Will “the Bros” Buy Insurance in 2014? If Your Son (or Boyfriend) is Uninsured, Please Send Him This Post
by Maggie Mahar from The Health Beat blog
Will “the Bros” Buy Insurance in 2014? If Your Son (or Boyfriend) is Uninsured, Please Send Him This Post
Some young men say they never go to the doctor. Why, they ask, should they buy into Obamacare?
Obamacare saboteurs are urging them to boycott the state marketplaces (a.k.a. the “Exchanges”) where people who don’t have health benefits at work will be able to buy their own insurance.
What reform’s opponent don’t tell them is that under Obamacare, a 25-year-old waiter who lives in North Los Angeles and earns $17,200 a year will be able to purchase coverage from one of the state’s highest-rated insurers, Kaiser Permanente, for just $33 a month.
How can this be? One word: “Subsidies.”
Next year some 11 million young adults (18-34) who are now either uninsured or buying their own (usually bare-bones) insurance will be able to purchase excellent coverage in the Exchanges. Since some 9 million of the 11 million earn less than $45,960 a year ($62,040 for a couple) they will be eligible for tax credits to help cover the premiums. Fully 96% of the youngest (21-27) will qualify for subsidies, says Linda Blumberg, a health policy analyst at the bipartisan Urban Institute.
Now that states have begun to announce the rates insurers will be charging in their marketplaces, we can move past speculation to discuss what young adults in particular cities actually will be paying, after applying those tax credits.
Fear-mongers should blush.
Why Bronze Plans Will Be Popular
The example of a 25-year-old waiter in North L.A. buying coverage for just $33 a month assumes that he purchases Kaiser Permanente’s “Bronze plan.
As you may remember, the Exchanges will offer four tiers of insurance: Platinum, Gold, Silver and Bronze. Plans in all four tiers will offer free preventive care and comprehensive coverage that includes the 10 “essential benefits.” . The only significant difference is that at one end of the spectrum, Platinum premiums will be higher, while co-pays and deductibles will be lower. At the other end, Bronze plans will cost less, but co-pays and deductibles will be higher.
In the Exchanges, young adults under 30 also will be able to purchase High-Deductible Health Plans (HDHPs). Often these catastrophic plans will be cheaper than Bronze plans. But subsidies cannot be used to buy them. Thus, HDHPs make sense only for relatively affluent young singles earning over $45,960 who won’t qualify for the tax credits.
The good news is that most young adults in that cohort already are covered–either by a parent’s plan or by their employer. (Thanks to Obamacare, beginning in September 2010, all insurance plans that offer dependent coverage have been required to insure 19-25 year olds at the same price.) Since then, nearly 8 million have signed up. This is one reason why, 91% of young adults 19-29 who earn $45,960 or more are now insured.
Less affluent young adults are not as likely to be covered because their parents are less likely to work for employers who offer health benefits. This year, fully 27% of young adults earning between $17,235 to $28,725 remained uninsured, along with 16% of those earning $28,725 to $45,960.
These are the young adults who will be shopping in the Exchanges, and there, they will qualify for the government subsidies that, at long last, will make coverage affordable. Meanwhile, as they join the insurance pool in the exchanges, these generally health young adults will help lower premiums for everyone buying their own insurance .
The subsidies are designed to make a Silver Plan affordable, but young adults don’t have to use the tax credit to purchase a Silver plan. If they choose, they can apply it to cost of a Bronze plan, lowering premiums to a point that virtually every 19-34 year old should be able to manage the cost of health insurance.
How the Government Will Calculate Subsidies
The IRS will begin by looking at your income. As the table below reveals, the lawmakers who wrote the Affordable Care Act decided that a aiter who earns less than $17, 235 (or 150% of the Federal Poverty Level) should not be expected to spend more than 4% of his income ($689) when purchasing health insurance in the Exchanges.
