It's not often during the midst of an antitrust fight that the public gets a look at the gamesmanship that's happening behind the scenes.
But thanks to the Huffington Post's Jonathan Cohn and Jeff Young, we got a glimpse at how health insurer Aetna is making its case to acquire rival Humana — and new insight into Aetna's decision announced Tuesday to pull out of Obamcare exchanges in 11 states.
The reporters obtained a copy of a letter from Aetna CEO Mark Bertolini to the Justice Department on July 5. The letter was written while the government was still deciding whether to oppose the insurance companies' merger on the grounds that it (and another proposed deal between Anthem and Cigna) would hurt consumers and reduce competition.
The Bertolini letter was in answer to a Department of Justice request for information about how a decision on the Humana deal would affect Aetna's participation in the health insurance exchanges created by the Affordable Care Act.
The letter is pretty direct. If the government moved to block the merger, then Aetna would begin to pull out of the health insurance exchanges.
Here's the key paragraph (emphasis added):
"Our analysis to date makes clear that if the deal were challenged and/or blocked we would need to take immediate actions to mitigate public exchange and ACA small group losses. Specifically, if the DOJ sues to enjoin the transaction, we will immediately take action to reduce our 2017 exchange footprint. We currently plan, as part of our strategy following the acquisition, to expand from 15 states in 2016 to 20 states in 2017. However, if we are in the midst of litigation over the Humana transaction, given the risks described above, we will not be able to expand to the five additional states. In addition, we would also withdraw from at least five additional states where generating a market return would take too long for us to justify, given the costs associated with a potential breakup of the transaction. In other words, instead of expanding to 20 states next year, we would reduce our presence to no more than 10 states. We also would not be in a position to provide assistance to failing cooperative exchanges as we did in Iowa recently." The Huffington Post reporters calls the letter "a clear threat."
A little more than two weeks later, on July 21, the Justice Department said it would sue to block the Aetna-Humana deal and the other proposed megamerger between Anthem and Cigna.
On Tuesday, Aetna said it would dramatically scale back its participation on the insurance exchanges in 2017. The company move would take it out of 546 counties in 11 states, leaving it active in 242 counties in four states: Delaware, Iowa, Nebraska and Virginia.
In the company's statement, CEO Bertolini said, "As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision."
The statement made no mention of the company's pending offer for Humana nor its recent correspondence with the government about how Aetna would likely respond if the feds moved to block the deal. Aetna didn't immediately respond to a request for comment on how to reconcile Tuesday's announcement with the July 5 letter made public by Huffington Post on Wednesday.
The change in tack for Aetna is also noteworthy because Bertolini was talking up the business potential of the exchanges as recently as April, when he said during a call with analysts and investors that the exchanges were "a good investment," despite the losses incurred.
At the time, Bertolini said, Aetna was "committed to working constructively with the administration and lawmakers to find solutions that can improve this program, stabilize the risk pool, and expand product flexibility, all with the goal of creating a sustainable program that makes healthcare more affordable and accessible for all consumers."
Now, the company appears to be taking its ball and going home.
For those not in the US, Aetna is a HUGE healthcare provider/insurance company. They serve 46 million Americans across the US. All three corporations I've worked for have used them. They are currently trying to purchase/acquire/whatever Humana, a decently sized healthcare company. They're basically saying "Give us what we want or we're going to stop playing ball on Obamacare".
It's like one of those blatant political threats from House of Cards that never really happens. I would think that they would be a little less...ballsy?...when in the middle of a major merger. Surely this won't backfire, right?!
Also, is this "A little more than two weeks later, on July 21, the Justice Department said it would sue to block the Aetna-Humana deal and the other proposed megamerger between Anthem and Cigna" sour grapes over them wanting to back out of Obamacare or the Justice Department really trying to break-up/stop a Healthcare Monopoly?
One would think a threat like this would incur an anti-Trust investigation of company officers pretty much right off the bat. If I were the DoJ, that's what my go-to response would be to a threat like that.
Compel wrote: Any news on their plans to rename the company Versalife after the merger?
Vaktathi wrote: One would think a threat like this would incur an anti-Trust investigation of company officers pretty much right off the bat. If I were the DoJ, that's what my go-to response would be to a threat like that.
That's probably how I would lean. "Don't poke the bear" and all that...
I want to start off with that I am against both mergers as I agree that overall, these mergers would reduce consumer choice in the overall medical insurance market which is more likely to affect the cost of insurance in the private insurance market.
However I don't really have a problem with what Aetna is doing. They are a for profit business. They looked at the Obamacare exchange market and came up with an analysis that if they wanted to stop losing money in the exchanges, they would need to merge with another insurance provider, otherwise they would need to exit certain markets.
As for the tenor of the letter, it would be naive to think that the DOJ and representatives of the company's proposing to merge were not in regular contact since before they filed. At some point in the review process, Aetna was informed by the DOJ that the DOJ was leaning towards suing to block the merger(s) and that after more "polite" discussions got no where in changing the DOJ's position, Aetna apparently decided that they needed to tell the DOJ in as explicit terms as possible that instead of protecting choice (in the Obamacare exchanges), the action would result in less choice in many exchanges. I am sure if we were privy to all the communications between Aetna and the DOJ we would see a slow escalation culminating in the referenced letter.
Also I think its worth noting that Aetna is not the only "large" insurance provider that is declaring that they are leaving certain or the majority of the public exchanges due to losses.
It's interesting that many industry analysts and political pundits cannot agree what effect if any these pullouts will have. Everything from it won't cause hardly any impact to these pullouts being as some of the surest signs of the inevitable collapse of the ACA. Even though some have accused the "large" insurance companies of engineering the losses and threatening to leave the exchanges as a way to get subsidies they believe they were promised if they lost money, I discount those claims given that 16 of the 23 nonprofit co-ops are going under. Everyone agree's that the risk pool in the ACA exchanges is not balanced, that the healthy, especially young adult (i.e. older than 26 but younger than 35) are not enrolling in the numbers hoped for.
This might not be popular, but go for it America. Nationalise your health service, and put an end to this nonsense of corporate bully boys trying to lay down the law.
You don't have to adopt our model, because there are a ton of good health care systems in Europe, but I think it could work in the USA.
The familar argument against this is choice, and no way is the government taking my money and so on and so on...
But you're having to spend money on health care anyway, so cut out the middle man, and the government or the state takes money off you anyway for tax., so handing over money to the government is hardly a new thing in the USA..
In the UK, the NHS is funded by National Insurance contributions that are deducted from your pay, and if you want private, you can still go private...
Our NHS is not perfect, there are problems, and there would be problems in an American version, that's life...
But there are advantages, especially when it comes to bulk buying drugs and vacinations for vacination problems...
There will be red tape, but I figure if you as a nation spend more on healthcare than any other nation on earth, and yet, you find yourself in the middle of the tablewhen it comes to comparing health care systems between countries,
Then you may as well try something different, becuase the status quo is ripping of the many, and enriching the minority...
