VA hospitals are a disaster. Let me say this again. VA hospitals are a disaster because they are managed by the US Federal government. Medicare is a disaster. Medicare is on a trajectory to suck up MOST of the federal budget within a few years. Medicare is a disaster because it is managed by the US Federal government. All this talk of a 'single payer' (the US Federal government again) health care system is just sheer insanity. All of the above are symptoms of the cancerous 'creeping socialism' that is crippling America from the inside out. Obamacare needs to be REPEALED and the IRS needs to get OUT of America's health care systems. Socialism is simply a stepping stone on the slippery slope to Marxism – and Marxism has been an abject failure all around the world. Thomas Jefferson is rolling over in his grave when he hears this absurd talk of 'single payer' health care !
3
I haven't read Aetna's financial statements, but my guess is that, overall, they made a handsome profit despite the PPACA policies.
As I have come to understand the medical insurance business they have adopted the idea that each-and-every policy has to be profitable even if there are policies that don't. That is the point of mutual indemnity that one policy holder covers the losses of another because later on somebody else will be covering your losses.
Unfortunately, the people who run insurance companies don't like policies that lose money they only want customers who pay for a policy and don't make any claims, or at least not enough to make the policy unprofitable.
The reality is that people without insurance get their bills paid by We-the-People so it is in our common interest to make sure that everyone has an insurance backup.
As I have come to understand the medical insurance business they have adopted the idea that each-and-every policy has to be profitable even if there are policies that don't. That is the point of mutual indemnity that one policy holder covers the losses of another because later on somebody else will be covering your losses.
Unfortunately, the people who run insurance companies don't like policies that lose money they only want customers who pay for a policy and don't make any claims, or at least not enough to make the policy unprofitable.
The reality is that people without insurance get their bills paid by We-the-People so it is in our common interest to make sure that everyone has an insurance backup.
3
"The testimonials could counter negative publicity generated by rising premiums, the withdrawal of major insurers like Aetna, Humana and UnitedHealth from many counties, and the collapse of insurance cooperatives in at least a dozen states." You're kidding, right? You seem to either have a whole lot of faith in testimonials or a complete lack of appreciation for the actual impact (not just in "negative publicity") of the higher prices, lower quality and reduced choices detailed in the second half of the sentence. A better headline would have included the phrase "Lipstick on this Pig".
2
The Affordable Care Act was never designed to succeed. It was designed to fail, to be followed by cries [from readers of the NYT] for a single payer system.
So far, it's going exactly according to plan.
So far, it's going exactly according to plan.
4
This article illustrates the idiocy of the ACA very well. The comments reveal the blindness of the American people in calling for a single-payer as the solution.
Medicare DOES NOT work. It is very expensive because it pays for tons of unnecessary medical care. A single-payer for all will do the same and cause the US to spend even more money, unless we are serious about reforms.
Being serious about reforms means: Controlling immigration so people who have never paid into the system do not wind up here, such as the ones I see weekly who come straight from the airport with obvious maladies to get free American care- problems that should have prevented them from boarding a plane. We need to stop the underground cash economy in which many people do not contribute "any share" let alone the liberals notion of a "fair share." Jail people who evade taxes or hire illegal workers.
But most importantly, we need to say "NO" to everyone. As in "No MRI for knee or shoulder pain when it is too old to matter, no to life-prolonging care for advanced alzheimers patients, no to treating terminal cancers beyond what is palliative, no to the most expensive drugs... And we must mandate that risk takers pay more.... $50 packs of cancer sticks (cigarettes), $10,000 health tax on motorcycles, and deny care to those who refuse to take medical advice and render their care more expensive.
That will save money and provide necessary care for all.
Will you go for it?
Did not think so.
Medicare DOES NOT work. It is very expensive because it pays for tons of unnecessary medical care. A single-payer for all will do the same and cause the US to spend even more money, unless we are serious about reforms.
Being serious about reforms means: Controlling immigration so people who have never paid into the system do not wind up here, such as the ones I see weekly who come straight from the airport with obvious maladies to get free American care- problems that should have prevented them from boarding a plane. We need to stop the underground cash economy in which many people do not contribute "any share" let alone the liberals notion of a "fair share." Jail people who evade taxes or hire illegal workers.
But most importantly, we need to say "NO" to everyone. As in "No MRI for knee or shoulder pain when it is too old to matter, no to life-prolonging care for advanced alzheimers patients, no to treating terminal cancers beyond what is palliative, no to the most expensive drugs... And we must mandate that risk takers pay more.... $50 packs of cancer sticks (cigarettes), $10,000 health tax on motorcycles, and deny care to those who refuse to take medical advice and render their care more expensive.
That will save money and provide necessary care for all.
Will you go for it?
Did not think so.
6
Another failed government attempt to run things.
That said, what alternative is there to 40 million Americans without health insurance?
Why not expand the USPHS and establish low-cost, bare-bones facilities for poor people?
That said, what alternative is there to 40 million Americans without health insurance?
Why not expand the USPHS and establish low-cost, bare-bones facilities for poor people?
2
New Mexico - Two major carriers, one health provider opted out of exchange.
My insurance co. cancelled within 4 months, not profitable enough despite only claims for normal check up and meds. Guess we need tele-med and do it yourself care.
Maybe a realty show, " America's Most Sick", vote on who gets health care... or your torch gets extinguished.
My insurance co. cancelled within 4 months, not profitable enough despite only claims for normal check up and meds. Guess we need tele-med and do it yourself care.
Maybe a realty show, " America's Most Sick", vote on who gets health care... or your torch gets extinguished.
5
There is no need to keep overhauling the system. Just hold your nose and give the insurers a subsidy to cover the sick people they used to be able to reject. We are making everything more difficult by trying to invent a model that pleases all parties.
Let's face it the ACA is a failure, unless you count the number of people with insurance as a success. Healthy people who don't make much are not going to pay anything for insurance and they can avoid the penalty by not getting money back. Time to go back and actually address improvement in health care, not insurance or single payer. Then assistance for those who actually need it as we have done in the past through a combination of private and government resources. We also need to eliminate the requirement for ER's to treat non emergency issues.
1
This is what happens when the free-market tries to solve problems that can only be solved by government. Single payer now, single payer tomorrow, single payer forever.
5
Sure, just like the $17 trillion put on the nation's credit card to end poverty really did end poverty. The government has not solved even one problem, extending Big Government's unbroken string of failure to healthcare would be a costly, deadly, disaster
2
Single payer will make costs higher and higher as the perception of "free" care expands. This all backfires one way or another.
1
"The total absence of governmental control had led to a portentous growth of corporations. In no other country was such power held by the men who had gained these fortunes. The Government [was] practically impotent. Of all forms of tyranny the least attractive and the most vulgar is the tyranny of mere wealth."
--Teddy Roosevelt, An Autobiography, Chapter XII 1913
Capitalism hasn't worked in healthcare.
9
These mega insures got sucked into a model that said, young uninsured people, would either sign up or the IRS would come after them. Next provision was, all these healthy young un-insured people, would make no claims, and their premiums would pay for the sick ones, not taking a big percentage of funds from those who never make a claim just pay. Got to rune understand shares in a bridge are going up for sale.
1
Bernie Sander's home state of Vermont already tried single-payer but it was so expensive they had to abandon it. Face facts: Big Government doesn't work
4
By your logic, we should not have declared war on Japan because this massively increased the size of the military which is part of the government.
3
Tell that to the Canadians. Tell it to the rest of the world. Now hope you don't have to go to the ear doctor after their loud laughter,... unless you have expensive insurance.
6
Let Medicare participate and offer plans on to Federal Exchanges.
1
This highlights the fact that insurers do not belong in a health care system. The only real way they can make a profit is by paying less to their insureds.
There is no risk here - everyone will get sick and die- so they must deny coverage where they can. The problem of "paying too much for sick people" is something that , upon close examination, should be absurd in talking about giving people health care - single payor system anyone??
There is no risk here - everyone will get sick and die- so they must deny coverage where they can. The problem of "paying too much for sick people" is something that , upon close examination, should be absurd in talking about giving people health care - single payor system anyone??
1
So if insurers don't belong in healthcare, I guess the areas no longer served by Aetna or the other insurers who are pulling out of ObamaCare will be better off, right??
Let us get real here. The CEOS of any of these so-called health providers, in 2015 earned anywhere from 27 million at the low end up to 48 million for the CEO of Humana. Yep, they are in real dire straights arent they? The fact remains, when Obama and the Senate committee folded up like a cheap suit and in order to pacify the insurance industry did not implement the public option, yet, Aetna is now taking their toys and going home because they did not get their way and allow the merger with Humana. It has nothing to do with profits OR the ACA.
2
Their salaries are nothing compared to the huge sums Obama spends on travel, vacations, and other perks we pay for
I'm very anxious to hear the Republicans offer a reasonable alternative to the Affordable Health Care Act. But, we've asked them many times, over the years, and they still haven't offered ANY alternative. All any of them ever say is that they will "repeal ACA," because it's been a so-called disaster. I'm waiting...(foot tapping.) Well, I'm beginning to believe that Republicans just can't think of an alternative. This is not about insurance for Americans, it's about doing everything possible to discredit our first African-American president. That's pretty much ALL it is.
3
The GOP proposed many improvements to ObamaCare while the law was being drafted, but Obama would have none of it. "I won", he declared, and he believed (and still does believe) the hype about him being the smartest human in history.
2
Prior to the ACA, people without employer provided insurance, Medicare, or Medicaid often could not get health insurance. The Republicans put nothing on the table. The ACA was passed by the Democrats to fill the vacuum.
But the ACA is badly flawed. The insurance is too expensive, and is in many cases unavailable. The taxes and cost transfers imposed by the law to fund the many subsidies are putting an unreasonable burden on many working folks in the middle class. There are multiple new taxes, the cost of Medicare is much higher for many, and the price of policies for non-subsidized individuals is too high.
The law should be revised to contain costs without overly disrupting consumer choice, interfering with competition and the free market, or, worst of all, increasing government control of the practice of medicine.
Several mechanisms for doing so include repealing the politically motivated mandates embedded in the law; reducing fraud such as the abuse of the special enrollment periods; reforming excessive FDA regulation, which keeps many drug prices high by enabling monopolies on many off-patient, proven medications; and requiring that the costs of medical care be disclosed to patients before they undergo treatment, to enable comparison shopping.
Companies are not leaving the insurance markets because they are evil. They are exiting because today’s ACA is unworkable. It needs to be fixed. Soon.
But the ACA is badly flawed. The insurance is too expensive, and is in many cases unavailable. The taxes and cost transfers imposed by the law to fund the many subsidies are putting an unreasonable burden on many working folks in the middle class. There are multiple new taxes, the cost of Medicare is much higher for many, and the price of policies for non-subsidized individuals is too high.
The law should be revised to contain costs without overly disrupting consumer choice, interfering with competition and the free market, or, worst of all, increasing government control of the practice of medicine.
Several mechanisms for doing so include repealing the politically motivated mandates embedded in the law; reducing fraud such as the abuse of the special enrollment periods; reforming excessive FDA regulation, which keeps many drug prices high by enabling monopolies on many off-patient, proven medications; and requiring that the costs of medical care be disclosed to patients before they undergo treatment, to enable comparison shopping.
Companies are not leaving the insurance markets because they are evil. They are exiting because today’s ACA is unworkable. It needs to be fixed. Soon.
1
The insurance companies and the Obama administration made Faustian bargains to pass Obamacare, and now they both find themselves in the middle of the river with scorpions on their heads. It didn't take much non-partisan common sense to predict that adverse selection would make the exchanges unsustainable once federal subsidies ran out.
C. S. Lewis pretty much nailed progressives like the President: “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
C. S. Lewis pretty much nailed progressives like the President: “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
4
It's so clear to me, when I read many of the comments, that most Americans don't understand just how dysfunctional the individual health insurance market is today post-ACA and was pre-ACA. I speak from experience having had really good employer provided coverage for many years, and now at 62 having to buy poor quality coverage on the individual market. (I do off exchange.)
The ACA may have been born out of good intentions, but both Bernie Sanders' call for single payer (I voted for him) and John Kerry's suggestion that Americans without employer provided coverage be permitted to buy into the Federal workers insurance program were far better solutions than the ACA. And, it's only going to get worse.
This year, at my annual physical. my internist announced I might be better off without health insurance when I shared my $604 per month premium and $6,450 deductible. I have no health issues and take no medication. Have what used to be called low blood pressure and is now considered ideal.
For people like me - older and healthy - the instinct to drop coverage as the cost rises grows. Last year, for the first time as an adult, I went without insurance for 1 month; this year I'm thinking of dropping coverage for 3 or more. The cost is just too high; the return too low.
Healthcare advocates champion Medicaid managed care companies Centene and Molina. But there is no way I am going to pay cadillac premiums for Medicaid. And, I suspect many others feel the same.
The ACA may have been born out of good intentions, but both Bernie Sanders' call for single payer (I voted for him) and John Kerry's suggestion that Americans without employer provided coverage be permitted to buy into the Federal workers insurance program were far better solutions than the ACA. And, it's only going to get worse.
This year, at my annual physical. my internist announced I might be better off without health insurance when I shared my $604 per month premium and $6,450 deductible. I have no health issues and take no medication. Have what used to be called low blood pressure and is now considered ideal.
For people like me - older and healthy - the instinct to drop coverage as the cost rises grows. Last year, for the first time as an adult, I went without insurance for 1 month; this year I'm thinking of dropping coverage for 3 or more. The cost is just too high; the return too low.
Healthcare advocates champion Medicaid managed care companies Centene and Molina. But there is no way I am going to pay cadillac premiums for Medicaid. And, I suspect many others feel the same.
1
"...the chairman and chief executive of Aetna, said that in the event of a lawsuit [to block Aetna's merger with Humana], 'we will immediately take action to reduce our 2017 exchange footprint.'"
So the insurance industry extorts not only American consumers but also the US government? Exterminate the brutes: A single-payer, Medicare-for-all type system would put Aetna et al. in their proper place.
So the insurance industry extorts not only American consumers but also the US government? Exterminate the brutes: A single-payer, Medicare-for-all type system would put Aetna et al. in their proper place.
1
As long as greed dictates profits "We the people have the pain". We don't need private insurances to run healthcare plans. Let them offer additional services not covered by basic healthcare. Add all working citizens to a medicare like system with an income dependend premium and the pool of the insured is suddenly large and diverse enough to sustain healthcare.
1
For the self employed here in NYC Obamacare has worked out very badly. Prices are very high and the insurance is not very useful becasue lots of physicians and hospitals won't accept it. Come January there will be only one real choice for the self employed, Blue Cross/Anthem -- along with a bunch of fly by night carriers that will soon be bankrupt. The only plan Blue Cross plan offer is a third rate HMO plan that many reputable hospitals and US educated physicians refuse to accept. Our Senators, Schumer and Gillibrand, were big cheerleaders for Obamacare. But they are now strangely silent as a disaster unfolds. This isn't a liberal/conservative issue but some very badly conceived legislation that has harmed a lot of New Yorkers. But who is going to do something?
2
Obama's people always knew the system wouldn't work but pushed it through the gang of Dems.
Now they can hide behind the failure of the market and switch to a government paid system that the left always wanted. Never waste a good failure.
Now they can hide behind the failure of the market and switch to a government paid system that the left always wanted. Never waste a good failure.
2
How about the insurers focusing on putting pressure on the hospitals to drive down costs rather than asking for more money?
When an orthopedic screw is dropped on the floor it is just thrown away with abandon, because that $8,000 cost (you read that right) is added to the client's bill for the insurer to pay. If a consultant pops into an operating room for 60 secs and offers a brief opinion to the surgeon then he has "consulted" and will get a $1000 fee for his time.
Costs are out of control. The govt here spends more money per capita on healthcare than the UK, and the UK is covered and 100% govt funded - that is insane. Meanwhile for the small minority that do pay for private care in the UK premiums cost a fraction of what they do in the US.
Just throwing more money at this will only ensure this level of cost continues. Allowing any further consolidation will expedite the current problems.
When an orthopedic screw is dropped on the floor it is just thrown away with abandon, because that $8,000 cost (you read that right) is added to the client's bill for the insurer to pay. If a consultant pops into an operating room for 60 secs and offers a brief opinion to the surgeon then he has "consulted" and will get a $1000 fee for his time.
Costs are out of control. The govt here spends more money per capita on healthcare than the UK, and the UK is covered and 100% govt funded - that is insane. Meanwhile for the small minority that do pay for private care in the UK premiums cost a fraction of what they do in the US.
Just throwing more money at this will only ensure this level of cost continues. Allowing any further consolidation will expedite the current problems.
11
While I suspect your examples are not correct, the idea of improving health care was rejected and is not a part of single payer either.
Yet another vindication for Bernie; government-sponsored universal insurance should have been a no-brainier from the get-go, especially since we already have a couple of role models in place (Medicare/Medicaid).
1
So the failure of Big Government ObamaCare is vindication of Even Bigger Government single-payer??? So if i get drunk after drinking a dozen beers, that's vindication for drinking 24 beers to avoid a hangover????
The wasteful inefficiency of Big Government disqualifies it from healthcare. Obamacare has proven that Big Government doesn't work. Even Sander's home state of Vermont tried single-payer, but abandoned it because it was too expensive
The wasteful inefficiency of Big Government disqualifies it from healthcare. Obamacare has proven that Big Government doesn't work. Even Sander's home state of Vermont tried single-payer, but abandoned it because it was too expensive
The Affordable Care Act is only affordable if one gets a government subsidy. For everyone else forced into the Affordable Care Act system, it isn't. This is unsustainable and it's obvious this needs to be fixed, and taking out the middle-man - the insurance companies - is part of the solution.
3
"... a fundamental dynamic in the marketplace in which too few healthy people are buying policies and too many sick people are filing costly claims."
Sigh.... if only someone could have foreseen this.
Sigh.... if only someone could have foreseen this.
3
Time to cut our losses and pull the thing out by the roots so it can't grow back. No tweak or public option. I had stable rates for many years until the ACA was signed into law. In a few years thereafter my rates doubled and coverage declined. Blue Cross sent me a letter saying they were being taxed for the ACA and were passing along those taxes on my legacy (pre ACA) plan. The bottom line is I'm on a strictly carb restricted diet, doing HIIT training on an elliptical every other day, taking melatonin by night and resveratrol by day so I can support the insurance of every AIDS infected crack whore in town. That's why my rates doubled.
3
Perhaps we can no longer support these giant insurance companies with their CEOs making an average of $25 million a year plus perks per insurance company per state with our health care dollars
2
Envy is not a substitute for workable ideas.
1
For seven years, the Obama Administration has tried to put lipstick on this pig and guess what, it still looks and smells like a pig. So when all else fails, bring in the marketing people.
As a Financial Professional in the Health Care Industry for 20 years, I learned a long time ago that Government Programs are more than happy to cap providers' (5% for Obama Care) and let you lose all the money you want. This is Obama Care's real struggle.
When it was first proposed, economists and actuaries all said that Obama Care would crash due to basic economic and risk management concepts. Over-Utilization, ill-conceived risk pools and adverse selection were all predicted, but the Democratic lawmakers would hear none of it. It is no surprise that not a penny of private capital has come into this debacle.
Actually, Obama was pretty shrewd about the whole thing. It was designed to collapse in 2017, his first year out of office. So the train wreck is right on time.
As a Financial Professional in the Health Care Industry for 20 years, I learned a long time ago that Government Programs are more than happy to cap providers' (5% for Obama Care) and let you lose all the money you want. This is Obama Care's real struggle.
When it was first proposed, economists and actuaries all said that Obama Care would crash due to basic economic and risk management concepts. Over-Utilization, ill-conceived risk pools and adverse selection were all predicted, but the Democratic lawmakers would hear none of it. It is no surprise that not a penny of private capital has come into this debacle.
Actually, Obama was pretty shrewd about the whole thing. It was designed to collapse in 2017, his first year out of office. So the train wreck is right on time.
4
It's easy to say "repeal and replace" or "amend it". But I haven't heard either presidential candidate say, how or with what. And if anyone thinks that Aetna and any other insurer backing out of the exchanges are stating the real reasons, there are a few bridges for sale, cheap. They just want to get back to the old free market and make more money. Solution? Either a true medicare for all or, the tax "penalty" has to be so great, that the real choice of the person needing insurance, would be to buy it, thereby bringing in the healthier individuals.
1
I'd be very happy to have my old health care plan back, you know the one I CHOSE and PAID for, the one the dems TOOK from me, the one that was less expensive and included a bigger network
4
I have Aetna thru my employer. I look at the bills and what some of these doctors charge. Naturally the doctors are jacking up their fees because they know companies like Aetna will not pay for what the doctors bill. My last primary physician "fired" a lot of his long term patients. He said if I want to keep him as my doctor I would be require to give him $7,500 up front before he will see me as his patient. He said that money could later be used for "my deductible." My response to him was "You're fired." A lot of the doctors in this country are just plain greedy and no one will convince me otherwise. If only I could make my cat's veterinarian my primary physician.
5
Obamacare is an abject failure and needs to be repealed and replaced just as Republicans have been saying all along.
2
jacobi--Of course, that IS what they've been saying all along. Unfortunately, none of us has heard ANY plans being offered by the Republicans, in all this time! They don't even have any suggestions for improvements that could be made. They like to destroy, not build. They are the party of NO, the party of no ideas.
1
Every GOP criticism of ObamaCare has been proven correct. Not one benefit that Obama promised has come to pass
Both Humana & Aetna should be ashamed of themselves.
Both "product brands" have sleazy reputations.
Humana, look at your "association" with Valeant whose prices to consumers are not sustainable.
Shareholders, divorce them, there are many other "fish in the sea" with more attractive yields.
Both "product brands" have sleazy reputations.
Humana, look at your "association" with Valeant whose prices to consumers are not sustainable.
Shareholders, divorce them, there are many other "fish in the sea" with more attractive yields.
4
The philosophies are all well and good. However, as the insurance administrator of a small company, I can tell you that the ACA is NOT what was promised. Our renewal this year came in at a 52% increase and was negotiated to 47%, thanks so much for the concession. So, we looked for alternatives that are still very expensive, but less than the former provider. In 2016 the ACA changed the clasification from large group to small group for employers with employees numbering between 50 and 100. It changed the methods for determining the pricing and the results are outrageous! This change alone must have impacted many businesses and the employees who likely must pay their share of the insurance. This needs to be fixed...
2
Extraordinary. Even the current occupant of the White House couldn't distort his signature initiative enough to throw sufficient money at the insurance companies to get them to continue this nonsense. This is yet another demonstration that no one in Washington understands the differences between cost and price. Continuing to manipulate prices does nothing to address the underlying cost problem. I am a thirty year veteran of the health care industry and I can state confidently that the system has staggering inefficiencies which have not been addressed because no one has the political will.
3
it's time--past time--to push for a "public option". obama's unhealthy alliance with private health insurance companies was doomed from the start, absent meaningful cost-cutting in the healthcare markets.
it's time to, effectively, make medicare, or a medicare equivalent, an option for everyone, and to allow that "option" to pursue cost reductions.
it's time to, effectively, make medicare, or a medicare equivalent, an option for everyone, and to allow that "option" to pursue cost reductions.
2
Do you think we are stupid? ObamaCare promised cost reductions, but the exact opposite happened. Let me guess: this time Big Government work!
1
@Larry
Yes.
Yes.
2
Everybody I have ever known to have Aetna health insurance HATED that company. So, I guess we will be better off without them. It seems that they aren't competitive enough, anyway, and very quick to deny a claim.
2
There are two principles about ObamaCare that are immutable and should be carved in stone:
(1) There is no such thing as affordable health care. Health care providers have seen to it by putting their greed above caring for people who need care.
(2) Any program that depends on getting the private health insurance bandits to behave themselves has doomed the program. See, for example, Aetna.
What do we do now? We can't repeal ObamaCare without replacing it with something better. What's Better? Single payer insurance, that's what.
(1) There is no such thing as affordable health care. Health care providers have seen to it by putting their greed above caring for people who need care.
(2) Any program that depends on getting the private health insurance bandits to behave themselves has doomed the program. See, for example, Aetna.
What do we do now? We can't repeal ObamaCare without replacing it with something better. What's Better? Single payer insurance, that's what.
5
Single payer Big Government is a guaranteed disaster, even worse than ObamaCare.
1
@Larry
Capitalism, with its baked In greed, is worse than than big government.
Capitalism had many years to attend to health care for all Americans. It did not.
Capitalism, with its baked In greed, is worse than than big government.
Capitalism had many years to attend to health care for all Americans. It did not.
2
REPEAL THIS STUPID LAW!!!
3
This November, Colorado is voting on single-payer for the state. It has an uphill climb. It is being attacked by the insurance companies, health care industry and conservatives.
Effectively, it would be funded by a 5% income tax on all wage earners, with 5% matching from employers. For me, I would end up paying aout $100 extra a month than I do now. But, no deductible, no out of network expenses, lo co-pays, watchdog over fees and medicines, etc.
Colorado is going with a model that is similar to the one used in Ontario, Canada.
The only way people will get single payer, for their own states do it on their own. If it passed, it will begin in 2019.
See: http://www.coloradocare.org/?nosplash=true
Also, this:
http://www.truth-out.org/opinion/item/37258-aetna-proves-that-single-pay...
And the mentality of America:
https://www.bloomberg.com/view/articles/2016-08-15/colorado-s-single-pay...
Effectively, it would be funded by a 5% income tax on all wage earners, with 5% matching from employers. For me, I would end up paying aout $100 extra a month than I do now. But, no deductible, no out of network expenses, lo co-pays, watchdog over fees and medicines, etc.
Colorado is going with a model that is similar to the one used in Ontario, Canada.
The only way people will get single payer, for their own states do it on their own. If it passed, it will begin in 2019.
See: http://www.coloradocare.org/?nosplash=true
Also, this:
http://www.truth-out.org/opinion/item/37258-aetna-proves-that-single-pay...
And the mentality of America:
https://www.bloomberg.com/view/articles/2016-08-15/colorado-s-single-pay...
4
That's only 10% of payroll. I wouldn't think they would get enough money from that to supply the level of service middle and upper income people are currently getting.
Vermont tried the same thing, but when they calculated the taxes needed to pay they had second thoughts.
Vermont tried the same thing, but when they calculated the taxes needed to pay they had second thoughts.
3
Everybody here ranting about health costs sound like people who are essentially healthy. So sure, let's throw the whole thing out and see where that gets us: back to only wealthy and employed people having health care. You can't have a rapacious for profit system of companies across the entire system--drug companies, hospitals, insurers, physicians--in a "product" whose "purchase" isn't a choice but a necessity.
Bernie Sander's was right that the US is the only country in the industrialized world that doesn't guarantee healthcare for its citizens.
The ACA was a tiny bandaid on an open wound where only those with means can afford healthcare. If you don't want people dying in the streets in the wealthiest country in the world, you have to totally redesign the paradigm of costs, access, and profit.
Nothing is free except death itself.
Bernie Sander's was right that the US is the only country in the industrialized world that doesn't guarantee healthcare for its citizens.
The ACA was a tiny bandaid on an open wound where only those with means can afford healthcare. If you don't want people dying in the streets in the wealthiest country in the world, you have to totally redesign the paradigm of costs, access, and profit.
Nothing is free except death itself.
9
Well, we will have to wait until 202, at least, because Clinton will leave this mess as is.
4
These same "healthy" folks will be pounding on the insurance door the first time they get a negative diagnosis. Do they not have comprehensive car insurance because they've never had an accident? Do they have no homeowners insurance because nothing bad has ever happened to their house? Good luck with that kind of gambling. I wouldn't do it.
2
Hi Christine, I would add preventive medicine to your list. We r living longer which requires more care for a myriad of disease states. If we each took better care of ourselves , became healthier as a society, we might decrease the costs over time
Folks, when I was only 20-something years old, I was denied private health insurance because of a pre-existing condition.
I'm concerned that Donald Trump may eliminate my options for obtaining health insurance. By the way, my state is not accepting any new applicants for the state's high risk pools.
Personally, I don't see why America doesn't offer a single payer health insurance system. It works well in other countries. It won't be as expensive as it seems because currently drug companies and hospitals unnecessarily overcharge (price-gouge) patients (such as that Martin Shkreli little twerp). With a single payer system, they won't be allowed to continue doing that, so health costs will be lower.
I'm concerned that Donald Trump may eliminate my options for obtaining health insurance. By the way, my state is not accepting any new applicants for the state's high risk pools.
Personally, I don't see why America doesn't offer a single payer health insurance system. It works well in other countries. It won't be as expensive as it seems because currently drug companies and hospitals unnecessarily overcharge (price-gouge) patients (such as that Martin Shkreli little twerp). With a single payer system, they won't be allowed to continue doing that, so health costs will be lower.
10
And how has Donald Trump caused a problem?
2
"...hit by tax penalties this year for failing to enroll."
Who pushed to lower the penalties to levels that are ineffective? Not Obama.
The cheap penalties, of course, encourage the presently healthy not to buy insurance.
"The companies point to a fundamental dynamic in the marketplace in which too few healthy people are buying policies and too many sick people are filing costly claims."
The "dynamic" is low penalties. Were the insurance companies pushing for higher or lower penalties?
If it weren't for insurance companies and our great GOP, we'd have real Obamacare in the form on universal single-payor health insurance like Canada. No cheap ways to buy out. And I wonder who pays for the healthcare of those who get badly sick and have opted out?
Who pushed to lower the penalties to levels that are ineffective? Not Obama.
The cheap penalties, of course, encourage the presently healthy not to buy insurance.
"The companies point to a fundamental dynamic in the marketplace in which too few healthy people are buying policies and too many sick people are filing costly claims."
The "dynamic" is low penalties. Were the insurance companies pushing for higher or lower penalties?
If it weren't for insurance companies and our great GOP, we'd have real Obamacare in the form on universal single-payor health insurance like Canada. No cheap ways to buy out. And I wonder who pays for the healthcare of those who get badly sick and have opted out?
6
Probably half the people in the country wouldn't even bother to file a tax return unless they were due a refund. It would take the IRS a long time to track down the millions who owe this penalty.
1
Perhaps you have amnesia, but the Democrats had unquestioned control of both the House and Senate when Obama rammed this down our throats
3
You conveniently don't mention the 7 Blue Dog democrats (Stealth republicans) who along with the registered republicans prevented single payer. That is why we still have to deal with HMO's who continually raise the premiums to pay for the runaway usury prices on prescriptions. It is a free for all now. Seeing who can rob us of the most cash and hope the gravy train doesn't collapse. The republicans deliberately refused any safeguards to prevent the runaway prices.
3
To make this a real welfare program,Obama need to subsidize it 100% for everyone and eliminate the deductibles.Otherwise,maybe go to a 100% govt run,highly inefficient,long delay,poor service system.That might finally convince Americans to take care of themselves and not need or depend on doctors,to fix what shouldn't be broken.
2
So all we have to do is take care of ourselves and we won't need to go the doctor. I wish I'd thought of that.
It's pretty amazing, watching people make claims about the PPACA's failure that have absolutely nothing to do with facts. So what if they've been benefitted by the law, which they have whether or not they know it?
But even more amazing:
1. Wailing about poor-picked-on Aetna, which just happened to get denied the big merger it wanted just last month.
2. Yammering about "Why can't we have just catastrophic insurance, which don't cost but $25 a month," when cat insurance is required to be offered under Obamacare, and hasn't cost $25 since about 1925.
3. Refusing, absolutely refusing, to look at any facts at all. I'd say try Kaiser Family Foundation's excellent primers and surveys, but I'm not sure some people can read.
By the way--if you get what you want and the PPACA goes away, here's what you lose:
1. Protection against being dumped when you get sick.
2. A guaranteee that you can get insurance.
3. A guarantee that your kids can stay on your insurance till they're 26.
4. A cap on insurance company profits.
5. A cap on your out of pocket costs.
6. A guarantee that mental health care will be part of your insurance.
7. Access to costs at hospitals.
8. Help for families in affording insurance.
9. Help for small businesses in affording insurance.
10. Support for trainining nurses, NPs, and doctors, as well as building new clinics.
Good luck. Sure, Trump'll help you.
