Chart Of New Health Care Law

[lektrode]

Re: Chart Of New Health Care Law

....
From my perspective, ObamaCare and its purported Massachusetts forebearer does just enough to stop real reform, and not enough to actually address the problem.

DING DING DING!!!!

B I N G O !!!

we have a winner....

methinks The Ultimate Intent (so to sop up the votes of those so inclined to get 'activated' by this issue
and it worked (sucked em in)
purrrrrfectly.

[vt]

Re: Chart Of New Health Care Law

Fair questions clue.

The two friends were between 55-64; one worked as a sales clerk, the other as an attorney for a company.

As to how reasonable the health insurance costs of $200 a month was for the contract employees, a large portion were married so their spouse also had income. For a married couple with two incmomes $200 a month wasn't outrageous. Plus Obamacare will not be free, though subsidized for lower income individuals.

The cost of living for these individuals was not nearly as high as the coasts so $200 a month, while an expense, did not cause a lack of essentials.

I have a friend who lives outside Washington, D.C. who raised a daughter from a young age as a single Mom, never had a high sal;ary, and still managed to contribute to a 401K, an IRA, and a Roth IRA. She lived frugally and bought a townhouse with a friend owed equally. There are a large amount of people that can budget well., save, and not depend on government. She is now 65.

Another friend retired from a local government with a small pension, social security, never married, and had a moderate IRA accumulation.
She too owns a house, now in a lower cost area 70 miles from Washington, D.C. With a $35K annual income she manages to live comfortably.

We need to increase economic activity so that all can enjoy decent living standards. How do we accomplish? More government? Or free market, non crony businesses competing, growing, and providing better products, services, and employment opportunities?

[dcarrigg]

Re: Chart Of New Health Care Law

My cynical side thinks its crazy to ever expect the courts to reign in the power of the Federal Government. We've been pretty much screwed since Wickard v. Filburn. I absolutely cannot fathom the Supreme Court deciding that Congress can't regulate insurance in a way that guarantees intrastate access. Apparently, you see that as likely.

I would love for you to share a Supreme Court precedent that suggests I am wrong.

Actually, I am wrong and your cynical side is right. The case was US vs. South Eastern Underwriters Association. And the decision went so that Congress could regulate these things and stop states from regulating them.

Then Congress immediately responded with the McCarran Ferguson Act of 1944.

And the Bohner has been trying to repeal McCarran Ferguson, or at least letting attempts hit the House floor. And Pelosi did before him.

Crazy.

I suppose because it had not happened in so long, I just assumed that the Feds butting out of state insurance reform had been a Supreme Court Decision.

Turns out it's a 1944 Congressional decision that for whatever reason Congress has not managed to undo in the wave of deregulation / state power reduction over the last 70 years.

I guess it's a mixed bag. The law limits Federal power, gives states power, but also gives some Insurance companies monopoly power in some states. There's both a federalism and an anti-trust argument baked into this one.

[c1ue]

Re: Chart Of New Health Care Law

he two friends were between 55-64; one worked as a sales clerk, the other as an attorney for a company.

As to how reasonable the health insurance costs of $200 a month was for the contract employees, a large portion were married so their spouse also had income. For a married couple with two incmomes $200 a month wasn't outrageous. Plus Obamacare will not be free, though subsidized for lower income individuals.

The cost of living for these individuals was not nearly as high as the coasts so $200 a month, while an expense, did not cause a lack of essentials.

Were the spouses not covered by insurance? One person working for $20/hr, but with a wife who has insurance can hardly be comparable to a single person working for $20/hr.

I'd also note that the cost for a plan is probably higher than $300/month if 2 people are involved vs. 1

I have a friend who lives outside Washington, D.C. who raised a daughter from a young age as a single Mom, never had a high sal;ary, and still managed to contribute to a 401K, an IRA, and a Roth IRA. She lived frugally and bought a townhouse with a friend owed equally. There are a large amount of people that can budget well., save, and not depend on government. She is now 65.

