Schadenfreude: New York's Cultural Elite Loses Their Health Insurance
Many in New York’s professional and cultural elite have long supported President Obama’s health care plan. But now, to their surprise, thousands of writers, opera singers, music teachers, photographers, doctors, lawyers and others are learning that their health insurance plans are being canceled and they may have to pay more to get comparable coverage, if they can find it.
They are part of an unusual informal health insurance system that has developed in New York in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country....
The predicament is similar to that of millions of Americans who discovered this fall that their existing policies were being canceled because of the Affordable Care Act. Thecrescendo of outrage led to Mr. Obama’s offer to restore their policies, though some states that have their own exchanges, like California and New York, have said they will not do so.
But while those policies, by and large, had been canceled because they did not meet the law’s requirements for minimum coverage, many of the New York policies being canceled meet and often exceed the standards, brokers say. The rationale for disqualifying those policies, said Larry Levitt, a health policy expert at the Kaiser Family Foundation, was to prevent associations from selling insurance to healthy members who are needed to keep the new health exchanges financially viable.
Siphoning those people, Mr. Levitt said, would leave the pool of health exchange customers “smaller and disproportionately sicker,” and would drive up rates.
Alicia Hartinger, a spokeswoman for the Centers for Medicare and Medicaid Services, said independent practitioners “will generally have an equal level of protection in the individual market as they would have if they were buying in the small-group market.” She said the president’s offer to temporarily restore canceled polices applied to association coverage, if states and insurers agreed. New York has no plans to do so.
Donna Frescatore, executive director of New York State of Health, the state insurance exchange, said that on a positive note, about half of those affected would qualify for subsidized insurance under the new health exchange because they had incomes under 400 percent of the poverty level, about $46,000 for an individual.
I still do not understand how anyone could consider it a "positive" that 50% of people who were previously self-reliant now become wards of the state.
You said "most," not I.
I showed far, far more evidence contradicting your idiotic claim than your single biased reference.
By any standard, that constitutes more than yours.
Your "most" statement is laughable at best, and an outright lie.
It's not irrelevant when it impacts your own citation.
mesaeconoguy: I showed far, far more evidence contradicting your idiotic claim than your single biased reference.
As we said, by only citing those from the far spectrum of economic thought, you undermine your position concerning prevalent expert opinion.
No, you stated your regression was simplistic (which it is), and it uses an incorrect measure of life expectancy.
Where it appears is irrelevant. You just destroyed your own argument.
I think you may be dumber than Larry, which is significant.
Libertarian isn't any part of the spectrum.
I believe you are dumber than LarryG.
I reject the intrusion into markets, but no one goes without treatment because of this intrusion. The
cost of the treatments is far less than your solution (see below).
A far better solution would be market-based.
We didn't say that
You most definitely draw that conclusion.
You favor a large, centralized system rife with waste and inefficiency, which will by definition result in higher cost and lower quality and quantity service delivery.
mesaeconoguy: No, you stated your regression was simplistic (which it is), and it uses an incorrect measure of life expectancy.
Gee whiz. When you said "Incorrect, unadjusted for accident & murder rates," you are making an oblique reference to Ohsfeldt & Schneider who were forced to admit their non-peer reviewed study was just qualitative, and not quantitative.
The cost curve is bending down.
mesaeconoguy: Libertarian isn't any part of the spectrum.
Now you're just quibbling semantics. Libertarianism is certainly part of the political spectrum.
mesaeconoguy: I reject the intrusion into markets, ...
Including requiring hospitals to provide emergency care.
mesaeconoguy: but no one goes without treatment because of this intrusion.
Hospitals are only required to provide emergency care. If a diabetic is in shock, they only have to stabilize the patient, not treat the underlying disorder.
mesaeconoguy: You favor a large, centralized system rife with waste and inefficiency, which will by definition result in higher cost and lower quality and quantity service delivery.