If you earn . . . . . You are expected to spend
100% to 133% of FPL ($15,282) 2% of your income on insurance
Up to 150% of FPL ($17,235) 3%-4% of your income
Up to 200% of FPL ($22,980) 4%-6.3% of your income
Up to 250% of FPL ($28,725) 6.3%-8.05% of your income
Up to -300% of FPL ($34,470) 8.05% to 9.5% of your income
Up to 400% of FPL ($45,960) 9.5% of your income
When calculating the tax credit, the IRS will make up the difference between the amount you are expected to contribute and the cost of the “benchmark” Silver plan where you live. (In every marketplace the “benchmark” is the second least expensive Silver plan. In North L.A. the benchmark is a Blue Shield PPO which carries a price tag of $2376 a year.)
The 25-year old in our example is expected to kick in 4% of his income, or $688 ($17,200 x 0.04 = $688) toward the premium. Subtract $688 from the $2376 premium, and he can count on a subsidy of $1688. If he chooses the Silver plan, he will wind up paying only $57 a month. ($2376 – $1688 divided by 12 = $57)
He can then apply his subsidy to any Platinum, Gold, Silver or Bronze plan sold in the Exchange. The Bronze plans call for higher out-of pocket spending, but since he rarely visits a doctor, he’s not worried about co-pays and deductibles. The premium is most important.
Moreover, in North LA Kaiser Permanente offers a Bronze plan for just $174 a month $2088 annually). After he uses his tax credit, it will cost him $33 a month, or about $400 a year.
Note to HealthBeat Readers :
I have published a longer version of this post on HealthInsurance.org.
- New York City
- Washington D.C
- Rochester, N.Y,
- Hartford, CT
- Sacramento, Cal.
- Portland, Oregon
- Denver, Colorado
In some cases, insurance will cost less than the penalties they will owe if they don’t purchase coverage.
That post also will explain why some young adults might well prefer Silver Plans. Just click here and scroll down to: “Bronze will be popular among 20-somethings, but it won’t best choice for all young adults.”
From <a href=”http://www.healthbeatblog.com/2013/09/will-the-bros-buy-insurance-in-2014-if-your-son-or-boyfriend-is-uninsured-please-send-him-this-post/#more-2306”>Health Beat blog</a>
Maggie this obviously can never work. Because it is a 2000 page bill.
Unless of course if the details of the plan that make it work require some portion of those 2000 pages of double spaced with large print huge margins as printed bill. As opposed to the hundred odd pages of the actual legislation that serves to remake a good part of one sixth of the American economy.
Snark aside thanks for your work here. Because I wore myself out back in 2009 actually reading all the iterations of the legislation and trying to explain to people here at AB and elsewhere **cough, cough, FDL** that this was complicated for a reason and that once you worked your way through it the odds were pretty damn good that it would all work. Maybe not as well as the original versions that emerged from the House Tri-Committees and Senate HELP in July 2009, but given the combination of the 80/85 MLR and exchange subsidies with maximum out of pocket costs well enough.
Except to those people on the left and right that screamed either “sellout to AHIP!!” or “Death Panels!!” and “Premium spikes!!”. None of whom actually seemed to take their own advice to “Read the Bill”.
Yes PPACA like most major legislation had elements of production reminiscent of the worst aspects of your typical sausage factory and maybe it was a damn miracle that an edible product emerged at all. But thanks to no one in particular this hotdog ended up basically in the Ball Park. Not a gourmet treat for lefties and yet not an indigestible plastic sleeve of sawdust for the righties.
But bottom line not a bad meal for the previously uninsured. Including the so-called ‘Young Invincibles’ (who apparently never engage in high risk activities including: driving an automobile, riding a motorcycle, riding a bicycle, surfing, skiiing, going to bars, eating out, travelling to foreign countries etc that might prove them not so ‘invincible’ at all).
ACA is going to work. At least well enough given its goals. Which by the way were not defined as ‘Perfect’ but instead under the twin rubrics ‘Accessible’ and ‘Affordable’. All of which was predictable. Because predicted. By people who took the time to ‘Read the Bill’ in real time.
Bruce:
Thanks . . .