It was blatantly obvious that the ACA and exchanges weren't going to work from the start. This gamesmanship on Aetna's part to try to force DOJ to approve the merger is just a byproduct of the situation created by fundamentally flawed legislation.
Vaktathi wrote: One would think a threat like this would incur an anti-Trust investigation of company officers pretty much right off the bat. If I were the DoJ, that's what my go-to response would be to a threat like that.
That's probably how I would lean. "Don't poke the bear" and all that...
Thats kinda what I was thinking. I'd want to play ball in this situation, particularly with what is shaping up to be a democratic landslide of an election led by a candidate who's backed a single payer system for decades...
Do_I_Not_Like_That wrote: This might not be popular, but go for it America. Nationalise your health service, and put an end to this nonsense of corporate bully boys trying to lay down the law.
I have a feeling if Aetna follows through on its threat to pull out and Hillary wins a landslide election, then they'll have given the gov all the political ammo they need to do just this with a President who will take great glee in pushing for it.
These insurance companies who participated in the ACA exhange wanta captive market where people were forced to buy their policies. Plus, there were beliefs that they'll be backed by the government, similar to Fannie Mae in the mortgage industry.
Well... that didn't happen.
So don't feel bad for them.
When Aetna loses $200 million in the second quarter on the exchanges... the only rational business decision is to merge with other exchange participants to maximize efficiencies... or to simply get out.
Do_I_Not_Like_That wrote: This might not be popular, but go for it America. Nationalise your health service, and put an end to this nonsense of corporate bully boys trying to lay down the law.
I have a feeling if Aetna follows through on its threat to pull out and Hillary wins a landslide election, then they'll have given the gov all the political ammo they need to do just this with a President who will take great glee in pushing for it.
Won't be able to do that w/o control of the House.
For right now, yes. If Hillary gets elected however, I'd expect she will hold the office for 8 years, during which redistricting will come into play again if I'm not mistaken, and may change that state of affairs.
This is why we need to get on the level with Universal Health Care. I don't think the ACA was the right move, but feth's sake we need something.
There shouldn't be $400 difference for medication between people on Medicaid and people who pay for insurance. Hence why I'm all for a healthcare system like Canada.
Do_I_Not_Like_That wrote: The familar argument against this is choice, and no way is the government taking my money and so on and so on...
Remember some of the "familiar" arguments are just that because they are hard to refute. For example lack of faith that the government could do a better job given how much of a role they have played in screwing up the market and their track record with the VA.
I think the article below also provides a good summary of the arguements
There also would be a myriad number of logistical issues that I don't think we could truly comprehend and given the beaucracy that would result from a single payer system, would likely multiply.
Do_I_Not_Like_That wrote: But you're having to spend money on health care anyway, so cut out the middle man, and the government or the state takes money off you anyway for tax., so handing over money to the government is hardly a new thing in the USA..
You are just changing one middle man for another, i.e. instead of multiple private businesses as the middle men (that you can pick), you have one, monolithic middle man, the US gov't.
Do_I_Not_Like_That wrote: In the UK, the NHS is funded by National Insurance contributions that are deducted from your pay, and if you want private, you can still go private...
I already have money deducted by the gov't from my paycheck for health insurance that I don't qualify for because I make too much money (I am solidly middle class btw) or not old enough to qualify for, i.e. medicaid/medicare. I also have money deducted from my paycheck for my private medical insurance which is cheaper and offers better benefits than what I could possibly get through the ACA exchanges (yes I did check).
Do_I_Not_Like_That wrote: Our NHS is not perfect, there are problems, and there would be problems in an American version, that's life...
Sounds like the rationale that may would come up in the discussion held by the infamous death panels...sorry no cancer treatment for you...but hey that's life
Do_I_Not_Like_That wrote: But there are advantages, especially when it comes to bulk buying drugs and vacinations for vacination problems...
I'm not so sure given how inflated the cost is of anything the government buys as the result of the convoluted procurement process. Just ask the US military how much they pay for commonly available items such as tools and toiletries because of gov't procurement requirements. I am hard pressed to think of something that gets cheaper when the US Gov't buys stuff.
Do_I_Not_Like_That wrote: There will be red tape, but I figure if you as a nation spend more on healthcare than any other nation on earth, and yet, you find yourself in the middle of the tablewhen it comes to comparing health care systems between countries,
Hard to compare a health care market for a country like the US (Geographically and hugely diverse, 350 million people, various and differing state regs and dramatic difference in cost of living....) with other countries.
Do_I_Not_Like_That wrote: Then you may as well try something different, becuase the status quo is ripping of the many, and enriching the minority...
Viva la Socialism /Venezuela
By the way this is not a knock on the NHS or anyone who lives in a country with a single payer system as apparently it work for those countries ( ), but just an attempt to point out why I think a single payer system is not the easy go to solution for the US that some would make it out to be.
Vaktathi wrote: For right now, yes. If Hillary gets elected however, I'd expect she will hold the office for 8 years, during which redistricting will come into play again if I'm not mistaken, and may change that state of affairs.
Redistricting happens on the state level and only the states governed by the Voting Rights Act need DOJ approval for it. What happens with redistricting is dependent on which party controls your state house.
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jreilly89 wrote: This is why we need to get on the level with Universal Health Care. I don't think the ACA was the right move, but feth's sake we need something.
There shouldn't be $400 difference for medication between people on Medicaid and people who pay for insurance. Hence why I'm all for a healthcare system like Canada.
Biggest problem is that the Congress that is full of people that thought it was a good idea to require young people to buy insurance in order to offset giving sick/unhealthy people guaranteed access to insurance while simultaneously allowing healthy young people to stay on their parents' health insurance plan until they were 27 years old. That kind of oxymoronic thinking/planning is what causes debacles like this to happen. And if you thought there was a lot of partisanship, obstructionism and back room dealing for the ACA wait until Hillary is president with a Republican controlled Congress. I'm pretty sure it would be literally impossible to get both Parties to cooperate and create a better system anytime in the next 4 years.
While I get that Aetna is a for profit business, it is a for profit business that is now holding millions of innocent people hostage because its not getting its way. That's some fine corporate citizenship right there (hello future example of how the health care industry is legal extortion!) Mega-mergers need to stop, and American anti-trust laws need to be enforced with some back bone. The DOJ is doing what it thinks it should do, Aetna is doing what it thinks it should do. Works out hopefully.
Vaktathi wrote: For right now, yes. If Hillary gets elected however, I'd expect she will hold the office for 8 years, during which redistricting will come into play again if I'm not mistaken, and may change that state of affairs.
Its also looking increasingly optimistic that the GOP can hold Congress imo. The Presidential race has an actual trickle down effect that isn't imaginary, and if Trump tanks it hard enough it could effect the party's broader prospects come November. Even if they hold on in November, if Hillary wins I don't see the party putting up a good candidate in Trumps wake, not just in another four years but as much as 12 years, which will further tank the party's ability to hold office in Congress, and the states.