The U.S. pays far more for only comparable results compared to its developed competitors.
Since you apparently can’t read, the data are from US National Cancer Institute (2003), year of diagnosis 1986-88, and International Agency for Research on Cancer (2003), year of diagnosis 1985-89.
They are survival rates, not regressions.
Your incorrect graph showed a nonlinear regression, based on the nonadjusted life expectancy rates for various countries. US life expectancy is significantly higher than represented there.
If you have information refuting the NCI and IARC data, by all means, do tell.
LMAO, from the semantic gymnastic idiot himself
Oh, is it now?
Which part?
Here, I’ll explain the full picture for you, because you are dense:
I am for the most people getting the best care at the lowest cost. That occurs under a market-based
system, with maximum pricing info, large out-of-pocket funding, and catastrophic policy pools, as Warren has blogged about here extensively (and you’ve ignored, because you are ignorant).
Failing that, the treatment guarantee preserves the availability of treatment, while still allowing for private policy purchase, and preserving the existing medical service delivery and insurance configuration.
Does that guarantee raise cost? Yes, but not as much as reworking the entire system, requiring everyone to participate (with the young subsidizing the old) and expanding third party payer on the way to single payer, the most expensive configuration of all.
The cost of a centralized enormous bureaucratic system is guaranteed to be much, much higher. That is economically certain, based on previous medical coverage and administrative expansions.
The previous configuration net total cost will be lower than Obamascare, and when that fails, single payer.
You are a fantastically stupid person.
Good bye.
Not because of Obamascare.
Libertarians generally want less government, as opposed to those who want more government.
mesaeconoguy: I am for the most people getting the best care at the lowest cost. That occurs under a market-based system
Sure. We understand your position. Any time the government intervenes in the markets, it distorts those markets. The Reagan-era Emergency Medical Treatment Act meant that hospitals were now saddled with providing free emergency care to the indigent. These costs were passed on to consumers, and that meant that hospitals in poor areas were undermined economically. Preventive care is suggested as a solution to that problem, and, of course, that will create its own market distortions.
mesaeconoguy: The cost of a centralized enormous bureaucratic system is guaranteed to be much, much higher.
The U.S., which has traditionally had the least government intervention, pays more than its economically developed competitors for only comparable results.
"The U.S., which has traditionally had the least government intervention"
Granting you that the US has had the least intervention (which is debatable), that is still not equal to no intervention. A free market exists (and works) in those cases where consumers are able to directly compare multiple options for the same product or service. This *should* be the case with routine health care. Pre-ACA, it was not the case. Post-ACA, it is still not the case.
The root cause of the USA's health care woes is the over-reliance on the insurance model. Insurance deals well *only* with unexpected events. Take, for example, the price of an insurance policy for a burning house: the price of the house plus the price of administering the policy and claim. In the case of a burning house, it will always be cheaper to pay for the house directly than to insure it.
The problem with the US is not that it's a free market, but that it's extremely distorted in a direction that reduces incentives for consumers to control costs and search for solutions that will be effective for them. Having employer-provided insurance receive tax-advantaged status creates an incentive (and expectation) that employer-provided health insurance will provide broad coverage, reducing tax-disadvantaged out-of-pocket expenses. This problem is made worse under the ACA with the coverage mandates.
Catastrophic-only insurance plans were starting to undo this damage and push the US market in a freer direction. The savings to both individuals and at an aggregate level were starting to show post-2005. Not coincidentally, the period of data supporting that Doug Elmendorf quote we discussed earlier is focused directly on the period when catastrophic-only plans were starting to have an impact. Unfortunately, these plans are illegal under the ACA.
You've made the argument that the ACA "certainly wasn't the only choice, but apparently the only politically
viable choice that could move the system towards universal coverage." The reality is that the only politically-viable choice is one that is poised to drive up costs both on the individual and aggregate levels and is already starting to degrade the level of care available to millions of Americans. Were that Democrats had the wisdom and maturity to follow the doctrine of "First, do no harm".