But even more amazing:
1. Wailing about poor-picked-on Aetna, which just happened to get denied the big merger it wanted just last month.
2. Yammering about "Why can't we have just catastrophic insurance, which don't cost but $25 a month," when cat insurance is required to be offered under Obamacare, and hasn't cost $25 since about 1925.
3. Refusing, absolutely refusing, to look at any facts at all. I'd say try Kaiser Family Foundation's excellent primers and surveys, but I'm not sure some people can read.
By the way--if you get what you want and the PPACA goes away, here's what you lose:
1. Protection against being dumped when you get sick.
2. A guaranteee that you can get insurance.
3. A guarantee that your kids can stay on your insurance till they're 26.
4. A cap on insurance company profits.
5. A cap on your out of pocket costs.
6. A guarantee that mental health care will be part of your insurance.
7. Access to costs at hospitals.
8. Help for families in affording insurance.
9. Help for small businesses in affording insurance.
10. Support for trainining nurses, NPs, and doctors, as well as building new clinics.
Good luck. Sure, Trump'll help you.
7
How the Times can publish such baldfaced lies is beyond rational thought. there is NO guarantee you can get insurance. ObamaCare costs thousands of dollars for a junk policy that has deductibles in the tens of thousands of dollars. It is costing everyone more than Obama promised it would. Where's the $2500 I was promised?
2
The Affordable Care Act is affordable if someone else is footing the bill. If you didn't have insurance before you can't afford it now. Our premiums have more than doubled, and our insurer is asking for a 34% increase for 2017. Everything Obama told us about this plan has been a lie. The one thing Obamacare didn't do was address the skyrocketing costs of care, and it did nothing to rein in big pharma. Guess why? It is because big pharma is a big contributor to political campaigns. When drugs cost tens of thousands of dollars for a month's supply, you can never control healthcare costs. Only in America do we have to put up with the ridiculously expensive drugs other countries get at a great discount. Good job Obama. By the way, nobody cares about your testimonials. People know what they live, and we are living with out of control costs that you did nothing about.
10
It's the Republican Congress that prevents drug discounts, not the President.
"People know what they live, and we are living with out of control costs that you did nothing about."
But he did, he increased the costs, in collusion with Big Insurance, and Big Pharma, and both Hillary and Trump will continue his legacy.
But he did, he increased the costs, in collusion with Big Insurance, and Big Pharma, and both Hillary and Trump will continue his legacy.
2
The skyrocketing costs of healthcare insurance was with us before Obamacare.
Some twenty million fewer Americans had healthcare. When is so attractive to you about Americans dying in the streets?
Some twenty million fewer Americans had healthcare. When is so attractive to you about Americans dying in the streets?
1
AETNA may be misjudging public tolerance for corporate profits dominating the provision of health insurance. Would be ironic if their behavior brings about the very changes that they have spent so much money on lobbying to prevent. Why are they allowed to shelter profit in one market from losses they may experience as they "learn" a new market? Other companies have learned how to cross-subsidize, they don't they? Instead, they argued for, and got, risk corridors. If those are broken, fix them. Otherwise, given the "law of large numbers," why are we tolerating small market definitions when a national market spreads risk most efficiently? Time to discuss Medicare For All seriously?
3
Best post here!
There can be no free market forces in the health care market as long as the government subsidizes private health insurance. For years, people have been shoehorned into health insurance policies because of tax incentives and now tax penalties, and this leaves them at the mercy of the opaque pricing schemes decided by providers and insurance companies. A free market solution requires consumers of health care to see the prices of the goods and services that they consume. We should give the free market a chance by allowing consumers to make payments directly to their health care providers, rather than funneling every transaction through a government subsidized insurer.
4
What many seem to ignore, for whatever reason, is the elephant in the room: healthcare costs way too high because of gouging by doctors, hospitals, drug companies, and the like with no regard to fairness.
This utter disregard for the "common good" is just one negative effect of unfettered capitalism.
I am NOT arguing against capitalism per se, but for some well-considered implementation of price controls on healthcare as practiced in other industrialized societies.
Unless and until that happens, I fear that steeply rising healthcare costs will continue to bankrupt many Americans, their families, and this country along with them.
This utter disregard for the "common good" is just one negative effect of unfettered capitalism.
I am NOT arguing against capitalism per se, but for some well-considered implementation of price controls on healthcare as practiced in other industrialized societies.
Unless and until that happens, I fear that steeply rising healthcare costs will continue to bankrupt many Americans, their families, and this country along with them.
7
Medical professionals and hospitals are fairly compensated for the training they undergo and the responsibility they bear.
2
It's time to admit this program is a failure and end it. Unfortunately President Obama has too much invested in it (including his name) to do so, but perhaps the next President will have more sense. Sure some more people are covered, but at an out of pocket cost far greater than they'll ever get out of it.
4
Health Care should not be about profit. Put these so called insurance companies out of business and severely curtail the price gouging of big pharma and hospitals. The richest country in the world can surely make it happen. Tax all fairly. The money is there. The bigger question is, where is the money going?
3
The only price gouging in America comes from a Big Government that is raking in record tax revenues
the profit motive is essential to healthcare. Profit is what attracts investment and bright minds to healthcare. Profit is what has given America the best healthcare system in the world. Profit keeps prices down. Because shareholders stand at the end of the line demanding a return on their investment, there is pressure to keep costs down. Any effort to remove profit from healthcare would be costly, deadly disaster
the profit motive is essential to healthcare. Profit is what attracts investment and bright minds to healthcare. Profit is what has given America the best healthcare system in the world. Profit keeps prices down. Because shareholders stand at the end of the line demanding a return on their investment, there is pressure to keep costs down. Any effort to remove profit from healthcare would be costly, deadly disaster
1
Obamacare is melting down - badly.
In my State, premiums are slated to rise 53%, insurers are dropping Medicaid and many coops have failed.
This against a backdrop where Medicaid takes 26% of the States budget Vs. 4.9% for Education (mostly Higher Ed as K-12 is funded from sky-high local property taxes) plus we're also $120+ Billion in the red from unfunded pension liabilities.
The pattern for us is Democratic control of the House and Senate (for seemingly forever) and Democrats in charge in all of the cities (for seemingly forever).
Democrats got us into this budget mess with Obamacare (and now expect the Republicans to fix it for them).
In my State, premiums are slated to rise 53%, insurers are dropping Medicaid and many coops have failed.
This against a backdrop where Medicaid takes 26% of the States budget Vs. 4.9% for Education (mostly Higher Ed as K-12 is funded from sky-high local property taxes) plus we're also $120+ Billion in the red from unfunded pension liabilities.
The pattern for us is Democratic control of the House and Senate (for seemingly forever) and Democrats in charge in all of the cities (for seemingly forever).
Democrats got us into this budget mess with Obamacare (and now expect the Republicans to fix it for them).
5
If a loaf of bread were covered by insurance it would probably cost over a hundred dollars. Of course the insurance company would only pay $4.00. If you did not have insurance. you would have to pay the $100.00..
Same with health care. If you think you are in good hands, just remember, the insurance companies motto should be "Your Money or your life"
Back in my day, the doc came to your house. Even a poor milkman, coal or ice man could afford it. An Appendectomy (4-5 days in hospital) or Tonsils operation (1 day in hospital w/ice cream) was very affordable for these workers. You did not need insurance. Insurance companies drove the price of healthcare up So Much that you have to buy it.
Insurance should be for catastrophic illnesses.
Since insurance got into the act, the first question in the docs office is "What insurance do you have?" Not, "What is the problem?" Back in the day, the 20% that Medicare did not cover was insignificant. Now you need insurance to cover the 20% or you go broke!!
Medicare needs to be restructured to cover 100%. This way the scam of covering everything but 20% goes away and an investigation should ensue should there be attempted gouging by any provider.
Same with health care. If you think you are in good hands, just remember, the insurance companies motto should be "Your Money or your life"
Back in my day, the doc came to your house. Even a poor milkman, coal or ice man could afford it. An Appendectomy (4-5 days in hospital) or Tonsils operation (1 day in hospital w/ice cream) was very affordable for these workers. You did not need insurance. Insurance companies drove the price of healthcare up So Much that you have to buy it.
Insurance should be for catastrophic illnesses.
Since insurance got into the act, the first question in the docs office is "What insurance do you have?" Not, "What is the problem?" Back in the day, the 20% that Medicare did not cover was insignificant. Now you need insurance to cover the 20% or you go broke!!
Medicare needs to be restructured to cover 100%. This way the scam of covering everything but 20% goes away and an investigation should ensue should there be attempted gouging by any provider.
4
Yes, but in those days surgeons did not drive Ferraris...
2
He came in a Packard. Brought a black leather bag and stethoscope.
1
ObamaCare is a complete disaster and failure in every respect, medicare is bankrupt. Both of these facts prove that Big Government is no more capable of providing healthcare as is fighting poverty or any of the other thousands of failed programs
6
And the answer is? Death panels by private for-profit insurers?
1
It was Obama that created death panels, then lied about it. he created a panel of nameless, faceless bureaucrats who decide who lives and who dies
2
While you're quoting Kevin Counihan about the "improving" claims climate, why not ask him about the public option that got him his job: Healthy CT, the taxpayer-subsidized public option in Connecticut, just closed its doors last month. Too many claims, not enough in premiums to pay them.
5
Yet another Obama failure, let's see if Obama interrupts his vacation and fundraising to address his latest disaster. Obama fed us a laundry list of lies of the great things ObamaCare was guaranteed to accomplish. Not one of them has come to pass. ObamaCare has unfolded exactly as the critics predicted it would
9
Way to apologize for a corporation's trying to strongarm us.
2
You're wrong. ACA will not allow insurance companies to deny people that have pre-existing conditions coverage. Until ACA came into play, insurance companies could do just that.
2
Slavery is illegal in America. You cannot force people to provide a service that is not profitable to them
Not coincidently, the article leaves unmentioned the most concerning part of this drama: the law's COSTS are increasing at a frightening [and ultimately unsustainable] trajectory. Due almost entirely to higher-than-projected Medicaid spending, the federal deficit is once again on the rise. I give Hillary about TEN MINUTES after her inaugeration address before the tax hikes start.
6
But, but, but Obama promised us ObamaCare would bend the cost curve down! He also promised us we could keep our doctors, we'd get $2500 in savings from cheaper premiums, etc, etc, etc
7
So over 400 comments in. Most lamenting about the cost of HC and asking for some kind of single-payer. Yet these same people couldn't vote for the one candidate that was talking about and running on, said SP. Unicorns and puppies, you all said. As your candidate pointed out, American't. It's too hard. This is what you voted for American'ts. This is what your candidate is promoting. Now the NYT and its commenters are upset? C'mon self claimed adults. Make better choices. Your candidate is paid by whom? Surprise!
6
Isn't it now the Unaffordable Care Act???
10
Too many here seem to not understand the healthcare system. You throw the insurance companies under the bus - and yes, for too long their profit margins were WAY too high.
It's too bad the ACA/Obamacare didn't take smaller steps towards reform and cost containment, starting with insurance companies.
We should have not allowed them to drop for pre-existing conditions,
not drop people from insurance (although it would have been better to allow them to drop after a cap of $2 million was reached), and
not make excessive profits - including SADA costs (bonuses, trips, etc. paid to employees that make profits appear to shrink while executives ride high on the hog. My friends husband that sells insurance to companies got a bonus of $500,000 and he's just a sales rep!
But to not understand the impact of having to give and pay for care for so many that are in bad health, while those in good health have naturally decided to pay a fine is pretty shocking to me. What do the readers here, and the NYTimes, think will happen. If you sell widgets and are told you must now give away 50% of your widgets to half the population, what would you do? Raise the price for those widgets, refuse to sell to the discounted population or ? IT would work if everyone bought widgets, but they don't. And the consequence is a very small fine. So, why should they.
We should allow for catastrophic insurance - used to cost $25 a month. My kids bought it - it was cheap.
It's too bad the ACA/Obamacare didn't take smaller steps towards reform and cost containment, starting with insurance companies.
We should have not allowed them to drop for pre-existing conditions,
not drop people from insurance (although it would have been better to allow them to drop after a cap of $2 million was reached), and
not make excessive profits - including SADA costs (bonuses, trips, etc. paid to employees that make profits appear to shrink while executives ride high on the hog. My friends husband that sells insurance to companies got a bonus of $500,000 and he's just a sales rep!
But to not understand the impact of having to give and pay for care for so many that are in bad health, while those in good health have naturally decided to pay a fine is pretty shocking to me. What do the readers here, and the NYTimes, think will happen. If you sell widgets and are told you must now give away 50% of your widgets to half the population, what would you do? Raise the price for those widgets, refuse to sell to the discounted population or ? IT would work if everyone bought widgets, but they don't. And the consequence is a very small fine. So, why should they.
We should allow for catastrophic insurance - used to cost $25 a month. My kids bought it - it was cheap.
3
Funny you should repeat the false claim that insurance companies have high profit margins. Humana's profit margin is 1.8%. Aetna's profit margin is 3.9%. United Healthcare has a profit margin of 3.5%. Obama's buddies at Facebook have a profit margin of 27%. Obama's pals at Google have a profit margin of 22%. Obama's friends at Apple have profit margin of 21.7%.
Facts are stubborn things
Facts are stubborn things
3
I wasn't aware that Google, Apple and Facebook provided healthcare insurance. Nice try.
I would expect those profit margins you quote were because the CEOs of these companies earned in 2015 anywhere from 28 million up to 47 million for the CEO of Humana. Yep, all these insurance companies are in dire straights arent they? They are pulling out and taking their toys and going home because the government refused to allow Aetna and Humana to merge, end of story. It has nothing to do whatsoever in their profit margins.
I know a couple who hate Obama.
They purchased a healthcare policy through an ACA exchange, because they could not find such an affordable policy outside the exchange.
They purchased a healthcare policy through an ACA exchange, because they could not find such an affordable policy outside the exchange.
7
ACA is a mess that needs to be thrown out or drastically revised. The two erroneous assumptions that drove this Frankenstein monster of government regulation and free-market private insurers were (1) reliance on the Massachusetts experiment (which worked fairly well until ACA came on line) and (2) the leap of faith that healthy millennials and horribly unwell people alike would all sign up. The MA system was modeled for and worked in a small homogenous state of about six million with one of the healthiest and most affluent populations in the country. To assume that example would work for a sicker and poorer country of over 300 million was folly. And of course the millenials are not signing up. Most are resigned to taking the tax penalty in lieu of getting gouged for insurance plans that are ridiculously more expensive with each passing year and have growing deductibles of thousands of dollars. Faced with the choice between paying $12,000 - $20,000 a year for an insurance plan that, if it's ever needed, will likely be useless, or paying a small fraction of that to the IRS, why would any rational economic actor choose the former over the latter, no matter how much Obama wants you to?
5
As terrified as I am of the potential election results in November, it's this issue that makes me lose sleep at night. I fear for the futures of my kids, both of whom have chronic medical conditions.
1
Obamacare was to built on the backs of younger and healthier individuals. I guess they have decided not to be slaves of the state.
9
Insurance companies that sell plans on the exchange should not be able to pick and choose counties. They're discriminating again based on need. High-cost counties = High-need counties = Counties with preexisting conditions.
4
These insurance companies are not innocent bystanders: people insured by the Marketplace are telling others how tight-fisted many of these policies are and how many policy "exclusions" force people to pay more and more of their medical bills. So there are fewer new sign-ups now, including the young and the healthy. That lowers the profits of the companies. This vicious circle, mostly generated by corporate policies only loosely monitored by the feds, can be turned into a virtuous cycle if insurance policies would reduce limitations on coverage. But the real reason these already-huge companies have not done that is this: their lower profits are their main argument to get the Justice Dept. to approve mergers leading to monopolistic practices that of course bring in maximum profits. Instead, coverage rules should become less restrictive, motivating younger people to enroll, and meanwhile the feds should not accede to corporate extortion.
16
Too bad we lost the public option part of Obamacare. Bernie has the right plan; expand Medicare by allowing all the option of buying into it. These insurance corporations are an unnecessary intermediary. Look at so many other nations where the publicly run health care systems outperform our privatized system. Look at how well Medicare does.
2
It should be clear that the solution to the mess called Obamacare is a modified single payer system that would essentially extend Medicare to every citizen not just the elderly and disabled. Private insurers would be free to offer supplemental coverage as is done with Medicare but the elephant in the room is the cost of liability insurance that health care professionals must pay, which is of course passed on to patients.
The giant insurers tell us they need to become even larger so it appears we have reached the point where competition is no longer the norm. The free market aspect of health insurance is therefore no longer needed. As with education, public works, etc. it is time to consider the so-called public option. It is the only rational choice we have anymore.
The giant insurers tell us they need to become even larger so it appears we have reached the point where competition is no longer the norm. The free market aspect of health insurance is therefore no longer needed. As with education, public works, etc. it is time to consider the so-called public option. It is the only rational choice we have anymore.
9
Great comment, I agree. Far from abolishing ACA, I'd convert it into single payer, every age group covered at birth. No opt outs, no healthy vs sick, one gigantic pool of 350 million citizens. Insurers can act like Medicare supplemental a already do, as more claims processors and picking up slack from what Medicare doesn't cover. Divorce insurance from employment, and deduct insurance premiums from payroll and social security as us already done. Subsidize the poor, as is already done. Eliminate Medicaid. No overlaps, healthy people opt outs, capricious GOP refusal to expand state Medicaid.
One federal program that covers everybody. Period.
One federal program that covers everybody. Period.
5
Big Government ObamaCare is a total disaster, so the solution is Bigger Government??
6
SP was the plan all along and ACA was the political step to make it happen. Republicans have no principles, which is obvious now. They obstructed any real progress on this issue for fear of the political success it would bring the democratic party. Thats why they opposed a plan identical to Romneys plan. FDR brought us SS and LBJ medicare. So these are the political tactics we must resort to now. Hillary 2016
Families are going to save $2500 on average with Obamacare. If you like your doctor you can keep your doctor. How's that working?
12
It is working better than being denied insurance due to preexisting conditions or being dropped from insurance due to coverage caps.
4
In 2007 - three years before the ACA was signed into law - my employer decided to change our company's health insurance plan and as a result, my doctor no longer accepted my insurance. Pretty sure I'm not the only person in America who experienced this inconvenience prior to passage of the law. Also, our insurance premiums weren't frozen in time prior to the ACA - they went up significantly each and every year.
Critics of the ACA pretend such things never existed before it became law and helped insure 20 million more Americans. Let's now work constructively to bring down costs and get more people covered instead of just criticize from an alternate view of life prior to 2010.
Critics of the ACA pretend such things never existed before it became law and helped insure 20 million more Americans. Let's now work constructively to bring down costs and get more people covered instead of just criticize from an alternate view of life prior to 2010.
2
Obama promised us ObamaCare would fix the issue of rising costs. Thank you for admitting ObamaCare is a total failure
I hope the Times will do some significant follow-up reporting to investigate what (if any) marketing initiatives the big insurance companies themselves have done each year since the ACA was passed to reach a younger, healthier market.
If there's indeed an untapped market of young, healthy Americans who don't have insurance, why haven't the insurance companies themselves figured a way to try and reach them? Isn't that what most other successful businesses do everyday? Instead it seems they'd rather sulk about being prevented from merging with other big insurance companies, an action which would drive up their own profits and limit consumer choices even further.
For a country built on market competition, consumer choice is a goal I'd hope the media would focus on more. And it's another reason I support the Clinton goal to add a public option for further competition. The consumer market - and the need for health insurance - exists; it's time for everyone (especially the GOP) to actually try and make it work better rather than simply to tear it down and strip 20 million people from their health coverage.
If there's indeed an untapped market of young, healthy Americans who don't have insurance, why haven't the insurance companies themselves figured a way to try and reach them? Isn't that what most other successful businesses do everyday? Instead it seems they'd rather sulk about being prevented from merging with other big insurance companies, an action which would drive up their own profits and limit consumer choices even further.
For a country built on market competition, consumer choice is a goal I'd hope the media would focus on more. And it's another reason I support the Clinton goal to add a public option for further competition. The consumer market - and the need for health insurance - exists; it's time for everyone (especially the GOP) to actually try and make it work better rather than simply to tear it down and strip 20 million people from their health coverage.
5
The premiums for young, healthy Americans is very overpriced (while those for older, sick Americans is underpriced. That makes marketing of the polices to the very overpriced audience difficult. That's why the number of uninsured who purchased polices is half of that projected by the CBO.
1
Now the insurance companies must reach out to the healthy young??? Obama told us he had that figured out: he would impose a tax on people who didn't sign up for insurance. Nice to see you admit how horribly Obama has failed
4
There are subsidies based on income to make those policies more affordable. Any insurance company should be able to come up with a marketing plan to reach those individuals and within that marketing, to advise them of possible subsidies.
2
ACA will not be affordable or just until the insurance companies, solely focused on profit and not direct medical services, are not part of the syste. The US people need universal health care that is like the Medicare model and also control Rx costs without limiting access. We need to stop this lockstep to Capitalism. We need to focus on justice, equity and sustainability. Capitalism relies on too much collateral human damage to be sustainable. It has no legitimate role in sustaining human rights. And let's not be fooled by for profit insurance companies cloaked as non-profits; making nothing but profits.
5
Capitalism has created the highest standard of living in history. Not one Big Government-run economy (see Cuba, Venezuela, USSR, etc) has ever contributed anything of value to human existence
5
Say what you will about Cuba (there's a lot of legitimately negative things to say) but the entirety of the world wants training from Cuban doctors, who are considered unbelievably skilled and knowledgeable.
Your repetition of jingoist propaganda doesn't make it true. Entities outside the USA contribute to the world whether you acknowledge it or not.
Your repetition of jingoist propaganda doesn't make it true. Entities outside the USA contribute to the world whether you acknowledge it or not.
1
You're wrong....again.....
So typical of critics of the Obama administration to "stick to the script" in their roles in the political theater. Meanwhile, Americans are suffering. Once again, the health-insurance industry shows their true colors. It's all about them and their profits, folks. Why would we the people continue to kowtow to Mark Bertollini and Aetna, who is admitting that theirs is a failed business model which relies on coercion and threats to survive? Medicare for All (or at least the version of it that Bernie Sanders proposes, which is actaully more sustainable as asystem)! People before profits with respect to health care!
4
Medicare is going broke -- it is doing worse financially then Aetna.
5
Good luck finding testimonials from any young person. The cost of premiums and deductibles are astronomical! For a generation already saddled with college loan debt and a shrinking job market the ACA is not at all affordable. The tax penalty is much more affordable. Stop making healthcare and education a profit driven enterprise. Every citizen should have the right to health care and an education provided by the tax dollars that we all should be paying.
7
Exactly, as a healthy in shape young person I was shocked that for basic insurance ( that doesn't mean 10000 deductible nonsense) and prescription coverage the cost was around 500/month. On top of student loans, and even worse somehow the federally mandated health insurance still counts as disposable income spending on income based student loan repayment options.
2
Unfortunately, the ACA is and will not be affordable/sustainable with bloat built in - the bloat being the health care insurance industry and Big Pharma. This was the negotiated deal, with absolutely no "public option". And both sides of the aisle get their palms greased by these industries, along with our presidential candidates. Something will have to give, some day, and at the rate it's going, it will be the healthcare of millions of Americans, which should be a right.
6
The ACA is worst of both worlds. Would have been better to copy the German system, they had Universal Health Insurance since 1883, and it works, It is based on well regulated , not-for profit companies, that compete with each other.
Note: Well regulated, and not-for-profit. Neither is the case in the US.
Note: Well regulated, and not-for-profit. Neither is the case in the US.
6
I believe the German insurance companies are in fact for-profit.
The big difference in the German system is that the government controls medical costs, and the insurance plans all cover the same doctors and hospitals. That makes the insurance affordable.
The big difference in the German system is that the government controls medical costs, and the insurance plans all cover the same doctors and hospitals. That makes the insurance affordable.
1
The failure of the ACA is entirely the fault of President Obama and the feckless, corrupt democrats who voted for it. They refused to recognize health care as a right. Now, the nation is going to suffer even more.
2
Get real. I support single payer, universal healthcare, but there were not the votes for it.
You want Americans dying in the streets to salve your dissatisfaction?
You want Americans dying in the streets to salve your dissatisfaction?
1
This is just more proof to me that we need a single payer option, preferably Medicare, but Medicare must be allowed to negotiate drug and other prices to effectively use the clout of a large customer base. Life would be so much simpler in a single payer system not only for patients but providers. half of the time in a visit is spent on administrative insurance issues nor health issues. Finally, it is a serious pain to spend so much time pouring over insurance plans and coverage to pick what is right for you and to have to do it year after year when the plans change their benefits.
4
Just whisper "single payer" into the ears of the Death Insurance Industry and they will come around to the government!
3
People also aren't buying policies because they offer crappy coverage. In NYC, good luck finding a decent doctor who takes the plans. And it's even harder to find one who takes new patients.
Yes, in many cases buying insurance comes down to price. But it also comes down to value. We're getting bupkis for the money
Next year, I'll be looking for my fifth health insurance company in five years
ObamaCare is making the backlash against HMOs in the '90's look quaint
Yes, in many cases buying insurance comes down to price. But it also comes down to value. We're getting bupkis for the money
Next year, I'll be looking for my fifth health insurance company in five years
ObamaCare is making the backlash against HMOs in the '90's look quaint
9
Absolutely. The insurance have gotten worse, not better, for the healthy who don't use a lot of medical care.
1
I can provide a testimonial for the "administration." My wife and I are retired and have to pay for our health care since we didn't work at some cushy government job that provides healthcare coverage for life. Our monthly premium is over $1,600 per month. This program is certainly not "Affordable" since it's like having another mortgage to pay. Our experience has been terrible with the ACA.
8
I think one of the benefits of Affordable care act is it made lot of people aware of the cost of healthcare in this nation. The insurance companies were consistently the most profitable industry, more than casino, oil, technology etc. Without some competition and changes in the system insurance companies were laughing their way to the bank because someone was paying that $1600. An informed citizen will be vigilant and ACA has the potential to become a major victory for the citizens as it evolves.
2
Luji, you are a liar. Liar, liar, liar. Insurance companies are NOT among the most profitable companies. Humana's profit margin is 1.8%. Aetna's profit margin is 3.91%. Isle of Capri casinos have a profit margin of 4.7% Obama's buddies at Google have a profit margin of 22% Obama's pals at Apple have a profit margin of 21.7%. Obama's friends at Facebook have a profit margin of 27%. Clearly, tech companies are more profitable
1
What has gone wrong with Obamacare?
One major contributor I believe is the very late change that occurred, around the time the first set of rates were close to being finalized. This is when states could allow those residents who had pre-Obamacare policies to keep those policies for three years before moving to ACA. Those who did not have pre Obamacare policies in those states (because insurers rejected them on account of health or other reasons) bought ACA policies on exchange. Over 30 states allowed this.
There was recognition that it would significantly unbalance the risk of those buying ACA policies; and the remedy for that was supposed to be through the risk corridor program. Subsequent legislation forced the risk corridor program budget neutrality. Payments into the program dropped and so did the payments out of the program. This put many insurers, who were expecting relief through it, in financial stress.
This was probably most painful for 2014 ACA policies - its first year. Insurers in subsequent years should have taken this into their stride. The larger insurers were slow in coming to the exchanges any ways so this may not have been a major problem for them.
Another thing that is happening is that people who have major health issues are signing up, incurring high care costs and then dropping their insurance.
And there are other reasons also, I can imagine.
One major contributor I believe is the very late change that occurred, around the time the first set of rates were close to being finalized. This is when states could allow those residents who had pre-Obamacare policies to keep those policies for three years before moving to ACA. Those who did not have pre Obamacare policies in those states (because insurers rejected them on account of health or other reasons) bought ACA policies on exchange. Over 30 states allowed this.
There was recognition that it would significantly unbalance the risk of those buying ACA policies; and the remedy for that was supposed to be through the risk corridor program. Subsequent legislation forced the risk corridor program budget neutrality. Payments into the program dropped and so did the payments out of the program. This put many insurers, who were expecting relief through it, in financial stress.
This was probably most painful for 2014 ACA policies - its first year. Insurers in subsequent years should have taken this into their stride. The larger insurers were slow in coming to the exchanges any ways so this may not have been a major problem for them.
Another thing that is happening is that people who have major health issues are signing up, incurring high care costs and then dropping their insurance.
And there are other reasons also, I can imagine.
2
I had some tests done recently at a nice NYC hospital, and gasped when I saw the charges paid by my insurer, which were negotiated, in-network prices. Healthcare costs are spiraling out of control because of hospitals and drug makers. I'm no fan of insurance companies but they are squeezed in the middle, it seems to me. Single payer is step one. Step two is reigning in hospital costs. These "providers" seem to pluck their numbers out of thin air. Patients don't know, going in, what the charges will be so the idea of shopping around is a joke.
5
I'm retired on medicaid. My wife receives no health insurance through her employer, and is not of age for medicare. We pay almost $600 a month for her coverage through the exchange. Tight as it makes it we are able to pay the premium. Why do we in the United States have to pay such high premiums. Republicans talk about abolishing A.C.A. but with what? Some vouchers and then the insurance companies raise the premiums because they know people are getting vouches from the Government. Just like colleges did when they saw students receiving grants and loans from the government. This country needs a single payer program. Remember the insurance companies' loyalty is to their stock holders whch is understanderble, not the uninsured.
6
Never fear, Krugman will soon write another glowing missive about the massive success of the ACA.
Given that the ACA was largely written by insurance and healthcare industry lobbyists, what did we really expect?
The vast majority of exchange participants are receiving government subsidies. The government pays the insurance company for the insurance in the first place. Under the generous reinsurance program, the government picks up any losses the insurance carrier experiences over 2%. The trillion+ dollars budgeted, 2013-2023 for paying back insurance companies, is running out too quickly and Obama has had to try and come up with money elsewhere to transfer over to the patrons.
It is in the interest of the insurance companies to figure out how to pile as much of their overall costs as a company into the accounting for ACA plans. This way they show how much they are losing on ACA plans, get paid back by the government for their "losses", and can justify large rate increases to the public. And the cycle continues.
It also allows them to argue for the need of consolidation, further concentrating their leverage over the health industrial complex.
The perverse incentives in our country's medical system are to balloon costs higher every year to justify increasing rates to provide more revenue to the health industrial complex.
Want to know who the real winners in the ACA are? Check out 5 year stock charts for the health insurers and health care companies.
Given that the ACA was largely written by insurance and healthcare industry lobbyists, what did we really expect?
The vast majority of exchange participants are receiving government subsidies. The government pays the insurance company for the insurance in the first place. Under the generous reinsurance program, the government picks up any losses the insurance carrier experiences over 2%. The trillion+ dollars budgeted, 2013-2023 for paying back insurance companies, is running out too quickly and Obama has had to try and come up with money elsewhere to transfer over to the patrons.
It is in the interest of the insurance companies to figure out how to pile as much of their overall costs as a company into the accounting for ACA plans. This way they show how much they are losing on ACA plans, get paid back by the government for their "losses", and can justify large rate increases to the public. And the cycle continues.
It also allows them to argue for the need of consolidation, further concentrating their leverage over the health industrial complex.
The perverse incentives in our country's medical system are to balloon costs higher every year to justify increasing rates to provide more revenue to the health industrial complex.
Want to know who the real winners in the ACA are? Check out 5 year stock charts for the health insurers and health care companies.
7
Your solution? Let Americans are die in the streets?
1
The Dutch or German model.
1
I would like to see greater militancy with respect to the insurance companies: if you want to do business here you need to do your part to support universal coverage. There is nothing "free" about the so called free market for healthcare services. Not with respect to pricing, access, quality or sustainability. Everyone needs it, everyone should pay for it--especially the health insurance providers who have created artificial monopolies. A true single payer system puts them out of business--and if they want to stay here they need to contribute their fair share--or go away, as we don't really need them. Too much business gets done in the interest of stability rather than optimizing long term outcomes. If the majority of businesses knew that they could be entirely free of having to support the healthcare of their employees--we'd have single-payer now.