Prestor Jon wrote: I'm pretty sure it would be literally impossible to get both Parties to cooperate and create a better system anytime before the sun burns out
IMO, Aetna did the right thing. They are not a charity, and if they don't have the economy of scale from the merger, then it's only rational to exit those markets where they are losing money. Whoever remains will have less competition, and can charge more, becoming profitable. That's a straight business decision there, no matter how HuffPo wants to frame it.
JohnHwangDD wrote: IMO, Aetna did the right thing. They are not a charity, and if they don't have the economy of scale from the merger, then it's only rational to exit those markets where they are losing money. Whoever remains will have less competition, and can charge more, becoming profitable. That's a straight business decision there, no matter how HuffPo wants to frame it.
On the other hand, eliminating competition so you can charge more is also the kind of thing that the laws are meant to prevent.
JohnHwangDD wrote: IMO, Aetna did the right thing. They are not a charity, and if they don't have the economy of scale from the merger, then it's only rational to exit those markets where they are losing money. Whoever remains will have less competition, and can charge more, becoming profitable. That's a straight business decision there, no matter how HuffPo wants to frame it.
On the other hand, eliminating competition so you can charge more is also the kind of thing that the laws are meant to prevent.
Isn't that why we have state insurance boards that regulate the industry and require that companies submit all proposed price hikes and supporting evidence for them to the boards for approval? It's not like leaving the exchange would let them raise premiums with impunity.
Except, that is exactly what capitalism is supposed to do - to remove non-profitable business from the market...
And Aetna isn't doing anything that violates any of the Anti-Trust laws. They weren't buying Humana to reduce competition, they were buying scale so they could continue to compete.
Also, Aetna leaving those exchanges means that whatever increases that were approved simply wouldn't have been enough for them to continue doing business.
The thing that surprises me is that the insurance board didn't simply let Aetna charge whatever they wanted, which is unlike how the overwhelming majority of utility regulators work. Most regulators bend over backward to accommodate the utilities.
JohnHwangDD wrote: IMO, Aetna did the right thing. They are not a charity, and if they don't have the economy of scale from the merger, then it's only rational to exit those markets where they are losing money. Whoever remains will have less competition, and can charge more, becoming profitable. That's a straight business decision there, no matter how HuffPo wants to frame it.
On the other hand, eliminating competition so you can charge more is also the kind of thing that the laws are meant to prevent.
Isn't that why we have state insurance boards that regulate the industry and require that companies submit all proposed price hikes and supporting evidence for them to the boards for approval? It's not like leaving the exchange would let them raise premiums with impunity.
In theory.... except when commissioners often come from a background where one could surmise a conflict of interest (according to Wiki, the current commish for my state used to be a doctor... yet ALL of the insurance "producers" I worked with hate the guy, and basically assume that he's on the insurance companies' side... they usually went so far as to say he went from working in their companies to working as commissioner)
And While I agree that capitalism is a system that should continue to be used in the US, and operate... I do not think that human health should be for sale.
I think it's high time we seriously look at the UK, Canada, or even the Bismark models for how to effectively construct a healthcare system that treats everyone.
JohnHwangDD wrote: Except, that is exactly what capitalism is supposed to do - to remove non-profitable business from the market...
Not really. That's just a byproduct of capitalist systems. What capitalism is supposed to do is maximize the economic potential of a population under the assumption that the best way to generate wealth is through voluntary exchange, competition, and the personal freedom to use your private property for your own benefit. Non-profitable businesses being removed from the market one way or another is just a byproduct of what capitalism is supposed to do. Arguably, the entire idea of health insurance (or even insurance in general) violates the principal of voluntary exchange. The out of pocket costs of healthcare are too severe for most people to ever afford it. In almost any case having health insurance is universally better than not having it. There is no question as to whether someone wants health insurance, only as to whether they can afford it.
Ensis Ferrae wrote: And While I agree that capitalism is a system that should continue to be used in the US, and operate... I do not think that human health should be for sale.
Human health cannot be for sale, because it is not a rational purchase. Many people are willing to spend nearly unlimited amounts of money to live another day, and this characterizes US Terminal Care.
At some point, we need to be very aggressive in denying care on a national basis, such that "old" people, "sick" people DO NOT GET care, but are simply eased into death as cheaply as possible.
When the US has the balls to get serious about how healthcare dollars are spent, then we'll see reform. And the elimination of US healthcare as we currently know it.
JohnHwangDD wrote: Except, that is exactly what capitalism is supposed to do - to remove non-profitable business from the market...
Not really. That's just a byproduct of capitalist systems. What capitalism is supposed to do is maximize the economic potential of a population under the assumption that the best way to generate wealth is through voluntary exchange, competition, and the personal freedom to use your private property for your own benefit. Non-profitable businesses being removed from the market one way or another is just a byproduct of what capitalism is supposed to do. Arguably, the entire idea of health insurance (or even insurance in general) violates the principal of voluntary exchange. The out of pocket costs of healthcare are too severe for most people to ever afford it. In almost any case having health insurance is universally better than not having it. There is no question as to whether someone wants health insurance, only as to whether they can afford it.
Aetna choosing not to waste their capital on a losing venture is Capitalism 101.
JohnHwangDD wrote: IMO, Aetna did the right thing. They are not a charity, and if they don't have the economy of scale from the merger, then it's only rational to exit those markets where they are losing money. Whoever remains will have less competition, and can charge more, becoming profitable. That's a straight business decision there, no matter how HuffPo wants to frame it.
On the other hand, eliminating competition so you can charge more is also the kind of thing that the laws are meant to prevent.
Nothing is stopping Aetna from leaving the exchange.
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SickSix wrote: Why can't States handle healthcare how they want?
Why does every issues have to have a federal solution?
If California wants a Single Payer system then let them have it.
If Florida wants private health insurance let us have it.
I really don't understand what is wrong with that.
Very hard to do...
Colorado is trying to go to single payer... but, every analysis from both sides agrees that taxes has to go waaay up in order to be viable.
If you're gonna drop out, drop out. Whatever that's fine, they have the right. If you're not turning a profit you're welcome to stop providing the service;. What you don't do and what rubs me the wrong way is, trying to strong arm the government into exempting you from regulatory oversight on threat of pulling support from their programs. Calling extortion would be the polite way of doing things.
If the world was a fair place all of the company's assets would be immediately seized and ownership fully forfeited to the government. Everyone within 2 degrees of the c-suite would be looking at their personal assets being seized and 40-Life. The world isn't a fair place though and I'm sure the government and the interests of the people it supposedly represents will be bending over backwards to beg forgiveness from those we were wronged by.
tneva82 wrote: Then again if you have monopoly what motivation you have to ensure you have quality or cost efficiency...