I would love to listen in on some calls between navigators and 25 year olds while this is being explained…….
Does the tax credit show up only when you pay your federal taxes so that the bro would have to pay about $200 a month, and then will get a refund check for $170*12 or whatever in may?
That’s one of the problems with providing benefits to low income people through the tax system. They aren’t well equipped to smooth income across the year.
Jeff:
I am not sure if your subsidy question was answered. In any case, the subsidy will be paid to the insurance company of your choice once you qualify for the subsidy in going to the State Healthcare Insurance Exchanges.
Ah, ok I guess you can fill out more forms and get the tax credit before the end of the year.
So there is a solution, but it is another hassle.
The endless hoop jumping to avoid the appearance of socialism.
Hm, and one catergory of subsidies will be paid directly to the insurers, making it simpler. Which seems like the catergory that would apply in the bro examples above.
Off topic….
While I understand the concern ie complexity, from a suppliers side I fail to understand why there is not more complaint about how the private side operates now through insurance.
As BC/BS and Tufts update billing systems, implement contracts, and put final touches on electronic medical info, the snafus are tremendous.
Contracts with companies and groups vary widely and nary a peep about complexity??? Endless snafus in billing, in plan or not, checks to supplier or customer? etc. Even following one patient can have a different result not only in coverage but even who gets the money first, and then even in different amounts. And the switch to MANDATORY electronic banking will make for a NIGHTMARE as even payment mistakes will be harder to track (not gov. mandated by the way), lest one lose track of what sources mandatory entails. Efficiency? No.
well, bruce, i haven’t read the bill, but
it still seems to me that Rube Goldberg would love it. it seems like the hard way to require that i both buy insurance AND pay taxes to buy insurance for those who cannot afford it. complicated enough to invite abuse… not BY people, but OF people.
it would be much simpler to just raise the Medicare tax enough to cover all reasonable medical costs, and then work hard to reduce those costs.
for one thing it might get people used to the idea that by paying “more than they need” for insurance while they are young, they are paying in advance for the insurance they will need when they are old and either sick or retired, or still poor, and will need the insurance… without having to scramble for co pays or supplemental insurance to make up the difference between what are reasonable needs and what the congress is willing to let the people pay for them.
by the way
“bipartisan” just means “the bankers love this.”
So in the bro example it ought to be pretty simple.
“Do you want the quick version, or for me to rattle on for a long time about your options?
OK.
How much do you make?
The cheapest option for you is a bronze plan. About $33 a month.
For a bit more you… oh. Ok. Yea if you are healthy it is a reasonable option. A simple injury like a broken arm would pay for years of $33 a month insurance, but if you don’t end up using it it won’t cost you much.”
I bought individual catastrophic coverage a few times in my 20’s and it was that complicated. No subsidies to ponder, but one had to pay a lot of attention to the coverage because it varied quite widely (I just wanted a high-deductible then full coverage up to a large amount so I was looking for the simplest possible thing). It was clearly a lot more complicated if the coverage was to be more complete.
Now If I Were King the concept of signing up for insurance would be eliminated and all the bro would do is get entered into the system whenever he first used healthcare… and in unusual circumstances even that could be skipped.
Actually Jeff under ACA the Bro still has the option of buying that nice simple catastophic coverage plan. Largely because of Obama’s rather foolish pledge that “If you like the coverage you have, you can keep it”. Which includes totally inadequate plans for anything short of a diagnosis of Stage 4 cancer. After all as you point out a broken arm could put you out many hundreds of dollars before you ever triggered any payout from the catastrophic plan.
The problem for opponents of ACA is that as premium projections start hardening into actual proposals it is increasingly turning out that the cost of that simple catastrophic plan with high deductibles and co-pays is turning out to be no cheaper than a bronze plan after subsidies.
That is the pool of Bros who are actually being put upon in some way is shrinking to that slice of single guys making $45,000 or so who for some reason are not covered by employer insurance. Which begins to overlap with that group of Bros that thinks little of buying $100 concert tickets or game tickets and maybe buying all the same high end Vodka that the ‘Players’ in TV ads are buying.
