds like what a triage nurse would say.

Also you say the line shouldn't move, why the heck not? Shouldn't it change to keep pace with technology?

If the nurse did, she should be fired. More likely, the nurse would say, "I cannot treat your cough right now because that person is bleeding to death."

The line should never move. Instead, take new technology into account on the next policy. The standard is annually renewing, which allows this.

J