Altruism? On the other hand, what motivation do you have to decrease quality or efficiency? The problem with private health care is that the people who benefit from the quality and efficiency incentives are the shareholders of large corporations, not the people who need health care. The incentive is to raise prices as much as possible without losing too many customers (after all, what are you going to do, decide not to get that cancer treated?) and deny as many insurance claims as possible. If there's any savings in efficiency they sure aren't going to be passed on to the average person. And this happens at every level of the process: doctors, hospitals, drug companies, basic supplies, etc. Someone has to make a profit from every part of health care, which pretty much guarantees that you're not going to be getting the best possible deal for the average person.
And then there's the "insurance pays for everything" problem where the system actively rewards inefficiency. Say you're a doctor. You know that most of your patients are covered by insurance, so they're paying the same fixed price no matter how much you charge for your services. So why charge $100 for a thing when you can charge $1,000 for it? Sure, the insurance company will eventually pass on the price increase to their customers but it's not like they can really choose to stop paying. The end result is that there's a lot of stuff that costs obscene amounts of money in the US compared to what it costs in other countries.
Peregrine wrote: Altruism? On the other hand, what motivation do you have to decrease quality or efficiency?
Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere. You see good examples of how inefficient monopolies are in Finland. Wherever there's goverment ran monopoly in Finland you know customers are getting screwed.
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
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tneva82 wrote: You see good examples of how inefficient monopolies are in Finland. Wherever there's goverment ran monopoly in Finland you know customers are getting screwed.
But how does this compare to customers getting screwed by private industry's profit motives? And to the inefficiency in the private industry system that I pointed out?
I cannot believe that Lord of Deeds thinks they are 'death panels' in the British health system...thats..just...
I remember that Fox News story about Stephen Hawking being killed by a 'death panel' but lo and behold, Hawking is alive and well...
You don't honestly believe that millions of ordinary Britons like myself would tolerate that?
But to be fair, some reasonable points were made, especially regarding middle men..
If I had the choice between a private company middleman, and a government middle man, it would be the government middle man any day of the week...
Why? Becuase as a voter you have more influence on government than you do on a private company...
In saying that, I refuse to believe that a country like the USA, rich, technologically advanced, and full of smart people and top universities, cannot make a better health care system for its people...
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
They can charge up more.
But how does this compare to customers getting screwed by private industry's profit motives? And to the inefficiency in the private industry system that I pointed out?
If one company screws customers too much customers can vote with their wallet and go elsewhere...Why pay X for worse service if another company offers better service at 90% price? Keeps companies at least from total screwing of customers because they would LOSE those customers. I sure as hell won't go to worse company "just because". Quality can be determined in advance fairly often and price is obviously well known in advance.
Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
So, AETNA and other big insurers pushed for ACA hoping for captive markets and made sure that their wouldn't be any meaningful competition between states. Now, when they don't get these mega mergers, they want to take their ball and go home. So let them.
Just shows yet another reason why relying on parasitic insurance companies was a bad idea.
LordofHats wrote: Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
As you would expect, healthcare is a major political issue in the UK.
Even though it's a national health service, there is no 'British' health service, because each of the individual 'states' in the UK: Scotland, England, Wales, Northern Ireland, run their own individual health services, to better tailor it to local needs, whilst still remaining under the national umbrella.
Couldn't the USA do something similar? Individual states tailoring things to local needs, because I recognize that tiny Rhode Island is going to be way different from Texas or California, but still sitting under the federal umbrella?
Just read this. I found it interesting how the American doctors first reaction was one of dread. Does the NHS really have that bad a rep in America? You hear the odd horror story here and there, but generally speaking, every interaction I've had with the NHS was satisfactory, y'know?
You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital.
Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abby. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought I was torturing him). Despite an extensive search and rinse mission no object or relief was to be found. I fretted about going to the hospital. It wasn’t the prospect of navigating a slightly foreign ER, but simply the prospect of the wait. While I am a staunch supporter of the British NHS in the back of my mind I envisioned a paralyzingly full emergency room and an agonizing 18 hour wait only to find he had nothing in his eye (the basic antechamber of Hell scenario). To ensure we really needed to go I gave Victor a choice between the emergency room and a toy store (Gunter’s 3rd rule), but he declined the toys so off we went to St. Thomas hospital, conveniently right over the bridge.
The hospital was on the aging side and a little drab, but clean and well-marked. I didn’t have to ask anyone for directions. We had to take a number to be registered, but waited less than 5 minutes. I gritted my teeth a bit in preparation for the we-are-not-from-the-UK conversation, but it wasn’t an issue at all. I offered my US insurance number for billing, but was told they didn’t need it. The clerk was, however, impressed with the fact that I flipped his eyelid and irrigated his eye before coming. “Well, you did all the right things,” and looking at his red and watering eye she smiled and said. “Looks like you are in the right place.”
Registration completed, we waited to be seen by the children’s part of the ER. A registrar (resident) did a quick triage within 5 minutes of our registering (also impressed with the eye irrigation) and then a nurse did his vitals and took a history. After that we waited less than 15 minutes for the registrar to do a formal assessment. He wanted ophthalmology to do the evaluation. I was a bit surprised the ER doc wouldn’t do it, but every facility is different and when they found out that Victor was born at 26 weeks and had retinopathy of prematurity they got a bit jumpy. Everyone does. I was ok with ophthalmology checking him out. What I have learned from years of medicine is don’t mess with the local order.
We were walked over to the urgent care clinic and were warned that the ophthalmology registrar was covering the whole hospitalIMG_8897 so it might be a while. This was our longest wait, about 20-30 minutes. She was very nice (also working on her PhD). Dr. Katie Williams (she gave me permission to use her name and her photo) diagnosed Victor with a corneal abrasion and easily snagged the offending speck of dirt wedged under his eyelid. Once removed Victor exclaimed, “It’s gone!,” and within a minute or two the redness cleared up. She put in antibiotic ointment and gave us a tube to use at home.
“So where do I pay?” I asked Dr. Williams.
The answer: you don’t. Perhaps they might bill us, she just wasn’t sure.
I was about as dumbfounded at her answer as she was at my asking.
I protested that it wasn’t fair. We had used services and I was very prepared to pay. I also have insurance that covers emergencies when out of network, so I was pretty sure I would be reimbursed at least some of the visit. However, we were just sent away. They do have my address so it is possible I will get a bill in the mail.
I am very curious what similar care would have cost in the US. The saddest commentary of all is that it is really impossible to tell as billing practices are so bizarre and opaque. My guess is it would be a minimum of $1000 in America for cash (which is egregious). If I ever get a bill from the UK, I’ll post a follow-up. If anyone has had similar care in the US and received a bill please do post in the comments. You can remain anonymous if you like.
But what of this idea that national health care means DMV-purgatory worthy waits, Dementor-staffed death panels, Saxon-age medical equipment, and incompetent care? Well, I can tell you we had great care at St. Thomas and Dr. Williams was fantastic. The slit lamp wasn’t brand new, but it worked just fine. Sure it’s an N of one, but I’ve been to the ER more times than I can count with my other son and this was as smooth as the best care we’ve had in the United States.