4
In reading the recent news about the health care INDUSTRY, its business shenanigans stand out. We are well on our way to supporting another industry like the banks which are becoming "too big to fail". Might I remind those in legislative positions who fought to destroy the ACA because it was proposed by a president they vowed to usurp, that the idea behind the ACA was a GOP plan back in the day and succeeded in MA. Might I also remind everyone that we would not be embroiled in this mire if insurance was not a business, but rather an American standard (dare I say universal health care, or utter the forbidden term -- single-payer? Or Socialism?).
When a major FOR-PROFIT insurance company can play a strategic game of chicken with the US Government for private gain, we really need to pay more attention. For those of us who either fear or bow down to the power of the NRA and Wall Street, we need to focus on whose America this is.
Next time you are having trouble paying your rent or mortgage, take a look at whose names are on most of the tall buildings in our major cities...might they be banks and insurance companies? Maybe we need to pay attention to who gets our votes and decides what kind of country we want. And we need to remember, as Bernie reminded us, that those powers start at the local level. We can write all the comments we want, but without our votes, our voices mean nothing.
When a major FOR-PROFIT insurance company can play a strategic game of chicken with the US Government for private gain, we really need to pay more attention. For those of us who either fear or bow down to the power of the NRA and Wall Street, we need to focus on whose America this is.
Next time you are having trouble paying your rent or mortgage, take a look at whose names are on most of the tall buildings in our major cities...might they be banks and insurance companies? Maybe we need to pay attention to who gets our votes and decides what kind of country we want. And we need to remember, as Bernie reminded us, that those powers start at the local level. We can write all the comments we want, but without our votes, our voices mean nothing.
4
Of course if we had a normal functioning Congress, we could work through these problems and any flaws in the ACA to improve it so that coverage to as many people as possible could continue and even be enhanced. But the GOP and conservatives in general are keen to exploit and trumpet and problems as a means to destroy the law and replace it with...nothing much if anything.
One problem is clearly that the tax assessment for not taking out health insurance was set way too low in the Act. But the primary problem is that there was such a pent up demand for health coverage from the many who had denied themselves (or been denied) coverage because of its astronomical cost before the ACA, that they are overwhelming the individual market place. This says as much if not more about the state of health coverage in America before the ACA as about the ACA itself.
But other insurance companies more efficient and competitive than Aetna (and probably with narrower provider networks) can still step in to compete in those markets, mainly in rural America, where insurance coverage is thin to non-existent. All is by no means lost.
One problem is clearly that the tax assessment for not taking out health insurance was set way too low in the Act. But the primary problem is that there was such a pent up demand for health coverage from the many who had denied themselves (or been denied) coverage because of its astronomical cost before the ACA, that they are overwhelming the individual market place. This says as much if not more about the state of health coverage in America before the ACA as about the ACA itself.
But other insurance companies more efficient and competitive than Aetna (and probably with narrower provider networks) can still step in to compete in those markets, mainly in rural America, where insurance coverage is thin to non-existent. All is by no means lost.
1
So,it's back to hidden $250 copays for blood tests, X rays, and biopsies, and the mythical "reasonable and customary" provider baseline for coverage. Insurers are not health care or insurance. They are a disease that kills you financially while another issue is killing you physically.
1
The Affordable Care Act is a failure, mainly because Obama and his fellow Democrats who pushed it down everyone's throats (Reid, Pelosi, and others) did not fully investigate the insurance companies. Obama allowed the insurance companies to continue to be for-profit, and their CEOs and other executives to be paid billions of dollars in unjustified salaries and tax-free bonuses.
Single payer would be the best way, and the payments should be made by Wall Street bankers and the ultra-wealthy (Soros, Peltz, etc).
Single payer would be the best way, and the payments should be made by Wall Street bankers and the ultra-wealthy (Soros, Peltz, etc).
2
Talk to your Republican Congress about that . Mr. Obama did what he could given the restraints.
2
The U.S. healthcare system is disgusting. I was on a generic drug for for several years. It cost me $20 for a 90 day supply. When I went to order it 2 months ago the cost had risen to $134. I did what I have been doing for years for another drug I take, I ordered it from Canada. The cost for a hundred tabs is $ 50. The other drug I've been ordering from Canada costs $84; here in the U.S. it is around $900.
Time for a single-payer health system in this country. Oh wait! Poor big Pharma, hospitals and the insurance industry will lose their profits from bilking Americans and we can't have that.
Time for a single-payer health system in this country. Oh wait! Poor big Pharma, hospitals and the insurance industry will lose their profits from bilking Americans and we can't have that.
8
The left thought (or pretended) that a death spiral would occur quickly and when it didn't happen in year 1, they declared it would never happen. Unfortunately, reality has caught up with the again and you still can't get anything for free. The death spiral has begun. Now their solution for the government induced wrecking of healthcare will be......MORE GOVERNMENT. Hey, let's have Amtrack or Post Office run a single payer healthcare system. They only lose billions per year.
2
I am so confused. Did they, Aetna and others like them, not write the law?
4
Aetna wants to leave? Good riddance. Did they really threaten the US Government? Time for some CEOS to do the frog walk. They can play Pinnacle with Trump at Club Fed.
1
One does have to feel sorry for Aetna's CEO...he only made 15.7 million last year.
3
Time to offer a FEDERAL OPTION in each state as one of the insurer choices.
Heh. Heh. Heh. (Take THAT you greedy insurance companies.)
Heh. Heh. Heh. (Take THAT you greedy insurance companies.)
2
A COUPLE OF INNOVATIVE IDEAS 1. large companies establish their own 'general practice medical dept' by hiring general practicioners to give free care within the company and cover specialty care with insurance. an internal hmo
2. since medicaid reimbursement is so low and few doctors will take medicaid patients,make medicaid reimbursement wholly or partially tax free. will induce coverage at little expense .
2. since medicaid reimbursement is so low and few doctors will take medicaid patients,make medicaid reimbursement wholly or partially tax free. will induce coverage at little expense .
I can see the headlines now: "Medicaid Doc Bills $1.2 Million, Pays no Tax!"
All these health corps should have the salaries and bonuses of their execs posted in every newspaper.
When the shock sets in for the average American, Maybe the SINGLE PAYER system, we elected Obama to implement, will become a reality. We always vote for it. It just never happens. Are you listening Hillary?
When the shock sets in for the average American, Maybe the SINGLE PAYER system, we elected Obama to implement, will become a reality. We always vote for it. It just never happens. Are you listening Hillary?
3
You just have to love the NY Times, the Democrats and the liberal media in general. We sold this law to you as a magic thing. It was going to lead to "Lower costs for everyone, better quality of care and better access to care!" Wow, like magic Nancy.
https://www.youtube.com/watch?v=fmg9vHCiJeM
The Critics of the Bill and THE MAJORITY of Americans who were opposed to this law knew that it was sold to the public on a pack of lies. "If you like you Dr, you can keep your Dr.. PERIOD!" "If you like your plan, you can keep your plan, Period!" "The Average American Family will save $2,500 in healthcare costs, by the end of my first year in office!"
Now as it fails, the liberal response? Well, we lied, we screwed up the system for 330 Million Americans so that we could insure 10 Million more; so let us take over the whole system with single payer!
It is so laughable. Obamacare will continue to be a political albatros around the neck of the Democrats as long as it stays in existence. They own it! Not a single republican voted for this Rube Goldberg contraption of a law.
https://www.youtube.com/watch?v=fmg9vHCiJeM
The Critics of the Bill and THE MAJORITY of Americans who were opposed to this law knew that it was sold to the public on a pack of lies. "If you like you Dr, you can keep your Dr.. PERIOD!" "If you like your plan, you can keep your plan, Period!" "The Average American Family will save $2,500 in healthcare costs, by the end of my first year in office!"
Now as it fails, the liberal response? Well, we lied, we screwed up the system for 330 Million Americans so that we could insure 10 Million more; so let us take over the whole system with single payer!
It is so laughable. Obamacare will continue to be a political albatros around the neck of the Democrats as long as it stays in existence. They own it! Not a single republican voted for this Rube Goldberg contraption of a law.
4
Aetna's move is terrorism, trying to push another huge merger.
1
This story is classified by NYT editors as "Politics"? I don't think so. Business, Economics, even Government. But "Politics"?
2
To the authors: what a bias on your part to conclude with a quote from Ms. Corlette that Congress has to fix Obamacare. It is Barry's job to do that! If I were him, I'd worry about this "legacy" that is quickly failing.
3
Bernie was right. Medicare for all.
6
There are a few comments on Medicare for all.
1. It has been studied. The CBO did it 10 years ago and found that to let people over 55 to buy in would cost them $400 a month per person. Since then health care costs have gone up and private insurance has increase by 10% a year. That is a 100% increase. Also I don't know if that included Part B which is now about $160 for new people and I know it didn't include Part D for Rx's.
2. Traditional Medicare is not that great. For one thing you will be responsible for 20% of many of the coverage's with no out of pocket max. It is why I chose a Medicare subsidized private insurance plan called Medicare Advantage through an Insurance Company.
1. It has been studied. The CBO did it 10 years ago and found that to let people over 55 to buy in would cost them $400 a month per person. Since then health care costs have gone up and private insurance has increase by 10% a year. That is a 100% increase. Also I don't know if that included Part B which is now about $160 for new people and I know it didn't include Part D for Rx's.
2. Traditional Medicare is not that great. For one thing you will be responsible for 20% of many of the coverage's with no out of pocket max. It is why I chose a Medicare subsidized private insurance plan called Medicare Advantage through an Insurance Company.
I have a simple fix for ACA. Create a National stop loss insurance program (NSLP), which all insurers that participate in the Exchange must join. The NSLP siphon’s off the risk of each carrier on claims which exceed $500,000 per family member per calendar year. This should bring down premiums by 15% or more.
The NSLP would be funded by a premium tax on Exchange premiums and a fee charge to each carrier, and part of the ACA's capital gains tax on dividends, which should be increased. Further high deductibles and out of pockets should be limited to the current HSA federal level.
The NSLP would be funded by a premium tax on Exchange premiums and a fee charge to each carrier, and part of the ACA's capital gains tax on dividends, which should be increased. Further high deductibles and out of pockets should be limited to the current HSA federal level.
It's pretty clear we need a public option to help keep prices low. If that doesn't work, then the ACA needs to be scrapped and go to a single payer plan.
1
"The bigger issue is a lot of people just don't find it affordable". Bingo... No amount of advertising is going to change the fact that even subsidized, the ACA is unaffordable. Premiums are unaffordable - and deductibles are even worse. Compared to most group plans - it is not even in the ballpark. You can't give up your house and car to buy insurance. Why don't you do to the rest of the country (people with large group plans) what you did in the Individual mandate and small business? They would throw you out of the white house and congress forever. No really - I laugh at the people who aren't a part of this when they talk about it - they don't even have a clue. It'd be like me trying to explain to someone what having a baby is like.
3
Very true. The biggest supporters of the ACA are those who've never had to use it and never will.
2
Maybe Aetna can start by cutting the high salaries of its top management.
"Bertolini was compensated $8.26 million last year, down from $36.36 million in 2012."
"Bertolini was compensated $8.26 million last year, down from $36.36 million in 2012."
I’m perfectly happy to pay the health care costs of the 10% of the population that cannot afford basic health care. What I’m NOT willing to pay for is the politically-driven laundry list of health care “services” delivered by overpaid bureaucrats with no accountability to either their “customers” – the patients – or the people paying the bill – the taxpayers. See “Veteran’s Administration” for further clarification.
3
Our pre-ACA model wasn't workable for Americans who didn't work for large companies. Buying insurance on the open market was a nightmare. Insurance companies routinely denied coverage for entire sections of the body, so, for example, if you once had a kidney stone, you wouldn't be covered if you contracted bladder cancer. And if you got sick, you couldn't renew your insurance. So now we are seeing what treating all Americans as equals looks like. An industry that can only survive by abusing a slice of the population is running on a flawed model. Insurance companies don't deliver health care. They just suck up money by holding our access to health care hostage.
2
Is anyone surprised that The democrats grand nanny state vision has turned out to be a debacle? Now we'll need big brother to step in again and take more of our money to fix a problem that they created, which of course will make things worse. When will the people off this country wake up?
5
Insurance companies are in the business for profits - not your health.
They just skim you money and offer nothing of value.
ACA should have been one payer from the start.
Put the insurance companies out of business.
They just skim you money and offer nothing of value.
ACA should have been one payer from the start.
Put the insurance companies out of business.
5
Obama's crowning achievement (other than letting the terrorists out of Guantanamo) turns out to be nothing more than another manifestation of his incompetence. If Hillary wins, and I hope she doesn't, it will be a major step up
for the country. Obama doesn't care, never did.
for the country. Obama doesn't care, never did.
3
The dems knew this would happen ,and the government would wind up paying for all the deadwood through taxes on the few people left with jobs, and the government printing press running 24 hours a day printing worthless paper. There is no amount of other people's money the dems won't spend to buy votes.
1
This waffling by Big Insurance points out the opinion, held by many, including myself, that the ACA is a compromise, a pact with the devil that is quite unlikely to work. Single payer is what Americans want, although one must wonder whether any transparency is possible within a demonstrably corrupt system.
1
So much is tragic here, but one particularly stands out. How did it come about that Marilyn Tavenner, who was once entrusted to administer Medicare and Medicaid, our public plans, is the lead for the private health insurance trade group?
How could she maintain both the values of public service and private profit all at once?
This is scary.
How could she maintain both the values of public service and private profit all at once?
This is scary.
4
Again, it needs to be said, Obama got the cart in front of the horse. We needed to first have controls on costs of drugs, doctors and hospitals. We needed controls on insurance companies not on those who are or need insurance.
We actually don't need insurance companies if the we were charged fairly for medical treatments and drugs. When insurance corporations balk because they want more for medical coverage, then they should be removed from the insurance business all together. Trump is right, If a business leaves America or I would add abuses it customers here at home than we the people and government/agencies should make them pay.
The ACA allowed insurance companies to take advantage of patients in yet another corrupt system in America that is suppose to do no harm. That doesn't seem to include gouging the people when they need help the most. What they are doing to people use to be called racketeering, or crimes against humanity. Now it is just, business as usual.
We actually don't need insurance companies if the we were charged fairly for medical treatments and drugs. When insurance corporations balk because they want more for medical coverage, then they should be removed from the insurance business all together. Trump is right, If a business leaves America or I would add abuses it customers here at home than we the people and government/agencies should make them pay.
The ACA allowed insurance companies to take advantage of patients in yet another corrupt system in America that is suppose to do no harm. That doesn't seem to include gouging the people when they need help the most. What they are doing to people use to be called racketeering, or crimes against humanity. Now it is just, business as usual.
5
An interesting aspect of these comments is how many people are using terms like 'single payer' or 'universal coverage' in different ways. The insurance companies, and many in this arena, thrive on mis-information. NYT, do the public a favor and consider a primer on terminology, helping to inform the public and promoting informed discourse on this important topic.
As an older couple, we are theoretically expensive to insure. But so far this year, our soon-to-be defunct state cooperative has made over $11,000 on us (they paid $767 in medical charges for us, while we have paid them over $12,000 in premiums).
We have lost insurance twice this year. We were going to go with Aetna, but now it will disappear in 2017. Who will insure us? We are hanging on by our fingernails until we can get Medicare.
Boo hoo, insurance companies. Maybe you're losing money on your ACA plans, but aren't you making huge profits overall ~ enough to stay in the game?
We have lost insurance twice this year. We were going to go with Aetna, but now it will disappear in 2017. Who will insure us? We are hanging on by our fingernails until we can get Medicare.
Boo hoo, insurance companies. Maybe you're losing money on your ACA plans, but aren't you making huge profits overall ~ enough to stay in the game?
Medicare for all who want it! No age limit. Let the insurance companies compete with Medicare. Profit does not belong in health insurance.
3
You can keep your doctor. You can keep your hospital.
Um, not so much.
Could it be that the intent all along was to eventually drive us to a single payer system? We seem to be headed that way. I don't qualify for the exchanges and my employer doesn't offer health insurance, so I'm stuck buying it on my own and paying exorbitant premiums. I'm forced to shop around every year for increasingly fewer options with restricted networks.
There's no easy fix for the mess we're in. It's clear though that the government is sticking its head in the sand and plodding along hoping that more young people will sign up rather than pay the penalty.
Good luck with that.
Um, not so much.
Could it be that the intent all along was to eventually drive us to a single payer system? We seem to be headed that way. I don't qualify for the exchanges and my employer doesn't offer health insurance, so I'm stuck buying it on my own and paying exorbitant premiums. I'm forced to shop around every year for increasingly fewer options with restricted networks.
There's no easy fix for the mess we're in. It's clear though that the government is sticking its head in the sand and plodding along hoping that more young people will sign up rather than pay the penalty.
Good luck with that.
3
Is there a problem with driving to single payer?
I received a bill... Emergency care,$1000. There is no insurance listed. Ok, add the insurance number, send it back. Now the bill magically is almost $7000! No change in the service, nothing, except my insurance was billed $7k.
Now, insurance EOB says 'our negotiated price' $897. Down from $7k. Wait a minute! This was $1000 a minute ago, you negotiated away a price that never existed. My payment, $897, savings '$6100' ? Uh, no. Savings $103. That entire $6k appears to be a fabrication, to claim a loss somewhere.
Moreover, right now there are at least three middlemen for any medical transaction. Doctor--> medical billing service--> insurer --> insurance broker --> patient. The three in the middle all make money-- a lot of money! Yet, except in extraordinary circumstances, they serve no purpose. Two never serve any purpose except to skim a little off an overly complex system.
Single payer? Get rid of this grossly inefficient, expensive hydra? Bring it.
I received a bill... Emergency care,$1000. There is no insurance listed. Ok, add the insurance number, send it back. Now the bill magically is almost $7000! No change in the service, nothing, except my insurance was billed $7k.
Now, insurance EOB says 'our negotiated price' $897. Down from $7k. Wait a minute! This was $1000 a minute ago, you negotiated away a price that never existed. My payment, $897, savings '$6100' ? Uh, no. Savings $103. That entire $6k appears to be a fabrication, to claim a loss somewhere.
Moreover, right now there are at least three middlemen for any medical transaction. Doctor--> medical billing service--> insurer --> insurance broker --> patient. The three in the middle all make money-- a lot of money! Yet, except in extraordinary circumstances, they serve no purpose. Two never serve any purpose except to skim a little off an overly complex system.
Single payer? Get rid of this grossly inefficient, expensive hydra? Bring it.
31
I am self-employed and now have to pay a fortune - over $20K a year - for health insurance that is so bad I can't even get a physical by an in-network doctor without paying $500 or more for lab fees. The healthcare system was broke before Obamacare, now I'm broke after it. I'm pretty sure which is worse.
3
Might be of interest to folks feeling sorry for companies like Aetna who averages a net profit of 2 billion annually with over 6 billion net income growth in the last 5 years (that is, btw, in the same time frame of ACA). Not to mention that they pay their top 5 executives 44 million a year. Boo Hoo!!!! Greed pure and simple. I don't see any reason why an insurance company needs to be the profiteering go between regarding people's health and their doctors other than to line their own pockets at the expense of the medically needy.
27
It's time for a single payer system and the end of for-profit health corporations like Aetna. They are greedy "middlemen."
1
Time for single payer. The insurance companies' business model is to collect enormous premiums and deter people from filing claims.. They're relentless on both fronts. Premiums go up. Coverage goes down. This has been going on and on for years.
1
I googled salaries for Aetna top executives and they're in the $7million to $17.2million/year range. What does "loss" mean for this company? How much would consumers save with single payer health care?
1
"Moreover, the administration said, most people buying insurance on the exchanges receive federal subsidies, so they will not feel the full impact of higher premiums."
No, we taxpayers will pick up the tab.
No, we taxpayers will pick up the tab.
4
I would rather help my fellow citizen receive health care than have helped the guys who tanked the global economy https://projects.propublica.org/bailout/list
1
Another argument for single payer, which is the direction we should have gone. I realize that it had a snowballs chance, but it's now obvious that most of these "health care" insurance companies could care less about Americans health. It was a pact with the devil and it's come back to bite us.
1
There are a few comments on Medicare for all.
1. It has been studied. The CBO did it 10 years ago and found that to let people over 55 to buy in would cost them $400 a month per person. Since then health care costs have gone up and private insurance has increase by 10% a year. That is a 100% increase. Also I don't know if that included Part B which is now about $160 for new people and I know it didn't include Part D for Rx's.
2. Traditional Medicare is not that great. For one thing you will be responsible for 20% of many of the coverage's with no out of pocket max. It is why I chose a Medicare subsidized private insurance plan called Medicare Advantage through an Insurance Company.
1. It has been studied. The CBO did it 10 years ago and found that to let people over 55 to buy in would cost them $400 a month per person. Since then health care costs have gone up and private insurance has increase by 10% a year. That is a 100% increase. Also I don't know if that included Part B which is now about $160 for new people and I know it didn't include Part D for Rx's.
2. Traditional Medicare is not that great. For one thing you will be responsible for 20% of many of the coverage's with no out of pocket max. It is why I chose a Medicare subsidized private insurance plan called Medicare Advantage through an Insurance Company.
2
I pay the Medicare Part F supplement at about $135 a month. With the Advantage plans expect the network to become smaller over your lifetime, it is basically a HMO run by the insurance company. I can go to any doctor or hospital in the US that accepts Medicare (virtually all) on my traditional Medicare.
I pay no deductibles and have no out of pocket expenses period. It's not cheap but it is the best available.
I pay no deductibles and have no out of pocket expenses period. It's not cheap but it is the best available.
1
I believe in the concept of ACA, but the costs, both in premiums and increased deductibles, are starting to far outweigh the annual benefits. I love the required coverage for pre-existing conditions (which I have) and preventative care, but the one-size-fits-all plans do not work well across the board. We need changes such as:
1) Lower premiums, subsidies, and deductibles for younger people and tiered higher costs and subsidies as people get older.
2) Close the loophole in many exchanges now where it allows people to sign up at the last minute (outside the regular enrollment period) for coverage when they get sick and need it and then subsequently drop coverage once they are well.
1) Lower premiums, subsidies, and deductibles for younger people and tiered higher costs and subsidies as people get older.
2) Close the loophole in many exchanges now where it allows people to sign up at the last minute (outside the regular enrollment period) for coverage when they get sick and need it and then subsequently drop coverage once they are well.
1
The ACA is a near mirrored image of a Bi-partisan, during a GOP governor (Romneycare to you), driven by the Heritage Society, field tested, very successful health program. The designer of Romney care even assisted in the design of the ACA. What problems exist are there because of the 151 changes to the ACA, to include eliminating the single payer option the GOP made to the program. Then the GOP defunded the logistical development of the program while it was being implemented.
Taxes have not been raised for ordinary, non-wealthy Americans to pay for the Affordable Care Act.
Only two Affordable Care Act taxes apply to individuals.
Households with earned income above $200,000 if single or $250,000 if married filing jointly pay an extra 0.9 percent Medicare tax on all earnings over that threshold.
Wealthy investors. There’s also an extra 3.8 percent Medicare tax on "net investment income" such as interest, dividends, and capital gains. But the tax only applies to households with a modified adjusted gross income of more than $200,000 if single and $250,000 if married filing jointly and it is only applied to total investment income or the amount that investment income exceeds those income thresholds, whichever is smaller.
Taxes have not been raised for ordinary, non-wealthy Americans to pay for the Affordable Care Act.
Only two Affordable Care Act taxes apply to individuals.
Households with earned income above $200,000 if single or $250,000 if married filing jointly pay an extra 0.9 percent Medicare tax on all earnings over that threshold.
Wealthy investors. There’s also an extra 3.8 percent Medicare tax on "net investment income" such as interest, dividends, and capital gains. But the tax only applies to households with a modified adjusted gross income of more than $200,000 if single and $250,000 if married filing jointly and it is only applied to total investment income or the amount that investment income exceeds those income thresholds, whichever is smaller.
The health insurance industry is nothing but a giant leech sucking the economic blood out of most Americans. What value do they provide? Shuffling paper and deciding who gets treatment and who doesn't? Making sure I have a high deductible and co-pays? My insurer is Aetna, and I don't care if I end up paying more they are gone when I can change. The fact that the CEO thinks it's OK to blackmail the American people (yes, that's what the government is - by the people, for the people) to try to push through a competition destroying merger is nauseating. The US has become a corporate kleptocracy and Aetna is near the top of the list.
2
I had to go to emergency room in Munich, Germany for a foot injury. I paid 98 Euros out of pocket for ER room, X-ray, doctor's consult and dressings. In the U.S., the visit would cost me probably 5 times more. Everyone in Germany is on single payer insurance and you can always pay private insurance in addition, if you want a private room and quicker access to specialists. The biggest advantage is that you do not lose health insurance if you lose a job or are between the jobs.
1
Since Aetna's decision was largely the result of its not being allowed to proceed with its planned acquisition of a competitor the answer is "single payor". Done. Over and out.
2
Buy a clue, time for universal health care like the rest of the world. Stop taking contributions from the industries that stand to profit and start thinking about what is best for the people that elect you to office.
Even with universal healthcare people can still buy private coverage if they want to.
Even with universal healthcare people can still buy private coverage if they want to.
2
This article is about "losses" at the insurance companies yet there is absolutely no information about those supposed losses. Are the insurers actually operating in the red or are they just not making as much profit as they did before the ACA?. It seems that when I hear financial reports about insurers, they are all making money. I don't hear news about insurer stock losing value. I'll bet there's not a single CEO at major insurers that isn't getting a large bonus on top of a multimillion dollar salary this year.
Are profits just not as high as they were before the ACA? That may be a result of proving... healthcare.
Dear New York Times. Please do your job and investigate the claims instead of simply parroting complaints of huge (and becoming more huge) corporations. I don't believe the ACA is perfect but articles such as this do not provide information needed to gain a better understanding of the problems or potential solutions. It's clear from the comments that it just reinforces existing beliefs and acts as mouthpiece for those who scream the loudest.
Are profits just not as high as they were before the ACA? That may be a result of proving... healthcare.
Dear New York Times. Please do your job and investigate the claims instead of simply parroting complaints of huge (and becoming more huge) corporations. I don't believe the ACA is perfect but articles such as this do not provide information needed to gain a better understanding of the problems or potential solutions. It's clear from the comments that it just reinforces existing beliefs and acts as mouthpiece for those who scream the loudest.
2
I am a healthcare provider and a consumer of healthcare. As a clinical social worker, I cannot afford to access the same care for myself as I offer in my practice. Obamacare has sucked the lifeblood of healthcare from the middleclass in order to cover more Medicaid recipients. Unfair!!!
4
Anh how exactly has "Obamacare has sucked the lifeblood of healthcare from the middleclass in order to cover more Medicaid recipients"? It might feel good to make unsubstantiated, baseless claims but if you had some facts to back up your perceived unfair treatment I might be more sympathetic.
1
The article and most others about the subject never mention the role of the GOP governors who chose to withhold the AFA benefits from their populations and thus hurt their state citizens and the insurance companies. And it is not that I hold the GOP responsible for hurting its citizens because they voted the GOP into office and control, thus voting to hurt themselves. It is the same with the GOP control of congress, a result of voters cutting off their nose to spite their face. If the media reported the whole story with some context and perspective, maybe Americans would understand what they are doing to themselves.
2
"A lot of people just don't find it affordable." Also, insurance companies are losing money and cutting back. One can wait until the need for insurance arises, then join and not worry about previous conditions. See anything wrong here? It has to be a single payer system if it is going to work. Ergo, this has no chance.
So much for Obamacare and the government getting involved into healthcare and insurance companies. Did anyone really believe insuring the masses of people of obesity, diabetes, cardiac and other disease states would/could be sustained from the premiums from the healthy population. Next time when Aetna does not cover your 3d mammogram and the co-pay is $56 you will understand.
1
Maybe, just maybe, this will be the push needed to move to single payer, like the rest of the world. It becomes increasingly clear that the insurance companies, especially the for profit ones, are the problem.
The ad campaign should be one that encourages citizens to lobby congress for "Medicare for All." That would wake up the insurance companies to the fact that no other developed country in the world puts up with this level of private profit from the health system.
1
Good. I couldn't be happier that Aetna lost money.
And I hope they continue to lose money until they go out of business.
In fact, if nothing else, I hope Obamacare ends up putting every single for-profit health insurance company out of business, and then, and only then might we be able to talk seriously about a non-profit public option.
And I hope they continue to lose money until they go out of business.
In fact, if nothing else, I hope Obamacare ends up putting every single for-profit health insurance company out of business, and then, and only then might we be able to talk seriously about a non-profit public option.
2
Adam Smith's rule #1: In order for free market competition to operate efficiently and to impose a cost control, information must be perfect. So how do Republicans apply this rule in their policy proposals? They don't. They pretend it doesn't exist. And they pretend their policy proposals DO exist. When, in fact, they don't.
1
Here we go again. Re: "The administration has minimized the significance of such setbacks." First, before commenting on this, the idea of the ACA was a lifeline to those who could never afford insurance and good medical care, and the troubles it is having must cause much worry to those who are following the twits and turns of the unfolding of its future. For those enrolled, there is a justifiable fear that can never be felt by those who have medical coverage
Okay. So, once again, Obama underestimates something that turns out to be catastrophic (ISIS as Jayvees, for example). In his** rush** to ensure his legacy of good deeds and a great president, he totally underplanned and underestimated this program, which from the moment of its inception was so incredibly flawed that "incompetent" is not nearly a strong enough description. So, now, because of Obama's good intentions but a larger ego, there is the possibility the whole program is in jeopardy. I am not afraid the GOP has a better plan, they don't. What I am afraid of it is the rotting from the inside of this plan, and its end. No comfort for those who use it and might lose it.
Okay. So, once again, Obama underestimates something that turns out to be catastrophic (ISIS as Jayvees, for example). In his** rush** to ensure his legacy of good deeds and a great president, he totally underplanned and underestimated this program, which from the moment of its inception was so incredibly flawed that "incompetent" is not nearly a strong enough description. So, now, because of Obama's good intentions but a larger ego, there is the possibility the whole program is in jeopardy. I am not afraid the GOP has a better plan, they don't. What I am afraid of it is the rotting from the inside of this plan, and its end. No comfort for those who use it and might lose it.
4
Thew high cost of premiums and a limited number of providers, specialists pariculary, that make the Affordable Care model unattractive to the average healthy person . Having tried it, I can speak for all the ways it's not working. The cost of health care services has to come down. It is still inaccesible. State's that do not participate like New Jersey make the system more inefficient. No matter what the officials say.
So, in its typical head-in-the-sand fashion the Obama administration tries to put a positive spin on a disastrous situation. What's good about the fact that most people on the insurance exchanges receive Federal subsidies to offset outrageously high health care premiums. The last thing this country needed is another "entitlement" program, but that's evidently what we have.
3
The simple, elegant solution- make Medicare the default, baseline health insurer for every American. Everyone pays in to the best of their ability. Then, if private insurers want to offer more cost effective, higher quality, or supplemental policies- for profit- they're free to do so.
3
"The companies point to a fundamental dynamic in the marketplace in which too few healthy people are buying policies and too many sick people are filing costly claims."
It was known from the beginning that it would be impossible to cover people who could sign up for "insurance" after they'd gotten sick. It is no different than buying insurance after you've wrecked the car or your house has burned down.
In this very newspaper a free lancer wrote about her husband of two years, and an attorney discovered he had pancreatic cancer. In one of her comments she was thankful that thanks to Obamacare they were able to get "insurance". His care included a Whipple, a very expensive operation which removes lymph nodes and takes 10-12 hours. he costs will be almost 150,000.
They have enough money for them to ride around in their antique Buick automobile on the weekends but didn't bother to buy health "insurance".
The fear that it would be the younger people who would not opt in was palpable. They are the most healthy of us and were being asked to subsidize those who aren't. But it turns out people in their 40s and 50s were also not buying in. Sadly these same people can just drop out and return if their disease flairs up again. They don't even have to pay the premium for 90 days. I wonder how many never do.
This is a disaster. it cannot be sustained under these rules. Obama considers this his legacy but it won;t be the one he though he was getting.
It was known from the beginning that it would be impossible to cover people who could sign up for "insurance" after they'd gotten sick. It is no different than buying insurance after you've wrecked the car or your house has burned down.
In this very newspaper a free lancer wrote about her husband of two years, and an attorney discovered he had pancreatic cancer. In one of her comments she was thankful that thanks to Obamacare they were able to get "insurance". His care included a Whipple, a very expensive operation which removes lymph nodes and takes 10-12 hours. he costs will be almost 150,000.