Another friend retired from a local government with a small pension, social security, never married, and had a moderate IRA accumulation.
She too owns a house, now in a lower cost area 70 miles from Washington, D.C. With a $35K annual income she manages to live comfortably.

I'm very happy for both these folks, but let's not forget that they are of the age group that was able to enjoy the benefits of the asset price inflation that started in the 1970s. A 25 year old in 1970 (who would be 68 now) could buy a house for under 3x income - with an absolute value in the $26K range (vs. 8.5K+ average income).

A 25 year old today has an average income of well under $30K, with house prices averaging 5x that.

The unemployment rate average in the 1970s was 6.22%
The unemployment rate average in the 2003-2012 time frame was 6.76%

The children of many of my friends - they're working all sorts of jobs trying to get by. They live on food stamps. ObamaCare might as well be $1 million a month for all they can afford - even at the Bronze levels.

[goodrich4bk]

Re: Chart Of New Health Care Law

How about a single-payer system for lawyers?

Something on the order of Medicaid. We could call it Adjudicaid.

Okay, I'll bite.

I'm a lawyer. Made partner in 7 years, managed a bankruptcy law department during the go-go years for bankruptcy lawyers, i.e., the deindustrialization of America.

At the top of my game, I was diagnosed with Type 1 diabetes. No family history, normal weight, religious about exercise and a very healthy diet. Go figure.

With a wife and three young kids, I decided to put my health first. Started my own practice to give me more control over my schedule, exercise and eating. Results have been as expected: excellent blood sugar control and after 14 years my eyes, which are the windows to the cardo-vascular system, show no damage from diabetes.

Of course, I've done all this on my own since I am uninsurable as a Type 1 diabetic. Without insurance, the needles, test strips and insulin are expensive. A bottle of insulin in 1998 was $25; today it is $100, and I use 3 bottles a month. Test strips are $.40 each, and I use 6 of them a day. Altogether it's about a $4,500/yr cash expense just to stay alive, and that's without ever seeing a doctor. If I need a doctor, all bets are off.

Then one day I have a "low" while driving. Head on collision at 25 mph. Miraculously, I walk away unharmed. No, correct that. It was not a miracle. I was saved by liberals and the politicians who listened to them and required airbags in all cars, including the car I was renting. But then that's a topic for another day.

So what do I do? I realize I am mortal and that without insurance I could have been wiped out financially in a second. An entire lifetime of saving and scrimping for my children's future would have been lost because on that day I didn't adequately match my carbohydrate intake with my insulin intake. But because I am uninsurable, there are no solutions.

Frankly, I was fine with that. At least I live at a time when I can buy insulin and live a full life; 100 years ago I would have been dead by now. And I have found that Walmart sells generic insulin for $25 a bottle.

But now I am also fine with Obamacare. I can now get insurance. No, it is not going to be cheap. I don't expect it to be. But I expect it will be worth every penny I pay, particularly if one day I unexpectedly hit a low again, or suffer a heart attack at 57, or injure a knee while trying to exercise enough to stay healthy.

I may have a preexisting condition. But I'm healthier than a lot of people I know who are completely insurable. I have something and someone to live for. And I'll be damned if I let my libertarian ideals blind me to the fact that sharing the risk is not the same as sharing the wealth. Pooling resources to protect each of us from catastrophic loss is not socialism. It is common sense.

[radon]

Re: Chart Of New Health Care Law

Then one day I have a "low" while driving. Head on collision at 25 mph. Miraculously, I walk away unharmed. No, correct that. It was not a miracle. I was saved by liberals and the politicians who listened to them and required airbags in all cars, including the car I was renting. But then that's a topic for another day.

I think that passing out and getting into automobile accidents demonstrates conclusively why insurance companies are apprehensive about insuring you against catastrophic loss.

But now I am also fine with Obamacare. I can now get insurance. No, it is not going to be cheap. I don't expect it to be.

Forcing the rest of us to overpay for a policy isn't called common sense. If it was voluntary I'd call it charity, but being that it isn't voluntary I have a different word for it.

[jiimbergin]

Re: Chart Of New Health Care Law

Fair questions clue.