We could have hit the ER at an opportune time, but to expand my N I’ve also asked many people about their medical care while I’ve been in the UK. Not one person wanted to abandon the NHS. I’ve heard of excellent care and some care that was lacking, but the bad care has nothing to do with the “national” part. Rather it was diagnostic errors or a full hospice unit, things that I hear about with the same incidence back in the world of commercial insurance. Take away the accents and I could easily have been listening to a group of Americans discussing their care. With one exception, no one in the UK is left wondering what the price will be or gets an egregious bill.
It makes you wonder exactly what frightens Americans about the NHS?
LordofHats wrote: Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
As you would expect, healthcare is a major political issue in the UK.
Even though it's a national health service, there is no 'British' health service, because each of the individual 'states' in the UK: Scotland, England, Wales, Northern Ireland, run their own individual health services, to better tailor it to local needs, whilst still remaining under the national umbrella.
Couldn't the USA do something similar? Individual states tailoring things to local needs, because I recognize that tiny Rhode Island is going to be way different from Texas or California, but still sitting under the federal umbrella?
Ideally... yes. The Federal government becomes empowered to raise taxes, then 'block grant' the money to the states 'run/administer' the services.
What gets sticky, is determining what will be covered as necessity and what is elective. Who determines that?
Best way would be to let the state decide, but knowing some folks, they'll want the feds to mandate 'you must include these things in order to recieve these grants!'
That was the Health Minister Jeremy Hunt trying to push through a new contract for junior doctors, involving changes to the pay scheme, hours worked, etc.
The gist of it is trying to get Dr's to do a 7 day week (paying them an overall higher base rate of pay, but losing some of the weekend rates [maybe late nights aswell], the other point of contention is that we don't really have enough doctors to cover a 7 day week, so these changes would stretch those we do have thinner.
Maybe a little off with my summary, somebody else maybe able to correct me.
djones520 wrote: Well, that whole strike thing that happened in the NHS recently? That didn't exactly get good press over here.
It was the first strike in the entire history of the NHS, over very good reasons, and the doctors ensured care was still available for those who really needed it.
It's not like it happens every other year and the system stops working, you know?
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Mozzyfuzzy wrote: That was the Health Minister Jeremy Hunt trying to push through a new contract for junior doctors, involving changes to the pay scheme, hours worked, etc.
The gist of it is trying to get Dr's to do a 7 day week (paying them an overall higher base rate of pay, but losing some of the weekend rates [maybe late nights aswell], the other point of contention is that we don't really have enough doctors to cover a 7 day week, so these changes would stretch those we do have thinner.
Maybe a little off with my summary, somebody else maybe able to correct me.
The idea was that the amount of money paid for emergency cover would be raised, but what counted as emergency cover would be moved from 5pm onwards to 9pm onwards. The result being less money effectively.
The reason for this was because the Tories wanted longer doctor open hours without hiring any extra staff. This meant that the NHS would have to have less doctors on at any point in order to timetable a longer working day, but of course, this would have taken more of them into the 'emergency cover' earning bracket, which would have cost more money.
So the Government had politically motivated plans (no study has shown longer open hours results in lower patient mortality or higher efficiency), and wanted to force doctors to work later and longer hours for less pay then they'd get under the current system. Understandably, the medical professionals are not too thrilled about the Government magnanimously giving away their evenings and earnings for political objectives.
But none of that is a problem with the NHS, rather the bullheadedness of the Government.
djones520 wrote: Well, that whole strike thing that happened in the NHS recently? That didn't exactly get good press over here.
Ketara and mozzyfuzzy have explained it well, but there was also the government's refusal to listen to common sense.
The government wanted weekend care to be as good as weekday care, no problem with that, but the doctors, recognizing it was a major change, wanted to trial it out for a few months in a few regions, which again, was pretty reasonable IMO.
Unfortunately, the government then proceeded to stick its fingers in its ears and starting singing la la la la
LordofHats wrote: Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
As you would expect, healthcare is a major political issue in the UK.
Even though it's a national health service, there is no 'British' health service, because each of the individual 'states' in the UK: Scotland, England, Wales, Northern Ireland, run their own individual health services, to better tailor it to local needs, whilst still remaining under the national umbrella.
Couldn't the USA do something similar? Individual states tailoring things to local needs, because I recognize that tiny Rhode Island is going to be way different from Texas or California, but still sitting under the federal umbrella?
The problem with having the states manage it is that certain stated would intentionally screw over their citizens if this would happen.
LordofHats wrote: Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
As you would expect, healthcare is a major political issue in the UK.
Even though it's a national health service, there is no 'British' health service, because each of the individual 'states' in the UK: Scotland, England, Wales, Northern Ireland, run their own individual health services, to better tailor it to local needs, whilst still remaining under the national umbrella.
Couldn't the USA do something similar? Individual states tailoring things to local needs, because I recognize that tiny Rhode Island is going to be way different from Texas or California, but still sitting under the federal umbrella?
Ideally... yes. The Federal government becomes empowered to raise taxes, then 'block grant' the money to the states 'run/administer' the services.
What gets sticky, is determining what will be covered as necessity and what is elective. Who determines that?
Best way would be to let the state decide, but knowing some folks, they'll want the feds to mandate 'you must include these things in order to recieve these grants!'
The fact that you have people determining it at federal level by voting for congressmen/women and senators, and the fact that you have another layer of oversight at state level, is way better IMO, than cowboy companies laying down the law and making the rules up as they go along...
As I said before, you'd be hard pressed to find anybody in the UK who thinks the NHS is perfect, it's not, but the USA has the money, has the skills, has the ability to provide a better healthcare system, so why not?
That's a rhetorical questions, becuase I know what the answer is: vested interests, campaign donations, and people happy to keep the status quo as it makes them rich, and if their fellow citizens should suffer, well, I doubt if they give a damn...
LordofHats wrote: Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
As you would expect, healthcare is a major political issue in the UK.
Even though it's a national health service, there is no 'British' health service, because each of the individual 'states' in the UK: Scotland, England, Wales, Northern Ireland, run their own individual health services, to better tailor it to local needs, whilst still remaining under the national umbrella.
Couldn't the USA do something similar? Individual states tailoring things to local needs, because I recognize that tiny Rhode Island is going to be way different from Texas or California, but still sitting under the federal umbrella?
The problem with having the states manage it is that certain stated would intentionally screw over their citizens if this would happen.
Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Trying to put single payer in will start all the same lies about huge wait times for emergencies and death panels...and certain states would make sure that these become true just to spite the poor.
LordofHats wrote: Functionally if the government is the primary provider of medical care, then medical care becomes a political issue that can't be ignored unless the electorate chooses to ignore it*. In the US at least, that probably wouldn't be the case. Recipients of government medical aid are some of the most active voters in the country.
*Note I say it can't be ignored. That doesn't mean that it can't be made worse, as its entirely possible for politicians to shovel do nothing policies and pretend they're keeping everything working right.
As you would expect, healthcare is a major political issue in the UK.