They have enough money for them to ride around in their antique Buick automobile on the weekends but didn't bother to buy health "insurance".
The fear that it would be the younger people who would not opt in was palpable. They are the most healthy of us and were being asked to subsidize those who aren't. But it turns out people in their 40s and 50s were also not buying in. Sadly these same people can just drop out and return if their disease flairs up again. They don't even have to pay the premium for 90 days. I wonder how many never do.
This is a disaster. it cannot be sustained under these rules. Obama considers this his legacy but it won;t be the one he though he was getting.
4
I've been saying for years that America should see how the French do it. The Government only pays up to 75% of the bill. Most French citizens have private insurance as well. French workers pay 13% percent of their income into the public insurance fund. Single payer can work if it's done right. The problem is that Obamacare was setup wrong.
1
This problem with Aetna is not solely about the ACA as it is about the desire of Aetna to merge with another provider and is blocked by the federal government. Aetna and other health care providers are playing hardball. If the federal government wants to solve this problem once and for all, evoke the Sherman and Clayton Anti-Trust Acts. Break 'em up for restraining trade and price fixing. This also includes the AMA, which limits the number of doctors available by restricting medical schools and other medical professionals entering the field. The whole medical industrial complex is rigged from Big Pharma to medical research to all points in between with only the patients and tax payers getting the shaft. The ACA was simply a stopgap measure until Americans come to their collective senses concerning a single payer health care system. Let’s keep our eyes on what’s needed and needed now not in the far distant future.
1
The basic reason market solutions don't work in health care is moral hazard, but NOT the demand side moral hazard that receives so much attention (that is -- the problem is not that patients use "too much" care because insurance pays for it). The problem is that doctors, hospitals and pharmaceutical companies can raise their prices without losing many customers because insurance pays for care. The solution is straight-forward -- all-payer rate setting. You need to control the prices. This is easy in a single payer system, but you can do it effectively in a multi-payer setting too -- see, for example, Germany and Switzerland.
1
Its amazing that all these publications are writing on Aetna and some other major insurers leaving the marketplaces and how that spells doom for Obamacare, but none of these "journalists" seem to want to do the research on the business models of these large insurers and how these companies have failed to invest or adapt their business models to fit the customer base in the Obamacare marketplaces. Meanwhile smaller regional health companies that have been able to adapt and are more invested in managing the health of their customers are finding a way to make profits in the marketplaces.
http://www.modernhealthcare.com/article/20160817/NEWS/160819922
http://www.modernhealthcare.com/article/20160817/NEWS/160819922
1
Aetna trying to strong arm the government, their CEO's admission of same, has just increased the price of poker. Tens of thousands of gov't employees can choose Aetna coverage. If Aetna wants to play hardball the government can up the stakes in any number of ways.
When I lived in D.C. and worked for a private employer it was nearly impossible to get a doctor appointment because I was not a government employee. The insurance giants have a lock on the government market there and doctors are in on the game - they know the government will always pay and that the coverage is excellent.
Non-government employees, including all that worked in my office, had to go to Maryland to see a doctor because no doctors took our lower benefit Humana plan. In short, the government is perhaps an unwitting participant in the monopolization of D.C. healthcare.
If Aetna wants to play hardball, the government should oblige by changing the rules for who gets to bid for government healthcare contracts. Perhaps those participating in ACA should be given preference? Or maybe those opting out of ACA should not be allowed to bid government contracts?
When I lived in D.C. and worked for a private employer it was nearly impossible to get a doctor appointment because I was not a government employee. The insurance giants have a lock on the government market there and doctors are in on the game - they know the government will always pay and that the coverage is excellent.
Non-government employees, including all that worked in my office, had to go to Maryland to see a doctor because no doctors took our lower benefit Humana plan. In short, the government is perhaps an unwitting participant in the monopolization of D.C. healthcare.
If Aetna wants to play hardball, the government should oblige by changing the rules for who gets to bid for government healthcare contracts. Perhaps those participating in ACA should be given preference? Or maybe those opting out of ACA should not be allowed to bid government contracts?
The insurance companies are making the case for single payer Medicare for all, but the administration still doesn't get it. Despite all the "incentives" the companies prime goal is to only insure care to the extent that it is profitable. Obama Care already has built in a fee structure that includes nearly 20% for administrative costs and profit. Some say the figure is higher and even that's not enough.
Doctors all across the country are declining to accept insurance because they would have to employ too many staff simply to process the dozens of different forms from the various insurance companies. Instead you pay up front and they give you a general form stating the service provided and you have to get your insurer to reimburse you, if you can.
None of the Western countries use the American system we call Obama care. It's too complex, it leaves too many people out, it relies too much on gimmicks like "exchanges" that companies can bail out of and it wastes dollars that could go toward health care on administrative costs and insurance company profits.
The NYTimes avidly supported Obama Care from the beginning and refused to run articles on the Canadian system unless they were critical. But our neighbors to the north have national health care that is more efficient and less costly than ours. Millions of voters feel the same way, but our elected leaders seem more interested in insurance company campaign support than the needs of the American people.
Doctors all across the country are declining to accept insurance because they would have to employ too many staff simply to process the dozens of different forms from the various insurance companies. Instead you pay up front and they give you a general form stating the service provided and you have to get your insurer to reimburse you, if you can.
None of the Western countries use the American system we call Obama care. It's too complex, it leaves too many people out, it relies too much on gimmicks like "exchanges" that companies can bail out of and it wastes dollars that could go toward health care on administrative costs and insurance company profits.
The NYTimes avidly supported Obama Care from the beginning and refused to run articles on the Canadian system unless they were critical. But our neighbors to the north have national health care that is more efficient and less costly than ours. Millions of voters feel the same way, but our elected leaders seem more interested in insurance company campaign support than the needs of the American people.
1
How can any company make money when the executives are earning millions? Here's a list of what the CEO's of the 5 largest health insurance companies are earning. What about the free housing, country club memberships, free travel, free private jets, free meals? And this is only the CEO's. What about the rest of the executive staff? The V.P.'s, the actuaries, the controllers, the managers. How much are lobbyists making? Everyone is feeding at the trough and then they cry that they are not making any money. The U.S. government should nationalize them and have them work for government style salaries, maybe 230,000 a year and get rid of the lobbyists. Bertolini of Aetna earned 15 million in 2014 and 30 million in 2013. Joe Swedish of Anthem earned 17 million in 2013. David Cordani of Gigna earns 14 million a year. Bruce Broussard of Humana earns 10 million. Stephen Helmsley of United Health Group earns 15 million. This is disgusting.
1
I lived in Sweden for 12 years. During that time I had major surgery gave birth to two children and went through all their ear infections and pneumonia and serious colds. The single payer health system was simple. It offered excellent, highly efficient care with no lines.
I'm fortunate to have Medicare now but that doesn't cover dental. Had to have 2 dental implants resulting from a fall for an out of pocket cost of $17K. Delta Dental is absurd.
Don't let them tell you single payer won't work. Health care is a basic human right. Single payer works so much better than what we've got. Demand it.
I'm fortunate to have Medicare now but that doesn't cover dental. Had to have 2 dental implants resulting from a fall for an out of pocket cost of $17K. Delta Dental is absurd.
Don't let them tell you single payer won't work. Health care is a basic human right. Single payer works so much better than what we've got. Demand it.
4
In my twenties I didn't have health care because it was expensive and I was healthy and at 68, with Medicare, I still am. I watch what I eat and I exercise. If ObamaCare and the insurance industry are counting on young and healthy people to pay for insurance they likely will not need, there is something very wrong with that formula. Our heath care system as it exists even with The Affordable Care Act improvements is a tax-based system using the word "premium" instead of "tax" that puts an unfair financial burden on our young people. Our health care as a nation needs to find its money elsewhere and Bernie Sanders, for one, knew where to look, with a nod to Willie Sutton on why he robbed banks: "Because that's where the money is." So let's leave our young people alone so they can explore their lives and stop burdening them with debt.
2
Aetna and Anthem have billions to spend on proposed mergers/take overs of other companies yet they are losing money? On paying for medical coverage. Have we lost sight of the purpose here. To provide medical coverage not profit for large corporations. I pay 12K a year for 2 people. Blue Cross wanted to deny my continued coverage for physical therapy claiming it was due to a car accident and sent the case off to a third party for subrogation. There was also a clause about what would happen if the government took any action. The health insurance industry is not working. NOt for the people paying the insurance premiums. BUt to say that they will not do what the government wants, even though they clearly have billions to spend is arrogance, and bilking the public is their game.
I'm told that Aetna wants to buy Humana and that this is a power-play so that Aetna's executives get what they want. If not, they take their ball and go home.
Easy fix - add a public option. Make Medicare an option in competition with Aetna and the lke.
Easy fix - add a public option. Make Medicare an option in competition with Aetna and the lke.
Time and time again, I hear criticisms of ACA with no viable alternative suggested. It's too expensive, single payer won't work, it harms health providers, hinders medical developments and on and on. But I never see a reasonable alternative that takes what's good about ACA and seeks to improve it in light of the criticisms. If a plan can't make health care affordable to most all citizens and people are left unable to pay or unable to receive decent health care, you have not moved one step forward. There is no doubt that all these critics without viable workable suggestions for providing all citizens viable health care have pretty decent health care already. You can bet on that!
1
The law tried to be a middle passage for a future single payer plan. It was a much needed overhaul of the system. However, it depends on the delicate balance of companies collaboration, clear communication from government and public awareness. Healthcare companies saw it as a way to win more profits and to have a way for healthcare monopolies, which the government are not allowing, thus, they decrease their participation. Clear communication from the government have been lacking, particularly in GOP states. It depended too much in the states, and the states were not ready (with obvious exceptions). Public awareness, then, is a mix of disinformation from the opposition to the law and miscommunication from the government. Still, I think is worth fighting for the law and make it better. It must start with the communities more affected and to bring more resources to educate the public, especially in schools (to outreach families), community centers and universities.
Of course this is all Republican's faults. Let's not look at economics or the price of research and development. Medicare works as a solution to some of our citizens so, logically, that must mean that it can work if it were the only system for all our citizens. Every country is hermetically sealed from the evil American exploitative health care system. They thrive in a bubble, completely independent of the fruits of our market-based systems for medical education, research and development. I'm not an expert in health care but I know that any flaw in the ACA must be due to greedy Republicans. Duh.
3
Constituents should demand that their Member of Congress and Senators vote to require all MCs and Senators and the President, VP and all federal political appointees to obtain their health coverage exclusively through the health exchanges.
Until the elected officials and the high bureaucrats have to face $20,000 family premiums with $6500 annual deductibles they will continue to say Obamacare is working. It's not.
Until the elected officials and the high bureaucrats have to face $20,000 family premiums with $6500 annual deductibles they will continue to say Obamacare is working. It's not.
1
Well Congress and its staff does have to buy on the exchange but since they are an employer group plan, just like all employer group plans, the employer must contribute at least 50% to the single employee rate, the average is surprisingly over 80% and the government contributes 70% or 75%, I think.
The whole problem with the non group market is that everyone in the group market gets an employer subsidy and only some people in the non group market. Most of the over 80% that get subsidies in the non group market have affordable coverage so the people in the non group market that are over the income threshold get neither employer or government subsidies for their health insurance. That is why it is unaffordable for many of them
The whole problem with the non group market is that everyone in the group market gets an employer subsidy and only some people in the non group market. Most of the over 80% that get subsidies in the non group market have affordable coverage so the people in the non group market that are over the income threshold get neither employer or government subsidies for their health insurance. That is why it is unaffordable for many of them
1
I think it is more about Rubio's successful law that disallows the government to backstop the Reinsurance type protections under the law. That means that they have to take into consideration worst case scenarios when requesting rate increases or whether to stay in a certain place or not.
A study has shown that year over year the risk pool is starting to be stable.
https://www.hhs.gov/about/news/2016/08/11/report-unchanged-medical-costs...
"According to today’s report, per-member-per-month claims in the individual market were essentially unchanged from 2014 to 2015, falling by 0.1 percent. Indicators of per-member cost growth in the broader private insurance market (such as employer coverage and Medicare) rose by 3 to 6 percent in 2015."
"Moreover, the states with the highest enrollment growth saw significant reductions in per-enrollee medical costs. These findings suggest a year-over-year improvement in the ACA individual risk pool, with the Marketplace gaining healthier, lower-cost consumers as it grew."
"Today’s data show that premium increases in 2015, which averaged 2 percent, would have been sufficient, on average, to keep pace with claims costs, because of the exceptionally slow growth in per-enrollee claims. However, the increases would not have been sufficient to make up 2014 gaps between prices and costs or to accommodate the partial phasedown of the transitional reinsurance program."
A study has shown that year over year the risk pool is starting to be stable.
https://www.hhs.gov/about/news/2016/08/11/report-unchanged-medical-costs...
"According to today’s report, per-member-per-month claims in the individual market were essentially unchanged from 2014 to 2015, falling by 0.1 percent. Indicators of per-member cost growth in the broader private insurance market (such as employer coverage and Medicare) rose by 3 to 6 percent in 2015."
"Moreover, the states with the highest enrollment growth saw significant reductions in per-enrollee medical costs. These findings suggest a year-over-year improvement in the ACA individual risk pool, with the Marketplace gaining healthier, lower-cost consumers as it grew."
"Today’s data show that premium increases in 2015, which averaged 2 percent, would have been sufficient, on average, to keep pace with claims costs, because of the exceptionally slow growth in per-enrollee claims. However, the increases would not have been sufficient to make up 2014 gaps between prices and costs or to accommodate the partial phasedown of the transitional reinsurance program."
1
Everything I read here is just ammunition for the argument for expansion of Medicare to all who want in. The current Medicare withholding from paychecks would increase, quite obviously and out of necessity, but I believe it would not amount to any more than the premiums Aetna and its co-conspirators charge.
Competitors just doesn't really describe the relationships of the major insurers; Bertolini's threat was thinly disguised blackmail. The attempt to swallow up Humana is driven by the desire for more profits and bigger CEO compensation packages. The ultimate result of insurance "mergers" doesn't require higher mathematics to see that the goal is one big for-profit insurance company.
It is time for the Republican Party to wake up to reality and stop protecting the private insurance industry. If we are headed ultimately to a single-payer system for medical insurance, it cannot be a profit-driven enterprise.
Competitors just doesn't really describe the relationships of the major insurers; Bertolini's threat was thinly disguised blackmail. The attempt to swallow up Humana is driven by the desire for more profits and bigger CEO compensation packages. The ultimate result of insurance "mergers" doesn't require higher mathematics to see that the goal is one big for-profit insurance company.
It is time for the Republican Party to wake up to reality and stop protecting the private insurance industry. If we are headed ultimately to a single-payer system for medical insurance, it cannot be a profit-driven enterprise.
21
I wouldn't be alive today if it weren't for Obamacare. That said, there is nothing affordable about the Affordable Healthcare Act. Thirteen months before Obamacare began, the non-profit I worked for closed. My health insurance, which wasn't great but better than most, was gone with the job. I struggled along, cutting dosages and rationing my meds. I spent hours researching where each med I needed was cheapest and joined at least 2 pharmacy discount programs. It was a harrowing year.
I was so relieved to finally get insurance through the Market Place! But, the policies available were worse than my previous insurance. Deductibles were enormous and premiums, even with a subsidy were a struggle, as they continue to be today. There are many flaws with Obamacare, but at least I am alive.
But, something has to give. I can't really afford to use what I am paying for beyond the necessary visits to keep getting my meds. All that really happened is that everyone was forced to buy insurance either through their work or the exchanges. We couldn't afford it in the first place! Deductibles need to be reduced and subsidies increased in amount and in who is eligible to receive them. Insurance companies have enjoyed the benefits of high profits for years. They need to tough it out, not pull out. Or we could go single payer! Then they wouldn't exist at all. Just pray that republicans become the minority this election. We'll have nothing and no hope for the future if they stay in power.
I was so relieved to finally get insurance through the Market Place! But, the policies available were worse than my previous insurance. Deductibles were enormous and premiums, even with a subsidy were a struggle, as they continue to be today. There are many flaws with Obamacare, but at least I am alive.
But, something has to give. I can't really afford to use what I am paying for beyond the necessary visits to keep getting my meds. All that really happened is that everyone was forced to buy insurance either through their work or the exchanges. We couldn't afford it in the first place! Deductibles need to be reduced and subsidies increased in amount and in who is eligible to receive them. Insurance companies have enjoyed the benefits of high profits for years. They need to tough it out, not pull out. Or we could go single payer! Then they wouldn't exist at all. Just pray that republicans become the minority this election. We'll have nothing and no hope for the future if they stay in power.
19
Somehow you lived for a year without the massive expense of the ACA, perhaps you could have continued if it did not exist. There will only be single payer if 60 senators desire it, perhaps never.
Aetna is no an "insurer", they are an interest harvester. Even when they are administering plans for self-insuring companies, they do not pay claims for years ! This means that new mothers and families of the most ill are dealing with debt collectors in times of high stress. Aetna doesn't care.
Their goal was to hold on the funds that companies were paying in monthly and invest them and collect interest for years, before they were forced to pay the bills incurred by the client-company's employees and their families.
Cigna tried the same tactics in Austin. Eventually, knowledgeable Austin companies refused to deal with them, because they caused stress in the families who were needed to provide support for employees completing important company projects..
Their goal was to hold on the funds that companies were paying in monthly and invest them and collect interest for years, before they were forced to pay the bills incurred by the client-company's employees and their families.
Cigna tried the same tactics in Austin. Eventually, knowledgeable Austin companies refused to deal with them, because they caused stress in the families who were needed to provide support for employees completing important company projects..
1
There is only one way to achieve a fair balance, which of course is enact single payer, full coverage single payer, for all whose incomes are less than $150,000 per annum; the rest can choose to pay as they go, or buy marketplace insurance, and yes, single payer is paid for by a tax on the wealthy, whose wealth, by and large, is accumulated off the backs of the poor and middle-class.
And the idea that Trump or Hillary will forgo the hundreds of millions of dollars, in corrupt payoffs, from corrupt Big Insurance and corrupt Big Pharma, is the big lie; both are vying for office simply to partake in the obscene revenue these companies enjoy.
The evidence has always been right in front of our noses, and we've so empowered Big Insurance, they openly admit it's all about profit, obscene profit.
And the idea that Trump or Hillary will forgo the hundreds of millions of dollars, in corrupt payoffs, from corrupt Big Insurance and corrupt Big Pharma, is the big lie; both are vying for office simply to partake in the obscene revenue these companies enjoy.
The evidence has always been right in front of our noses, and we've so empowered Big Insurance, they openly admit it's all about profit, obscene profit.
4
What in the world is a "free market"? There is no such thing. The harm purpatrated by so-called "free" capitalism and the need for fair regulation is well documented throughout the history of this country. The current abuse of the health care insurance system is evident in every Explanation of Benefits. What is the real price for an MRI? What is the real daily rate for a surgicenter? All I get is a bunch of high cost itemizations, payouts that are a fraction of the so-called list price, and a "balance" that I may have to pay. Doctors are squeezed to accept less while insurance companies keep complaining about unprofitability as they seek 45-65% rate increases. This seems to be the ultimate shell game with the consumer/patient with no recourse other than to pay for the bet as the insurance companies continue to smile at each other with the knowledge that they have a monopoly on the win. Getting the profit bloat out of the healthcare system seems like the only way to deliver quality healthcare to all.
2
We are just beginning to see the shortcomings of the Affordable Care Act, or Obamacare, and it ls likely to get worse, much worse, particularly when insurance choices dwindle, policies cost more, penalties for no insurance increase, deductibles increase making policies useless (except for the extremely ill), and more doctors and other healthcare providers refuse to accept Obamacare policies. A European style socialized medical care system would probably not work well in the US, but this is likely what our liberal legislators in the House and Senate secretly (except Sanders who openly advocated for it) talk about behind closed doors, and it is probably coming soon, if we do not come up with more workable solutions.
3
Remove remove moral hazard and promise "free" stuff, and this is what you get.
Price controls, rationing and a more nationalized health insurance marketplace are coming soon, because the architects of this plan cannot admit nor accept the consequences of its failure of design.
You can blame the insurance companies all you want. They are simply operating rationally, matching input revenues, including government sponsored taxpayer subsidies, with uncontrolled costs.
Expect to pay more and receive less, except where spending and production have been reconnected in a separate healthcare market. The rich are able to access this through concierge medicine. The answer for the rest of us will be to scale back benefits and expectations.
All is not lost. We will simply adapt to a different future than was promised by Obama et al. Providing everything to everybody for less than they pay now is not possible. Did anyone ever believe otherwise?
Price controls, rationing and a more nationalized health insurance marketplace are coming soon, because the architects of this plan cannot admit nor accept the consequences of its failure of design.
You can blame the insurance companies all you want. They are simply operating rationally, matching input revenues, including government sponsored taxpayer subsidies, with uncontrolled costs.
Expect to pay more and receive less, except where spending and production have been reconnected in a separate healthcare market. The rich are able to access this through concierge medicine. The answer for the rest of us will be to scale back benefits and expectations.
All is not lost. We will simply adapt to a different future than was promised by Obama et al. Providing everything to everybody for less than they pay now is not possible. Did anyone ever believe otherwise?
3
I think the DOJ has over-played its limited hand. The Department should approve Aetna's merger with Humana and thereby keep Aetna in the exchanges.
Why? It's obvious the Department of Justice itself has limited leverage at present on Aetna and its desire to merge with Humana: (a) If DOJ approves the merger, then, according to the Department, competition will be reduced; (b) If DOJ opposes the merger, then, as Aetna's CEO already informed the Department, Aetna will withdraw from the exchanges, and thereby reduce competition.
I guess the Department is really convinced that the reduction in competition from (a), the merger, will exceed the reduction in competition from (b), Aetna's decision to pull out of the exchanges. That's an untenable level of confidence given the experimental nature of the Obamacare enterprise.
Aetna is a quality insurer and the exchanges do not benefit from the company's exit decision.
Why? It's obvious the Department of Justice itself has limited leverage at present on Aetna and its desire to merge with Humana: (a) If DOJ approves the merger, then, according to the Department, competition will be reduced; (b) If DOJ opposes the merger, then, as Aetna's CEO already informed the Department, Aetna will withdraw from the exchanges, and thereby reduce competition.
I guess the Department is really convinced that the reduction in competition from (a), the merger, will exceed the reduction in competition from (b), Aetna's decision to pull out of the exchanges. That's an untenable level of confidence given the experimental nature of the Obamacare enterprise.
Aetna is a quality insurer and the exchanges do not benefit from the company's exit decision.
1
My daughter (age 26) lives in Scotland. All prescriptions are free, paid for by the National Health Service. Even medications that cost thousands of dollars in the USA. So are doctor visits. Free. When she visited the USA last week it cost her $120 for a visit to the local "urgent care" facility. My son (age 27) is too old for our family medical insurance and had to buy insurance on the "Obamacare" market. The cheapest policy costs him $100+ a month and the deductible is $6,400 a year!!! That means he has to pay full price for any medical care up to that amount. So while he has "catastrophic" insurance he certainly does not have meaningful, beneficial medical insurance to cover routine medical care. No wonder many people are simply not buying insurance on the "Obamacare" markets. The price is high and the policies don't help with day-to-day medical expenses. Time to provide useful coverage at a price people can afford. This means getting the insurance companies out of the picture and have a government-paid plan like the UK, Canada and so many other countries.
30
You son does not pay 'full price'. He pays his insurer's negotiated rate, unless he goes out of network. If he does, whatever he pays does not count against his deductible.
1
My son was surprised to learn that if he went through his insurance for all medical care that he did not have to pay full price. He had thought he just had to shell out the "uninsured price" until he paid the entire deductible.
Doctors in Scotland also earn around $80k-$100k/year... How do you propose getting them off their $300k+/year feeding trough and back in line with what the rest of the world pays?
One thing I have noticed is that while the NHS has plenty of flaws and plenty of sub-standard care, the Brits are the first to defend it. They are proud of it, and rightfully so.
One thing I have noticed is that while the NHS has plenty of flaws and plenty of sub-standard care, the Brits are the first to defend it. They are proud of it, and rightfully so.
Left out of this article are the millions of Americans who buy individual health insurance off exchange and the role they play in the market. By most accounts these unsubsidized Americans are equal or greater in number to those purchasing plans on exchange.
The ACA put everyone into the same risk pool for actuarial purposes, hoping to eliminate adverse selection. That failed because, unless you lived in a state like New York where everyone was compelled to buy through the exchange, the unsubsidized stayed off and bought insurance, as in the past, directly from insurers or through brokers. Many wisely held on to lower priced grandfathered plans or kept transitional plans until insurers cancelled them.
Aetna's withdrawal from the public exchanges. while at the same time continuing to sell individual insurance in most locations previously served off exchange, underscores the bifurcated market created. The exchanges are largely for low income, heavily subsidized people; off exchange for middle and upper income individuals. Aetna has more customers off exchange at 1.1 million than on exchange.
Aetna has kept its more profitable, lower risk customers and jettisoned the higher risk group with more medical claims. They complained to HHS about losses connected to the 90 day grace period for the subsidized (for others it's 30 days) and the outsize medical costs of exchange "special enrollment" customers as compared to off-exchange. Now they acted.
The ACA put everyone into the same risk pool for actuarial purposes, hoping to eliminate adverse selection. That failed because, unless you lived in a state like New York where everyone was compelled to buy through the exchange, the unsubsidized stayed off and bought insurance, as in the past, directly from insurers or through brokers. Many wisely held on to lower priced grandfathered plans or kept transitional plans until insurers cancelled them.
Aetna's withdrawal from the public exchanges. while at the same time continuing to sell individual insurance in most locations previously served off exchange, underscores the bifurcated market created. The exchanges are largely for low income, heavily subsidized people; off exchange for middle and upper income individuals. Aetna has more customers off exchange at 1.1 million than on exchange.
Aetna has kept its more profitable, lower risk customers and jettisoned the higher risk group with more medical claims. They complained to HHS about losses connected to the 90 day grace period for the subsidized (for others it's 30 days) and the outsize medical costs of exchange "special enrollment" customers as compared to off-exchange. Now they acted.
2
Actually you are incorrect.
"The ACA has several provisions that keep any potential for risk segregation in check. First, to keep insurers from segregating their risk pools, the ACA requires each insurer in the individual or small-group market to maintain a “single risk pool” for ACA-compliant plans.4 This means that insurers must use the same premium rating factors for all subscribers and plans within the relevant market, rather than using different rates for separate risk pools. If an insurer sells coverage both on and off the exchanges, rates must be identical for identical coverage. If coverage differs, rates may be adjusted only for actuarial value and not for differences in health status or overhead costs. Second, to counter insurers’ incentives to avoid greater risks across the market, the ACA has a risk-adjustment mechanism in the individual and small-group markets that requires insurers with lower-risk subscribers to subsidize insurers that enroll people expected to incur more medical claims."
http://www.commonwealthfund.org/publications/issue-briefs/2015/aug/compa...
"The ACA has several provisions that keep any potential for risk segregation in check. First, to keep insurers from segregating their risk pools, the ACA requires each insurer in the individual or small-group market to maintain a “single risk pool” for ACA-compliant plans.4 This means that insurers must use the same premium rating factors for all subscribers and plans within the relevant market, rather than using different rates for separate risk pools. If an insurer sells coverage both on and off the exchanges, rates must be identical for identical coverage. If coverage differs, rates may be adjusted only for actuarial value and not for differences in health status or overhead costs. Second, to counter insurers’ incentives to avoid greater risks across the market, the ACA has a risk-adjustment mechanism in the individual and small-group markets that requires insurers with lower-risk subscribers to subsidize insurers that enroll people expected to incur more medical claims."
http://www.commonwealthfund.org/publications/issue-briefs/2015/aug/compa...
It is important to consider how health insurance has changed in the last 40 years. Health Insurance companies have moved from not for profit to for profit entities. Even a not for profit cannot survive for very long with such huge losses. Simply stated, people sign up for policies, an underwriter rates policies, and individuals by a formula and premiums are set. A percentage of the premiums pay for operating costs, some are invested and some set aside for paying claims. To that end, for profits have in order to attract investors by making a profit and paying dividends. The science of health care is growing exponentially through research, app development and technological advances. How much an insurer will pay for care is negotiated with in network providers . In theory, the more people paying premiums the lower the cost for everyone but the reality of the " true cost" of paying was not considered. The reality is the premium itself. It is way to expensive for lower middle class and the poor to buy outright, living is too expensive.The government will have to cover premiums for these groups. Insurers are slowly reducing costs through differentiating between being admitted for care and being admitted for observation and terming caregivers differently...Dr's, nurses or hospitalists. Patients require the same physical care but claims are not paid at the same rate. Soon the tax for those that have employer plans will be due. A pill those who have plans will not want to swallow.
2
As usual, the article offers only a partial explanation of the ACA's failures. What about "Affordability" (the first "A" in the acronym). The ACA encouraged further formation of multibillion dollar health system cartels, including "ACOs". Under the guise of "clinical integration" and with no anti-trust enforcement, are we surprised to see massive horizontal and vertical health provider consolidation…. and resultant, big provider price increases?
While insurers profits are limited under the ACA (a min. 80% of premium must be spent on health benefits), there are no price controls for the cartels. No focus in the article re: why the 80% of premium rises so quickly.
How about the lame brain notion of trying to stimulate competition via not for profit coops, financed with taxpayer loans, now gone bust, leaving taxpayers with billions in losses. Is anyone surprised that a start up, financed with taxpayer money, would underprice when positioning against established insurers? (BTW, a large percentage of the US population already is covered by not for profit insurers, a fact never mentioned). Such under pricing certainly did not add stability.
DHHS also created great instability by arbitrarily extending open enrollment periods when the Fed Exchange website crashed, AND in subsequent years. Then, there were the Cadillac, mandated coverage levels, much more extensive than individuals previously purchased (e.g., contraceptives, abortion, no $ limits).
Economics 101!
While insurers profits are limited under the ACA (a min. 80% of premium must be spent on health benefits), there are no price controls for the cartels. No focus in the article re: why the 80% of premium rises so quickly.
How about the lame brain notion of trying to stimulate competition via not for profit coops, financed with taxpayer loans, now gone bust, leaving taxpayers with billions in losses. Is anyone surprised that a start up, financed with taxpayer money, would underprice when positioning against established insurers? (BTW, a large percentage of the US population already is covered by not for profit insurers, a fact never mentioned). Such under pricing certainly did not add stability.
DHHS also created great instability by arbitrarily extending open enrollment periods when the Fed Exchange website crashed, AND in subsequent years. Then, there were the Cadillac, mandated coverage levels, much more extensive than individuals previously purchased (e.g., contraceptives, abortion, no $ limits).
Economics 101!
1
The insurance companies DO negotiate with provider networks, and knock them down on price as much as they can. Even so, healthcare is overpriced across the board. You can go to a 'non-profit' hospital, and still receive a giant bill - the doctors, the nurses, the heads of the departments there make the same salaries they would in the commercial sector.
The provision of health care may be the ultimate Gordian Knot. To many of us who are progressive, we remain suspicious of any program that relies on a profit motive for something so essential as health care. The political climate is often one where companies portrayed as entrepreneurs and innovators are also looking to provide large amounts of money to executives and shareholders. These are funds not going to healthcare. I believe health care is a right, but I also believe that those who neglect their health, as opposed to those who have health issues beyond their control, should pay a penalty for their lack of concern for themselves and dependence on others financing their poor choices. Perhaps it comes from being a nation that has always put too much emphasis on individual freedom at the cost of weakening the social fabric and contract that united us as citizens. Some endeavors require a "bigger picture" and a focus on others, not just the self or the shareholders. After watching the "Reagan revolution" I am less convinced than ever that there is anything magical about a marketplace that puts profit over society. It is a bad mix as long as the profit motive cannot be tempered for social betterment and widespread improvement in health outcomes. After all, that is why we desire a national health insurance program in the first place. This one is failing because of too many concessions to choice, by providers and consumers.
12
Tom: VERY well said.
So you expect all providers to work for nothing or just enough to exist? Every employee wants a great standard of living, the higher trained want even more. That is a profit motive.