Quincy: Granting you that the US has had the least intervention (which is debatable), that is still not equal to no intervention.
Sure, but would most people want a completely free market, meaning people would be turned away from doctors and hospitals if they can't pay?
Quincy: The root cause of the USA's health care woes is the over-reliance on the insurance model.
Sure. Though insurance is part of the free market, it tends to detach the market from market signals. In particular, patients want the best care when they're sick, while insurers want only healthy customers.
Quincy: The reality is that the only politically-viable choice is one that is poised to drive up costs both on the individual and aggregate levels and is already starting to degrade the level of care available to millions of Americans.
Again, do most people want a completely free market?
Quincy: Were that Democrats had the wisdom and maturity to follow the doctrine of "First, do no harm".
When attempting to change any complex system, there will be unintended side-effects. (Indeed, that's the basic definition of complexity.) On the other hand, you shouldn't allow this to lead to paralysis, and the eventual decrepitude of the health care system.
"Sure. But would people accept a completely free market in health care?
That would mean turning people away from doctors and hospitals for lack
of ability to pay."
That's a strawman position. It's possible to have a free market yet make sure that people have an ability to purchase what they need. The trick is getting assistance in the hand of those who need it in a way that allows them to make purchasing decisions that maximize value. We do it in other sectors of the economy today.
"insurance companies want to only insure healthy people."
This demonstrates you're absolutely ignorant of the way insurance works. Period.
It's not an unwillingness of the insurance companies, it's the mathematical reality of being able to pay claims that make this the case. Put simply, many sick people are not insurable because they are the medical equivalent of a burning house. The ACA handles this in the worst possible manner, by forcing sick people into the risk pools of insurance companies *and* mandating increased coverage.
"Catastrophic insurance helps in some respects, in that it provides an
immediate market signal for some products. On the other hand, the young
still tend to rely on the kindness of strangers, while preventive care
may have long range benefits on the cost curve, but still tend to be put
off by people in financial stress."
From an insurance company's perspective, the ideal offering would actually be very long-sighted: a generally catastrophic-only plan that pays (or offers discounts) for preventive care and other risk mitigation factors while the insured is young and reap the benefits while the insured is older. The problem is the tax-advantaged nature of employer-provided insurance over individually-purchased insurance means that insureds have to switch insurance with every change in employment. COBRA was designed to mitigate this, but it's usually so outlandishly expensive it's just not an option.
So, the payoff for insurance company of offering preventive care is lessened by the linking of health insurance to employment. Therefore, more of the cost has to be covered by current-year premiums instead of future-year savings. Rather than lowering insurance prices, preventive care drives up prices because insurers can't count on keeping insureds. A perfect example of a regulation causing a private player to be more short-sighted than they otherwise would be.
"Markets don't solve all problems, and tend to be short-sighted."
Markets are not meant to solve problems, in the left wing delusions-of-grandeur sense. They're meant simply to facilitate transactions between participants at a mutually-agreeable price. Functioning free markets tend to produce both reasonable price and adequate supply. This is a condition that centralized economic planners have yet to achieve in human history. In the context of health care, the horrible wait times in countries with socialized medicine speak to constrained supply.
"And yet most other developed economies have much lower health care costs for comparable results."
So passing a law that makes health care more expensive and less available helps this how, exactly?
"Sure. The problem with changing any complex system is that there will be
unintended consequences, but refusing to change can mean paralysis and
steady erosion."
So, it's just fine to take actions that are obviously stupid and detrimental because change is needed, is that right? That's a load of horse hockey. The negative consequences associated with the ACA that are beginning to manifest were utterly predictable (and predicted) before passage. These consequences are only unintended to the Democrats in Washington who were blinded by hubris and the urge to change things that they ignored critical faults in a fatally-flawed law.
Quincy: The trick is getting assistance in the hand of those who need it in a way that allows them to make purchasing decisions that maximize value.
