Healthcare.gov crashes on the last day before deadline
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Ideally you wouldn't have to pay for health insurance but this is what was able to be passed at this time. It has provided insurance to millions and largely reduced costs across the board. Everyone gets sick or at the very least eventually old. It isn't gambling, it isn't a risk, it's certain. You need to be insured. I'd just suggest it's better than what you had before.
It has cancelled the insurance of more millions. You're not just required to have insurance, you're required to have insurance meeting higher standards than many can afford and/or were living just fine without (ex.: not paying for birth control coverage when there is absolutely zero chance of pregnancy).
My dislike for it is that one provision could have been its own separate law that would have been passed easily, with more bipartisan support, and would have fixed much of what ails the system. We could quibble all day over whether or not the ACA is the best way to get there (and I think very few would suggest that it is), but there are parts of it that I would support in isolation that didn't require the individual mandate, which I believe wholly violates the Constitution, regardless of what Justice Kennedy maintains.
There are a variety of problems with medical coverage in the United States, in large part, because most of our medical coverage is handled by insurance. Insurance, at its core, is not good at complete coverage, and if we expect it to be, it's always going to be more and more expensive, especially as the payer is abstracted away from the true cost.
Medical insurance arose as a response to the wage freezes enacted by the government during the war. Wages were frozen to 'stabilize' the economy and money could be dedicated to fighting the war. The unintended consequence here was that businesses, leveraging 'benefits' to compete for top talent, petitioned the IRS to allow for medical coverage to be pre-taxable income. The result is that we have a system where largely, other people are footing the bill for medical costs. This was, IMO, the genesis of our failing health care system.
This got worse and worse and worse until the ACA. Now, the ACA appears to be fixing the problem with more of the same. More people abstracted further away from the actual cost of health care.
(Again, IMO) this is not a long-term fix, and I'll be very surprised if we don't see rates escalating dramatically in the next few years.
Before insurance became pervasive, insurance was for catastrophic purposes. E.g., cancer. For general health care needs, the flu, a cold, a pulled muscle, a broken wrist, etc., people should be paying for their medical expenses out of pocket, while paying into their insurance to buffer against bankruptcy from something like cancer, leukemia, etc.
If that were the case, we'd see the free market work. People wouldn't get three X-rays and two MRIs to determine whether or not a wrist had a very minor fracture or a very major sprain -- they'd just slap a cast on it and wait a few weeks until it was better. That cast costs a small fraction of the cost of an X-ray, or an MRI... but because the insured don't generally pay those costs out of pocket, they get all the X-rays that are needed, because they're free -- and then they're surprised at the cost of health care.
I have objections to the ACA on grounds of politics, and I have concerns with the ACA on grounds of pragmatism. I certainly don't begrudge those who have needed insurance but didn't have it until now, but if we really want to lower the cost of routine health care coverage, I find the current approach to be the least likely way to address it, and foresee rising health care costs in the future.
Again, just an opinion (though I think it's informed), and I could be proven completely wrong in a few years.
> My dislike for it is that one provision could have been its own separate law that would have been passed easily, with more bipartisan support, and would have fixed much of what ails the system
No, it would have destroyed the system.
This happened in Washington state in 1994. They passed a law in 1993 that required acceptance of people with pre-existing conditions, prevented charging sick subscribers more, and had an individual mandate to get health insurance. The mandate would start in a few years.
In 1994, Republicans got control of the state legislature, and repealed the individual mandate part of the law.
The result: people dropped insurance until they got sick, then got insurance. If their condition was not chronic, they would drop insurance after they got treatment. Insurance companies started bleeding money.
By 1998, 17 insurance companies that had provided individual health insurance in Washington no longer did so. By 1999, the last two companies that provided individual health insurance in the state stopped. You could essentially no longer buy individual health insurance in Washington.
In 2000, they modified the law so that people with pre-existing conditions had to wait nine months before insurance would be effective. I'm not sure why they picked nine months, but my guess is that it has something to do with how long pregnancy lasts in humans, because people buying insurance when they found out they were pregnant and dropping it when they brought the baby home was one of the biggest causes of losses to the insurance companies.
I'm eager to see how many young, healthy people are signing up for health care under ACA, because if the registrations are primarily from sick people, the system can't work, right.. or at least, not without further raising rates for those who can afford it?
There's a appalling lack of transparency in all this, but when the curtain is occasionally lifted (generally at a state site), or we otherwise hear stuff, there's nothing that indicates "young invincibles" are signing up in significant, let alone sufficient, numbers.
That may change as they get dinged for every higher penalties, but the political sustainability of those is highly questionable.
Guaranteed issue are the words of art for not considering preexisting conditions.
Community rating (https://en.wikipedia.org/wiki/Community_rating), means charging everyone the same amount, although that's often "Adjusted"; for Obamacare, by smoking, and maybe somewhat by age.