We will have single-payer health care. The question is: will it happen before or after Mammon's acolytes on Wall Street and in DC are hanging from street lamps. As an aside, free med school tuition would enable graduated doctors to work for what the rest of us could afford to pay.
2
@Times- Thank You for following up, with this analysis.
However, I think it's very important, to call out the relationship between this unraveling of the ACA (dare I say it ), and the sharp reduction in Risk Corridor funds, as detailed so exactly, in "Marco Rubio Quietly Undermines Affordable Care Act"
(http://mobile.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-a......
"The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio’s efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law’s new insurance marketplaces."
My Point is-- the original version of the ACA didn't have this fatal flaw. Rubio weakened it , and changed the ACA dramatically; so that now, it is not the plan that the health insurers signed up for.
Please publish further, about the elimination of the Risk Corridor funding, as well as other underlying causes for the destabilization of the ACA "business model." Thank you.
However, I think it's very important, to call out the relationship between this unraveling of the ACA (dare I say it ), and the sharp reduction in Risk Corridor funds, as detailed so exactly, in "Marco Rubio Quietly Undermines Affordable Care Act"
(http://mobile.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-a......
"The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio’s efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law’s new insurance marketplaces."
My Point is-- the original version of the ACA didn't have this fatal flaw. Rubio weakened it , and changed the ACA dramatically; so that now, it is not the plan that the health insurers signed up for.
Please publish further, about the elimination of the Risk Corridor funding, as well as other underlying causes for the destabilization of the ACA "business model." Thank you.
2
Blue Cross Blue Shield of Alabama has massive cash reserves. Yet, the non/profit corporation with a 76% market share in the state just after paid huge executive bonuses months ago and now announces a 40% rate up due to Obamacare. Profits over patients.
5
But they're 'non-profit'! How can this be? Aren't all their employees working for the benefit of humanity? Evidently not....
3
Health is a vehicle for insurance companies to make profit. Health care is what physicians, counselors, physical therapists and others do. Caring for everybody makes it difficult to make a profit when the profit comes from reducing care, raising the price, or limiting coverage in order to make a profit. We have to rethink how to pay for health care and that may not include insurance companies in the middle. This isn't rocket science. Actuaries can tell us how much it costs to provide health care and we can determine how to pay for it.
Aetna’s stance is yet another blatant example of corporations that place the interests of their shareholders above the basic needs of people who buy health insurance. Insurance companies are in the business of making profits and they influence members of congress through strong lobbying tactics to protect their corporate welfare. Having insurance companies provide health care through employment is an atavistic throwback to earlier times that no longer works. Health care is a basic right and not a privilege and the only effective way to ensure and deliver care for all Americans is through a single payer system.
30
Whenever the government inserts itself in an industry, chaos ensues. Obamacare is no exception. The plan was advanced by mr. Obama and others to save money while keeping your doctor and hospital. None of this was true and those that said this knew it. The architect mr. Gruber knew this from the start and knew Americans were too stupid to understand that it (Obamacare) was inherently flawed:
https://m.youtube.com/watch?v=Adrdmmh7bMo
How Americans can excuse this deception and waste of tax dollars is beyond my comprehension.
There is no solution better than a free market based system. The government has failed (again) so let's take our losses and go back to a free market system again. For those that cannot afford insurance we can give them the equilivent of food stamps to buy health insurance.
https://m.youtube.com/watch?v=Adrdmmh7bMo
How Americans can excuse this deception and waste of tax dollars is beyond my comprehension.
There is no solution better than a free market based system. The government has failed (again) so let's take our losses and go back to a free market system again. For those that cannot afford insurance we can give them the equilivent of food stamps to buy health insurance.
2
Sir, do you understand that "food stamps" or the "equivalent" are both funded entirely by a "waste of tax dollars," as you put it. However, that may be "beyond your comprehension."
Leave, insurers, please. Get the hell out of my medical life. Get on board, Congress, with single-payer healthcare. Stop your political power games. Do the right thing for the American people. Thank you.
5
Over half the co-ops set up by Obamacare are out of business costing taxpayers billions - The major insurance companies are dramatically reducing where they offer policies and where they do their premiums and duductibles are soaring plus fewer doctors and hospitals are part of the coverage - Not to mention 30 million Americans do NOT have any health insurance - In summary Obamacare is huge failure and the democrats lied to Americans in order to pass it...
3
People need access to medical care and I include people who are in the US illegally. We cannot just turn a blind eye to someone who is sick. That being said how do we distribute it and pay for it. I would charge the leader so the insurance companies and government officials to sit down at a table and work it out. We need to drop the repbulican and democrat theologies because they do work in the modern world. We need new ideas to be generated by people who believe in "hey, we can do this".
If only Nancy Pilosi had read it..
6
Lawyers don't read. I should know. I've worked for them for almost 30 years.
1
If the Feds want young, healthy folks to join up so they can pay for the old and sick, they are going to need more than a new advertising campaign. The prices have increased sharply over the past two years and I know my policy is going to jump in price this year. As one keeps dropping levels from Gold to Bronze to keep the payments from skyrocketing, the plans lose their luster. I'm paying $206 a month this year for the identical policy and income that cost me $161 a month last year. Here's the rub-I have had a $5500 deductible for the past two years because I can't afford the better plans. So I get to pay out of pocket for most things and I get to pay a premium. Such a deal. You can't buy a Gold plan on a Bronze salary.
20
The deductible is the insurance company's guarantee that they can collect the premiums, and nearly never have to be concerned boutique the customer using the plan, since they must spend their own money, all of it, before the plan pays one cent.
Obviously your plan must be a subsidized one, since the premium is that low; for my wife, not yet Medicare age, her deductible would be at least $5,000, with annual premium of at least $12,000.
So she has no insurance, and pays for every visit, and medication, plus the IRS illegal penalty, and still does not spend the $5,000 annually, so why buy coverage; of course there is the possibility of a major medical problem, but one could also get hit by a rock from space ...
Obviously your plan must be a subsidized one, since the premium is that low; for my wife, not yet Medicare age, her deductible would be at least $5,000, with annual premium of at least $12,000.
So she has no insurance, and pays for every visit, and medication, plus the IRS illegal penalty, and still does not spend the $5,000 annually, so why buy coverage; of course there is the possibility of a major medical problem, but one could also get hit by a rock from space ...
9
You hit the nail on the head; the problem is the "bronze salary" being paid to the overwhelming majority of hard working Americans. This is simply another example of corporate welfare; a taxpayer subsidized, hard profit floor for the massive insurance companies.
1
Yep... they just can't figure out why us young, dumb pleebs won't spend $150+ a month we don't have for the privilege and honor of paying all our own doctor bills until we exceed $5,000 (and some expenses won't even COUNT toward that). ON. WHAT. PLANET!?!?!! is health insurance a good deal?
I'm 31, I work 2 jobs that offer NO insurance and work wake to sleep at least 2-3 days a week without earning any overtime pay. If I do that and still can't earn enough to pay for health insurance even with relatively low monthly expenses like a $540 a month mortgage and liability-only coverage on a paid-off, 20 year old car? IT'S NOT AFFORDABLE AT ALL. I'm a pretty liberal guy in a lot of respects, but the ACA is a trainwreck and I have thus far refused to buy in.
If I get it, I won't have enough to pay a primary care doc. If I don't I'll be screwed if I get stuck in a hospital for a day.
I'm 31, I work 2 jobs that offer NO insurance and work wake to sleep at least 2-3 days a week without earning any overtime pay. If I do that and still can't earn enough to pay for health insurance even with relatively low monthly expenses like a $540 a month mortgage and liability-only coverage on a paid-off, 20 year old car? IT'S NOT AFFORDABLE AT ALL. I'm a pretty liberal guy in a lot of respects, but the ACA is a trainwreck and I have thus far refused to buy in.
If I get it, I won't have enough to pay a primary care doc. If I don't I'll be screwed if I get stuck in a hospital for a day.
2
Oh stop being a bunch of dummies. The ACA was designed to cause exactly what is happening as a step toward, "single payer," i.e., government paying and Controlling your health and medical care. As soon as reading groups pointed this trick out after Obama and the then Democratic controlled congress slammed the Act through before reading it - No Thank You Nancy Pelosi, et al - most of the media pooh-pooh the concern. Well, Obamaphiles, your chickens are coming home to roost, Suckers.
2
And you are better off than the "Suckers," how?
1
Other media sources describe a major part of the problem as being the virtually automatic issuance of "waivers" by government bureaucrats. Reportedly they routinely allow people to sign up "out of season," just as they realize they need an expensive procedure--surgery for example. Then, when these newly insured people recover, they simply cancel the coverage. Times reporters need to explore the extent to which this undue flexibility by government health system bureaucrats is a part of the problem.
2
The issue of single-payer or an improved medicare for all program is really straight forward and clear. It is not difficult to understand. We tax 2% of our personal incomes to cover the cost of health care. That's it. It is a progressive, not regressive, tax structure. 95% of people would end up spending less on healthcare than in our current system. No deductibles, co-pays or other hidden expenses. Single -payer would eliminate the $400 billion dollars wasted on administrative costs. Other savings would come from the ability of a single-payer system to set a budget and negotiate lower prices from drug companies. We would be free to seek care from any clinician or health provider.. All needed care is covered.This model of care has worked in developed countries though out the work. Taiwan is a recent, inspiring example.
What i find incredible is the lack of clear thinking on this issue. This includes much reporting by media outlets that buy into false statements made by both insures and our political leaders.It is well past time to look at the evidence right in front of us. Much suffering could be avoided if we adopted a single-payer system. The idea that a free market approach to health care is better than government involvement is not substantiated by any credible evidence.
What i find incredible is the lack of clear thinking on this issue. This includes much reporting by media outlets that buy into false statements made by both insures and our political leaders.It is well past time to look at the evidence right in front of us. Much suffering could be avoided if we adopted a single-payer system. The idea that a free market approach to health care is better than government involvement is not substantiated by any credible evidence.
3
If Aetna's leaving the exchanges, the Aexit if you will, forces the government to reconsider the "public option", then I say good riddance to another greedy corporate giant feeding at the taxpayer trough. To paraphrase Ike, beware the insurance industrial complex.
40
The public option or single payer won't happen for some time because Obamacare was our best shot at anything close to national healthcare for a while. The last time Hillary tried to "fix" healthcare was in 1992. On that basis, it will be another 25 years before we get get there.
1
This was a lie from the very beginning......you can keep your doctor, your premiums will be reduced by $2,500 a year. Pie in the sky promises made by an arm twisting president who refused to work with Republicans. If he had attempted any kind of cooperation and listened, instead of doubling down, we would not be in this mess.
And now, of course, liberals will blame health care companies that cannot afford to operate their businesses
And now, of course, liberals will blame health care companies that cannot afford to operate their businesses
4
I can assure you, sir, that the insurance companies are not even remotely close to a situation where they "cannot afford to operate their business"; rather they are whining about their inability to artificially create ever increasing profits/bonuses.
So it turns out that people purchasing insurance through the exchange are sicker than we had expected. This validates the need for Obamacare. Millions of people needed care but couldn't afford it. This also exposes the inherent conflict between medicine and the profit motive. Medicine's objective should be to help the sick. Yet, Aetna's specifically avoiding people because they need care.
3
This treachery by Aetna, effectively blackmailing the federal government as lackeys of libertarian forces that have tried to gut Obamacare from the start, should be a wake-up call to the American people about the threat that far-right forces pose to the American Middle Class. The very idea of a major player in the U.S. health care industry trying to destroy the marketplace exposes Aetna's base motives and their willingness to marshall force against the transparent best interests of both the nation and of its own members. I, for one, hope that Obama's lawyers find a way before he leaves office to slam Aetna executives until they cease using blackmail to achieve the evil aims of the Koch brothers and their ilk. It's time for decency and respect for the rule of law to trump (to use a word) greed and shameless self-interest.
27
"Decency" and "Respect", from our government, the government "we the deaf, dumb, blind, and stupid people, continuously place in power, to enslave us.
Those two words, from their twisted perspective, only apply to the proles.
Those two words, from their twisted perspective, only apply to the proles.
2
The problem is that they are asking healthy individuals to shoulder the costs disproportionately. If you don't qualify for a subsidized rate, you're expected to pay $500-$700 per month for a plan with a $6,000 annual deductible. It's exorbitant. No wonder they aren't getting the enrollments.
4
The cost factor will solve itself if s lot more Doctors were allowed to practice. Currently the AMA vehemently controls the number of Doctors thus artificially inflating costs. More doctors would allow costs to plummet, a lot less paperwork and s lot less bureaucracy.
2
Many post that if the government took over the nation' health care we'd be better off - just look at the VA - "isn't it great?" Well, actually, not so great. Speak to doctors who work at the VA or who have resigned from it and the view is much different. The only things that are great at the VA are the dissatisfaction level of the doctors and the individual patient costs.
Rapid turnover of frustrated doctors, for example, is the norm. Because of that there is little personalized care; patients are constantly facing new physicians who have no past medical history knowledge of the patient now sitting across from them. Of course there is the designed by committee computerized medical records system that can be referred too; as if the doctors faced with a heavy load have the time or patience to wade through an extraordinarily complex and inefficient system. Basically - a joke.
And then there is the typical convoluted hierarchy one can expect at a government run organization. Among the least powerful at the VA are the doctors themselves; the nurses for example, sit much higher as do the administrators. Best medical practice then takes third place to fulfilling CYA paper trails and political objectives. Gee - does this surprise? It's the government; this is what happens when the government takes over any enterprise.
Rapid turnover of frustrated doctors, for example, is the norm. Because of that there is little personalized care; patients are constantly facing new physicians who have no past medical history knowledge of the patient now sitting across from them. Of course there is the designed by committee computerized medical records system that can be referred too; as if the doctors faced with a heavy load have the time or patience to wade through an extraordinarily complex and inefficient system. Basically - a joke.
And then there is the typical convoluted hierarchy one can expect at a government run organization. Among the least powerful at the VA are the doctors themselves; the nurses for example, sit much higher as do the administrators. Best medical practice then takes third place to fulfilling CYA paper trails and political objectives. Gee - does this surprise? It's the government; this is what happens when the government takes over any enterprise.
5
Anyone who thinks nationalization of healthcare by our Federal politicians and bureaucracies would be a good idea isin denial. The reality is that despite having benefited a small % of the population(3% receiving health insurance of whom it is alleged half or more had prior insurance and were not uninsured), the ACA as implemented has damaged the fabric of care for all, resulting in increased costs due to an insane web of regulations, reporting requirements and mandates for dysfunctional electronic records and smaller networks of providers available to all patients whether in ACA, employer, Medicare or Medicaid plans. Waits for appointments are longer, older providers retiring faster, the majority of physicians seeking employment by hospitals and insurers, further increasing costs and rapidly increasing physician burnout are all consequences. In addition, the typical encounter with a physician, physician assistant, nurse practitioner or nurse for the average patient, in hospital or out now consists of verbal responses to the back of the head of someone typing and staring at a screen. Really humane. Further, the proportion of care provided by midlevels(NPs and PAs) employed by physicians, rather than physicians themselves has risen rapidly. The people who brought you all this are the ones who woud design and implement a national health plan. Good luck with that.
2
As private insurers pull out (good riddance) the US will have to provide a public option where there aren't enough private insurers. Perhaps let those people join Medicare early.
Once people see how much cheaper and better a public option is, everyone will want it. That will lead to single payer.
And finally the US can join the rest of the developed world, which figured out the solution to this problem a long time ago.
And all the people who worked for private insurers will then be able to do something productive with their lives.
Once people see how much cheaper and better a public option is, everyone will want it. That will lead to single payer.
And finally the US can join the rest of the developed world, which figured out the solution to this problem a long time ago.
And all the people who worked for private insurers will then be able to do something productive with their lives.
37
"Once people see how much cheaper and better a public option is, everyone will want it."
Virtually every "public option" insurer has gone out of business. The Insurance Commissioner in Connecticut just shut down Healthy CT, which was marketed as one of the best-run non-profits in the nation.
Public Option: Sounds great. Doesn't work.
Virtually every "public option" insurer has gone out of business. The Insurance Commissioner in Connecticut just shut down Healthy CT, which was marketed as one of the best-run non-profits in the nation.
Public Option: Sounds great. Doesn't work.
1
Why do you say that they must? If those Republicans in the house refuse to pass a bill allowing this, then it won't happen. And you mean those working for insurance companies will be hired by the government at higher compensation or be unemployed. It won't be cheaper in total or better either.
Health insurance costs in Europe are half of what they are in the US, care is better and everyone is insured.
Go figure!
Go figure!
7
and nationalize BigPharma as well, eliminate vampire corporate predations upon human suffering, pain, disease. genius pharmacology researchers will happily work in spare-no-expense state-of-the-art FDA-CDC facilities for $6-7 figures plus incentivizing bonus opportunity, thereby eliminating an Everest of useless-but-to-themselves executive suite & promotional expenses.
5
All these insurance companies merging to form "a combined insurance giant" sure sounds like Medicare for all controlled by gargantuan corporations. What could go wrong with that?
I wonder who benefits from having insurance companies as the middle man in this colossal betrayal of the right of the public to health care.
Obviously, the insurance companies are the master of this Ponzi scheme, aided and abetted by the pharmaceutical industry, giant hospital corporations, and as always greedy and corrupt politicians vying for contributions from those very entities.
Mr.Obama's plan to send out some emotional "testimonials” advertising the benefits of coverage under the Affordable Care Act" to "counter negative publicity generated by rising premiums, the withdrawal of major insurers like Aetna, Humana and UnitedHealth from many counties, and the collapse of insurance cooperatives in at least a dozen states" is a complete waste of taxpayer money and does not address any of the problems, but rather is a vain effort to tried to rescue his already flimsy legacy of accomplishments.
Was it fraud or just bait and switch when your health care reform was advertised as 'affordable'?
You should have gone for single payer, but you couldn't even get the democratic chairman of the committee, sell-out Sen.Bacchus, on board and then you rewarded him later with a cushy job as ambassador to China.
That and your secret deal with Big Pharma make your signature legislative 'accomplishment" a total joke.
I wonder who benefits from having insurance companies as the middle man in this colossal betrayal of the right of the public to health care.
Obviously, the insurance companies are the master of this Ponzi scheme, aided and abetted by the pharmaceutical industry, giant hospital corporations, and as always greedy and corrupt politicians vying for contributions from those very entities.
Mr.Obama's plan to send out some emotional "testimonials” advertising the benefits of coverage under the Affordable Care Act" to "counter negative publicity generated by rising premiums, the withdrawal of major insurers like Aetna, Humana and UnitedHealth from many counties, and the collapse of insurance cooperatives in at least a dozen states" is a complete waste of taxpayer money and does not address any of the problems, but rather is a vain effort to tried to rescue his already flimsy legacy of accomplishments.
Was it fraud or just bait and switch when your health care reform was advertised as 'affordable'?
You should have gone for single payer, but you couldn't even get the democratic chairman of the committee, sell-out Sen.Bacchus, on board and then you rewarded him later with a cushy job as ambassador to China.
That and your secret deal with Big Pharma make your signature legislative 'accomplishment" a total joke.
28
Chris, your comment is so right on! Senator Baucus responded to the corporations that so well funded his campaigns, as did Senator Lieberman. The public option never stood a chance in our corrupt electoral system. Our best hope at this time, as advocated by Bernie, is to expand Medicare to younger folks, and to keep expanding it little by little.
1
Just as new very sick people came pouring into the clinics due to being able to buy Obamacare policies, Obamacare laid an enormous bureaucratic burden on physicians, forced them to use unfamiliar electronic charts, and changed the economics so that doctors all are now employees of hospitals, few independent clinics remain.
Of course patient care has collapsed as a result!
Of course patient care has collapsed as a result!
3
We'll see who plays the better long game, President Obama or the greedy insurance companies. I'm betting on the Prez.
5
The Affordable Care Act has completely upended the medical care industry - and not for the better for the consumer, or the nation's finances. Consequences of the ACA have included the rise of giant hospital organizations with insatiable appetite to swallow independent physician practices and smaller local hospitals. This was a purposeful intention of the ACA - and, according to the Journal of Medical Practice - raised the per patient costs to Medicare alone by over 30% since its inception.
Doesn't it make sense that hospital systems not facing competition can charge ever higher fees? And because these monopolistic systems have turned the table on insurance companies even the insurance companies are in no position to resist. Clearly this is the underlying reason insurance companies are seeking to combine - it's the only counter to the giant hospitals' market power.
None of this has brought efficient or improved health care. This could have been accomplished much simpler by the expansion of the one part of the ACA which is working to some extent - the expansion of Medicaid. That would not have engendered the total realignment of the industry and the much higher costs the nation is now settled with. But then, the would have been counter to the idealogical forces of Democrat and Obama administration progresiveism unleashed upon the nation in typical underhanded and subterfuge manner, which, in the light of day, would never have passed muster with Americans.
Doesn't it make sense that hospital systems not facing competition can charge ever higher fees? And because these monopolistic systems have turned the table on insurance companies even the insurance companies are in no position to resist. Clearly this is the underlying reason insurance companies are seeking to combine - it's the only counter to the giant hospitals' market power.
None of this has brought efficient or improved health care. This could have been accomplished much simpler by the expansion of the one part of the ACA which is working to some extent - the expansion of Medicaid. That would not have engendered the total realignment of the industry and the much higher costs the nation is now settled with. But then, the would have been counter to the idealogical forces of Democrat and Obama administration progresiveism unleashed upon the nation in typical underhanded and subterfuge manner, which, in the light of day, would never have passed muster with Americans.
4
Soc!***ized Med***ne.
There, I've said it !
1
I guess you have to be a 78 year old man like me to remember it was not always this way . when I entered the work force back in the late 50'ts , as far as I can recall , there was only blue cross and blue shield health insurance to cover your health care cost . The cost of this coverage was deducted from your paycheck twice a month . The amount deducted was so insignificant that it did not even need to be figured into your monthly expenses .
What went wrong ?
I believe it started during the Nixon years when they came up with " competition in the marketplace " idea . Does not seem to be working out to good for us serfs does it ?
Like Michael Douglas said in the movie Wall Street , Greed is good , for some people ,that is , for everybody else ,well, just let them eat cake .
What went wrong ?
I believe it started during the Nixon years when they came up with " competition in the marketplace " idea . Does not seem to be working out to good for us serfs does it ?
Like Michael Douglas said in the movie Wall Street , Greed is good , for some people ,that is , for everybody else ,well, just let them eat cake .
47
Leave to a Times reader to blame Nixon for the failure of ACA. Shush.
3
I also remember the 'old' system. My parents had BCBS from work. they paid 80%, the insured paid 20% of a health care event. Back then we didn't go to the doctor just because we had a sniffle or a hang nail. We certainly didn't go to the emergency room unless we broke something or worse. I think the biggest change (possibly to the negative) was the 'new' idea and implementation of HMO, or Health Management Organizations. People complain about costs but one thing I know is that if I have to have heart or brain surgery I want the attending medical staff to be very happy campers, I want the OR and ICU to be top flight (even acknowledging that something could still go wrong). If that means they get paid a lot it's worth it.
1
Of course, the other side of that is we might be able to have 1958-level healthcare costs if we were OK with a 1958 level of healthcare -- no CAT scans, no MRI's, no joint replacements, few if any transplants, no NICU's, far fewer drugs, fewer cardiac and cancer treatment options, etc.
If insurers are unhappy, and those whose insurance premiums have skyrocketed are unhappy, and health care providers are unhappy, it seems that the only ones who are happy are the formerly uninsured and the politicians who can now bicker over the efficacy of Obama Care.
6
The Supreme Court, Free Higher Education and Medicare for all!
It's absurd to read comments here that government-mandated healthcare can't work.
Such systems have been running for a lifetime in every other wealthy country -- where healthcare is half the price, covers everyone, and gives equivalent outcomes. Most of these countries have no medical bankruptcy, no one goes without healthcare because of cost, and no one spends a second worrying if they have coverage. All these countries started off with a US-style free-market approach: obviously none of them will go back.
Shouldn't we ignore anyone who says, "It can't work"?
Such systems have been running for a lifetime in every other wealthy country -- where healthcare is half the price, covers everyone, and gives equivalent outcomes. Most of these countries have no medical bankruptcy, no one goes without healthcare because of cost, and no one spends a second worrying if they have coverage. All these countries started off with a US-style free-market approach: obviously none of them will go back.
Shouldn't we ignore anyone who says, "It can't work"?
4
The US spends twice as high a percentage of GDP, as other OECD nations for healthcare. For worse outcomes and a lower life expectancy.
http://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf
But of course, as she that must not be criticized says, this is not possible here in American't. She is for a Universal Insur. type coverage. Why would anyone be against a not for profit system? Because they get paid. They get paid really, really well, to not be for single-payer. Exploitation of sick and dying men, women and children.
As STMNBC said in an NYT '08 interview, " You know, I have thought about this, as you might guess, for 15 years and I never seriously considered a single payer system."
The American't Peoples financial losses produce astronomical financial gains for the investors in Pharm., Insur. and HealthCare Corp. Not to mention the stratospheric pay and pensions of it's executives.
There is good reason these same characters were partying big in the Dem. Pa convention.
Just as with the other Op-Ed today discussing America's Gov. being the largest gun runner in history. We make and allow those cluster bombs banned in the rest of the world. These are choices you/we make and allow. Blame and Shame. Those that expect and accept fraud, deception, media collusion and election manipulation. These pragmatic, incrementalist that have sold us out to Mammon.
But hey, STMNBC has said (ha!) she'll think about a Medicare buy in. Maybe.
Well alright! Never mind.
http://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf
But of course, as she that must not be criticized says, this is not possible here in American't. She is for a Universal Insur. type coverage. Why would anyone be against a not for profit system? Because they get paid. They get paid really, really well, to not be for single-payer. Exploitation of sick and dying men, women and children.
As STMNBC said in an NYT '08 interview, " You know, I have thought about this, as you might guess, for 15 years and I never seriously considered a single payer system."
The American't Peoples financial losses produce astronomical financial gains for the investors in Pharm., Insur. and HealthCare Corp. Not to mention the stratospheric pay and pensions of it's executives.
There is good reason these same characters were partying big in the Dem. Pa convention.
Just as with the other Op-Ed today discussing America's Gov. being the largest gun runner in history. We make and allow those cluster bombs banned in the rest of the world. These are choices you/we make and allow. Blame and Shame. Those that expect and accept fraud, deception, media collusion and election manipulation. These pragmatic, incrementalist that have sold us out to Mammon.
But hey, STMNBC has said (ha!) she'll think about a Medicare buy in. Maybe.
Well alright! Never mind.
2
We continue to be held hostage by the profit-driven agenda of big health insurance companies. That has to stop. If Aetna or United Healthcare want to pull out of the Affordable Health Care exchanges, then they shouldn't be allowed to operate in those States. What they're doing is discriminating against certain consumers. They should be sued. We need affordable healthcare, and if these companies are in the way, then get them out.
5
Canadian doc here. When you finally get what you think you want (single payer), and every problem you have now is worse, you will understand what fools you were to want it.
But on the plus side, every American will technically be on the list stating they have coverage. Maybe that will make you feel warm and fuzzy while you wait 18 months to see a specialist.
But on the plus side, every American will technically be on the list stating they have coverage. Maybe that will make you feel warm and fuzzy while you wait 18 months to see a specialist.
9
I assure you Robert, when it fails spectacularly these same folks will convince themselves it was a success. Just look at the current delusions about Obamacare in these very comments.
2
Time to start the public option ... if HRC wins, she'll do that, right? Ha.
2
Let me share my story. At the time I was 63 years old. I was on a group plan for which I was paying $500 a month and with miniscule copays ($10). When I became ineligible for the group plan at work, I had to buy Obamacare. The same plan I had just days before now cost $900 a month. Same plan. So I went with the bronze plan which cost me $500 a month which came with big copays and deductibles up to $5000 a year.
The point being, I don't think these insurance companies are losing on the program. In my case, they made twice as much money.
These insurance companies are feeding at the government trough through Medicare and Medicaid. They shouldn't be allowed to charge more than their group plan rate.
This is just another of their continuing efforts to get rid of the customers they don't want. Which is what they have been doing over the last thirty years through loopholes in the laws, mergers and non-profit to profit conversions.
The stories about young people not signing up is just smoke. I can guarantee you this, 60 year olds pay a lot more in insurance premiums than 30 year olds. The premiums that insurance companies charge are still based on costs associated with each age group.
The point being, I don't think these insurance companies are losing on the program. In my case, they made twice as much money.
These insurance companies are feeding at the government trough through Medicare and Medicaid. They shouldn't be allowed to charge more than their group plan rate.
This is just another of their continuing efforts to get rid of the customers they don't want. Which is what they have been doing over the last thirty years through loopholes in the laws, mergers and non-profit to profit conversions.
The stories about young people not signing up is just smoke. I can guarantee you this, 60 year olds pay a lot more in insurance premiums than 30 year olds. The premiums that insurance companies charge are still based on costs associated with each age group.
5
The insurance companies who are losing money reported they had each had several thousand customers using more than $100,000 worth of medical care a year. That is how they can lose, even if most of the customers pay huge premiums get nothing in return.
3
Sure, that's their job. They have people on group plans that are using more than $100,000 a year and people on Medicare using more than $100,000 a year.
1
Yet it is a fact that the insurers are losing money. Just because you pay more, doe not mean they make more. When they cannot turn anyone down, they get loaded up wth sick people, their costs skyrocket and they lose money even when charging more.
1
Insurance companies having to make large price increases, offer fewer services and shut down altogether is exactly what was predicted would happen with the ACA, and exactly what is happening.
At this still in the era of subsidies. When they cut back next year as schedule, you will finally feel what Obamacare really is.
At this still in the era of subsidies. When they cut back next year as schedule, you will finally feel what Obamacare really is.
2
Single Payer!!! Say it loud and proud...SIngle Payer!
3
At what price? People said 'yes' when they were asked if they wanted equal access to health insurance without regard to pre-existing conditions, and then complain when they were told OK, your bill is now $1400 a month for coverage.
So if I tell you OK, single payer, your share in taxes is $40,000 a year, do you promise not to complain?
So if I tell you OK, single payer, your share in taxes is $40,000 a year, do you promise not to complain?
6
The writing's on the wall all caps that ACA is a massive failure, and what's the administration's response? An advertising campaign seeking "testimonials"! Talk about heads in the sand, only in America can a sitting president with nothing to do, indulge in re-painting massive failures as "successes", not just that, endorse his wannabe successor running on the same so-called successful track record. When, in fact, Hillary should be actively distancing herself from Obama's blunders and proposing overhauls.
But Hillary doesn't have to and won't. Why? Because the American people are dummies. If GW got re-elected despite his lying about Iraq, HRC can just as easily sweep Obama's failures under the carpet with no price to pay (as long as he scratches her back which finally ended up doing).
Fact is, the insurance companies should be applauded for sending a strong message to government: that the private health insurance business model, not unlike life insurance, is permanently broken.
The only model that succeeds in favor of people's health is one that socializes it. Which in turn implies strong regulation, strong governmental control, and a heavy, continuous hand in all medical choices, including those who execute them, yes doctors and big pharma.
The last of which explains why single pay will never see light of day, it's too high a cost for Americans. So what's one to do? Nothing. Americans have neither the will nor the capacity for change. Have a nice day.
But Hillary doesn't have to and won't. Why? Because the American people are dummies. If GW got re-elected despite his lying about Iraq, HRC can just as easily sweep Obama's failures under the carpet with no price to pay (as long as he scratches her back which finally ended up doing).
Fact is, the insurance companies should be applauded for sending a strong message to government: that the private health insurance business model, not unlike life insurance, is permanently broken.
The only model that succeeds in favor of people's health is one that socializes it. Which in turn implies strong regulation, strong governmental control, and a heavy, continuous hand in all medical choices, including those who execute them, yes doctors and big pharma.
The last of which explains why single pay will never see light of day, it's too high a cost for Americans. So what's one to do? Nothing. Americans have neither the will nor the capacity for change. Have a nice day.
4
This problem is easily fixed. If a healthcare company refuses to participate in the marketplace in a particular state, make that company ineligible to participate in any government programs in that state. They'll eat their tiny marketplace losses to keep the lucrative Medicare faucets on.