I don’t know how many people are going to be sympathetic to the argument “Man the individual mandate in Obamacare is going to crowd out one round of Apple Martinis on my next pub crawl! Freedom now! Freedom forever!”
And finally the problem with the “whenever he first used healthcare” method of signing people up for insurance is that is might well be on the occassion where the Bro managed to break three cervical vertibrae by wrapping his ‘crotch rocket’ around a tree by driving off a curve at 120 miles/hr (“Just like on TVEEEEE! ARGGGGGH!!!!!. )Otherwise the Bro would likely to try to keep every bit of needed medical assistance for minor things under the table/cash only.
Bruce
i find your argument a little bit inconsistent (not a major sin, but perhaps worth pointing out):
you seem to think that “being out a couple of hundred dollars for that broken arm is a “problem.” But you have no patience with those who prefer to spend their couple of hundred on designer vodka than on the Obama differential.
i have lots of problems with Obama care, all of the inconsistent by the way, but among the objections
i don’t think “poor people” are going to be able to “read the whole law” or understand their options.
i don’t like paying the criminal syndicate that brought us here or go to jail, which is what the “mandate” implies.
the law may make insurance “more affordable” for some, but does not reduce the cost of health care overall. and i have serious doubts about how long the “for some” will last.
i am well aware that “government paid” health care is “mandatory” and “expensive” and subject ultimately to the same abuse as mandated private health care, but i think the subtle differences are both more promising for the future, and better for us from a mental hygiene perspective.
Bruce–
Thanks very much.
I , too, have read the bill–and have gone back to it many times to re-read sections. What I find is that “the good is in the details–thousands of details
For instance see my reply to Jeff Fisher about subsidies to help cover premiums below. The architects of the bill thought about the many
problems that ordinary people face .
Below, some more “good” details:
What most people don’t know is that in addition to subsidies that will help cover premiums, there are also two types of cost-sharing subsidies to lower co-pays and deductibles for low-income and middle class families. I’ve written about them here. http://www.healthinsurance.org/faqs/were-a-family-of-four-with-an-income-of-47000-a-year-what-kinds-of-subsidies-are-available-to-help-us-purchase-insurance-through-the-ex Yes, it’s a bit complicated. But would you rather have these families go without healthcare because they can’t afford the co-pays?
Some liberals would ask: “why do there have to be co-pays and deductibles in the first place? Why can’t all health care be free for everyone, the way it is in single-payer systems? It’s not free in those systems–everyone pays much higher taxes to fund it.
(Sometimes I think that liberals who support single-payer simply suffer from math block. In college, they took English courses, philosophy courses, history courses (as I did). They didn’t study math and few took economics courses (other than Marx) As I did.
But later, I learned about economics because I realized that if you want to understand politics and history, you have” to follow the money.”
You can’t ignore it– ultimately economics determines politics,
In this case, if you want to understand the economics of health care and health care reform in the U.S. you need to recognize that we have many more low-income families and many more very rich and upper-middle class families than in other developed countries (which are primarily middle class).
Secondly, our tax system is not as progressive as it should be. So we need to find other ways to help the low-income and lower-middle class families .Having upper-class and upper -middle class pay co-pays and deductibles (while capping out of pocket spending for low-incomer and middle-class families at much lower levels) is one way to do that. Another way would be to raise income taxes for the upper-middle-class–individuals earning over roughly $125,000) and put VAT taxes on expensive consumer items.
Liberals earning over $125,000 would not be happy. Most think they are “middle-class”. Show them median income and they say “But I’m not rich!” Return to what I said about liberal math block above. The fact is that median income defines middle-class–and includes those earning, say 10% less and 15% more (up to perhaps $70,000 for an individual). This is what many on the left don’t understand. Some believe there is an easy, simple solution called “single payer”. Have they ever looked into the details of Canada’s or the UK’s single-payer plans? No.