Even though it's a national health service, there is no 'British' health service, because each of the individual 'states' in the UK: Scotland, England, Wales, Northern Ireland, run their own individual health services, to better tailor it to local needs, whilst still remaining under the national umbrella.
Couldn't the USA do something similar? Individual states tailoring things to local needs, because I recognize that tiny Rhode Island is going to be way different from Texas or California, but still sitting under the federal umbrella?
The problem with having the states manage it is that certain stated would intentionally screw over their citizens if this would happen.
What happens with the Federal Government screws up everyone? Then what?
At least each of the state has a chance to get it right...
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Trying to put single payer in will start all the same lies about huge wait times for emergencies and death panels...and certain states would make sure that these become true just to spite the poor.
I can categorically assure you there are no death panels in the UK, and I remember a few years back, the insulting Fox News stories that said they were, and I remember nearly putting my foot through my TV screen
Yeah, I get what you're saying, and it would be a shame if poor people in red states bought into this propaganda, because there the people who would benefit the most, but ultimately are convinced to shoot themselves in the foot by hucksters and conmen who only care for their own pockets...
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Dude... the states who hasn't expanded are geniuses right now.
The who has expanded are going to have to raise taxes a feth ton or reduce services for everyone.
Trying to put single payer in will start all the same lies about huge wait times for emergencies and death panels...and certain states would make sure that these become true just to spite the poor.
"spite the poor"??
You have a very flawed view of some group/states who are different that you...
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Trying to put single payer in will start all the same lies about huge wait times for emergencies and death panels...and certain states would make sure that these become true just to spite the poor.
I can categorically assure you there are no death panels in the UK, and I remember a few years back, the insulting Fox News stories that said they were, and I remember nearly putting my foot through my TV screen
Yeah, I get what you're saying, and it would be a shame if poor people in red states bought into this propaganda, because there the people who would benefit the most, but ultimately are convinced to shoot themselves in the foot by hucksters and conmen who only care for their own pockets...
Death Panels are nothing more than a hyperbolic name for some government mechanisms that determines what services are rendered and 'when'.
Rationing finite services was unfairly being conflated to 'Death Panels'. It's a scaremongering tactic... yes, but when you get down to it, it's not false.
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
All monopolies are bad, period. Arguing that one entity holding a monopoly is better than another entity holding a monopoly is like arguing that Person A punching you in the stomach is better than Person B punching you in the face, when nobody wants to get punched at all.
Government has zero incentive to do perform at its best and healthcare is no different in that regard. Nationalized healthcare would be politicized and subject to partisanship when it came to funding and policies, the actual workers would have to accept whatever wages and conditions the govt offered or not work and they wouldn't have any incentive to do anything beyond the minimum required. There are plenty of municipal and state depts. that I have to work with for my job that literally tell you that they don't process any new work after 4pm Mon-Fri even though they're open until 5 and on Fridays they usually stop processing anything earlier than that. Govt run healthcare would be a monopoly saddled with massive bureaucracy, little accountability and no incentive to maximize performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
Slightly OT, but here in the UK, we were sold the line in the 1990s that privitizing our railway system would provide better services, better competition etc etc
Result?
Fething disaster!!!
Predictably, the rich made their money out of it, everybody else got screwed by bad service, and the taxpayer had to bail out these companies when it went wrong...
Don't believe the hype about competition and the free market knows best...
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
Slightly OT, but here in the UK, we were sold the line in the 1990s that privitizing our railway system would provide better services, better competition etc etc
Result?
Fething disaster!!!
Predictably, the rich made their money out of it, everybody else got screwed by bad service, and the taxpayer had to bail out these companies when it went wrong...
Don't believe the hype about competition and the free market knows best...
After living with the MBTA this past winter (look up that fiasco, should you want to enjoy some suffering), I'm convinced that nobody is qualified to run public transit systems.
We've all seen those league tables that have the USA as the number 1 country for healthcare spending in the world, but number 23 for quality of healthcare per 100,000 people, or something like that...
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
All monopolies are bad, period. Arguing that one entity holding a monopoly is better than another entity holding a monopoly is like arguing that Person A punching you in the stomach is better than Person B punching you in the face, when nobody wants to get punched at all.
Government has zero incentive to do perform at its best and healthcare is no different in that regard. Nationalized healthcare would be politicized and subject to partisanship when it came to funding and policies, the actual workers would have to accept whatever wages and conditions the govt offered or not work and they wouldn't have any incentive to do anything beyond the minimum required. There are plenty of municipal and state depts. that I have to work with for my job that literally tell you that they don't process any new work after 4pm Mon-Fri even though they're open until 5 and on Fridays they usually stop processing anything earlier than that. Govt run healthcare would be a monopoly saddled with massive bureaucracy, little accountability and no incentive to maximize performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
Some things should never be privatized as 'optimal service' leaves out the human factor. I'm continuously reminded of the 'let them die' chants from the Republican debates 4 years ago...or the more recent Republican lawmaker telling a mother that is too poor to afford her son's diabetes treatment to just earn more money to pay for it...
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
All monopolies are bad, period. Arguing that one entity holding a monopoly is better than another entity holding a monopoly is like arguing that Person A punching you in the stomach is better than Person B punching you in the face, when nobody wants to get punched at all.
Government has zero incentive to do perform at its best and healthcare is no different in that regard. Nationalized healthcare would be politicized and subject to partisanship when it came to funding and policies, the actual workers would have to accept whatever wages and conditions the govt offered or not work and they wouldn't have any incentive to do anything beyond the minimum required. There are plenty of municipal and state depts. that I have to work with for my job that literally tell you that they don't process any new work after 4pm Mon-Fri even though they're open until 5 and on Fridays they usually stop processing anything earlier than that. Govt run healthcare would be a monopoly saddled with massive bureaucracy, little accountability and no incentive to maximize performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
We need to distinguish nationalized healthcare (NHS?) vs. nationalized insurance (Canadian model?).
The former healthcare providers is (mostly) government ran that is paid by collected taxes.
That later is socialized health insurance plans that provides coverage to all Canadian citizens paid by taxes - but the healhcare providers are mostly privately ran. (I'm not sure if there's a government ran healthcare system in Canada).
I'm in favor of the Canadian model... imo, it's the best of both world, where the government collect taxes to create a socialized insurance (single payor or groups of socialized insurance), which provides "block grants" to regional entities (maybe by state) to be administered to the privately-ran healthcare system.
Then, they compete for those dollars.
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Do_I_Not_Like_That wrote: We've all seen those league tables that have the USA as the number 1 country for healthcare spending in the world, but number 23 for quality of healthcare per 100,000 people, or something like that...
Something has to change IMO...
Those tables regarding 'quality' is very much in dispute.
We're #1 in spending, and the view is we'd be in the top 5 in quality.
whembly wrote: What gets sticky, is determining what will be covered as necessity and what is elective. Who determines that?
For that, you need a Death Panel.