Taxing some people to pay for the medical care of others is not a completely free market. Leaving aside the tax itself, it means the poor have little incentive (or knowledge) to regulate costs, unless you plan to cut them off when care gets expensive.
Quincy: It's not an unwillingness of the insurance companies, it's the mathematical reality of being able to pay claims that make this the case.
Sure. As we said, insurers are incentivized to avoid people with a high risk, not just those who are sick.
Quincy: Put simply, many sick people are not insurable because they are the medical equivalent of a burning house.
Sure. And as you seem to be advocating subsidized care, it means insurance companies will find ways to dump high-risk people onto the government.
Quincy: Markets are not meant to solve problems, in the left wing delusions-of-grandeur sense.
Um, we're discussing a societal problem which is a result, in part, of market forces: Most people don't think people should be refused health care because they are poor. Market-based solutions are certainly a possible solution to this conundrum.
Quincy: So passing a law that makes health care more expensive and less available helps this how, exactly?
The obvious point was to look at how other countries have managed to provide comparable results for less money. They're not all the same, you know. There are many possible solutions.
Quincy: So, it's just fine to take actions that are obviously stupid and detrimental because change is needed,
Of course not. Just because there are inevitably going to be unintended consequences doesn't mean that we're blind to all consequences. You've already decided ObamaCare won't work, but more than likely, it will be modified, not abandoned.
"Sure. As we said, insurers are incentivized to avoid people with a high risk, not just those who are sick."
You continue to claim that this is something that insurance companies could do if they were incentivized to. Mathematical reality dictates otherwise. The most unethical action an insurer can take is to bring more risk into the risk pool than it can collect premium for. Why? This action means that it will eventually be unable to pay claims.
Frankly, your refusal to stop living in a fantasy land on this issue tears your credibility on the health care issue to shreds.
"Taxing some people to pay for the medical care of others is not a
completely free market. Leaving aside the tax itself, it means the poor
have little incentive (or knowledge) to regulate costs, unless you plan
to cut them off when care gets expensive."
In the semantic sense, true. In the real world sense, using targeted assistance to put purchasing power in the hands of the needy (as opposed to providing things for them) results in a much freer and more effective market than we have today.
"Sure. And as you seem to be advocating subsidized care, it means
insurance companies will find ways to dump high-risk people onto the
government."
I'm in favor of finding the least disruptive way possible to help those who can't get health care do so while leaving the rest of us alone. Simple position, no?
Now, as to the idea that insurance companies don't want to insure uninsurable people? Shocker. As stated earlier, math is a harsh mistress when it comes to risk pooling. Math *will* enforce reality, no matter how politically inconvenient.
"Um, we're discussing a societal problem which is a result, in part, of
market forces"
People lose their insurance every time their employment changes because of market forces, really? Try regulation as a root cause here.
"Most people don't think people should be refused health
care because they are poor. Market-based solutions are certainly a
possible solution to this conundrum."
I'm one of them. But I also believe we'll end up in a better spot if we find ways to leverage market mechanisms to get there. They're not incompatible positions.
"The obvious point was to look at how other countries have managed to
provide comparable results for less money. They're not all the same, you
know. There are many possible solutions."
There are, but they all involve other tradeoffs. Wait times being the biggest (Canada and the UK being the most notorious examples). And this is an open, honest, transparent discussion that needs to be had if we're to be asked to push in those directions. Is it better to pay more or leave someone waiting in pain for months on end? I can tell you, from my family members who have been subjected to the tender mercies of the NHS, they'd pay more in a heartbeat.
There is more to health care than total cost.
"Of course not. Just because there are inevitably going to be unintended
consequences doesn't mean that we're blind to all consequences."
How I hate that phrase unintended consequences. The phrase is an excuse for hubris and stupidity. I pointed the loaded gun at my wife and pulled the trigger, but I didn't mean to kill her. It was an unintended consequence!