Individual Mandate: everyone must be part of the system.
It's the latter two that are politically difficult. Community rating means the healthy young ("young invincibles" is the current phrase) must pay a lot more to cover the less healthy older folk, also men must pay more to cover women. And it's not hidden in taxes like a single payer system.
The mandate of course means you can't escape the game for the sorts of reasons you've noted. And it's political poison, e.g. presidential candidate Obama, unlike Hillary!, was against individual mandates. And as you've noted, it's relatively easy to zap and in due course kill the rest of such a system.
Three guesses what's going to happen in 3 years when the mandate ramps up....
Ah, another critical line of attack: "BAILOUTS FOR INSURERS!!!", the "risk corridors" that will prevent them from going under this year, and the next one or two, due to insufficient signups and more importantly payments.
"Official" enrollment figures for Healthcare.gov were those who've put a plan in their cart, as of a while ago not even those who then hit "sign me up", and the communications between it and insurers are horrible, and I doubt the government even knows who's "signed up" but never paid, or stopped paying, or didn't pay their first huge bill that started to satisfy the huge deductibles of lower grade plans.
There will be attrition over the next several months, but I don't think it's accurate to say the official figures refer simply to people who "put a plan in their cart".
The argument here is....
It is in our best interest as a society as a whole to have a society that controls its fertility. We have less children born that aren't wanted, less teen pregnancy. Les children in hardship. That's a plus for society.
It is also beneficial to society to have children who are born healthy. That's why we are all required to pay for maternity care.
It is also beneficial to society to have a well educated populace, that's why we are all required to pay for primary education (through property taxes) even if we have no children, and can't have children.
Educating the women in society and giving them access to birth control is one of the best ways to pull a society out of poverty.
Conjures up images of other societies who have controlled their fertility..
A recent study from Rand Corp. debunks these claims:
Researchers found that the share of adults ages 18 to 64 without
health insurance has declined from 20.9% last fall to 16.6%
as of March 22.
http://www.dailymail.co.uk/news/article-2594309/President-pl...
Methinks you've got your facts wrong.
It isn't gambling, it isn't a risk, it's certain. You need to be insured.
I don't know many who are making an argument against lowering health costs or enabling access to more people. Neither of those things necesitate compulsory purchase of an insurance product.
I think what we need for people who don't want insurance is some way to "opt out" of the health care insurance system - maybe a special card you carry that indicates to the emergency room or hospital (where maybe you have been admitted, unconscious and close to death from a car accident) that indicates any medical assistance provided will be 100% your responsibility - i.e. bill me or whatever.
The only problem is that someone could then just claim bankruptcy and push the burden back onto the insured - so we'd need to make it so bankruptcy could not remove that outstanding debt.
Making bankruptcy harder isn't the right solution. Complete nationalization is only solution that doesn't leave uninsured and underinsured individuals who need to take a bankruptcy after an illness or accident. If that is truly the goal, then that is what should be worked at.
You do realize medical bills can be in the millions of dollars, right? It isn't even vary hard to get into the hundreds of thousands. Requiring everyone to have insurance solves the "free rider problem," where some individuals pay less than others for the same thing. You can "negotiate" all you want, but that just means person A pays less than person B for the same thing. Especially if you get a $200,000 hospital bill and you had to declare bankruptcy. If there are a lot of Person As, it makes the costs for all the person Bs rise. If there is no incentive to be a Person B, then many people would be a Person A. Requiring insurance tries to eliminate the Person As.
Disclaimer: In the real world of US healthcare, prices are nuts and different for insured and uninsured.
> I realize this isn't a trade that every person is in a position to make, but why do I need the insurance?
Because most people can't deal with a $30,000 medical bill.
Also most people are, for lack of a better word, stupid. They don't make rational choices. My sister for example, thinks that she doesn't need health insurance because juice fasts can cure all diseases. How many of my sisters are out there vs people who are responsible with their money?
You may think you will be completely healthy, but really, we are all human and something terrible (and expensive) can happen to you tomorrow.
Do I think this is a good system or a good solution to the problem? No, I do not.
Edit: For clarity, the insurance company decided to pay 80% of what they claimed the procedure was worth, not what it actually cost. Apparently there was something in the fine print about that.
I don't believe they will be there for me either, and I've been burned before too. That's one of the reasons why I don't support the ACA. However, making others take on your risk is any sane solution. You are just shifting the burden to others.
> As it stands I paid monthly insurance premiums + deductible + most of the bill
You can appeal and appeal and appeal, then go to your state insurance board. This is a government required right. There wasn't any reason to just accept what the insurance company told you. You can even get an external review. Over 90 percent of insurance decisions are reversed on appeal.
Just several phone calls sometimes resolves the issue. I've been on the phone so many times I've practically gotten them on speeddial.