All universal health care systems are complicated because they have to meet the many, many needs of a diverse population. In the U.S. our population is larger and far more diverse than in any other nation. In addition our society is fragmented by gender, class race and religions. Begin with young vs. old. The young don’t want to pay for the healthcare for the old . So in the Exchanges insurers are allowed to charge older American 3 times as much as they would charge a 25-year old for the same policy.
This is one detail that, in my view, is Not Good. But the legislation would never have passed Congress if the young and the old were going to pay the same rates. Too many young, supposedly liberal Democrats would have been furious with their Congressmen. And Democrats need the youth vote.
There are many other ways that our society is fragmented as many men don’t want to pay for “women’s problems.” Nevertheless the legislation includes good maternity benefits, preventive care for women, and breast pumps for working women who want to nurse (one of the best ways to fight childhood obesity. Contraception was labeled “preventive” care (because it prevents unwanted pregnancies and so it is free. (All good details)
All of this involved intense negotiation. To get the things women want, legislators included things that young men want like deductible plans for 20-somethings. (Note they are available Only to those under 30. Another good detail. I understand your reservations about HD plans, but I see these plans as training wheels for Bros who need to get used to the idea of paying for insurance.
Then there are special provisions for families–particularly dental and eye care for kids.
For seniors, Medicare Advantage plans are being put under pressure–if they don’t offer quality care (with good outcomes) their funding is cut . Many are responding to the pressure,improving their coverage.
For upper-middle class families: their kids can stay on their parents employer sponsored insurance until they are 26. As it turns out, the people who have benefited from this provision over the past 3 years are majority white, majority upper-middle class–and the majority identify themselves as “Republicans.” (Commonwealth Fund just did a report on this.)
Middle-income, low-income, black and Latinos parents are less likely to have health benefits at work.
Beginning in 2014, young minorities and lower-middle class 20-somethings and 30-somethings will be getting subsidies in the Exchanges to make insurance affordable for them. (Relatively few affluent young adults will be in the Exchanges–they’re already covered by parents’ plan, employer’s plan or spouse’s plan.)
Then there are the many rules regulating insurers. The 80/20 rules; the rule that they can’t charge women or people with pre-existing conditions more, the rule that they must cap out of pocket spending for everyone.
Insurers are not happy with these rules. This is why many of the big brand names are refusing to participate in the Exchanges in many states. That’s fine. More non-profits like Kaiser Permanente are taking their place. When it comes to quality of care and customer satisfaction, they get significantly higher scores.
Going forward I predict that your insurance will become mainly non-profits competing with a government option (a version of Medicare for all–but much less wasteful than today’s Medicare.) More details that make the legislation “complicated” explain how it pays for itself– with contributions from drug-makers, device-makers and insurers who will get more customers as well as contributions from individuals earning over $200,000 and families earning over $250,000. No middle-class or upper-middle-class taxpayers will pay a penny in extra taxes to fund this bill. If we had single-payer this would not be true. In Europe, families typically pay 10% of their income to fund universal care–mainly through taxes.
I could go on–but I imagine that the folks who believe in simple solutions to complex problems stopped reading 4 or 5 paragraphs ago. To the rest of you–thank you for listening.
Jeff–
The legislators who wrote the bill thought of that.
The IRS will send a check to your insurer every month beginning Jan. 1 2014. You send a much smaller check to make up the difference between the subsidy and the sticker price on the insurance.
The IRS calculates your subsidy based on your income in 2012. (They won’t yet have your 2013 income taxes.) If during the course of 2014, your income goes up (new job) or down (lose job or have less freelance work than expected) you simply call your state Exchange, let them know, and they adjust your monthly subsidy.
When you file your 2014 taxes in the Spring of 2015, you and the IRS settle up: If your subsidy is higher than it should have been (because your 2014 income turned out to be significantly more than your 2012 income), you owe the IRS money. If it was lower than it should have been, they owe you money–you get a bigger refund. If you don’t like the idea of having to pay money back to the IRS in 201t5, you can tell them, from the outset, they you want them to send only 2/3 or 1/2 of the subsidy they think you deserve, beginning in Jan. 14. That way it is much more likely that the IRS will owe you money in 2015.