There is no excuse for being blind to the most obvious consequences of a law. There are reasons, certainly, and hubris and pig-headedness on the part of the Democrats who rammed this through without the support of the opposition or the American people are two big ones.
"You've
already decided ObamaCare won't work"
I've already laid out in rather painstaking detail *why* I predict the ACA won't work. Performance to date suggests the mechanisms I'm describing are working as I predicted they would. Given the reality of the situation today, my position is extremely reasonable.
"but more than likely, it will be
modified, not abandoned."
Eventually, the ACA will be abandoned. The question is what replaces it. If Democrats are in power, we get single payer. If Republicans are in power, we get a rollback. Since the problems with the law are in the core mechanisms that are supposed to make it work, modification will continue to be ineffective.
Quincy: You continue to claim that this is something that insurance companies could do if they were incentivized to.
They *are* incentivized to do so.
Quincy: The most unethical action an insurer can take is to bring more risk into the risk pool than it can collect premium for.
Sure. As we said, they are incentivized to reduce risk by trying to insure the healthy, and avoid insuring those with a high risk of illness.
Quincy: I'm in favor of finding the least disruptive way possible to help those who can't get health care do so while leaving the rest of us alone. Simple position, no?
Sure, that's a reasonable position, But keep in mind that any interference in the markets distorts them. Not sure what you think would be a viable reform.
Quincy: I pointed the loaded gun at my wife and pulled the trigger, but I didn't mean to kill her. It was an unintended consequence!
No. There's every reason to believe it was an intended consequence.
Quincy: Performance to date suggests the mechanisms I'm describing are working as I predicted they would.
Medicare Part D took about a year to settle down into a practical program. ObamaCare is more complex and will take considerably longer. Pointing to the chaos of the rollout isn't evidence that the program will fail in the long run.
Quincy: Eventually, the ACA will be abandoned.
Possible, but doubtful. The program will probably muddle along, and markets will adjust to the new reality.
I bring up the mathematical reality of insurance. You continue to insist your fantasy is reality.
I bring up specific failure mechanisms of the ACA. You respond only in generalities and broken analogies.
I bring up the trade offs that occur in socialist countries. Silence.
It's obvious this discussion is going nowhere productive. I'm out.
Quincy: I bring up the mathematical reality of insurance.
Which we acknowledged and agreed with. We even agree on the goal. So what is your proposed solution?
Since you're being reasonable and there appears to be a misunderstanding, let's try this again:
Quincy: "I bring up the mathematical reality of insurance."
Zachriel: "Which we acknowledged and agreed with."
No, you haven't. You've said:
"insurance companies want to only insure healthy people."
"Sure. As we said, they are incentivized to reduce risk by trying to
insure the healthy, and avoid insuring those with a high risk of
illness."
The words you're using, "want" and "incentivized" cast the matter as a subject of will or desire on the part of insurance companies. This is flatly incorrect.
The reality of the matter is that no matter the insurance company's will, insuring people above a certain level of risk is a mathematical impossibility, akin to trying to escape Earth's gravity going less than 25,000 mph.
Understanding that this is a hard mathematical limit is key to understanding my viewpoint on the ACA. It is bound to fail because it pushes people who are mathematically not insurable into the risk pool, forcing the healthier individuals in the risk pool to pay for them. This is an unsustainable strategy, given demographic trends. As the population ages, there will be fewer younger, generally healthier individuals to form the subsidy pool.
More immediately, healthy individuals need to purchase the more expensive insurance. The enrollment data I've seen indicate that this is not the case. Far fewer people are purchasing through the exchanges than were displaced from pre-ACA plans. In some cases, this is largely explainable due to technical problems. However, the trend appears to be holding true in states where the exchanges are working. Only 156,000 people were signed up for health plans as of Dec. 7. This is roughly 15% of the 1 million Californians who lost their pre-ACA coverage due to the law's coverage mandates. That means approx 844,000 previously-insured (and therefore low-risk enough to be insured) individuals *exiting* the risk pool. That seriously undermines the strategy of keeping low-risk people in the risk pool to subsidize high-risk people, doesn't it?