Additionally, make insurers pay 85% of their profits on claims. That will stop all the bogus rate hikes that do nothing more than increase profits.
One last thing: Make it illegal for politicians to take contributions that are in any way connected to insurers or big pharma . With no incentive to bow to those interests, I truly believe our legislators will do the right thing. Politics must be disengaged from health care.
Additionally, make insurers pay 85% of their profits on claims. That will stop all the bogus rate hikes that do nothing more than increase profits.
One last thing: Make it illegal for politicians to take contributions that are in any way connected to insurers or big pharma . With no incentive to bow to those interests, I truly believe our legislators will do the right thing. Politics must be disengaged from health care.
6
Reality check affordable health care act saved wall street an made trillions for health care stocks .never entended to provide health care for poor
2
Losing money bull. They said it was a good investment recently and they threatened to pull out if the Justice department did not approve their merger with Humana. The administration refused the extortion. They did not get their merger and they made good on the threat. It's as simple as that.
3
We should allow Medicare to take over the customers of the insurance companies that stop offering ACA policies.
3
They can dig up all the testimonials they want. It's like putting your finger in the dyke as the water comes gushing over the top and the cracks widen very fast. Obamacare is a disaster, Unless you are poor enough to get on Medicaid, which won't help that much anyway, you will be throwing money away. And there's all the other side problems like the penalties and the IRS coming after you. I was audited twice because of this law, and believe me I only made enough to just barely not qualify for Medicaid. The sooner it collapses the better. I would rather go back to what was before, as bad as it was, then keep the ACA. Sooner or later the whole health care system will fall apart, if it hasn't already. And maybe then we will finally wake up and implement single payer or medicare for all. Maybe Mrs. Clinton will try like she did as first lady, but I am not very optimistic about that either. Once a month there's another article like this for how many years now. Health Care for profit will never work. And anyone who thinks it will is either lying or feverishly fooling themselves.
Orange, NJ
Orange, NJ
6
After working full time for 44 years as a nurse and raising my children as a divorced parent, I now find myself at the poverty level and can't even afford to buy in to Obama Care. Due to declining health, I had no choice but to retire early. There are no 401Ks, savings,etc. Raising children alone does not leave any extra money to save. I've made some poor choices and now must pay the price. I expect I will be homeless soon. Since I don't have health insurance, I can't have any tests to confirm my disabilities. SSI disability is not an option. What little allowance I receive from Social Security is now being used to pay NYS taxses from 1999, repayment to Social Security as they made an error calculating my allowance and payment to the IRS due to an error in my 2015 tax return. Plus at tax time I will have a large penalty charge for not having Obama Care. I recently turned 63 but I'm not sure I will see 64. So much for the Golden Years. If I had stayed home with my children and lived on Welfare, I would probably be better off now. God Bless America!
so much
so much
6
Aetna has a reputation for always denying claims (as does Cigna). Mid-level providers - the ones who aren't physicians but who do you the favor of billing your insurance - are being squeezed out. The cost of running a small independent practice - psychotherapy, OT, PT, SLP or Nurse Pract. type - is much higher than people realize. For every hour of therapy I provide I am doing another half hour to 45 minutes of paperwork and have extensive costs that go with that. The solution for mid level providers is not to provide for those insurance companies that don't pay, or fight you for reimbursement, or to go to a cash only practice for a fee that actually gives you a real wage. Aetna has no money? Please. They never pay out to most of us, they're sitting on a boatload of it. Same with Cigna...whose offered reimbursement to providers is 20 dollars below Medicaid - the gold standard for low. Single payer may be a solution for consumers but not for providers - the pay is very low and if you're doing Medicare the application process, reimbursement rates and denials make it not worth bothering with.
1
single-payer or bust
4
So if that is so, when does the POTUS and Hillary start to demonize the insurers?
Or is there another executive order up their sleeves?
Or is there another executive order up their sleeves?
1
Has anyone considered that the cost of health care is just outrageous? If insurers are having to pay costly claims, it's because people are being charged extraordinary amounts for health care. Last summer my son had to go to the emergency room, doubled over with severe stomach pains. He didn't even get a room, but a cot in the hall. An all day visit, he was given an MRI and of course 3 doctors had to read his scan and consult. He was also given pain killers. His bill was $10,000!!! The stomach ailment came from bad lettuce. Sorry, but that's just a rip off. And the fact that people are being forced to buy insurance makes medical providers bolder in gouging sick people.
I wonder how many people actually pay off enough of their deductible for the insurance to even cover anything? Instead of hunting for testimonials, why not do something to control skyrocketing costs for health care? It seems to me, that would solve most problems. If that can't be done, then bring on single payer.
I wonder how many people actually pay off enough of their deductible for the insurance to even cover anything? Instead of hunting for testimonials, why not do something to control skyrocketing costs for health care? It seems to me, that would solve most problems. If that can't be done, then bring on single payer.
46
No, NYT readers have never considered that health care costs are really, really big!
You must have figured that out somehow.
Hospitals are full because we are older, more frail, needing more medical care. Perhaps if seniors had their health care rationed and couldn't in hospitals then your little snowflake wouldn't have waited so long.
And as for waiting on a cot, I got a cot and got shoved into a utility room awaiting heart surgery. Just too many people in the hospital.
You should pray for a plague.
And once again, brilliant point about the costs of healthcare!!
You must have figured that out somehow.
Hospitals are full because we are older, more frail, needing more medical care. Perhaps if seniors had their health care rationed and couldn't in hospitals then your little snowflake wouldn't have waited so long.
And as for waiting on a cot, I got a cot and got shoved into a utility room awaiting heart surgery. Just too many people in the hospital.
You should pray for a plague.
And once again, brilliant point about the costs of healthcare!!
I was recently in Strasbourg, France, of course as a non citizen. Went to hospital ER for tooth ache, had abscess diagnosed and was given prescription for antibiotic. In and out in 20 minutes, paid them 60 euros, antibiotic was 12. If I had gone to dentist there, all procedures are capped at 170 euros, root canal and crowns included.
Private insurance companies negotiate the cost of health care with providers. Before I retired, my health insurance was Blue Cross that was provided by my employer. My doctor thought I should have an MRI of my head (he suspected I had seizures). The MRI was negative and the bill was $2200. Because my neurologist was part of the group of preferred doctors, the cost to Blue Cross was about $1200 (I paid 20% and Blue Cross paid 80%). If I had not had insurance, I would have been stuck with a bill for $2200 and I either would have had to take out a loan (like taking out a loan to buy a house or a car) or simply refused to pay the bill and declared bankruptcy. This is why it is so important to get people covered by insurance.
Didn't the single payer folks warn you that this would happen?
Thank you. I thought so.
I won't bother explaining it again, since evidently "only a fool learneth by experience."
Thank you. I thought so.
I won't bother explaining it again, since evidently "only a fool learneth by experience."
5
The only way to ensure that everyone participates is for the government to pay for everyone. This could be accomplished by a national Value Added Tax of 10%. No more premium payments or deductibles. The tax will be hard to dodge, and will be paid by everyone, including those who are who are not reporting incomes.
2
And those not reporting income will have a lucrative new business of selling untaxed goods.
1
I just love the socialist mental midgets on the my times that think "well if this forced socialist system doesn't work, it's only because we haven't made it even more socialist" .
Why is it so hard to learn the lessons of other countries that are failing at a single payer system. And I do mean FAILING!!
It is not a success when a single payer system starts dropping options that are only available outside of it! You get an overpriced system that gives universal very little or simple basic care that would be much much cheaper without a single payer system.
Why not simply do the same system as car insurance. Allow cross state competition.
Why is it so hard to learn the lessons of other countries that are failing at a single payer system. And I do mean FAILING!!
It is not a success when a single payer system starts dropping options that are only available outside of it! You get an overpriced system that gives universal very little or simple basic care that would be much much cheaper without a single payer system.
Why not simply do the same system as car insurance. Allow cross state competition.
20
Really? Holland and Germany and France and all of Scandinavia? Most actually have rational systems that support both public and private sources of coverage. The main thing is that nobody in those societies goes without care. Can't say that about the good ole non-socialist USA.
Why is this comment a TImes pick?
1
Do you understand that the only socialist health insurance is Medicare and Medicaid? Socialism is government control of the means of production. There is no market and law of supply and demand under socialism that determines prices and wages.
Under tha ACA, you must purchase private health insurance (there are multiple-payers), unless you are eligible for Medicaid, then the government is the single-payer.
When the government pays providers for services, the market does not determine what is paid, Medicare decides what the Medicare-approved amount is and then pays this amount.
I live in Nebraska where there is public power. We the people own the electric company. This is socialism because the government provides our electricity. My electric bills are lower than those in states where private companies generate electricity. This is because a private company must maximize shareholder value. My electric company has no shareholders. This means it can return any excess revenue over the cost to generate electricity back to the people in the form of low electric rates.
I'll take Medicare any day and twice on Sunday over private health insurance.
The only people who benefit from capitalism are the capitalists because as Ayn Rand famously said: "selfishness is a virtue."
Under tha ACA, you must purchase private health insurance (there are multiple-payers), unless you are eligible for Medicaid, then the government is the single-payer.
When the government pays providers for services, the market does not determine what is paid, Medicare decides what the Medicare-approved amount is and then pays this amount.
I live in Nebraska where there is public power. We the people own the electric company. This is socialism because the government provides our electricity. My electric bills are lower than those in states where private companies generate electricity. This is because a private company must maximize shareholder value. My electric company has no shareholders. This means it can return any excess revenue over the cost to generate electricity back to the people in the form of low electric rates.
I'll take Medicare any day and twice on Sunday over private health insurance.
The only people who benefit from capitalism are the capitalists because as Ayn Rand famously said: "selfishness is a virtue."
1
The problem has never been access to health insurance, rather it's health care in the USA costs far too much! ACA hasn't done anything tangible to fix this. Until the cost-side of the problem has been addressed, it won't matter who is paying, even single-payer -- we can't afford it.
48
David, it seems to me that you believe we are here to serve corporations and actually it is suppose to be the other way around.
1
Great comment, right on. But now tell me the answer: what country HAS addressed the cost-side? And, please...don't say Canada, or the Europeans. Both of them are so mired in healthcare-related costs that their economies make ours look like a DYNAMO!
2
Yup. Costs won't get controlled until we actually control costs. Basically all of the alleged problems with the ACA stem from the compromised and Rube Goldbergish nature of it, trying to accomplish goals indirectly that single payer addresses head-on.
No innovation, no investment, no advances in healthcare delivery have come from single-payor systems. They all piggy-back off American pharma, lab, med schools, research, imaging, etc., all the innovation which comes from the American system. Kill that (which single-payor will) and you damage the global healthcare system.
The only way forward is to move quickly from fee-for-service to multiple competing Kaiser-model HMOs in each region, such as you see in the SF Bay Area and LA.
With the Kaiser model the inpatient, specialist, and primary care functions are all integrated, providing excellent continuity of care. Departments and providers are continually rated for quality and patient satisfaction, and low scores mean quick consequences.
Most important, the healthcare delivery and insurance functions are combined in one organisation, so all the economic incentives are aligned and pointing in the right direction! Kaiser loses money if they don't take good care of their populations! They create a surplus (for investment or lowering premiums) if patients are healthy and need less care! This is the opposite of fee-for-service, where the sicker patients are, the more care they need, the more bills are generated, the more revenue is generated, and the providers/insurers make more money!!
The present fee-for-service system is based on perverse economic incentives which drive demand, costs, and revenue up, not down!! Single-payor will not change this at all.
The only way forward is to move quickly from fee-for-service to multiple competing Kaiser-model HMOs in each region, such as you see in the SF Bay Area and LA.
With the Kaiser model the inpatient, specialist, and primary care functions are all integrated, providing excellent continuity of care. Departments and providers are continually rated for quality and patient satisfaction, and low scores mean quick consequences.
Most important, the healthcare delivery and insurance functions are combined in one organisation, so all the economic incentives are aligned and pointing in the right direction! Kaiser loses money if they don't take good care of their populations! They create a surplus (for investment or lowering premiums) if patients are healthy and need less care! This is the opposite of fee-for-service, where the sicker patients are, the more care they need, the more bills are generated, the more revenue is generated, and the providers/insurers make more money!!
The present fee-for-service system is based on perverse economic incentives which drive demand, costs, and revenue up, not down!! Single-payor will not change this at all.
21
As a physician, my thought is to take to take it even further.
Create a nonprofit company in each state and make every person 18 and up a shareholder.
The shareholders elect a Board of Directors who sets the price of healthcare in their state along with the base fee everyone pays to fund their health system.
The Board of Directors from all states pick one electronic health record. And then each Board (as essentially a private company) can leverage down the price of medications.
My idea is called P.S.Y.C.H (Practical Solutions Yielding Comprehensive Healthcare) and is the only way to get health insurance out of the equation. And I agree: single payer will only worsen the current conditions. It's time to think outside the box!
Create a nonprofit company in each state and make every person 18 and up a shareholder.
The shareholders elect a Board of Directors who sets the price of healthcare in their state along with the base fee everyone pays to fund their health system.
The Board of Directors from all states pick one electronic health record. And then each Board (as essentially a private company) can leverage down the price of medications.
My idea is called P.S.Y.C.H (Practical Solutions Yielding Comprehensive Healthcare) and is the only way to get health insurance out of the equation. And I agree: single payer will only worsen the current conditions. It's time to think outside the box!
1
This is spot-on in my opinion. The real issue is the high cost of health care. As American expat, I can the astounding difference in costs, and there is not necessarily a difference in quality. A friend from the US visited a hospital here in Bangkok and was impressed not only with the services and facilities, but the prices were the real jaw dropper. A health check-up, with all the bells and whistles costs between $300-500. So the rub is the high costs.
1
The problem is "economic incentives" in the first place. When health care is profit driven you will always find corruption, corners will always be cut, deals will always be made. The capitalist model neither works well for government nor medical services. Just ask the people in Kansas who live in a state with privatized Medicaid under the euphemism “KanCare,” where costs go up and services are not rendered. Corruption, whether one likes it or not, is at the very heart of the capitalist model since it is premised on a zero-sum game or as Paul Ryan likes to say, there are winners and losers. Compassion, as Ayn Rand told generations of her acolytes is for sissies. In other words, if patients weren’t so stupid they’d never be sick. In this world if you are sick you are a loser and let the devil take the hindmost.
10
Folks, it's basic economics, and single-payor won't change that. An expanding aging population with chronic illness, growing obesity, and a shrinking pool of healthy young workers, many of whom don't want to pay for insurance they feel they don't need - do the maths yourselves. No organisation can run in the red forever, and nationalising them won't change that.
Obamacare/ACA does nothing to contain healthcare costs, and the only way single-payor can lower costs is 1) by forcing doctors, nurses, pharmacists, lab techs, etc. to work for less 2) forcing pharma and device/supply makers to lower their prices, leading to less investment and eventual bankruptcy, thus killing the golden goose which provides the entire world with advanced medicine.
I've spent over thirty years working on healthcare reform, six of them consulting for the NHS in the UK. Believe me, you do not want single-payor. Stifling bureaucracy, no integration between hospital and primary care, higher admin costs and admin staffing than private insurance, low salaries for nurses, no innovation, no investment, low quality of care (especially oncology, cardiac, maternity, and eldercare), and very low patient satisfaction. In single-payor, costs and demand are controlled by very long wait times for services. So folks here avoid care, don't get preventive care, and then go to the ER when they fall ill. Last winter there was a crisis when the ERs clogged up during flu season.
Obamacare/ACA does nothing to contain healthcare costs, and the only way single-payor can lower costs is 1) by forcing doctors, nurses, pharmacists, lab techs, etc. to work for less 2) forcing pharma and device/supply makers to lower their prices, leading to less investment and eventual bankruptcy, thus killing the golden goose which provides the entire world with advanced medicine.
I've spent over thirty years working on healthcare reform, six of them consulting for the NHS in the UK. Believe me, you do not want single-payor. Stifling bureaucracy, no integration between hospital and primary care, higher admin costs and admin staffing than private insurance, low salaries for nurses, no innovation, no investment, low quality of care (especially oncology, cardiac, maternity, and eldercare), and very low patient satisfaction. In single-payor, costs and demand are controlled by very long wait times for services. So folks here avoid care, don't get preventive care, and then go to the ER when they fall ill. Last winter there was a crisis when the ERs clogged up during flu season.
34
That is nonsense. Citizens of socialist civilized countries live longer, healthier lives, and nobody has ever seen a doctor or researcher in those countries standing in a breadline.
2
If they don't want to apply the law the break them up and distribute them around to smaller companies or pass a Single Payer option instead of the current one.
The NHS is not just single payer, it is a socialized delivery system -- I have had substantial contact with it since my husband's family is in the UK. One of our children was hospitalized while we were visiting; years of observing the plusses and minuses of the system for my mother-in-law (died at 100) and sister-in-law (with Parkinson's). On balance, infinitely better than the US, but not problem free. Short of resources at the beginning, and way too complicated since the various rounds of internal market reforms (started under Conservatives, but continued/altered by Tony Blair's Labor government)
“A company’s business interests may conflict with a program’s policy goals”. So? Who wins? Government, flogging its policy goals at any cost to business, or business deciding that it’s time to get off the train merely to survive? If it’s government, then forget about ever seeing an economic revival here again, because what we’re living in is no longer America but … Finland; and businesses here won’t spark such a revival.
Dems have been claiming for years that ObamaCare is working just fine, though it’s clear that the whole mess is dysfunctional: skyrocketing premiums causing people to do without and pay the tax penalty, basically paying retail for their healthcare because they don’t exceed stratospheric deductibles; offering nothing to the healthy young, who avoid it like the plague; insurers and government surrogates that can’t survive unless subsidized with more and more tax dollars until they destroy our capacity to do anything else as a society – much as Medicaid has been doing for years in our states.
Since we can’t blame the authors of this mess, we must now blame insurers for the program’s fundamental lack of viability. But how long can you lose hundreds of millions or billions per year and remain in business? FOR-profits or NON-profits?
Some Republicans call for the dismantling of HHS. This would be extreme, but government’s inability to avoid the consequences of a program it rammed down our throats and that just doesn’t work simply feeds that fire.
Dems have been claiming for years that ObamaCare is working just fine, though it’s clear that the whole mess is dysfunctional: skyrocketing premiums causing people to do without and pay the tax penalty, basically paying retail for their healthcare because they don’t exceed stratospheric deductibles; offering nothing to the healthy young, who avoid it like the plague; insurers and government surrogates that can’t survive unless subsidized with more and more tax dollars until they destroy our capacity to do anything else as a society – much as Medicaid has been doing for years in our states.
Since we can’t blame the authors of this mess, we must now blame insurers for the program’s fundamental lack of viability. But how long can you lose hundreds of millions or billions per year and remain in business? FOR-profits or NON-profits?
Some Republicans call for the dismantling of HHS. This would be extreme, but government’s inability to avoid the consequences of a program it rammed down our throats and that just doesn’t work simply feeds that fire.
28
We will have single-payer health care. Will it come before or after our streets run ankle-deep in the blood of martyrs and corporate parasites?
1
Finland is doing quite fine guy. Pick a country that isn't and your post makes sense.
1
Well Dick, that's partly the point. Healthcare is bigger than either party and their ideologies. Obamacare was never considered an end-all solution. It's the first blow to a very convoluted and dysfunctional national system that needs uprooting. I'm neither an expert nor saying single payer is the solution. But, going backward is not going to get us to lower costs and better health.
If you want single payer, work for the nationalization of big health care corporations, because, unless the government is able to control of health care costs, including employee compensation, the tax increases required to fund single payer will be staggering.
Insurance companies came into being because individuals and families did not have the resources to pay the full bills for any health care cost that could occur, whether associated with accidents or with illness. Pooling their resources was the only viable option.
One way that insurers make their profits is to reduce the amount due to healthcare providers through negotiation and contracts.
Medicare (as we know it) for all won't work, because current Medicare costs are heavily subsidized by the privately insured. If the program is expanded to cover everyone, that subsidy will disappear.
Insurance companies came into being because individuals and families did not have the resources to pay the full bills for any health care cost that could occur, whether associated with accidents or with illness. Pooling their resources was the only viable option.
One way that insurers make their profits is to reduce the amount due to healthcare providers through negotiation and contracts.
Medicare (as we know it) for all won't work, because current Medicare costs are heavily subsidized by the privately insured. If the program is expanded to cover everyone, that subsidy will disappear.
14
Thank you!! Sometimes I worry that the actuaries in this country are going to get tarred and feathered for trying to do their jobs.
Kathleen from Anywhere,
The problem seems to be in your assumption that insurers still pool their resources in the manner of 1950s, "Father Knows Best" America. The mega-insurers are out there hedge-funding(i.e. gambling), acquiring and building, acquiring each other unless someone in the government says, "there's only really five of you guys anyway, you don't like competition?" to which the answer is a resounding "no."
I know medical costs are through the roof, but maybe we ought to look at this rise of medical corporations, and that's what they are, even if they have religious affiliations, which just hides the fact that they are still corporations, eating up smaller local hospitals that used to consider providing service as their "mission' which is sure a joke now. The doctors and hospitals have better equipment now, but how long are the wait times? Is the service better?
If you don't like the idea of single-payer because of higher taxes, fine, but give me the higher taxes up-front any day over this idea that pooling reduces costs: if a person is paying over a thousand dollars a month in premiums to an insurance company, and then if you have to pay all of the medical costs up to a $10,000 deductible before insurance kicks in, that's probably going on your MasterCard, right? Medical savings accounts? It's still coming out of your paycheck; the insurers are still taking money that you could be using elsewhere.
I'll take Medicare for all & taxes.
The problem seems to be in your assumption that insurers still pool their resources in the manner of 1950s, "Father Knows Best" America. The mega-insurers are out there hedge-funding(i.e. gambling), acquiring and building, acquiring each other unless someone in the government says, "there's only really five of you guys anyway, you don't like competition?" to which the answer is a resounding "no."
I know medical costs are through the roof, but maybe we ought to look at this rise of medical corporations, and that's what they are, even if they have religious affiliations, which just hides the fact that they are still corporations, eating up smaller local hospitals that used to consider providing service as their "mission' which is sure a joke now. The doctors and hospitals have better equipment now, but how long are the wait times? Is the service better?
If you don't like the idea of single-payer because of higher taxes, fine, but give me the higher taxes up-front any day over this idea that pooling reduces costs: if a person is paying over a thousand dollars a month in premiums to an insurance company, and then if you have to pay all of the medical costs up to a $10,000 deductible before insurance kicks in, that's probably going on your MasterCard, right? Medical savings accounts? It's still coming out of your paycheck; the insurers are still taking money that you could be using elsewhere.
I'll take Medicare for all & taxes.
4
Right, Kathleen. Single payer works in every other industrialized country. It costs less and has better outcomes.
But for magical Republican reasons it wouldn't work in this country.
But for magical Republican reasons it wouldn't work in this country.
5
The insurers are lying
Just earlier this year they said things were looking good as they announced their mergers. Now with both mergers in doubt they decide that they don't like ACA.
My answer is single payer
Ditch the insurers and their shareholders and the CEOs with 30 million dollar bonuses.
Just earlier this year they said things were looking good as they announced their mergers. Now with both mergers in doubt they decide that they don't like ACA.
My answer is single payer
Ditch the insurers and their shareholders and the CEOs with 30 million dollar bonuses.
154
Amen!
Quality affordable health care is a human right that the government should provide to it's citizens.
Quality affordable health care is a human right that the government should provide to it's citizens.
2
The whole rest of the world has universal health care (single-payer administration by the national government vs allowing these global corporations to gauge men, women and children! ) Medical Care is NOT a consumable goods... you can't decide to get sick later when you can afford the costs -- you can't buy used goods to save on the cost. Health Care as a RIGHT is the LAW in all nations in the civilized industrial world EXCEPT the USA. Totally WRONG!
5
And embrace waiting lists, lack of family doctors accepting you, 8 hour waits in emergency, 6-12 month waits for MRI, and months to years waiting in surgery for painful conditions which are 'elective'. That is the reality up here in Canada, the system where I work as a doc.
1
Here's Greg Ip, formerly of The Economist, writing, not unreasonably, on what he considers to be Obamacare's "unstable economics," in The Wall Street Journal: http://www.wsj.com/articles/the-unstable-economics-in-obamas-health-law-...
And here's Jonathan Gruber, partial architect of the Affordable Care Act, writing in Politico a few weeks ago: http://www.politico.com/agenda/story/2016/07/obamacare-what-we-didnt-see...
I've long believed that GOP opposition to the law was hindering sign-up, and Gruber says there is now evidence that this is the case. It is downright weird to continue this level of opposition to a law that's been in place this long. It's one thing to detest a law, another to actively discourage people from benefiting from it. Why not say "I really hate this law, but since it IS the law, let's try to make it work as best we can"?
I'm not one of these "let's blame everything on Republicans and never admit we were wrong" types, but it's perfectly clear that the very word "Obamacare" was made so toxic to Republican voters that many stayed away from signing up -- or even considering doing so. Be that as it may, the ACA is going to need reforms; that much is evident. But do read both Ip and Gruber, and do consider where America was pre-ACA. And recollect the long-nonexistent GOP alternatives.
We have to tone down the hysteria and hyperbole in our political discourse.
And here's Jonathan Gruber, partial architect of the Affordable Care Act, writing in Politico a few weeks ago: http://www.politico.com/agenda/story/2016/07/obamacare-what-we-didnt-see...
I've long believed that GOP opposition to the law was hindering sign-up, and Gruber says there is now evidence that this is the case. It is downright weird to continue this level of opposition to a law that's been in place this long. It's one thing to detest a law, another to actively discourage people from benefiting from it. Why not say "I really hate this law, but since it IS the law, let's try to make it work as best we can"?
I'm not one of these "let's blame everything on Republicans and never admit we were wrong" types, but it's perfectly clear that the very word "Obamacare" was made so toxic to Republican voters that many stayed away from signing up -- or even considering doing so. Be that as it may, the ACA is going to need reforms; that much is evident. But do read both Ip and Gruber, and do consider where America was pre-ACA. And recollect the long-nonexistent GOP alternatives.
We have to tone down the hysteria and hyperbole in our political discourse.
137
Really? It's healthy young people who aren't signing up. I d not think its because they're evil Republicans.
The most likely answer is that if they had to buy health insurance, they could not pay the rent and buy food.
The most likely answer is that if they had to buy health insurance, they could not pay the rent and buy food.
7
Hysteria is the Democrat way and hyperbole is the Republican path.
The PPACA was a compromise that brought out the medical device and pharmaceutical companies support by removing any competitive alternative. Followed by reassuring the insurance companies, private hospitals and medical groups that there would be no public option alternative.
The PPACA was a compromise that brought out the medical device and pharmaceutical companies support by removing any competitive alternative. Followed by reassuring the insurance companies, private hospitals and medical groups that there would be no public option alternative.
1
Nonsense. The reason many refuse is because the law has made it insanely expensive to do so as individuals. Others simply can't organize themselves enough to fill out paperwork, as demonstrated in the Oregon Medicaid study.
2
Totally agree with all the comments that the time is right for single payer. And the beauty is that the current presidential campaign provides a wonderful opportunity for Hillary to take up the cudgel.
The angry white working class voters who make up a large chunk of Trump's supporters are some of the foremost victims of our horrible health insurance system. They make too much for Medicare but not enough so that health care costs aren't crushing. While I'm under no illusion that many won't vote against their economic self-interest, regardless, the pain is too great for all of them to ignore it. I'd bet Hillary could peel off a lot of their votes if she recognized their plight and offered a solution.
Come-on Hillary! Make single-payer health insurance a centerpiece of your campaign. The time is right!
The angry white working class voters who make up a large chunk of Trump's supporters are some of the foremost victims of our horrible health insurance system. They make too much for Medicare but not enough so that health care costs aren't crushing. While I'm under no illusion that many won't vote against their economic self-interest, regardless, the pain is too great for all of them to ignore it. I'd bet Hillary could peel off a lot of their votes if she recognized their plight and offered a solution.
Come-on Hillary! Make single-payer health insurance a centerpiece of your campaign. The time is right!
45
She said it is not possible and will work to strengthen the ACA; whatever that "lie de jour" means.
35
@Alex Kodat in Portland: your suggestion that Hillary go for a single payer system because you think that Trump supporters would go for it is stunningly off base. Trump supporters are among some of the most anti-institution and anti-"big" government folks we have. They resent paying taxes; resent being told that they "have to have" insurance; and resent any mandate coming from Washington or even their state capital. They view government involvement in healthcare as "socialism," which they believe to be the political philosophy of the devil himself.
Unfortunately, many who do not carry insurance plan (when they think about it at all) to depend upon so-called "charity care," if they have a major health crisis. Being a civilized society we require hospitals to care for all who come in an emergency, even if they cannot pay. So, hypocritically, those who hate government and hate government programs, actually plan to depend upon tax payers and those who do pay for insurance to pay for their needs when the chips are down. Additionally, many younger folks foolishly assume that they will stay healthy and/or pay for whatever they need out of pocket. So, no, Trump supporters would not turn to Hillary if she suddenly started calling for single-payer. Quite the opposite.
All of that says nothing about the little fact that in our current climate passing such a system through Congress would be impossible.
Unfortunately, many who do not carry insurance plan (when they think about it at all) to depend upon so-called "charity care," if they have a major health crisis. Being a civilized society we require hospitals to care for all who come in an emergency, even if they cannot pay. So, hypocritically, those who hate government and hate government programs, actually plan to depend upon tax payers and those who do pay for insurance to pay for their needs when the chips are down. Additionally, many younger folks foolishly assume that they will stay healthy and/or pay for whatever they need out of pocket. So, no, Trump supporters would not turn to Hillary if she suddenly started calling for single-payer. Quite the opposite.
All of that says nothing about the little fact that in our current climate passing such a system through Congress would be impossible.
14
She can evolve. Gay marriage was impossible until suddenly it wasn't.
2
The price human beings pay for having pre-existing conditions, which cannot be denied anymore. So insurances make up for it in so many other ways....to make their bucks. A sick business, no pun intended.
33
The ACA as it's currently structured must seem like a pyramid scheme to healthy individuals, where premiums only go up but coverage for required services becomes more limited. No wonder they're not buying insurance on the individual market. A possible solution: 1. expand bipartisan-supported community health centers that offer free primary health care and some commonly used specialty services to all Americans, 2. make health insurance like every other type of insurance, i.e. the transfer of catastrophic risk from an individual to a larger organization (private or public) that can assume the risk in exchange for a monthly payment, 3. create a low cost plan that is the default for all citizens with the option to purchase supplemental insurance that covers additional services for a higher premium.
22
Expand "bipartisan-supported community health centers" - haven't seen too many examples of bipartisanship in any aspect of healthcare.
NK: You are talking about the Japanese system. They have a basic healthcare funded by taxes and premiums (small) and citizens can buy options for more premium. Perish the thought we should learn from them.
And perish the thought that we should demand that citizens make better decisions about their health. The choices they make have great influence on their health costs. Sugar, cigarettes, alcohol, drugs---all the issues that drive up the costs. Pareto would be proud. 80% of the costs are incurred by 20% of the people.
And perish the thought that we should prevent the food companies from loading nearly every packaged food with sugar in some form to make it 'taste better'. Just insane. Sugar, in all its forms, is the White Death and responsible for a major portion of our health issues in the USA, most especially the obesity epidemic and diabetes, heart disease, etc.
And perish the thought that we should demand that citizens make better decisions about their health. The choices they make have great influence on their health costs. Sugar, cigarettes, alcohol, drugs---all the issues that drive up the costs. Pareto would be proud. 80% of the costs are incurred by 20% of the people.
And perish the thought that we should prevent the food companies from loading nearly every packaged food with sugar in some form to make it 'taste better'. Just insane. Sugar, in all its forms, is the White Death and responsible for a major portion of our health issues in the USA, most especially the obesity epidemic and diabetes, heart disease, etc.
1
Health is not guaranteed to anyone. The healthiest person can become terminal tomorrow. That is the reality many naysayers are ignoring.