The two friends were between 55-64; one worked as a sales clerk, the other as an attorney for a company.

As to how reasonable the health insurance costs of $200 a month was for the contract employees, a large portion were married so their spouse also had income. For a married couple with two incmomes $200 a month wasn't outrageous. Plus Obamacare will not be free, though subsidized for lower income individuals.

The cost of living for these individuals was not nearly as high as the coasts so $200 a month, while an expense, did not cause a lack of essentials.

I have a friend who lives outside Washington, D.C. who raised a daughter from a young age as a single Mom, never had a high sal;ary, and still managed to contribute to a 401K, an IRA, and a Roth IRA. She lived frugally and bought a townhouse with a friend owed equally. There are a large amount of people that can budget well., save, and not depend on government. She is now 65.

Another friend retired from a local government with a small pension, social security, never married, and had a moderate IRA accumulation.
She too owns a house, now in a lower cost area 70 miles from Washington, D.C. With a $35K annual income she manages to live comfortably.

We need to increase economic activity so that all can enjoy decent living standards. How do we accomplish? More government? Or free market, non crony businesses competing, growing, and providing better products, services, and employment opportunities?

+1 - Indeed there are many who know how to live within their means. Unfortunately there are even more who don't.

[don]

Re: Chart Of New Health Care Law

I'm curious - which are the single payer disaster examples?

c1ue, as you know, it's faith based

[thriftyandboringinohio]

Re: Chart Of New Health Care Law

.... sharing the risk is not the same as sharing the wealth. Pooling resources to protect each of us from catastrophic loss is not socialism. It is common sense.

+1

[vt]

Re: Chart Of New Health Care Law

http://www.businessweek.com/bwdaily/...064_666715.htm

The key takeaway here is that all should have health insurance from birth. Being uninsured because one is healthy does not protect from one day having unexpected medical costs and not having insurance.

[DSpencer]

Re: Chart Of New Health Care Law

Okay, I'll bite.

I'm a lawyer. Made partner in 7 years, managed a bankruptcy law department during the go-go years for bankruptcy lawyers, i.e., the deindustrialization of America.

At the top of my game, I was diagnosed with Type 1 diabetes. No family history, normal weight, religious about exercise and a very healthy diet. Go figure.

With a wife and three young kids, I decided to put my health first. Started my own practice to give me more control over my schedule, exercise and eating. Results have been as expected: excellent blood sugar control and after 14 years my eyes, which are the windows to the cardo-vascular system, show no damage from diabetes.

Of course, I've done all this on my own since I am uninsurable as a Type 1 diabetic. Without insurance, the needles, test strips and insulin are expensive. A bottle of insulin in 1998 was $25; today it is $100, and I use 3 bottles a month. Test strips are $.40 each, and I use 6 of them a day. Altogether it's about a $4,500/yr cash expense just to stay alive, and that's without ever seeing a doctor. If I need a doctor, all bets are off.

Then one day I have a "low" while driving. Head on collision at 25 mph. Miraculously, I walk away unharmed. No, correct that. It was not a miracle. I was saved by liberals and the politicians who listened to them and required airbags in all cars, including the car I was renting. But then that's a topic for another day.

So what do I do? I realize I am mortal and that without insurance I could have been wiped out financially in a second. An entire lifetime of saving and scrimping for my children's future would have been lost because on that day I didn't adequately match my carbohydrate intake with my insulin intake. But because I am uninsurable, there are no solutions.

Frankly, I was fine with that. At least I live at a time when I can buy insulin and live a full life; 100 years ago I would have been dead by now. And I have found that Walmart sells generic insulin for $25 a bottle.

But now I am also fine with Obamacare. I can now get insurance. No, it is not going to be cheap. I don't expect it to be. But I expect it will be worth every penny I pay, particularly if one day I unexpectedly hit a low again, or suffer a heart attack at 57, or injure a knee while trying to exercise enough to stay healthy.