Now, to add fuel to the fire, the ACA mandates significantly increased coverages without dollar limits. This means that a high-risk person can run up a nearly limitless amount of health care expenses that must be covered by the premiums of those in the risk pool. So, someone who was uninsurable before can become downright toxic to a risk pool under the ACA. This, too, is not sustainable.
Which brings to your last question: "So what is your proposed solution?"
It's a truism that it's easier to criticize than create. Understanding that the concept of risk pooling (which is at the core of insurance) has hard mathematical limits allows us to take a critical eye to the ACA. Once this is done, it becomes blatantly, awe-inspiringly obvious that the law is broken. To me this is as obvious as the fact that pointing a loaded gun at somebody and pulling the trigger will wound or kill them. This is why I can't accept the problems with the law as "unintended" consequences that are endemic to any change.
(As an aside, you might be wondering why insurers went a long with this. My belief here is that the insurers felt it too risky to oppose an administration that already had a track record of strong-arming corporations. Their play, as best I can read it, was to support the law and try to capture the regulators once the publicity died down. It's not working well for them.)
That said, I can give you the key characteristics I would look for in a solution:
1. Decouple insurance from employment.
2. Use insurance to cover only insurable (i.e. not predictable) events.
3. Eliminate all coverage mandates.
4. Allow insurers to use targeted coverage exclusions to handle pre-existing conditions.
5. Move to a system where insurers pay insureds instead of doctors.
These would turn us towards a system where the vast majority of people are covered against unforseen health events while empowering consumers to make purchasing decisions and search for the best deal. There are a lot of details to work out, certainly, but it's a start.
Quincy: The words you're using, "want" and "incentivized", cast the matter as a subject of will or desire on the part of insurance companies. This is flatly incorrect.
Now, you're quibbling semantics. We can't find the phrase "insurance companies want to only insure healthy people,", but when someone says they want a job, they normally mean they are seeking the incentive that comes from a job. And yes, the market incentive for insurance companies is to insure the healthy and avoid insuring the unhealthy.
Quincy: Understanding that this is a hard mathematical limit is key to understanding my viewpoint on the ACA. It is bound to fail because it pushes people who are mathematically not insurable into the risk pool, forcing the healthier individuals in the risk pool to pay for them.
Yes, we understand the concept of risk pools.
Quincy: This is an unsustainable strategy, given demographic trends. As the population ages, there will be fewer younger, generally healthier individuals to form the subsidy pool.
There are more than enough financial resources to provide healthcare for all Americans, so the only issue is participation. Most people want health insurance, including the healthy.
Quincy: Now, to add fuel to the fire, the ACA mandates significantly increased coverages without dollar limits. This means that a high-risk person can run up a nearly limitless amount of health care expenses that must be covered by the premiums of those in the risk pool.
Medicare already has limitless coverage. Few people need the extended coverage, and that is limited by the natural limits of medicine.
Quincy: 1. Decouple insurance from employment.
2. Use insurance to cover only insurable (i.e. not predictable) events.
3. Eliminate all coverage mandates.
4. Allow insurers to use targeted coverage exclusions to handle pre-existing conditions.
5. Move to a system where insurers pay insureds instead of doctors.
1. Sure
2. What? You would prohibit preventive care if insurance companies provided it willingly? It can save them money.
But you haven't proposed a solution to the problem of the uninsured, including the poor and young free riders, which you had indicated above was the problem at issue.
Quincy: 4. Allow insurers to use targeted coverage exclusions to handle pre-existing conditions.
The result, which is the current policy, is to spend-down the person's resources, then put them on Medicaid, meaning the government pays.