1
It has always seemed to me that the ACA was meant to serve as a bridge to single-payer insurance run by the government. And that could indeed be affordable if the government could bargain for medications and for services (which Medicare already does to some extent). The transition, however, will be painful and not without problems: to create the political will means first creating an expectation.
26
The root cause of the high cost not Obamacare, but the lack of transparency in the American health system which is designed to maximize profits and to hide information that would make the marketplace competitive. The rigged system guarantees that Americans pay far more and get far less than in all the other countries that have universal health insurance. To fix the system will probably require turnover in the US Supreme Court along with Democratic super-majorities in both houses of Congress.
74
Democratic supermajority? The Republicans have a majority in both houses.
1
Transparency has been the enemy of the recent rollup of healthcare providers. As pricing power becomes concentrated in the few, so does lack of choices (or no choice) flows to the consumer.
The Congressional Budget Office studied the idea of allowing Americans under age 65 to buy into Medicare in 2008, and it has remained a popular idea.
I think its a great idea to allow any American to buy into Medicare, and allow Medicare to negotiate drug prices (like Canada, UK, etc). Younger, healthier people buying in would bring down costs for older Americans.
I think its a great idea to allow any American to buy into Medicare, and allow Medicare to negotiate drug prices (like Canada, UK, etc). Younger, healthier people buying in would bring down costs for older Americans.
50
I doubt that they could afford that cost. Have you ever figured out what it is costing a person enters the workforce at 18 when he gets his first real job until he is eligible at 65?
1
Buy into Medicare? Medicare does not cover all care. Seniors on Medicare must pay for private secondary insurance to supplement it. How is "buying in" supposed to save money? My 90 year old mother pays $4000 per year for her Horizon NJ BCBS supplemental plan. Medicare is NOT a single payor program!
1
You cannot, I repeat Cannot have an entitlement society with Open Borders. The weight of the system will collapse on itself. Obamacare is a failure. It was bound to fail because it was poorly conceived, rushed through, using reconciliation, and relied on the ignorance of the American Public.(Developers own words). It will take years for this to unwind, well after Obama has left office. The consequences are staggering and it is a sign of things to come if Single payer is ever rammed through.
31
Health care should never be considered an entitlement. I think I know what you mean when you mention a capitalized "Open Borders;" Trumpian for immigrants, right?
Perhaps if the Republicans would have worked with the Dems on the healthcare law, especially since this "Obamacare" is nothing more than a revised version of the early 1990s plan Republicans were pushing and that Romney adapted and adopted for Massachusetts, then this plan might have been more wisely thought out and not rushed through. The American Public, as you give them a capitalized title, was desperate for a plan to cut down onerous healthcare costs, and didn't get a public option or single-payer. What they got was a cobbled-together piece of legislation that in reality is the fault of both parties. If the Republicans would have worked with Obama and the Dems, instead of obstructing from Day One of Obama's term starting with McConnell's shameful meeting that day, just maybe we'd have a smoothly functioning plan in place. This is on the GOP leadership every bit as much as it is on the Dems.
So, if you don't want single-payer, what is your plan? It's easy to be petulant and say what you don't want, but not having your own plan when you obstruct somebody else's idea is just as bad. The Republicans "public option" from the beginning has not been "to repeal and replace." No, just "repeal."
Perhaps if the Republicans would have worked with the Dems on the healthcare law, especially since this "Obamacare" is nothing more than a revised version of the early 1990s plan Republicans were pushing and that Romney adapted and adopted for Massachusetts, then this plan might have been more wisely thought out and not rushed through. The American Public, as you give them a capitalized title, was desperate for a plan to cut down onerous healthcare costs, and didn't get a public option or single-payer. What they got was a cobbled-together piece of legislation that in reality is the fault of both parties. If the Republicans would have worked with Obama and the Dems, instead of obstructing from Day One of Obama's term starting with McConnell's shameful meeting that day, just maybe we'd have a smoothly functioning plan in place. This is on the GOP leadership every bit as much as it is on the Dems.
So, if you don't want single-payer, what is your plan? It's easy to be petulant and say what you don't want, but not having your own plan when you obstruct somebody else's idea is just as bad. The Republicans "public option" from the beginning has not been "to repeal and replace." No, just "repeal."
1
Ever spent time in Europe?
Great job of parroting Faux News. Utilizing a service one pays into is not an entitlement and I suspect at some point in your own life, you too, will use this, "entitlement. "
1
The exchange is a joke, the plans are incredibly expensive and have high deductibles.
63
That is exactly right. So how are they losing money when they'll cover the same person on a group plan for 1/2 the price?
3
Any true fiscal conservative understands the basic principle that keeps insurance solvent: largest risk pool.This means everybody in. It can't be voluntary; rugged individualists & foolish youth say they don't want to be forced to buy something. The healthcare system is mandated to provide free care to anyone who gets to the ER with acute illness. FREE. After a car accident, pneumonia, cancer, toxic exposure,et al.When people are uninsured, their free care cost is shifted to those who pay premiums or to hospital losses.No other commodity is required to be given for free; health care must not be likened to something we choose to buy.
Nobody expects to get sick or get rear-ended or fall from a ladder or slip on the ice. It happens. Medicare can be expanded gradually, with a buy in at age 60, then 55, etc. Eventually, everyone will have a premium (or subsidy) mandated just as Medicare is funded now.
This lowers over head from the private market's 40% admin/marketing (with CEO's getting millions) and provides economies of scale (lower medication costs, etc). It can send money though existing private entities like Blue Cross & Kaiser or remain like current Medicare fee-for-service.
Health savings accts, tax breaks and interstate marketing (the Trump/GOP solution) is like arranging the chairs on the deck of the Titanic !
Universal health insurance will also eventually lower total costs as preventable conditions can be treated early. It's the only realistic long term solution.
Nobody expects to get sick or get rear-ended or fall from a ladder or slip on the ice. It happens. Medicare can be expanded gradually, with a buy in at age 60, then 55, etc. Eventually, everyone will have a premium (or subsidy) mandated just as Medicare is funded now.
This lowers over head from the private market's 40% admin/marketing (with CEO's getting millions) and provides economies of scale (lower medication costs, etc). It can send money though existing private entities like Blue Cross & Kaiser or remain like current Medicare fee-for-service.
Health savings accts, tax breaks and interstate marketing (the Trump/GOP solution) is like arranging the chairs on the deck of the Titanic !
Universal health insurance will also eventually lower total costs as preventable conditions can be treated early. It's the only realistic long term solution.
37
Sara, there is NO FREE HEALTH CARE IN THE ER. If you doubt me...go there, and see if you can get "free care".
They will treat you, but they will bill you at "rack rate" -- 3-5 times what insurance would pay -- and if you don't pay that, they will get collection agents after you, and then sue you.
The only way not to have that happen is to be "indigent poor" -- you have no job, no income, no assets, so they can't get a penny. Or to be an illegal alien, with no IDs.
Everyone else pays "rack rate". You also CANNOT get care in the ER for non-emergency conditions! You cannot get care for chronic illness like diabetes, or regular cancer care like chemo or radiation! You could get a broken leg put in a cast, or an antibiotic shot for an infection. That's about it.
THERE IS NO FREE CARE IN THE ER....not for people who have any jobs or assets.
NONE!
They will treat you, but they will bill you at "rack rate" -- 3-5 times what insurance would pay -- and if you don't pay that, they will get collection agents after you, and then sue you.
The only way not to have that happen is to be "indigent poor" -- you have no job, no income, no assets, so they can't get a penny. Or to be an illegal alien, with no IDs.
Everyone else pays "rack rate". You also CANNOT get care in the ER for non-emergency conditions! You cannot get care for chronic illness like diabetes, or regular cancer care like chemo or radiation! You could get a broken leg put in a cast, or an antibiotic shot for an infection. That's about it.
THERE IS NO FREE CARE IN THE ER....not for people who have any jobs or assets.
NONE!
2
There is no meaningful Republican response, other than trash the ACA. While the ACA needs to evolve, it's likely the GOP needs to evolve sooner.
29
Very well said. Articulate and accurate.
"If you like your doctor you can keep him/her...If you like your insurance plan you can keep it...you will save $2,500 per year..." Somebody told somebody a big fib. But of course, his intentions were good so who cares about the results.
Bottom line - there is no free lunch whether promised by a democrat, republican, communist, or right wing dictator. The sooner the American public leanrs this the better.
Bottom line - there is no free lunch whether promised by a democrat, republican, communist, or right wing dictator. The sooner the American public leanrs this the better.
43
ObamaCare was perfectly designed from a political standpoint. All the good stuff (no exclusion for pre-existing conditions, children on parents insurance until age 26) was front-loaded. The main roll-out was timed to occur just after President Obama was safely re-elected in 2012. And then the massive stop-loss coverage and other taxpayer subsidies were timed to phase out after Obama left office, leaving the coming implosion of the health insurance industry for the next President to deal with.
The other problems with ObamaCare are that the government made it too easy to enroll anytime after getting sick, using one of dozens of "life events" as a reason, and they hugely underpriced the tax penalty - all to avoid offending the electorate. The clear incentive for young healthy people (aka the people who elected Obama) is to wait until getting sick to buy insurance and pay the meager tax penalty in the interim.
This is what always happens with government "insurance". The government underprices premiums, is overly generous with benefits, and the suckers (aka taxpayers) pick up the difference.
The remaining insurers offering ObamaCare are staying in on the chance that a Democrat President and Congress are elected in 2016 to pass a trillion dollar ObamaCare bailout. If it is not forthcoming, other insurers will be out too.
The other problems with ObamaCare are that the government made it too easy to enroll anytime after getting sick, using one of dozens of "life events" as a reason, and they hugely underpriced the tax penalty - all to avoid offending the electorate. The clear incentive for young healthy people (aka the people who elected Obama) is to wait until getting sick to buy insurance and pay the meager tax penalty in the interim.
This is what always happens with government "insurance". The government underprices premiums, is overly generous with benefits, and the suckers (aka taxpayers) pick up the difference.
The remaining insurers offering ObamaCare are staying in on the chance that a Democrat President and Congress are elected in 2016 to pass a trillion dollar ObamaCare bailout. If it is not forthcoming, other insurers will be out too.
34
"hugely underpriced the tax penalty"
This is what people don't seem to get. People don't, for the most part, pay the penalty to be petulant, they pay it because the insurance and deductables are unaffordable. Jacking up the penalty is only going to hurt those low-income workers even more, even as the premiums and deductables are skyrocketing.
This is what people don't seem to get. People don't, for the most part, pay the penalty to be petulant, they pay it because the insurance and deductables are unaffordable. Jacking up the penalty is only going to hurt those low-income workers even more, even as the premiums and deductables are skyrocketing.
28
Yes, JM, no amount of lipstick on this pig will work. Major re-work is required.
2
I expected this to unravel by 2020, looks like it will be much sooner, than later. Mr. Obama will leave office, just in time for the 2017 changes to take affect. If if rates are already by very high double digits; next year will bring even more. This is what happens when supposed "health care reform" was a sham, because no reform was ever done, no cost containment, no attempt to create large groups; nothing.
The good aspects of the law? You cannot eb denied a policy and there are no life time caps. problem is it is now a worse minefield to figure out if you get treated in network or not. Deductibles, fro all kind sof policies, exchange and employer provided policies are rising rapidly, as are co-pays, with premiums.
I agree with Mr. Alexander; he is right. And the comment “the future of the marketplace is strong.” is as out of touch as Senator McCain, when he ran in 2008, said "“the fundamentals of the economy were strong”, on day one of the stick market crash of 2008.
The ACA is a perfect example of a bought and paid for government, by our oligarchy. The oligarchs are losing money and they want to pull the plug.
Trump or Clinton will face a very harsh reality when the house of cards comes tumbling down.
The good aspects of the law? You cannot eb denied a policy and there are no life time caps. problem is it is now a worse minefield to figure out if you get treated in network or not. Deductibles, fro all kind sof policies, exchange and employer provided policies are rising rapidly, as are co-pays, with premiums.
I agree with Mr. Alexander; he is right. And the comment “the future of the marketplace is strong.” is as out of touch as Senator McCain, when he ran in 2008, said "“the fundamentals of the economy were strong”, on day one of the stick market crash of 2008.
The ACA is a perfect example of a bought and paid for government, by our oligarchy. The oligarchs are losing money and they want to pull the plug.
Trump or Clinton will face a very harsh reality when the house of cards comes tumbling down.
45
Its a shame that Aetna's shareholders are unable to sufficiently profit from the sickness of others. They deserve the sympathy and understanding of us all.
131
If Aetna didn't have shareholders, it wouldn't exist, and prices would be even higher due to less competition, and even more sick people would be in huge trouble.
Knee jerk reactions are not thoughtful ones.
Knee jerk reactions are not thoughtful ones.
1
Maybe we should reimburse them.
It is time for Medicare for all.
160
How will we pay for that or is that not a consideration?
1
The health insurance companies sell health insurance in markets that they dominate because of (1) the small number of competitors, (2) a lack of transparent information about available alternatives, and (3) the high cost of switching from one health insurer to another.
Most of these markets are oligopolies in which the health insurers naturally practice oligopoly pricing: the largest firm sets its prices and other terms of service, and the few others in the market offer essentially the same terms.
Some of these markets have become duopolies: in these markets there are only two significant health insurers, whose prices tend to be even higher, and whose other terms of service tend to be even less generous.
Lastly, in some markets a single insurer wields monopoly power, which over the long run results in the highest prices and the worst service.
But our health insurers, being concerned only with their own profits, insist that they must merge with one another to continue participating in ACA markets. That is, they openly wish to operate as unregulated monopolists and oligopolists.
The better remedy lies in the opposite direction. Use antitrust to break up the oligopolies and monopolies. Allow competition to flourish. If afterwards we find that competitive markets cannot yield good service to everyone at affordable prices, then we should switch to a single-payer system.
Most of these markets are oligopolies in which the health insurers naturally practice oligopoly pricing: the largest firm sets its prices and other terms of service, and the few others in the market offer essentially the same terms.
Some of these markets have become duopolies: in these markets there are only two significant health insurers, whose prices tend to be even higher, and whose other terms of service tend to be even less generous.
Lastly, in some markets a single insurer wields monopoly power, which over the long run results in the highest prices and the worst service.
But our health insurers, being concerned only with their own profits, insist that they must merge with one another to continue participating in ACA markets. That is, they openly wish to operate as unregulated monopolists and oligopolists.
The better remedy lies in the opposite direction. Use antitrust to break up the oligopolies and monopolies. Allow competition to flourish. If afterwards we find that competitive markets cannot yield good service to everyone at affordable prices, then we should switch to a single-payer system.
31
"The better remedy lies in the opposite direction. Use antitrust to break up the oligopolies and monopolies"....
....agree totally....and this would include breaking up the ACA.
No human "central command" management system has ever worked for more than 2-3 million people in any industry or government agency....which is why we have local, county and state government.
....agree totally....and this would include breaking up the ACA.
No human "central command" management system has ever worked for more than 2-3 million people in any industry or government agency....which is why we have local, county and state government.
7
But the UK has 80M and Australia has 25M. All centrally controlled single payer health systems.
1
All the behaviour you lament here, is directly driven by the incentives of the ACA.
1
The ACA is a failure. There are many alternatives, but none will be adopted until the majority of Americans realize that what we have now, Obamacare, failed.
37
We are currently #31 in life expectancy, behind all those countries with some form of single-payer health care. Perhaps you should travel more outside of Texas.
1
We will never get to single payer so long as people believe the solution is to just "fix" Obamacare. It failed. by the way,i would like to get back to Maine. i was there a couple of years ago in October. absolutely gorgeous state.
And then there are people like my family. We purchase our insurance as individuals on the open market because we do not (thankfully) require assistance. Our premiums have exploded and our deductible has increased too - $6,500. This year Anthem is asking for another 26% increase. After we pay our premiums - we have no additional money for health care - so we don't use it. Individual policy holders for Anthem in Ct - over 54,000 have no one lobbying for them.
This is an impossible situation. We need to separate our health insurance from our employment - like we did with our retirement and 501k's to create real and fair market pressures in health insurance. If everyone had to write a monthly premium check - this would be resolved.
This is an impossible situation. We need to separate our health insurance from our employment - like we did with our retirement and 501k's to create real and fair market pressures in health insurance. If everyone had to write a monthly premium check - this would be resolved.
78
I've wondered that as well. The problem is the insurers get to treat different groups of people differently. They should be offering one policy price for all 27 year old females, one price to all 45 year old men, regardless of whether you came to the market individually or whether the employer pays.
This is so true. No one wants to talk about the gorilla in the room - the deductible, but the Obama administration, and the NY Times editorial board, are obsessed with providing premium assistance. Our premium for a family of three is $5,976 a year, but our deductibles are $6,000. In other words, we don't get a dime's worth of benefits until we spend $12,000 a year. The word Affordable in the ACA is a joke!
And by the way, UHC sent us a letter saying that they are pulling out of the marketplace, so I'm dreading having to shop for even fewer options this fall. [Aetna and UHC had the most plans during last year's enrollment window].
And by the way, UHC sent us a letter saying that they are pulling out of the marketplace, so I'm dreading having to shop for even fewer options this fall. [Aetna and UHC had the most plans during last year's enrollment window].
2
In Canada, everyone has single-payor health insurance provided by the provincial governments. In addition, we may purchase additional health insurance from a private insurer to provide additional coverage for use when the public system's wait time is too long. Finally, in Quebec, every citizen MUST have drug insurance, either through their employer as a benefit, or through the province.
America should move toward something like this.
America should move toward something like this.
226
Easy for you to say, Heidi.
Canada doesn't suffer from incurable Republican polio that renders the nation's citizens helpless regarding health care, public safety and a host of other basic human decency issues simply because a few greedy pirates love to economically torture 320 million Americans for sport and profit.
Canada is a civilized country; America is not - that's why we even have GOP Death Panel states where the state governments specifically withhold health care insurance (Medicaid) from the working poor just for spite....nice people...and good 'Christians', too.
Canada doesn't suffer from incurable Republican polio that renders the nation's citizens helpless regarding health care, public safety and a host of other basic human decency issues simply because a few greedy pirates love to economically torture 320 million Americans for sport and profit.
Canada is a civilized country; America is not - that's why we even have GOP Death Panel states where the state governments specifically withhold health care insurance (Medicaid) from the working poor just for spite....nice people...and good 'Christians', too.
196
Canada has a very healthy population, though folks are getting a little more obese. If Canada had a population mix like the States, its costs would be soaring and so would taxes to subsidise healthcare. Also, Canada, like every other country, piggy-backs off the American system: pretty much all the advanced pharma, lab, imaging, surgical procedures, preventive care measures, etc. come from the States, financed by the American consumer. Kill that (which single-payor will) and you hurt healthcare globally. No innovation, no investment, no advances in healthcare delivery have come from single-payor systems.
7
I'm a doc in Canada. There are extremely few options in the private market here. If you want any mainline type of care and you are not in imminent serious trouble, it is largely characterized by long waits and shortages. In theory you are covered, that is not the same as getting care when you want it.
3
Simple solution to expand and stabilize individual market. Change tax code to allow employers to subsidize premiums for employees in individual market with same or better tax benefits as enployer coverage. Will increase size of individual market by multiples overnight and stabilize individual market
2
Once again, it's apparent that, in the words of St. Ron, "Government is not a solution to our problem, government is the problem." Oh wait, maybe he should have said, "Corporate greed is not a solution to our problem, corporate greed is the problem." Especially when it's taken over the government through outrageous gerrymandering, control of almost all media and Citizen's United.
86
It turns out that Aetna wanted a quid pro quo to remain with the ACA carriers--the ability to purchase Humana.
Teddy Roosevelt was behind anti-trust legislation for a reason. Today's GOP doesn't give a damn about history, the voters, or the Constitution (despite their protests)--it's the money, honey!
Flush them from governance in the upcoming elections.
Teddy Roosevelt was behind anti-trust legislation for a reason. Today's GOP doesn't give a damn about history, the voters, or the Constitution (despite their protests)--it's the money, honey!
Flush them from governance in the upcoming elections.
68
The program has lots of problems and was poorly designed. One thing they can do is to adopt rules (no need for Congress) to stop the gaming of the system. People sign up (even mid-year with the right excuse), get themselves administered to at the insurance companies expense, and then drop out. This is the Administration's fault by writing generous rules so on one would be denied care. It is a disaster. It should be that you come in at the start of the policy year and must stay in for the year. The only way in at mid-year wouid be for life changing, provable events such as a death in the family, divorce etc where other coverage was lost. All they have to do is change their own rules.
10
You are incorrect. You can only join mid-year if you have a "life event" -- lose your previous coverage, lost job, divorce, death of primary breadwinner and so on.
You CANNOT just join mid-year because you suddenly need to see a doctor. The enrollment clearly asks about why you are joining mid-year, and you must submit proof -- or they will yank your subsidy.
Nothing keeps you from then dropping out -- but you can't rejoin again until the new enrollment period, which is November!
Also, you will get reported to the IRS and be charged a HUGE HUGE FINE -- thanks to the Traitor John Roberts.
You CANNOT just join mid-year because you suddenly need to see a doctor. The enrollment clearly asks about why you are joining mid-year, and you must submit proof -- or they will yank your subsidy.
Nothing keeps you from then dropping out -- but you can't rejoin again until the new enrollment period, which is November!
Also, you will get reported to the IRS and be charged a HUGE HUGE FINE -- thanks to the Traitor John Roberts.
1
And what is the Republican Congress' alternative to the ACA ?
Let the 'free-market' decide ?
We tried that.
That's what gave the United States the most expensive - 17% of GDP vs. 10% to 12% in civilized countries - health care system in the world in the first place.
What exactly are the Republican ideas to help fix the American health care system besides screaming 'Obamacare !' ?
Medicare (single-payer) works pretty good for older Americans.
Why not treat the rest of country with the same health care respect and human decency ?
I know...too simple....too easy...too affordable...too logical....it just makes too much sense to actually go through with it.
The Republican-led Congress could fix America's health care system very quickly IF they liked Americans more than they hated President Obama.
But alas, the GOP Congress refuses to lift a finger to help America once again, preferring to shoot spitballs at the guy who tried to help while one arm was tied behind his back by the New Confederacy.
GOP 2016: The party of spite, ill will and ill health.
Let the 'free-market' decide ?
We tried that.
That's what gave the United States the most expensive - 17% of GDP vs. 10% to 12% in civilized countries - health care system in the world in the first place.
What exactly are the Republican ideas to help fix the American health care system besides screaming 'Obamacare !' ?
Medicare (single-payer) works pretty good for older Americans.
Why not treat the rest of country with the same health care respect and human decency ?
I know...too simple....too easy...too affordable...too logical....it just makes too much sense to actually go through with it.
The Republican-led Congress could fix America's health care system very quickly IF they liked Americans more than they hated President Obama.
But alas, the GOP Congress refuses to lift a finger to help America once again, preferring to shoot spitballs at the guy who tried to help while one arm was tied behind his back by the New Confederacy.
GOP 2016: The party of spite, ill will and ill health.
318
I say we do let the 'free market' decide and give the health insurance companies some true competition and let them go up against Medicare for Everyone. If it's the free and competitive market they want, then let's give it to them. And let's make sure they aren't immune to federal anti-trust regulations anymore so they can't collude. Oh yes, the free market of health insurance, what a joke.
16
This law, The ACA has nothing to do with Medicare for all. It is a give away to the insurance companies and health care industry. They are now making double what they made before and giving way less, And on top of it you are fined heavily if you don't give them your money. That is tyranny. Yes the Republican's would fight against single payer, but I got news for you so would many Democrats. I like the President, but he sold us out with this disaster. It was better before, as bad as it was. At least for around $400 a month for a single person you got something for your money. Obama had a majority in Congress when he first got in but caved in without a fight.
2
'We tried that'
No you didn't. You tried single payer Medicare and Medicaid, the most expensive programs anywhere on earth. That's not free market. You banned negotiation of drug prices by health systems in bulk, and the purchase of insurance a cross state lines. That not free market.
At one time you had something close to a free market health care system, and it was by far the best in the world.
You should actually try the free market.
No you didn't. You tried single payer Medicare and Medicaid, the most expensive programs anywhere on earth. That's not free market. You banned negotiation of drug prices by health systems in bulk, and the purchase of insurance a cross state lines. That not free market.
At one time you had something close to a free market health care system, and it was by far the best in the world.
You should actually try the free market.
The comments here are astute. For-profit health insurance by its nature prioritises profits before quality of service. Another reason enrollments were ight be down is that unemployment is down.
9
I want the insurance policy we give the do nothing, well heeled clowns in the Congress.
49
Let's try it the other way: each person in Congress gets their health insurance reset yearly to the worst exchange coverage available in their (gerrymandered) districts. For Senators, the worst in their state. Changes would come quickly.
For profit insurers have made their position clear: If they're having to deliver the service they exist to provide, and they can't show an ever increasing profit while buying back stock, fueling the company jet(s) and paying millions to their CEO's, they just don't want to play.
Make them happy. Public option/ single payer.
Make them happy. Public option/ single payer.
36
Time for you to keep your campaign promise Mr. President and fight for a Public Option. You made a deal with Big Pharma to scrap the Public Option to get their support for the ADA while promising the opposite.
Obamacare is getting more expensive by the year, and in some cases offering less coverage. Would be great to see you pass something that is more about ordinary Americans, than some thinly veiled giveaway to a select few. That would be something worth putting in your presidential library.
Obamacare is getting more expensive by the year, and in some cases offering less coverage. Would be great to see you pass something that is more about ordinary Americans, than some thinly veiled giveaway to a select few. That would be something worth putting in your presidential library.
18
Nothing is passable given our current Congress.
Now that insurers seem to not want to play ball with Obamacare, it might make a different option more palatable to American voters. Whether it is 'Medicare for all,' with Rx price controls or 'marketplace' type solutions such as they have in Switzerland, Netherlands and Germany (where products/services/prices are regulated), the insurers' greed has made it more likely than not that it will indeed be a public option that we have. (Which would frankly mean better actual health for more people for less money...)
17
Of course along with these changes you will accept long waiting lines, restrictions on drugs and therapies, and limited access. There is no free lunch. If you don't believe that check out the VA system where everything is free but you just can't get it.
6
Obviously never used the VA. Works fine for 99%. Vets like it.
10
I know several people using VA as their insurer -- it definitely is NOT FREE. You have sizable co-pays. It costs $50 to see a doctor. They charge more for many meds than you would pay at a discount drugstore. The facilities are not convenient, and for most people, you have to drive long distances. The wait to see a specialist can be 3-6 months! People who use the VA as an insurer are DESPERATE and can't afford policies on the exchanges.
We need a single payer system and we will all have to pay higher taxes to fund it, not just the rich.
We pay one way or another, as the uninsured simply walk into any emergency room and get 'free' treatment, which is passed along to the taxpayers and the insured.
One suggestion is to lower the eligibility age for Medicare every year, while raising the Medicare payroll tax to cover the costs. That tax (2.9%, half of which is paid by employers) is way too low to cover medical care for the elderly, so should be raised anyway and many older workers would retire earlier, if they had a health care plan, thereby freeing up jobs for younger generations.
If we want this, we all have to pay more for it, no matter how many times Sanders said it would be 'free'.
We pay one way or another, as the uninsured simply walk into any emergency room and get 'free' treatment, which is passed along to the taxpayers and the insured.
One suggestion is to lower the eligibility age for Medicare every year, while raising the Medicare payroll tax to cover the costs. That tax (2.9%, half of which is paid by employers) is way too low to cover medical care for the elderly, so should be raised anyway and many older workers would retire earlier, if they had a health care plan, thereby freeing up jobs for younger generations.
If we want this, we all have to pay more for it, no matter how many times Sanders said it would be 'free'.
12
I agree completely. My husband will be 63 this year; he would absolutely retire NOW if he could get Medicare! And some young worker would get his job. It would be "win win" all around.
1
the biggest problem with single payer is getting the unions to agree. Most of the cadillac insurance polices are to union members. Employers get to stop paying for health insurance? Great they would love that - but how to you get a tax increase to cover that? With the big corporate tax increase to make up for the increased government single payer system - the incentives to invert to foreign soil increases - and if they don't invert - it makes products from foreign companies more affordable.
1
Until we acknowledge that having health insurance is a right, and not some privilege that is granted with employment - and until we normalize the way we spend for that care, as a nation - we will continue down this rabbit hole.
33
This country needs to stop messing around, and join the community of industrialized, advanced capitalist nations that provide free health care for all. It is completely immoral, and also unworkable, to have a for-profit system in this day and age.
Americans, grow up!!!
Americans, grow up!!!
59
No health care is free. Someone pays.
10
And somebody profits. Under the current system, the healtcare companies profit exorbitantly.
8
Healthcare costs have to be contained. Until we do this, no plan ACA, single payer or whatever will stop the insanity which will bankrupt this country. I work with a guy who just started at 45K. Rather then sign up for the employer healthcare plan, he has his family of four covered by the states Husky Medicaid program. Everything is free. He goes to the ER for the slightest problem. If someone in this situation can pull this why would anyone pay for coverage with 6K deductibles.
7
His "FREE" health care is paid for by you and me.
11
Current health care costs are artificially high due to a bloated private sector bureaucracy. A single payer option with Medicare like reimbursement rates is a good way to reduce health care costs.
20
You don't qualify for Medicaid at that salary. He probably lied on the application
I did read the ACA. All of it. And the two bills that were blended together to create it in committee.
The ACA has remarkably little to do with healthcare. It is actually a complex blueprint of a centralized management structure, akin to the one that controlled General Motors for decades.
It mandates central control of required health offerings, the "evidence" used to construct disease/treatment categories, the "meaningful use" electronic medical records systems making their way through the national system, the methods for assessing "quality", and the macro pricing and subsidies for generic categories of patients (minimum care requirements, no prior-condition exclusions, etc).
The "exchanges" in question are at the margin (edges) of this command system, where the most needy patients would clearly end up.
The current problems were easily predicted at the passing of the law.
Just as the ER in most hospitals was the place most uninsured patients sought care several years ago, the exchanges would be the insurance of "nearly last resort" under the ACA.
So. All of this was predictable, and is the rational consequence of the law.
The question now is, "Who pays the subsidies for the poorest and sickest patients in the country?"
The simplest and least expensive answer is - extend Medicare to these patients, AS they need it...just as ER physicians once treated "street" patients who needed care.
The blame game with Aetna is a red herring.
Patients come first. Politics later
The ACA has remarkably little to do with healthcare. It is actually a complex blueprint of a centralized management structure, akin to the one that controlled General Motors for decades.
It mandates central control of required health offerings, the "evidence" used to construct disease/treatment categories, the "meaningful use" electronic medical records systems making their way through the national system, the methods for assessing "quality", and the macro pricing and subsidies for generic categories of patients (minimum care requirements, no prior-condition exclusions, etc).
The "exchanges" in question are at the margin (edges) of this command system, where the most needy patients would clearly end up.
The current problems were easily predicted at the passing of the law.
Just as the ER in most hospitals was the place most uninsured patients sought care several years ago, the exchanges would be the insurance of "nearly last resort" under the ACA.
So. All of this was predictable, and is the rational consequence of the law.
The question now is, "Who pays the subsidies for the poorest and sickest patients in the country?"
The simplest and least expensive answer is - extend Medicare to these patients, AS they need it...just as ER physicians once treated "street" patients who needed care.
The blame game with Aetna is a red herring.
Patients come first. Politics later
20
They should be required to offer Obamacare plans. If they want to sell private plans in a state they need to sell a public and open enrolment Obamacare plan.
This trend of insurers withdrawing from the exchanges is only making the point that this parasitical industry deserves to, at best, have a secondary role in underwriting our medical system.
We need a single payer system, just like Britain and Canada, paid for by taxes instead of premiums, that includes a private option.
Every American would be automatically enrolled in this national system, but would be eligible to receive a voucher that could be used to enroll with a private insurer.
Only a national healthcare system run by the Federal Government would have the clout to meaningfully reduce the cost of healthcare in America - just as the Canadian and British governments have in their systems.
When I hear the argument that a single payer system is unrealistic, I say tell that to the Brits and the Canadians. These nations spend half-the percentage of GDP that we do, while covering everyone - and their citizens are generally quite satisfied with this arrangement.
A single payer / private option model would, however, give those American who insist on paying through the nose for the same services the liberty to do just that.