I may have a preexisting condition. But I'm healthier than a lot of people I know who are completely insurable. I have something and someone to live for. And I'll be damned if I let my libertarian ideals blind me to the fact that sharing the risk is not the same as sharing the wealth. Pooling resources to protect each of us from catastrophic loss is not socialism. It is common sense.

Thanks for sharing and I'm sorry to hear about your situation. I hate to be critical given your circumstances, but this is a perfect example of where the disagreement lies on a popular part of Obamacare. Out of curiosity, did you have insurance at the time you were diagnosed?

You are probably "healthier" in MOST ways, but in one very critical way you are not. That one issue can outweigh the rest. It's not fair, but that's life.

Of course insurance that covers preexisting conditions will be worth every penny TO YOU. That's because somebody else is picking up part of the bill.

Risk sharing is common sense. A preexisting condition is not simply a risk. It is a known condition. I think everyone deep down understands this. Nobody demands a home insurance law that allows people to buy home insurance AFTER their house floods, burns down, etc. They know that would be insane and illogical.

In the end, I think that VT is correct that an ideal situation means everyone has insurance from birth (maybe before?) until death. And single payer advocates would correctly point out that an idea like that meshes very well with a single payer system. Unfortunately it also creates other problems.

[dcarrigg]

Re: Chart Of New Health Care Law

Were the spouses not covered by insurance? One person working for $20/hr, but with a wife who has insurance can hardly be comparable to a single person working for $20/hr.

I'd also note that the cost for a plan is probably higher than $300/month if 2 people are involved vs. 1



I'm very happy for both these folks, but let's not forget that they are of the age group that was able to enjoy the benefits of the asset price inflation that started in the 1970s. A 25 year old in 1970 (who would be 68 now) could buy a house for under 3x income - with an absolute value in the $26K range (vs. 8.5K+ average income).

A 25 year old today has an average income of well under $30K, with house prices averaging 5x that.

The unemployment rate average in the 1970s was 6.22%
The unemployment rate average in the 2003-2012 time frame was 6.76%

The children of many of my friends - they're working all sorts of jobs trying to get by. They live on food stamps. ObamaCare might as well be $1 million a month for all they can afford - even at the Bronze levels.

Well, Obamacare was always supposed to have half of the reduction of the uninsured come via Medicaid expansion. Everyone making under $15k is supposed to get on it. Between that and letting a 25 year old stay on mommy's health plan, they are mostly, but not always covered.

Someone 26 making $25,000 per year will be typically in a tougher spot under the law. But she'll receive a subsidy for $1,289, which covers a bit more than half of a bottom-barrel MA bronze plan right now. But she'll still need to scrape up $100 per month. At $20,000 the subsidy increases to $2,000, which covers nearly all of a bronze plan. Getting raises or starting out between $20k and $30k will be hampered by subsidy reduction.

If you think things are all sunshine and rainbows for kids in Massachusetts, I've got a bridge to sell you. They're dealing with it ok (the state subsidizes plans instead of the feds in this case). Just like they do when they hit 16 and have to figure out car insurance if they want that car.

I'm not even a fan of this plan. Yet almost this exact plan already happened in Mass. People acting like it's the apocalypse have not spent any time in Boston.

It's going to happen. People are going to huff and puff for a couple of years. Then nobody will care. Even the chamber of commerce will quiet down eventually.

[dcarrigg]

Re: Chart Of New Health Care Law

Another friend retired from a local government with a small pension, social security, never married, and had a moderate IRA accumulation.
She too owns a house, now in a lower cost area 70 miles from Washington, D.C. With a $35K annual income she manages to live comfortably.

I worry about what will happen to these people when all the pensions are gone because politicians take them away and they take an axe to Social Security.

I've watched a man who had a pension from factory work lose it in his eighties. The result is not pretty. And by that time, the IRA's already gone. If you are one of the lucky few to wake up surprised to be 92, what is left but Social Security and Medicare? A tiny little gambly 401(k)? Not bloody likely.

Pensions and Social Security are the only notable assets median Joe has.

[dcarrigg]

Re: Chart Of New Health Care Law

Interesting and workable ideas.