I gak you not.
Someone needs to determine how limited healthcare funds get spent, and the outcome of not spending it a certain way means that someone dies.
Ergo, "Death Panel".
It is better that we call it what it is, than to make up some bullgak nonsense about how it does NOT decide life or death for people.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
That is the rational result of a Death Panel in action, and it is fair and reasonable.
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
All monopolies are bad, period. Arguing that one entity holding a monopoly is better than another entity holding a monopoly is like arguing that Person A punching you in the stomach is better than Person B punching you in the face, when nobody wants to get punched at all.
Government has zero incentive to do perform at its best and healthcare is no different in that regard. Nationalized healthcare would be politicized and subject to partisanship when it came to funding and policies, the actual workers would have to accept whatever wages and conditions the govt offered or not work and they wouldn't have any incentive to do anything beyond the minimum required. There are plenty of municipal and state depts. that I have to work with for my job that literally tell you that they don't process any new work after 4pm Mon-Fri even though they're open until 5 and on Fridays they usually stop processing anything earlier than that. Govt run healthcare would be a monopoly saddled with massive bureaucracy, little accountability and no incentive to maximize performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
We need to distinguish nationalized healthcare (NHS?) vs. nationalized insurance (Canadian model?).
The former healthcare providers is (mostly) government ran that is paid by collected taxes.
That later is socialized health insurance plans that provides coverage to all Canadian citizens paid by taxes - but the healhcare providers are mostly privately ran. (I'm not sure if there's a government ran healthcare system in Canada).
I'm in favor of the Canadian model... imo, it's the best of both world, where the government collect taxes to create a socialized insurance (single payor or groups of socialized insurance), which provides "block grants" to regional entities (maybe by state) to be administered to the privately-ran healthcare system.
Then, they compete for those dollars.
The issue with the Canadian model is that you can't nationalize health insurance because the federal govt can't dictate to states what companies can sell health insurance within each state. That's a states' rights, intrastate commerce issue. The federal government could try to incentivize companies to offer interstate insurance plans but the Feds can't force Tennessee to allow Blue Cross Blue Shield of North Carolina to sell health insurance in Tennessee. Congress could offer block grants to states to run intrastate exchanges but that still doesn't expand the risk pool beyond the state boundaries.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
My 84 year old grandmother beat stage 4 lymphoma. She's still independent, drives herself (mostly to the casino), and active. She received 6 children-sized Chemo treatments. She's been cancer free for 3 years.
Who are you to say she can't get treatment? With your dumbass death panel, she'd have missed the birth of 2 Great Grand Children, at least 2 more Christmases, and a Codex: DeathWatch release.
Death Panels are dumb and you should feel bad.
They should have a death panel for 30 years olds that still live at home with no fething job. Those are the REAL drain on society.
Also, Triple Riptide players.
It's less arbitrary than the Death Panel because no one likes either of my examples.
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
All monopolies are bad, period. Arguing that one entity holding a monopoly is better than another entity holding a monopoly is like arguing that Person A punching you in the stomach is better than Person B punching you in the face, when nobody wants to get punched at all.
Government has zero incentive to do perform at its best and healthcare is no different in that regard. Nationalized healthcare would be politicized and subject to partisanship when it came to funding and policies, the actual workers would have to accept whatever wages and conditions the govt offered or not work and they wouldn't have any incentive to do anything beyond the minimum required. There are plenty of municipal and state depts. that I have to work with for my job that literally tell you that they don't process any new work after 4pm Mon-Fri even though they're open until 5 and on Fridays they usually stop processing anything earlier than that. Govt run healthcare would be a monopoly saddled with massive bureaucracy, little accountability and no incentive to maximize performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
We need to distinguish nationalized healthcare (NHS?) vs. nationalized insurance (Canadian model?).
The former healthcare providers is (mostly) government ran that is paid by collected taxes.
That later is socialized health insurance plans that provides coverage to all Canadian citizens paid by taxes - but the healhcare providers are mostly privately ran. (I'm not sure if there's a government ran healthcare system in Canada).
I'm in favor of the Canadian model... imo, it's the best of both world, where the government collect taxes to create a socialized insurance (single payor or groups of socialized insurance), which provides "block grants" to regional entities (maybe by state) to be administered to the privately-ran healthcare system.
Then, they compete for those dollars.
The issue with the Canadian model is that you can't nationalize health insurance because the federal govt can't dictate to states what companies can sell health insurance within each state. That's a states' rights, intrastate commerce issue. The federal government could try to incentivize companies to offer interstate insurance plans but the Feds can't force Tennessee to allow Blue Cross Blue Shield of North Carolina to sell health insurance in Tennessee. Congress could offer block grants to states to run intrastate exchanges but that still doesn't expand the risk pool beyond the state boundaries.
Why can't you nationalize the health insurance industry in the US? I think that can work with Congress pass it as law, and the President signing it.
I think the mere fact that it's funded by taxes from the General Fund qualifies it as interstate commerce.
If the state (ins company within) wants to offer supplemental insurance, not sure how the Feds could stop them.
JohnHwangDD wrote: When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
My 84 year old grandmother beat stage 4 lymphoma. She's still independent, drives herself (mostly to the casino), and active. She received 6 children-sized Chemo treatments. She's been cancer free for 3 years.
Who are you to say she can't get treatment? With your dumbass death panel, she'd have missed the birth of 2 Great Grand Children, at least 2 more Christmases, and a Codex: DeathWatch release.
Death Panels are dumb and you should feel bad.
They should have a death panel for 30 years olds that still live at home with no fething job. Those are the REAL drain on society.
I don't feel bad at all. Treatment is expensive, and when there is a small pool of money, it only goes so far. Someone has to do without, simple as that.
But I guess you don't feel bad, happily eating your steak and lobster feast while the rest of your family goes to bed starving.
And those layabouts? How about we stop importing fething Indians to literally steal their jobs? Shut down the H1-B program, and they might actually take some of those STEM jobs we've been pushing, at wages that make it worth getting a STEM degree.
tneva82 wrote: Fill up own pockets? Charge up more or do less while charging same. No competition so no need to worry about customers going elsewhere.
But if the government has a monopoly on health care then there is no incentive to profit. Nobody running the system gets any personal benefit from it, any "profits" the system makes would just disappear into the government's general budget. And there certainly won't be any bonus checks for employees who manage to increase "profits". In fact, you might get fired for finding a way to increase "profits" without immediately passing the savings on to the customers.
All monopolies are bad, period. Arguing that one entity holding a monopoly is better than another entity holding a monopoly is like arguing that Person A punching you in the stomach is better than Person B punching you in the face, when nobody wants to get punched at all.
Government has zero incentive to do perform at its best and healthcare is no different in that regard. Nationalized healthcare would be politicized and subject to partisanship when it came to funding and policies, the actual workers would have to accept whatever wages and conditions the govt offered or not work and they wouldn't have any incentive to do anything beyond the minimum required. There are plenty of municipal and state depts. that I have to work with for my job that literally tell you that they don't process any new work after 4pm Mon-Fri even though they're open until 5 and on Fridays they usually stop processing anything earlier than that. Govt run healthcare would be a monopoly saddled with massive bureaucracy, little accountability and no incentive to maximize performance.