Every American should have an unalienable right to be a fool parted from his money by the insurance industry; but no American should have the liberty to prevent the rest of us from adopting a more sensible arrangement.
We need a single payer system, just like Britain and Canada, paid for by taxes instead of premiums, that includes a private option.
Every American would be automatically enrolled in this national system, but would be eligible to receive a voucher that could be used to enroll with a private insurer.
Only a national healthcare system run by the Federal Government would have the clout to meaningfully reduce the cost of healthcare in America - just as the Canadian and British governments have in their systems.
When I hear the argument that a single payer system is unrealistic, I say tell that to the Brits and the Canadians. These nations spend half-the percentage of GDP that we do, while covering everyone - and their citizens are generally quite satisfied with this arrangement.
A single payer / private option model would, however, give those American who insist on paying through the nose for the same services the liberty to do just that.
Every American should have an unalienable right to be a fool parted from his money by the insurance industry; but no American should have the liberty to prevent the rest of us from adopting a more sensible arrangement.
38
I have worked with those international systems for a long time.
Almost everyone in the US ignores the key ingredient of success in the "national" healthcare systems of Canada, UK, Sweden, Denmark...etc...
....they are all based on local care, not on nationally "commanded" care.....
....and they all are applied to populations much smaller than the US.
(And they have very little litigation, and don't have a "malpractice industry".)
Even Sweden, with a total population roughly equivalent to the NYC region, runs the system from the Kommun (county) upward, and they recently privatized pharmacy and other elements.
The UK system applies to 63 million people and has neighborhood care. Canada 35 million citizens. Both have queues of patients waiting.
The current issues with the ACA are happening because the ACA has no mechanism for dynamic local problem solving.
It requires an Act of Congress to change.....literally.
Jumping to a single central payor system, on top of the centralized administrative structure of the ACA would NOT help the patients in trouble at the edges of the system.
The "Medical Home" in the ACA is the key.
It can be the Swedish equivalent of the Kommun, and can bring patients back into the system.
Right now all we have are "interest groups" battling for $2 Trillion at the national level.
Allocate Medicare supported independence to the local Medical Homes, and then get the big lobbies out of the way.
Almost everyone in the US ignores the key ingredient of success in the "national" healthcare systems of Canada, UK, Sweden, Denmark...etc...
....they are all based on local care, not on nationally "commanded" care.....
....and they all are applied to populations much smaller than the US.
(And they have very little litigation, and don't have a "malpractice industry".)
Even Sweden, with a total population roughly equivalent to the NYC region, runs the system from the Kommun (county) upward, and they recently privatized pharmacy and other elements.
The UK system applies to 63 million people and has neighborhood care. Canada 35 million citizens. Both have queues of patients waiting.
The current issues with the ACA are happening because the ACA has no mechanism for dynamic local problem solving.
It requires an Act of Congress to change.....literally.
Jumping to a single central payor system, on top of the centralized administrative structure of the ACA would NOT help the patients in trouble at the edges of the system.
The "Medical Home" in the ACA is the key.
It can be the Swedish equivalent of the Kommun, and can bring patients back into the system.
Right now all we have are "interest groups" battling for $2 Trillion at the national level.
Allocate Medicare supported independence to the local Medical Homes, and then get the big lobbies out of the way.
13
Australia is centralised...
Ah, and here comes a November election and a chance for the Insurance Companies to make Affordable Care an issue with claims of spiraling high costs
What a coincidence in timing, don't you think?
Well, this has so far survived the attack of the Republicans.
Will it survive the attack of the Insurers?
What a coincidence in timing, don't you think?
Well, this has so far survived the attack of the Republicans.
Will it survive the attack of the Insurers?
13
Despite the happy talk from Obama Administration and ACA officials, this system of private health care insurers offering policies under the ACA law is imploding upon itself. Private insurers suffering increased losses and jacking up premiums by double digit amounts and pulling out of numerous markets is a clear sign that this can't and won't go on for very long. The ACA law has badly misjudged the risks that insurers are subject to and they are doing what any private company will do when faced with an endless seas of losses: leave.
20
That's not all the ACA law badly misjudged. The fact that Medicaid was going to be flooded with the low-income previously uninsured well beyond the administration's projections was obvious from the get-go to anyone with more than two brain cells. So was the fact that the deductibles from the lowest cost plans were going to result in lower income working people scraping together the monthly cost of the insurance while being unable to afford the deductable. Or the fact that many in that position would rather pay the penalty and use the few bucks they saved foregoing the exchanges to go to a CVS clinic for minor seasonal ailments.
What really galls though, is to be charged a "tax" for having the audacity to be unable to afford insurance, while those who get insurance via their employers get it as essentially tax-free income.
What really galls though, is to be charged a "tax" for having the audacity to be unable to afford insurance, while those who get insurance via their employers get it as essentially tax-free income.
12
It's time for the government to use its significant buying power to control the cost of medications, and also to set provider reimbursement rates. Only then can we reign in healthcare costs, which are currently a wealth transfer from the people and the government to insurers, physicians and pharmaceutical companies.
5
Stumbling toward single-payer. ACA has accomplished a lot for those with preexisting conditions and parents wanting to cover kids, but we need to get the greedy middlemen--aka insurers--out of the mix. Remind me: what value do they add to the process, other than to ensure that illness is treated as a for profit opportunity? When will Americans demand healthcare as a right the way they do in every other civilized western nation?
108
Randy - Many Americans did demand healthcare as a right, and supported the candidacy of Bernie Sanders, who championed this view, loudly and often. Unfortunately, the DNC and media felt that he and his views were way too - too what? Fair? - to ever be enacted. Instead, they went with his opponent, who takes a lot of money from the health insurance and pharmaceutical industries.
1
Not to worry.
On his first day in office, President Trump will sign a law abolishing the Affordable Care Act, passed by McConnell and Ryan's Congress, and President Trump will then replace Obamacare with...NOTHING.
Millions of people who be thrown into the streets with no insurance.
It's a win-win situation for everyone!
On his first day in office, President Trump will sign a law abolishing the Affordable Care Act, passed by McConnell and Ryan's Congress, and President Trump will then replace Obamacare with...NOTHING.
Millions of people who be thrown into the streets with no insurance.
It's a win-win situation for everyone!
14
Not really -- the whole infrastructure of regular insurance still exists outside the ACA. Such people will probably mostly buy much cheaper "high deductible policies" -- but NOT at the threat of a fine, as it is right now.
Also, it will force Congress to act on stuff like controlling the Big Insurance and Big Pharma industries, and perhaps expanding Medicare to those 55-65.
Because right now the ACA is a flimsy band-aid on a dike, and one day that dike will burst -- no matter who is in office.
Also, it will force Congress to act on stuff like controlling the Big Insurance and Big Pharma industries, and perhaps expanding Medicare to those 55-65.
Because right now the ACA is a flimsy band-aid on a dike, and one day that dike will burst -- no matter who is in office.
1
Let them eat cake, free market cake. Just making America great again.
Health insurance companies are, at best, oligopolies, and , in some markets, they are monopolies. It is time for the President to use what regulatory and investigative resources he has to make them sweat - a la Standard Oil before the break up. It appears that the insurers may want to use approval for anti-competitive mergers as bargaining chips for participating in the ACA market. Turn the table on them. Show the insurers what they will lose if they don't play ball. And use the bully pulpit to cajole these behomeths that spend far more on share buy backs than they lose in the ACA market. It's time for the gloves to come off.
59
When America says the nation is headed in the wrong direction, they are not talking about ACA. They are referring to a Congress by Nihilists that have not lifted a finger to :
Allow Cross-state Competition on the ACA Exchange
Limit Pharmaceutical Costs Like Every Other Industrialized Nation
The Right Wing House is an utter embarrassment, and we would be better off electing goats to fill their positions.
Allow Cross-state Competition on the ACA Exchange
Limit Pharmaceutical Costs Like Every Other Industrialized Nation
The Right Wing House is an utter embarrassment, and we would be better off electing goats to fill their positions.
89
The GOP had nothing to do with the ACA; it passed without a single GOP vote.
The ACA was DESIGNED not to permit negotiation on drug prices. This is how they got Big Pharma to sign on, and agree not to fight the ACA with "Harry & Louise-style" ads.
The ACA was DESIGNED not to permit negotiation on drug prices. This is how they got Big Pharma to sign on, and agree not to fight the ACA with "Harry & Louise-style" ads.
1
Baaaah, no insurance for you.
Has Congress attempted to pass legislation for either of the 2 listed items?
No ...because doing so would be beneficial to the American People.
No ...because doing so would be beneficial to the American People.
1
So, are these companies actually losing money overall, or merely reaping lower outlandishly huge profits?
80
Here's the problem. With young, healthy people it is a matter of simple math. Is the penalty greater than the premiums? As long as the answer is no, there's no reason to by insurance.
13
This "health care" racket will kill us. The ballooning premiums and deductibles with shrinking of coverage adds up to one thing. It's not sustainable.
It's disproportionate in that we can't support the overhead of for-profit drug advertising and capitalist profit seeking from the vulnerable. Which is 99% of us. What we have is government sponsored racketeering. It's out of whack.
It's gotta stop.
It's disproportionate in that we can't support the overhead of for-profit drug advertising and capitalist profit seeking from the vulnerable. Which is 99% of us. What we have is government sponsored racketeering. It's out of whack.
It's gotta stop.
26
We knew this was going to happen eventually. The big insurers participating in these exchanges would start complaining about diminishing profit margins—or try and use their participation as leverage for unfair business practices. Why are we not moving to a single-payer program? Two-thirds of Americans support it. And it's time we joined the rest of the industrialized world and offer affordable healthcare for all.
65
dmuise - we as a nation are not moving to a single-payer program because the corporations who make money on the backs of sick people will not permit it. They pay off, through campaign contributions, all of Congress. Both sides of the aisle. And they pay off presidential candidates as well. Note how much money Mrs. Clinton takes from the health "insurance" and pharmaceutical industries. The one politician who was supported by the peoples' money - us - was Bernie Sanders, who made single payer a key plank of his platform. And look what happened to him.
1
"She said that companies’ business interests may conflict with a program’s policy goals."
Umm, you think?! This is why every other developed country on the face of the Earth has a public health care system -- often a single-payer arrangement -- or, if they do have "marketplaces," like in Switzerland or the Netherlands, insurers cannot profit from the sale of the core health insurance policies.
The U.S. health care system is barbaric, insane, monstrous. I have a European passport and am contemplating leaving the country for good, because after already needing two surgeries in my 20s, I can't imagine growing old and being forced to engage with this nightmare health care "system" even more regularly.
There aren't enough obscenities to describe my feelings about U.S. health insurers.
Umm, you think?! This is why every other developed country on the face of the Earth has a public health care system -- often a single-payer arrangement -- or, if they do have "marketplaces," like in Switzerland or the Netherlands, insurers cannot profit from the sale of the core health insurance policies.
The U.S. health care system is barbaric, insane, monstrous. I have a European passport and am contemplating leaving the country for good, because after already needing two surgeries in my 20s, I can't imagine growing old and being forced to engage with this nightmare health care "system" even more regularly.
There aren't enough obscenities to describe my feelings about U.S. health insurers.
135
Only three nations on earth have single payer. One is Canada. The other two are in Asia.
NO NATION IN EUROPE HAS SINGLE PAYER HEALTH CARE.
My point is there are many ways to provide universal health care, and single payer is only ONE of them.
NO NATION IN EUROPE HAS SINGLE PAYER HEALTH CARE.
My point is there are many ways to provide universal health care, and single payer is only ONE of them.
Health insurance companies are sucking up too much of our premiums for skyscrapers and executive salaries. All we need are actuarial tables and payroll tax deductions. Get rid of the profit motive for dropping coverage to the sick and let us all share the cost of their welfare because we will all be there someday.
101
Oh dear, poor poor health insurance companies. Simply can't afford to stay in the health exchange marketplaces. Have to become monopolies in order to afford to. Tut tut, poor things. Is there any chance the Times could follow up this article with one that mentions the record profits health insurance companies are currently making? Yes, they might be losing money in the health exchange marketplace. But they are more than making up for those losses elsewhere. More than making up for it being an understatement. When are we Americans going to learn that corporations that answer to shareholders can not be counted on to contribute to the greater public good?
52
Remember that they can STILL sell regular insurance policies OUTSIDE OF THE EXCHANGES -- I did not know this, and I'll bet most here don't know it! You can STILL buy high deductible plans -- you can still buy plans which discriminate against pre-existing conditions, or exclude maternity benefits! They are MUCH cheaper! but they won't "qualify you" at tax time, so you will have to pay the fines AND the premiums -- but they do exist.
These are very profitable for insurers, as they have all the old dodges to get out of paying for actual bills....
These are very profitable for insurers, as they have all the old dodges to get out of paying for actual bills....
America needs to join the rest of the developed world and get single payer system because the current system we have now is more of the same ole status quo. The insurance companies will win. We need to get rid of the insurance companies and its lobbyists in Congress that is what is killing America healthcare system and putting America further behind in the world.
47
Healthy young people don't want Obamacare for the simple reason that it's 1) too expensive, and 2) is administered by the the most hated companies in America, in their time-honored fashion.
The coverage was plainly designed around the needs of insurance companies. Providing good medical care was barely an afterthought. The result is obvious, as this article itself makes clear: it's all about insurance companies, their demands and their trheats. Not a word about actual health care.
Obamcare *is* a vast improvement for Americans just above the poverty line (too rich for Medicaid), but earning so little enough they qualify for both premium and cost sharing subsidies.
In other words, its great, s long as customers don't have to pay for it. But nobody in his right mind would buy these plans at market prices, penalty or not.
The coverage was plainly designed around the needs of insurance companies. Providing good medical care was barely an afterthought. The result is obvious, as this article itself makes clear: it's all about insurance companies, their demands and their trheats. Not a word about actual health care.
Obamcare *is* a vast improvement for Americans just above the poverty line (too rich for Medicaid), but earning so little enough they qualify for both premium and cost sharing subsidies.
In other words, its great, s long as customers don't have to pay for it. But nobody in his right mind would buy these plans at market prices, penalty or not.
22
In my search for a new policy, I talked to dozens of agents -- some idiots, but some very knowledgeable.
There is a "sweet spot" for a particular customer -- young (under 40), with some pre-existing condition -- with a steady job with a very predictable income stream --BUT no more than about $22,000 or so. This customer qualifies for the absolute maximum subsidy, AND lower premiums due to their youth. They can pay as little as nothing, but most likely $50-$150 a month for a silver plan.
Everyone else is screwed and cheated. The exchange can legally charge older customers up to 300% of what they charge young people -- even if the young person has several expensive medical conditions, and the older person completely healthy! This hits the most vulnerable older workers ages 50-65 brutally -- if they lose employer coverage, in the years leading up to Medicare. They have few options, as almost nobody wants to sell insurance to an older person in any event, healthy or not.
There is a "sweet spot" for a particular customer -- young (under 40), with some pre-existing condition -- with a steady job with a very predictable income stream --BUT no more than about $22,000 or so. This customer qualifies for the absolute maximum subsidy, AND lower premiums due to their youth. They can pay as little as nothing, but most likely $50-$150 a month for a silver plan.
Everyone else is screwed and cheated. The exchange can legally charge older customers up to 300% of what they charge young people -- even if the young person has several expensive medical conditions, and the older person completely healthy! This hits the most vulnerable older workers ages 50-65 brutally -- if they lose employer coverage, in the years leading up to Medicare. They have few options, as almost nobody wants to sell insurance to an older person in any event, healthy or not.
1
Aetna's problem is that it doesn't know how to compete in an exchange environment. It has hardly competed on price in the past. Most of its customers (employers and government) bear the insurance risk, Aetna doesn't insure them. Only its small employers tend to be fully insured as have been individuals who have had private insurance. Prior to ACA Aetna risk-rated/red-lined sick employees and it used pre-existing condition clauses to exclude sick individuals.
Under the ACA it has to offer coverage to any eligible applicant. And it has to compete (mostly on premium level) to sell plans on a level playing field - plans that cover the same services, have the same terms and conditions of coverage, have standardized communications and that have to be transparent about out-of-pocket exposure, drug coverage and networks.
So, Aetna's actuaries underestimated the plan cost of the enrollees it attracted and/or Aetna underpriced its plans to attempt to capture more enrollment. Suck it up Aetna and learn to insure sick people and compete.
Aetna is an oligopoly wanting to be a monopoly in certain regions. Don't threaten the government and then announce you are withdrawing because the feds are challenging your monopoly power play. Your behavior greatly increases the likelihood that a public option will be introduced to give you some real competition. If that doesn't work, the next step, single payer health care will put you out of the health insurance business. Few will mourn
Under the ACA it has to offer coverage to any eligible applicant. And it has to compete (mostly on premium level) to sell plans on a level playing field - plans that cover the same services, have the same terms and conditions of coverage, have standardized communications and that have to be transparent about out-of-pocket exposure, drug coverage and networks.
So, Aetna's actuaries underestimated the plan cost of the enrollees it attracted and/or Aetna underpriced its plans to attempt to capture more enrollment. Suck it up Aetna and learn to insure sick people and compete.
Aetna is an oligopoly wanting to be a monopoly in certain regions. Don't threaten the government and then announce you are withdrawing because the feds are challenging your monopoly power play. Your behavior greatly increases the likelihood that a public option will be introduced to give you some real competition. If that doesn't work, the next step, single payer health care will put you out of the health insurance business. Few will mourn
61
Dream on. The insurance industry went along with the ACA -- didn't see any protests, did you? -- because A. THEY WROTE THE ACA...designed it to benefit THEMSELVES....and B. the understand was that if they went along, it would mean no single payer -- not ever -- NEVER EVER EVER.
That was the agreement. So you will never ever see single payer in your lifetime. Obama sold you out.
That was the agreement. So you will never ever see single payer in your lifetime. Obama sold you out.
1
To Concerned Citizen:
You've made two unfounded charges.
You claim insurers wrote the ACA. Please provide just one legitimate source documenting that claim. I doubt that you can. I've followed the ACA closely since its inception and have never read or heard that from a legitimate source. Think about it. Would the insurers have capped their administrative fees plus profit at 20% of revenue? The ACA does. Would they have eliminated pre-existing conditions exclusions, required guaranteed issue, greatly increased consumers rights to appeal medical claim denials, required all insurers to communicate in the same way, agreed to pay a $14 billion tax on their revenues to help fund the ACA, required themselves to compete on exchanges controlled by quasi-governmental organizations, required themselves to compete by having to cover exactly the same services, post their premiums and have them displayed to consumers from low to high, required them to be fully transparent about out-of-pocket costs, etc. etc. etc.? Your claim that insurers wrote the ACA is not credible.
Neither is your claim believable that President Obama made an agreement with insurers that single payer would not be offered in our lifetimes. Again, please provide a legitimate source of documentation. You can't because he didn't. Obviously there is no way that anyone could guarantee single payer will not be passed in our lifetimes. So, please quit making baseless claims, such as "Obama sold you out".
You've made two unfounded charges.
You claim insurers wrote the ACA. Please provide just one legitimate source documenting that claim. I doubt that you can. I've followed the ACA closely since its inception and have never read or heard that from a legitimate source. Think about it. Would the insurers have capped their administrative fees plus profit at 20% of revenue? The ACA does. Would they have eliminated pre-existing conditions exclusions, required guaranteed issue, greatly increased consumers rights to appeal medical claim denials, required all insurers to communicate in the same way, agreed to pay a $14 billion tax on their revenues to help fund the ACA, required themselves to compete on exchanges controlled by quasi-governmental organizations, required themselves to compete by having to cover exactly the same services, post their premiums and have them displayed to consumers from low to high, required them to be fully transparent about out-of-pocket costs, etc. etc. etc.? Your claim that insurers wrote the ACA is not credible.
Neither is your claim believable that President Obama made an agreement with insurers that single payer would not be offered in our lifetimes. Again, please provide a legitimate source of documentation. You can't because he didn't. Obviously there is no way that anyone could guarantee single payer will not be passed in our lifetimes. So, please quit making baseless claims, such as "Obama sold you out".
The last line of the article where it is said, ".....a lot of people just don't find it affordable." is the crux of the situation, to say the least. Not only are many of the insurance policies not affordable, it is doubtful if the country as a whole can afford Obamacare. This explosion of costs may be just the beginning, and as an entitlement there is no exit plan.
11
This spring, I unexpectedly lost my former decent (not great, but decent) employer-based health care. I was forced into the exchanges. I was against Obamacare like so many, once "they passed it and I finally got to read it". But even I had NO IDEA until I had to use it for myself how appallingly awful it is.
It's really NOT health coverage AT ALL -- it's like a bad joke or a nightmare. High monthly premiums, but such high deductibles that unless you are hospitalized, you won't EVER hit the deductible -- for a SINGLE PERSON, it is $6800 a year (this year -- going up next year!).
That's not insurance for a PERSON; that is insurance for a HOSPITAL that if you have a major operation, you won't declare bankruptcy or at least, they will get 80% of the bill paid.
For all over medical costs....forget it. You won't see a dime of coverage, but forced to pay at least $250 a month for "compliance" and to avoid a fine.
Oh it gets better! If you calculate your income off a bit, or get some freelance work late in the year or ANY OTHER extra income....you LOSE your subsidy or it gets lessened, so you have to PAY IT BACK! That's right -- you could end up owing as much as $6000 BACK TO THE GOVERNMENT! Each year!
You will NEVER know until tax time if you get to keep that subsidy...or pay all or part of it back!
Even insurance agents were apologizing to me as they spelled out my options (or non-options). Also, all policies are HMOs -- no choice!
It's really NOT health coverage AT ALL -- it's like a bad joke or a nightmare. High monthly premiums, but such high deductibles that unless you are hospitalized, you won't EVER hit the deductible -- for a SINGLE PERSON, it is $6800 a year (this year -- going up next year!).
That's not insurance for a PERSON; that is insurance for a HOSPITAL that if you have a major operation, you won't declare bankruptcy or at least, they will get 80% of the bill paid.
For all over medical costs....forget it. You won't see a dime of coverage, but forced to pay at least $250 a month for "compliance" and to avoid a fine.
Oh it gets better! If you calculate your income off a bit, or get some freelance work late in the year or ANY OTHER extra income....you LOSE your subsidy or it gets lessened, so you have to PAY IT BACK! That's right -- you could end up owing as much as $6000 BACK TO THE GOVERNMENT! Each year!
You will NEVER know until tax time if you get to keep that subsidy...or pay all or part of it back!
Even insurance agents were apologizing to me as they spelled out my options (or non-options). Also, all policies are HMOs -- no choice!
2
What's spiraling out of control? the insurance companies. cut them out completely. single payer.
282
It's the perfect opportunity for Medicare to simply take over the policies when the private insurance companies drop out of providing ACA coverage. If private companies can create monopolies, so can Medicare.
The only spiral going on is a death spiral, due to the healthy opting for the slap-on-the-risk penalty and the sick abusing "life events." You can't have guaranteed issue with such a weak individual mandate (similar systems have their penalties usually be the equal to or even greater than the cost of the would-be premiums).
The insurance companies aren't to be blamed in this.
The insurance companies aren't to be blamed in this.
2
Fully agree that we don't need private health insurance companies. They are in the game only to make money not to provide the best health insurance the world has seen. We could have the fairest and most complete health system ever devised. We start by cutting out the fat cats.
1
It seems as thou many insurers are cherry picking counties. Keeping the healthy ones and dumping the sickly ones. Isn't that what the ACA was passed to alleviate? Cherry picking?
8
You do realize that the insurance industry WROTE THE ACA? I mean, they literally wrote it. It was written by an insurance exec, hired by Obama, expressly so the industry would get on board and not fight the ACA, the way they fought Hillary's 1993 reforms -- with those devastating "Harry & Louise" ads!
4
In the spirit of Congressional gerrymandering, why not? It's not so much picking the regions which are least customer sickly, it's more about keeping those that have the least competition, where they have pricing power.
We can't go backwards - I don't think anyone would support that. I've always thought of ACA as transitional - too compromised and wobbly to hold indefinitely, and a step toward the obvious. I don't think we'll suddenly tumble into universal health care, I think it'll happen in increments, so long as Democrats keep nudging in the right direction. I may be mistaken but in the long view I'm thinking this is probably good news.
19
This is is nice and I would like to believe it but the republicans that remain will staunchly refuse to oblige. So what is your plan B?
Am I the only one who sees this as a major endorsement of the idea of "medicare for all"? If Aetna argued that "they needed to form a combined insurance giant to mitigate it's losses on the exchanges." Why can't we just take advantage of the insurance giant already operating within the federal government? Why do we need insurance companies anyway? They don't represent the best interest of either patient or caregiver? Their only motivation in this transaction is to make a profit. How does that help either party? "For profit healthcare" will always put profit ahead of your health.
321
Why privatize a good government system? There IS a reason--the skim for private individuals. That's what Grover Norquist and his "loyalty oath" for presumptive Republican candidates is all about.
10
MEDICARE FOR ALL is the lowest cost and most efficient health care insurance plan. A nonprofit service with 3% overhead and lower priced medication. Doctors, nurses, and support staff are dedicated to your health and wellness. We don't need a guy in the middle ripping off 30% of your payments.
14
Maybe Aetna's pulling out will force reconsideration of the "public option."
1
ObamaCare officials ... head in the sand? Whistling in the dark? Maybe it'll go away?
6
No, they simply understand that some of the problems, like this one, require a legislative solution that Republicans will not allow.
7
th world will come to an end before americans accept socialized medicine
why do you always resist th simpler way for th more complicated
and costly
30
Sometimes I wonder if NYT reporters have time to read articles on their own paper, maybe even the articles they wrote themselves.
Way back on Dec 2015, Robert Pear reported that Sen Marco Rubio quietly inserted a provision in a huge spending bill to eliminate billions in "risk corridor" funds designed to compensate insurers for anticipated losses in the initial years of Obamacare.
The early sign-up of the most expensive uninsured was anticipated by the law and the risk corridor funds, cut by Rubio, were intended to provide transitional assistance. Once they were gone, the big insurers tried the consolidation approach. Shot down on that, for good reasons, they are opting out.
So the media seems thusfar to be cooperating and complicit in Marco's quiet attack.
http://mobile.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-a...
Way back on Dec 2015, Robert Pear reported that Sen Marco Rubio quietly inserted a provision in a huge spending bill to eliminate billions in "risk corridor" funds designed to compensate insurers for anticipated losses in the initial years of Obamacare.
The early sign-up of the most expensive uninsured was anticipated by the law and the risk corridor funds, cut by Rubio, were intended to provide transitional assistance. Once they were gone, the big insurers tried the consolidation approach. Shot down on that, for good reasons, they are opting out.
So the media seems thusfar to be cooperating and complicit in Marco's quiet attack.
http://mobile.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-a...
48
This appears to be one of the few things Little Marco showed up for.
1
The risk corridor was written into law by the insurance companies (who basically wrote the whole thing) to allow them to charge what ever they wanted with middle class paying the taxes to support. I'm glad it got torpedoed and look forward to single payer. The biggest thing this law has done has speed us faster to having to deal with this. No surprise at all how it's turning out...
5
Oh that's rich! Marco Rubio represents Florida where the governor has chosen not to get on board with ACA thus locking the poor out of federal health insurance offsets. A straight up shill for the insurance industry.
2
Single payer. Wipe out these companies, with their $11m CEO salaries.
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Make that $27.9 million for Aetna's CEO. All you right wing shills out there, do you seriously think that enough "efficiency" was gained thanks to this man's "incentive" that it turns out to be a good deal for society as a whole? Maybe if you define efficiency as figuring out every way possible to deny appropriate care for people when they get sick, and stiffing doctors through monopoly power.
20
See what's happening. The exchange policies are being segregated from the insurers' other policy holders. My initial concept of how this new system would work, (I didn't read it either before it was passed) was that all of the new customers would be lumped in with all the other existing customers. That didn't happen. These new groups of policy holders are in a separate pool. As it turned out, they are a primarily sicker, lower income group that requires much more care. Of course, the medical establishment is more than happy to charge away as these new customers show up at ticket counter.
The more competition, the more insurers in any given market, the smaller the individual pools are. Instead of amortizing these high claim customers over a huge base, relatively few customers must bear the brunt of the higher costs. Those of us that make over $50K (like $50K is a lot of money) are faced with high premiums and crushing deductibles that often range over $6000. (Mine is $6450). Lower income people are subsidized but all are dealing with these horrible deductibles.
In spite of all of this, the insurers are losing money as the healthcare void just swallows up more and more dollars. (Fee for service coupled with unlimited inelastic demand tends to do that).
The market based nature of the system is causing it to collapse in on itself. I'd kill it and put everyone on a Medicare type system and pay for it with a payroll tax.
The more competition, the more insurers in any given market, the smaller the individual pools are. Instead of amortizing these high claim customers over a huge base, relatively few customers must bear the brunt of the higher costs. Those of us that make over $50K (like $50K is a lot of money) are faced with high premiums and crushing deductibles that often range over $6000. (Mine is $6450). Lower income people are subsidized but all are dealing with these horrible deductibles.
In spite of all of this, the insurers are losing money as the healthcare void just swallows up more and more dollars. (Fee for service coupled with unlimited inelastic demand tends to do that).
The market based nature of the system is causing it to collapse in on itself. I'd kill it and put everyone on a Medicare type system and pay for it with a payroll tax.
182
There is about $2 trillion a year in medical costs currently not covered by Medicare and Medicaid. The total US payroll is about $7 trillion. How high would that payroll tax have to be?
And don't say you're going to see huge savings n administrative overhead, that's unrealistic.
The huge tax increase required is the reason Cingress would never pass such a program. The voters would throw them all out in the next election. The current system, where the voters' wrath is directed at insurance companies, is much better for the safety of our politicians' seats.
And don't say you're going to see huge savings n administrative overhead, that's unrealistic.
The huge tax increase required is the reason Cingress would never pass such a program. The voters would throw them all out in the next election. The current system, where the voters' wrath is directed at insurance companies, is much better for the safety of our politicians' seats.
6
I don't want to pay for your health care with a payroll tax !
I already pay Federal tax, state tax, city tax, FICA, Sales tax, a car tax....
Why don't you simply pay for what ever services you use instead of looking for others to pay.
Maybe you could use a bike instead of a car. Give up your TV & internet service. Give up your cell phone and then you can afford health insurance!
I already pay Federal tax, state tax, city tax, FICA, Sales tax, a car tax....
Why don't you simply pay for what ever services you use instead of looking for others to pay.
Maybe you could use a bike instead of a car. Give up your TV & internet service. Give up your cell phone and then you can afford health insurance!
1
Here we go again!
You would not be paying for my healthcare with your payroll tax. You would be paying for your healthcare and everyones healthcare too.
If you have employer provided healthcare, you are already paying for it. The average cost for coverage for a family of four is something like $10,000 per year. For an individual it is is $6800. That money is already taken from you. Employee benefits are earned, not given.
If everyone is taxed, then those that make less pay less. Those that make more pay more. If you are out of work, you are still covered. If you have to take a low paying job for a while, you are still covered. If you make big bucks, your income helps to offset those at the bottom. That is why we have a progressive tax system.
I'm currently paying $6312 per year for a policy with a $6450 deductible. I would much rather pay say $5000 per year and have a small deductible on the order of $500. I would be way ahead. That would be real coverage. That's what I'm talking about.
We are already paying through the nose and getting nothing. You, me, everyone.
You would not be paying for my healthcare with your payroll tax. You would be paying for your healthcare and everyones healthcare too.
If you have employer provided healthcare, you are already paying for it. The average cost for coverage for a family of four is something like $10,000 per year. For an individual it is is $6800. That money is already taken from you. Employee benefits are earned, not given.
If everyone is taxed, then those that make less pay less. Those that make more pay more. If you are out of work, you are still covered. If you have to take a low paying job for a while, you are still covered. If you make big bucks, your income helps to offset those at the bottom. That is why we have a progressive tax system.
I'm currently paying $6312 per year for a policy with a $6450 deductible. I would much rather pay say $5000 per year and have a small deductible on the order of $500. I would be way ahead. That would be real coverage. That's what I'm talking about.
We are already paying through the nose and getting nothing. You, me, everyone.
14