One or both of these scenarios probably applies: you are young and healthy, so your purchase is necessary to spread risk over the population as a whole; or you're underestimating the odds of getting a major disease and the cost of paying out-of-pocket.
I'm not saying we shouldn't work to lower health care costs. What I'm saying is that insurance companies pay less than cash customers for health care and they spend a lot of time checking their risk calculations. Over the long term, over the population as a whole, you can't win that game.
Let's work to lower costs and fix that, but realistically, right now, in America, it's not a game you want to play.
http://healthjournalism.org/resources-tips-details.php?id=65...
[0] http://talkingpointsmemo.com/livewire/drudge-individual-mand...
No; however, Drudge did post something about his taxes and everyone was like "OMG Matt Drudge is probably lying!!! There is no fine this year!!!" untilsome real analysts got on the line (e.g. the H&R Block people) who said "yep, that's about the state of things, if you're doing self-employed quarterly estimated taxes and the like. it's possible he is in fact overpaying, but there's really no formula the IRS has issued yet, so if he wants to be safe, that's what he'd do." and Drudge fears audits from the IRS, since he thinks that's exactly what they WOULD do to an administration critic.
It was a pretty stupid kneejerk response. :b
The self-employed are already paying double in medicaid and social security (I know employers pay half for the employed but it still discourages self-employment).
'Scheduled maintenece' is either one hell of a euphamism or a most cynical Dark Pattern.
Snark Response: The Obama administration built a system for buying health insurance, and here we are... Presumably this system will work better?
Except they didn't, as we usually view ecommerce sites. It sends (often erroneous) signup info to insurers, and it's between you and them to arrange payment.
Good morning, London. It is 6 am, the fifth of November 2019 and this is the voice of Fate. The new day brings good news and bright prospects from overseas, where negotiations with New China are moving in a positive direction. Last night's scheduled demolition of two deteriorating landmarks went off without a hitch. Spokesman for the Interior ministry said both structures were severely damaged and judged to be a danger to the unsuspecting public. Plans for new landmarks are well underway. - Prothero, _V_for_Vendetta_ (Government commentary spinning unexpected destruction as "planned".)
"The Congress shall have Power...
To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;
To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;
(Yes, some M16s et al are legal, but they're at least 28 years old, cost >20x what new retail price would be without prohibition, supply is extremely limited (hence the price increase), and are smothered in regulative "red tape".)
Ya know, it's kinda like making healthy youth pay into a healthcare system that they likely won't benefit from for a long time to come (if ever; most will put more in than they'll get out): giving people access to products (physical or financial) designed to save their lives in short-notice crises is arguably so important as to be compulsory.
If those acts were repealed, I agree that the suggested MSRP for an M16 would be ~$1,000-$2,000.
So presumably in an arming the militia regime, our cost would be lower than the 1-2K you postulate, probably even lower due to massive quantity. With of course subsidies to help the poor ^_^.
(Beginning modified, for bmelton not surprisingly does get the point.)
That said, your sub-point is humorous, but overlooks that if modeled after the ACA, subsidized M16s would be available for near free, while non-subsidized M16s would be ~$4,000-$5,000, if you're in too high a tax bracket.
Disclaimer: I am not in support of the ACA, I don't think that it does a good or sane job of solving a problem.
Don't confuse "health insurance" (which ACA enforces purchase of) with "health care" (which, oddly, ACA doesn't).
Absolutely, but you won't die if you don't receive financial services. That's what makes healthcare very very different. It isn't simply a "product," it is a lifesaving measure.
>Don't confuse "health insurance" (which ACA enforces purchase of) with "health care" (which, oddly, ACA doesn't).
Of course I am not confusing the two, but if you don't purchase health insurance, you can still get healthcare in some respect. If you cannot pay for it, then someone has to foot the bill.
If you are living, there is a good chance you will, at some time in your life, require healthcare past your ability to pay. Withholding care in the ER based on ability to pay or insurance status is already illegal (not to mention immoral). Requiring one to buy insurance to protect you, and everyone else, in that position isn't in the same realm of most things.
Note: I don't actually support the ACA because it is a very poor bandaid on a gushing wound with a lot of inefficiencies attached.
Note: most (if not all) States require car insurance as a requirement of owning and operating a motor vehicle. This is because operating a motor vehicle is dangerous and can potentially cause damage. There's a chance you'll cause damage beyond your ability to pay. Required insurance is to protect you and others, because a significant number of people will forgo insurance on their own.
However there is an arguably better chance of you getting sick or injured sometime in your life beyond your ability to pay than there is causing damage in a motor vehicle beyond your ability to pay.
First off, healthcare.gov is not the only way to get health insurance. Secondly, it's not even the only way to find health insurance using the ACA (you could do this in person, or via telephone).
Finally, a snowstorm is an excellent excuse for not jogging today, but a horrible excuse for never exercising.
The fine is, what, $95? So you could request a fee reduction of $0.26 per day that the system was down this year.