I suspect the overwhelming majority, if not everyone on this forum, wants to see the middle class prosper, and less the fortunate have a safety net to provide basic living standards.Any difference of opinion is based on the best way to accomplish this.

Some feel government does this best, and certainly some government programs are necessary. I actually worked with the anti poverty programs briefly in the 70's, living on poverty wages and living in a poor community. I have seen what government programs can and cannot accomplish.

Some view private industry as the best way to grow the middle class, and take people out of poverty. Governments cannot pay for services without a strong and growing tax base, and private industry cannot grow with excessive regulation and red tape.

There are problems in that corruption and favored interest prevent the poor and middle class from being helped in a fair manner. One of the principal tenants of Itulip is to accomplish a strong and growing middle class by proper ethics in the public and private sectors. We need to expand these discussions and find ways aid those entities that help achieve these goals.

Special interests, aided and abetted by politicians at both ends of the political spectrum have veered away from the noble goals of the American experience. The people need to correct this through the democratic process.

Yeah, there are some philosophical differences. But I think the most important may be this hard line between "government" and "free markets" that exists for libertarian minded folk, but not the rest of us.

I've just spent too much time working in both the private and public sectors and running a business to think that there's that much of a difference.

In the end of the day, it's all cubicles and Dell towers with a different logo on the door. Some departments are very good. Some suck. Just like workers. Just like anything else in a big organization.

Having worked at one of the big insurance companies years ago, I can tell you for a fact that if you think government is kafka-esque, labyrinthian, arbitrary, innovation killing, and boring you've never worked for big I.

They had a whole division that would exclusively print out spreadsheets and re-type them into a database for 40 hours per week. I've never seen government do anything quite that dumb and inefficient in the years when I worked for them. They were always simply too broke to waste 9 FTEs on that kind of nonsense.

Don't get me wrong. I'm not anti business. I run one. It's what I do now. But there's no debate in my head about whether government or private industry is best. Because in my experience, there's no firewall between them. They're not that different. Government often works for business, not automatically to its detriment. Business leaders are the first one's who get things done in government. And it's going to be both business and government that make up the middle class. It always has.

Like I said. I don't care if an insurance company or government runs healthcare. Because in the end of the day, Rhonda will still be sitting in a cubicle. She'll still have that Dell PC. And she'll still be listening to Foreigner on her headphones typing policy data into a form. And what the policy covers will be dictated by government whether it's an insurance company or government shuffling the paper around.

There will just be a different logo on the door.

So what I ask myself is, can we do it cheaper, more efficiently, and with more bargaining power in a way that doesn't bankrupt or hurt Americans the way the current system tends to?

I agree that the middle class needs to do something to look after its own interest, or it will die. And we do need to start coming up with ideas.

But I also fear that the middle class will not agree on any solid way to move forward.

The economy has become a religious thing to some people. Wall street worships a golden calf (or bronze bull - same thing) right in our faces every day. And people think that there is something holy about what goes on on that trading floor. They call it "freedom." They call it "liberty." They call it "free-markets." And they think government (the devil) should leave it alone to do whatever it wants.

One big problem is, every time their golden calf fails them, they burn down half of Jerusalem, then they come crying to the temple, begging for absolution. Another problem is that if America (the actual state of the United States of America) is the devil, then what is the good? Just making money with no sense of responsibility or duty to God or country or community whatsoever? That seems off to many of us. And yet this is how things are today.

But the religion of the golden calf - of the holiness of economics and the sacredness of free markets - is their religion. They have won many converts. But they are just suckers to be taken for their tithe. They actively want to suck all of the wealth they can out of the middle class. They do not want it to exist. And the middle class defends them.

Just look at the way they have used propaganda to conflate Free Markets and the Constitution. The Constitution never utters the phrase. Not once. In fact, it explicitly gives Congress the power to regulate commerce. But somehow the founders were free marketeers? The phrase didn't even exist yet.

But anything they can do to conflate the religion of the golden calf with what people deem is the good, they will do.