"Now, you're quibbling semantics. We can't find the phrase "insurance
companies want to only insure healthy people,", but when someone says
they want a job, they normally mean they are seeking the incentive that
comes from a job. And yes, the market incentive for insurance companies
is to insure the healthy and avoid insuring the unhealthy."
There you go again. It's painfully obvious that the distinction between can't and won't is beyond you. As I said, until you understand this everything else I wrote will make no sense. And I was right.
Quincy: It's painfully obvious that the distinction between can't and won't is beyond you.
We are quite aware of the distinction. Such a quibble is irrelevant to the point. Markets are such that insurance companies are incentivized to insure healthy pools of people and attempt to exclude the unhealthy. It's impossible to have a perfect pool of insured, but insurance companies that do better at reducing risk, the more successful they are in the market.
And that means that insurance markets will tend to dump the unhealthy, leaving them to suffer, or leaving the problem to others.
"We are quite aware of the distinction. Such a quibble is irrelevant to the point. Markets are such that insurance companies are incentivized to insure
healthy pools of people and attempt to exclude the unhealthy. It's
impossible to have a perfect pool of insured, but insurance companies
that do better at reducing risk, the more successful they are in the
market."
The point here is not market success, but financial failure of risk pools. With any set of coverages, there is a level of risk that, if allowed into risk pools in numbers, will cause them to fail. Failure is the inability to pay claims with premiums collected. This is a mathematical certainty. All the talk in the world of incentives and markets does not change this simple, unavoidable fact. Neither does your insistence that it is irrelevant.
Quincy: The point here is not market success, but financial failure of risk
pools. With any set of coverages, there is a level of risk that, if
allowed into risk pools in numbers, will cause them to fail.
That is correct. We had agreed to this point above.
Yet, every argument you put forward still contains the mathematically impossible idea that the uninsurable should be insured.
To reiterate: It is reality that there are people that cannot be insured by health insurers. These folks are generally require a lot of care. This is expensive and needs to be paid for. So far, we're in agreement.
My point has been that the absolute dumbest, most sure to fail way to pay for these individuals' care is to use the force of law to shoe-horn them into risk pools. It is dumber still to mandate expanded coverages for members of the risk pool at the same time. In short, the ACA is literally THE worst solution to the problem because it will push the entire health insurance system into failure.
It would have been far smarter to provide a targeted, small-scale solution to help those who need care but can't pay for it.
As for the young invincibles, the solution to getting them the health insurance they need is to remove coverage mandates so that cheap, tailored-to-the-young health plans can be offered. The ACA plan designs screw the young invincibles in two ways:
1. Pure, redistributive exploitation baked into the ACA's mandated rate structure.
2. Legislated over-insurance through expansive (and expensive) coverage mandates.
In news that came out today about healthcare.gov's December enrollments, it appears that the young invincibles aren't falling for it. They're refusing to be exploited by obeying the individual mandate. Moreover, it's a form of civil disobedience that could have been predicted by a simple demand curve.
Quincy: Yet, every argument you put forward still contains the mathematically impossible idea that the uninsurable should be insured.
Everyone is insurable. It's a question of the size of the pool of insured, and cost. In a completely free market, however, the incentive is to avoid risk. Those that are the best at avoiding risk will tend to dominate. A simple example is the Good Samaritan Hospital which takes all emergency patients regardless of ability to pay. Other hospitals will dump the poor at their doorsteps. This situation is unsustainable, of course, which is why laws were passed that hospitals couldn't dump their emergency patients.
Quincy: In short, the ACA is literally THE worst solution to the problem because it will push the entire health insurance system into failure.
The system may not be sustainable, but not for the reason you have provided. If all insurers have to take all comers, then they will compete on the same level playing field.
Zachriel: "Everyone is insurable. It's a question of the size of the pool of insured, and cost."
You make it sound so simple! I finally see the light now! I was *so* wrong to insist that the real world placed limits on an individual's insurability. If the size of the risk pool and the cost of insurance are the only questions, there are obviously no limits whatsoever on what's insurable!