Complicated? Yes.
Fair? Yes.
Actually, Bruce, I read the original post which says that catastrophic plans are still available. It goes on to say that for people who qualify for subsidies it is stupid to buy one, as the subsidies don’t apply so catastrophic plans end up costing more out of pocket for less coverage. For people who don’t qualify for subsidies it may be stupid, or not, depending on circumstance.
By the way a broken limb can easily end up costing quite a few thousand dollars in the US even without requiring surgery. A single ambulance ride with a bit of diagnostics costs that. The catastrophic plans I bought years ago were available with deductibles from $500 to $5000. I think I bought $3000 because I could pay that comfortably from my unusually high savings, but didn’t want to have a bite bigger than that taken.
Catastrophic plans aren’t inherently dumb. At the time I had a lot of savings for my age and could afford a few years of that deductible, but I could easily be wiped out by being injured in a car accident or something. I have no objection to such plans not being subsidized, or really even to their being removed entirely because I think the circumstances under which they are smart are rare enough “first world problems” to neglect.
The lack of a problem with the “whenever he first used healthcare” method is that because it is obviously part of a universal government paid healthcare scheme there is no concept of people being covered and not covered. Everyone is covered all the time. Some of them just haven’t filled out the forms so the system can keep track of them yet. The problem that signing people up solves simply doesn’t exist. See that person over there? Covered. You can tell because they are a person.
BTW the point of that post was that signing up for health insurance has always been a pain. Even in the very best case (young healthy person buying a dead simple policy) it wasn’t trivial. So the ‘bro’ doesn’t seem to be in for any new difficulty under obamacare.
Coberly–
I realize you haven’t read the bill. Few people have the time or the patience to read the whole thing. But here’s the news: The legilslation does lower the overall cost of care.
It has already lowered costs.. The growth in Medicare spending has slowed dramatically, in part because hospitals realize that under the ACA they will face financial penalties if they don’t begin to reduce waste by doing a better job of coordinaring care, avoiding redundant tests and useless treatments that expose patients to risk without benefit, and reducing preventable medical errors (from bed sores to wrong side surgery that cost us a fortune.)
The growth in the cost of employer-sponsored also has slowed. Google “Kaiser FAmily Foundation” and employers and insurance.
You don’t have to read the whole bill. Just Google Peter Orszag (former head of CBO) and ” health care reform” and” lower costs” (or some variation ) . Orszag is just one of many people who is very good at explaining this.
Also the legislation moves us away from paying “fee for service’ and toward pay more to doctors and hospitals who achieve better outcomes for less. In this country overtreatment is a Huge problem–when hospitals and docs are paid piece-meal, per service, they are understandably inclined to overtreat, Without even thinking about it, they order 8 more tests. Or recommend surgery rather than trying physical therapy first. Every medical procedure–even a test– carries some risk (Infection, false positives that lead to unnecessary further treatments).
We are not well-served by over-treatment.
Jeff,
In the U.S. not everyone is “covered.”
If you have no insurance and show up at an ER with a broken leg, they are required to “stabiilize” you. They are not required to operate on you and they won’t–unless you have insurance or qualify for Medicaid. Surgeons don’t take IOUS. Stabilizing you means getting you into shape so that you can walk out the door–with crutches. And no rehab to help you get off the crutches. You don’t get the leg operation you need. You will probably always walk with a limp and may have a serious problem with your knee. This happened to a young friend I knew about 10 years ago.
In many cases, people die because they don’t have insurance. Cancer patients who are in great pain and go to the ER will get pain medication (assuming the nurse doesn’t think they are junkies). But they won’t get chemo or an operation. They go home. Eventually, they probably land back in the hospital ICU while they are dying.
If you know many low-income people you know that they don’t go for routine care because they can’t afford the $150. And so they get sicker. By going without coverage, a person is taking a tremendous risk.