If it ever seems like I'm being anti-business, please realize that I'm not. I couldn't be that much of a hypocrite. What I'm against is the religion of the golden calf. Any time anyone writes a sentence where the phrase "free markets" or "the economy" could as easily be substituted with "The Volcano," I get leery. It's magical thinking.

Just look at this drivel JP Morgan puts out. And pay careful attention to the dog whistle phrases "free markets and free enterprise." As if de-regulating JP Morgan is as wholesome as grandma's apple pie...

[shiny!]

Re: Chart Of New Health Care Law

http://www.businessweek.com/bwdaily/...064_666715.htm

The key takeaway here is that all should have health insurance from birth. Being uninsured because one is healthy does not protect from one day having unexpected medical costs and not having insurance.

Respectfully, I disagree. The argument has been framed by FIRE politicians as an either/or proposition. Everyone insured -vs- fend for yourself in a climate of unaffordable health care. There are more options than this but they're not on the table.

I say disband the insurance companies. Drive a stake through their black hearts!

Insurance companies have become the locust plague of our economy. Medical insurance was invented to protect us from a catastrophic expense. Now, for millions of us, trying to pay for medical insurance IS the catastrophic event, month after month. For people without insurance, the question is "buy food, or get medical care?" For people who have to pay for their own insurance, it's "buy food, or pay my insurance premium?"

We're being brainwashed into seeing only these two options. Propaganda uses two lies to keep the FIRE system going:

• "We have the best health care in the world" and
• "Stick with the insurance model because socialized medicine leads to rationing."

I call BS. We're being BLACKMAILED: either pay insurance premiums that bankrupt you, or run the risk of financial devastation in our obscenely expensive health care system. But insurance is one of the biggest drivers of rising expenses in health care.

We already have rationing! If you can pay, you get care. If you can't pay, you get no care, or you get substandard care and medical debt that destroys you.

Without insurance, your hospital will bill you far more than the amount an insurer would pay for the same procedure. That's insane! Just charge those low reimbursement fees to everyone directly, and cut out the insurance middle man!

Why is it that an MRI with insurance will cost me $3000 out-of-pocket before my deductible kicks in, but only a few hundred $$ at a private MRI clinic that doesn't take insurance? If I go to that clinic to save money, guess what? I can't submit the bill to my insurer to have it applied towards my insanely high deductible.

Why is veterinary surgery so inexpensive compared to human surgery? Because people pay for it out of pocket. Veterinarians don't need extra staff for insurance billing; they don't charge grossly inflated fees so as to be reimbursed only a portion of it. Ask your vet what a procedure will cost; they give you a printout detailing every charge before you sign on the dotted line. Before we had "universal insurance" human health care was like this. The contract was strictly between patient and doctor.

You guys know I'm a libertarian. But insurance companies have financially raped us so badly that I now favor disbanding the insurance industry completely. Use a mix of government run clinics and private practice care for those who wish to pay for it. When providers don't have to pay extra staff to handle insurance billing, their fees go down dramatically. You also get transparency in pricing.

Cut out the insurance middle-man and health care costs become sane again. It's why health care costs so much less in Thailand, Mexico, Costa Rica, Ecuador... Some surgical clinics in the U.S. are starting to go adopt this business model already.

I like a model whereby people pay a reasonable fee to be members of their nearby hospital, which charges low fees for services and bills the patient directly. Hospitals provide reciprocity with each other if a member needs emergency care at a distant hospital. Costs could be subsidized by the government.

Private physicians can provide affordable care to patients who pay a modest monthly subscription fee to be a member of their practice. Charge low fees for their services and bill their patients directly. I used to see a doctor in Santa Fe who did business on this model. He got his medical degree from Harvard. He was the only doctor in town who cared for low-income patients who couldn't afford insurance.

It won't be perfect, but I don't see how it could be worse than what we have now. I'd much rather have tax revenues used to subsidize health care than for fighting endless wars around the world. This is why small countries with small economies can offer decent health care for a fraction of what it costs here: they use a non-profit model and they aren't throwing away their money on wars.