Oh, wait. There *are* limited resources in the real world. Given that, your point is facile and idiotic. For a given pool and demand curve (i.e. ability and willingness to pay), there is a level of risk that cannot be insured. That's true with any kind of insurance. Premiums rise above the market clearing price, adverse selection begins, and eventually the pool collapses.
Not even the individual mandate stops this, since unless the penalties are adjusted to be greater than the inflated premiums it's cheaper for the healthy to forgo insurance. (Note that no politician would make the career-killing vote for penalties that high, so it's not going to happen.)
Zachriel: "In a completely free market, however, the incentive is to avoid risk. Those that are the best at avoiding risk will tend to dominate."
This is irrelevant to the discussion of risk pool failure in an environment where it's illegal to avoid risk.
Zachriel: "A simple example is the Good Samaritan Hospital which takes all emergency patients regardless of ability to pay. Other hospitals will dump the poor at their doorsteps. This situation is unsustainable, of course, which is why laws were passed that hospitals couldn't dump their emergency patients."
Completely irrelevant example. A hospital is not an insurer.
Zachriel: "If all insurers have to take all comers, then they will compete on the same level playing field."
Or, more likely, they stop taking any comers when the books don't balance. Does the government force them to keep offering insurance at a loss? Will Aetna, Blue Cross, Humana, and UnitedHealthcare be forced back into the individual policy markets they've already abandoned?
Quincy: If the size of the risk pool and the cost of insurance are the only questions, there are obviously no limits whatsoever on what's insurable! ... There *are* limited resources in the real world.
The cost can be reasonable. Most western democracies provide universal coverage through a variety of mechanisms, so you're simply wrong on this.
"The cost can be reasonable. Most western democracies provide
universal coverage through a variety of mechanisms, so you're simply
wrong on this."
An assertion without evidence, how utterly convincing. Put simply, I'm right. These limits exist. The US individual market is already running up against them in the individual market thanks to the ACA.
That does not mean, however, that the western democracies you mention aren't taking other steps to keep from running up against the limit I describe:
1. How many of these western democracies rely on private insurers to provide this universal coverage?
2. Of those, how many provide subsidies to insurers to prevent bankruptcy?
3. What level of coverage is provided by these western democracies?
4. What level of cost-sharing is expected of insureds?
5. How many of these western democracies rely on price controls and supply limitations to artificially limit cost?
6. How many of these western democracies have wait times of months or years for care?
Quincy: An assertion without evidence, how utterly convincing.
The evidence of possibility is its actual existence.
Quincy: How many of these western democracies rely on private insurers to provide this universal coverage?
Most developed countries use a mix of private and public provision. Germany is such a mixed system.
Quincy: How many of these western democracies have wait times of months or years for care?
Most developed countries have comparable health care results for considerably less cost than the U.S.
http://i.huffpost.com/gen/1478324/original.jpg
Zachriel: "Most developed countries have comparable health care results for considerably less cost than the U.S"
Why is it that every socialist trots out this chart to avoid discussion about the tradeoffs that occur under a socialist system? Rather than answer specific questions with actual information, you offer up the same tired generalities. Say what you will, but it utterly fails to convince when you refuse to answer any points (like wait times) that prove inconvenient to your point.
You've wasted enough of my time with your ignorance and unwillingness to address the issues. You have failed to convince me of anything other than your own mendacity.
Quincy: Rather than answer specific questions with actual information, you offer up the same tired generalities.
Um, it is information. Most developed countries have comparable health care results for considerably less cost than the U.S. More so, it means that it is possible to insure everyone.
Quincy: Say what you will, but it utterly fails to convince when you refuse to answer any points (like wait times) that prove inconvenient to your point.
Wait times vary considerably even among countries with universal coverage. They don't appear to impact health care results. Critical care is provided immediately, while non-critical care can wait.