You had enough money to cover a $4,000 deductible–but a great many people don’t. Unfortunately, high-deductible plans are often sold to the poor–because that’s the only plan with premiums they can afford.
But then they can’t afford to use it.
Maggie:
Thanks for explaining stabilized as opposed to fixing the problem. Many people believe hospital actually have to care for you. It is still a “Scrooge” world and they have to get back to work regardless of health.
Thanks Maggie M. for this grand tour of the new healthcare bill. Granted it will need tweaking and fine tuning along the way, but it is about time we got off the sidelines and got moving on something that will usher in the changes. Hope everyone stays engaged.
Maggie, I’m getting a bit frustrated by people failing to read what I write before climbing onto their high horses to demonstrate that they have not read what I have written.
Please use the search function of your web browser to find the phrase “If I Were King” and read the surrounding text and the following four or so comments and you will find that you are arguing with a figment of your imagination and I already made nearly every point in your comment myself.
Maggie Mahar
thanks for the note. i am not sure you understand my objection, but i hope your optimism is not disappointed.
i have my own reservations about the thinking skills and actual “generosity” of some liberals, but I don’t think you help your case much by being snotty about them. It is not what people usually think of as “math” that defeats them. It is an inability to think carefully. Perhaps because they don’t have time, are lied to constantly, and have learned that no one cares what they think anyway.
my math skills are … ah, above average… and Peter Orszag is not one of my favorite people, since he wrote a whole book about Social Security “reform” without understanding the first thing about Social Security… that it is insurance and not an investment club.
His concept of the “legacy debt” simply has nothing to do with Social Security, and it has been a source of pained amusement for me to watch some people who think very well of themselves utterly fail to explain legacy debt and conclude that the fault must be in the intelligence of the person they are trying to explain it to.
It is a trivial exercise to juggle various pay-in and pay-out schemes to achieve “a balanced solution,” if all you care about is the numbers and not what they actually mean to the people who will be doing the paying in and abiding the paying out.
My own “bet” is that Obama care was the last chance of the insurance – provider complex to avoid “single payer,” and we will continue to have the insurance company abuses we have grown to expect… at a price that will continue to be much higher than it would be under a rational system.
maggie
by the way… thanks for the article. i may not like obamacare but i am glad someone is giving it a fair hearing.
perhaps it will turn out to be the needed foot in the door. we’ll see when the sleeping dogs wake up which way they’ll bite.
Coberly–
I truly am very hopeful that Obamacare will reform and transform our health care system. It will not make it perfect; but over 10 years, I think
we will see a vast improvement..
First, we will see much less over treatment. Doctors and hospitals will no longer be rewarded for “doing more”. Most Americans–and many physicians–believe that “more care is better care.” This just isn’t true: about half of angioplasties done are no good. They do not reduce fatal heart attacks and strokes. They simply relieve angina temporarily. Meanwhile, the surgery exposes patients to needless risks.
Many spine surgeries, treatments for asymptomatic prostate cancer are unnecessary. Aggressive treatments for late-stage cancer are futile — and reduce the patient’s quality of life during the precious final months of life.
As a population we are over-medicated–this is particularly true of older Americans. All of this can and will change as we change how we pay for healthcare- rewarding evidence-based medicine that produces better outcomes for less cost.
As for insurers, already the large for-profit insurers like Aetna and United HealthCare are beginning to drop out of the game. They are not selling policies in most state Exchanges because they know the new regulations will make it impossible for them to make the profits Wall Street expects.
Non-profit insurers- who rate higher when it comes to customer satisfaction and quality of care — will be dominating the Exchanges (I’ve written about this here).
Today for-profit insurers provide insurance for large companies (or serve as their back office when large companies self-insure.) In a few years, large companies will be able to join the Exchanges where small companies will begin purchasing insurance in 2014. At that point, the for-profit health insurance industry will wither away.
As for Peter Orszag , I don’t agree with him about Social Security. You are right, it is not meant to be an investment club.
Thanks Maggie
we’ll hope you are right.