The only way you incentivize optimal service and budgeting is through competition because competition allows consumers to avoid bad businesses and let them go out of business if they don't improve. Monopolies, both private and public, remove competition and therefore remove incentives for peak performance.
We need to distinguish nationalized healthcare (NHS?) vs. nationalized insurance (Canadian model?).
The former healthcare providers is (mostly) government ran that is paid by collected taxes.
That later is socialized health insurance plans that provides coverage to all Canadian citizens paid by taxes - but the healhcare providers are mostly privately ran. (I'm not sure if there's a government ran healthcare system in Canada).
I'm in favor of the Canadian model... imo, it's the best of both world, where the government collect taxes to create a socialized insurance (single payor or groups of socialized insurance), which provides "block grants" to regional entities (maybe by state) to be administered to the privately-ran healthcare system.
Then, they compete for those dollars.
The issue with the Canadian model is that you can't nationalize health insurance because the federal govt can't dictate to states what companies can sell health insurance within each state. That's a states' rights, intrastate commerce issue. The federal government could try to incentivize companies to offer interstate insurance plans but the Feds can't force Tennessee to allow Blue Cross Blue Shield of North Carolina to sell health insurance in Tennessee. Congress could offer block grants to states to run intrastate exchanges but that still doesn't expand the risk pool beyond the state boundaries.
Why can't you nationalize the health insurance industry in the US? I think that can work with Congress pass it as law, and the President signing it.
I think the mere fact that it's funded by taxes from the General Fund qualifies it as interstate commerce.
If the state (ins company within) wants to offer supplemental insurance, not sure how the Feds could stop them.
I guess if you ignore the content of the constitution and established Federal jurisdiction anything is possible. State govts and state insurance commissions control intrastate insurance markets. The federal govt doesn't have the authority to step in and tell state govts and insurance commissions how to run their intrastate insurance markets. The Federal govt can offer states' federal money and the Federal govt can put all kinds of caveats on what states have to do in order to get those Federal dollars but they can't force states to act.
JohnHwangDD wrote: When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
My 84 year old grandmother beat stage 4 lymphoma. She's still independent, drives herself (mostly to the casino), and active. She received 6 children-sized Chemo treatments. She's been cancer free for 3 years.
Who are you to say she can't get treatment? With your dumbass death panel, she'd have missed the birth of 2 Great Grand Children, at least 2 more Christmases, and a Codex: DeathWatch release.
Death Panels are dumb and you should feel bad.
They should have a death panel for 30 years olds that still live at home with no fething job. Those are the REAL drain on society.
I don't feel bad at all. Treatment is expensive, and when there is a small pool of money, it only goes so far. Someone has to do without, simple as that.
But I guess you don't feel bad, happily eating your steak and lobster feast while the rest of your family goes to bed starving.
And those layabouts? How about we stop importing fething Indians to literally steal their jobs? Shut down the H1-B program, and they might actually take some of those STEM jobs we've been pushing, at wages that make it worth getting a STEM degree.
Wait, are STEM degrees *NOT* worth it? I mean, I'm still entry level, so I'm not making oodles of money, but the demand for my skillset is extremely high.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
My 84 year old grandmother beat stage 4 lymphoma. She's still independent, drives herself (mostly to the casino), and active. She received 6 children-sized Chemo treatments. She's been cancer free for 3 years.
Who are you to say she can't get treatment? With your dumbass death panel, she'd have missed the birth of 2 Great Grand Children, at least 2 more Christmases, and a Codex: DeathWatch release.
Errr....we do have private care too? Odds are, she'd have had exactly the same treatment, only at half the price. The existence of the NHS depresses the prices of private care in the UK, y'see.
whembly wrote: I think this is useful on the context of this thread and why letting the states administer some sort of "single payor or NHS-style" healthcare:
Spoiler:
States by themselves don't have the revenue stream to offer a single payer health care system to all state residents. Many states are required by state laws to produce balanced budgets and all states are limited to taxation and borrowing to generate revenue so there's limits on how much money can be earmarked for health care expenses. That's why there are still states who haven't opted in for the Medicaid expansion provisions in the ACA. The Feds would cover costs for a couple years and then cut back to standard Medicaid matching rates leaving the states to find new revenue streams to offset the increased costs of expanded Medicaid rolls and states don't have a surplus to draw funds from and don't have the political capital to spend on raising taxes.
If one company screws customers too much customers can vote with their wallet and go elsewhere...Why pay X for worse service if another company offers better service at 90% price? Keeps companies at least from total screwing of customers because they would LOSE those customers. I sure as hell won't go to worse company "just because". Quality can be determined in advance fairly often and price is obviously well known in advance.
This is a flawed way of understanding state-run and state-financed healthcare because the point is explicitly to not be a customer. There are guidelines and rules for treatment and resource allocation and the incentive people have for doing a good job and making sure that there isn't a lot of waste is professionalism and a love for helping people, which are powerful motivators and happen quite naturally. There is less inherent waste in universal healthcare than there is in private healthcare because profit is a chunk of money that just disappears.
Viewing the world through the lens of a consumer is very dangerous.
If one company screws customers too much customers can vote with their wallet and go elsewhere...Why pay X for worse service if another company offers better service at 90% price? Keeps companies at least from total screwing of customers because they would LOSE those customers. I sure as hell won't go to worse company "just because". Quality can be determined in advance fairly often and price is obviously well known in advance.
This is a flawed way of understanding state-run and state-financed healthcare because the point is explicitly to not be a customer. There are guidelines and rules for treatment and resource allocation and the incentive people have for doing a good job and making sure that there isn't a lot of waste is professionalism and a love for helping people, which are powerful motivators and happen quite naturally. There is less inherent waste in universal healthcare than there is in private healthcare because profit is a chunk of money that just disappears.
Viewing the world through the lens of a consumer is very dangerous.
There is plenty of waste, fraud and abuse in private sector health care in spite of the exact same professionalism and love for helping people that exists within the pool of employees in the health care sector. Doctors, nurses, technicians, orderlies, janitors, clerks, etc. that currently work in private sector health care aren't going to suddenly become more professional and care more about helping people because the system gets nationalized.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
As it is a government funded and run program, it should be prioritized by voter. Sorry hipsters and unmarried 20 year olds but you losers don't vote. Us old farts will get the platinum plan but you...well we've had to make some cutbacks....
Frazzled wrote: When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
As it is a government funded and run program, it should be prioritized by voter. Sorry hipsters and unmarried 20 year olds but you losers don't vote. Us old farts will get the platinum plan but you...well we've had to make some cutbacks....
Oh, so what's currently happening, when the old farts ruined the housing market?
I really don't get the fight to the death over public v private. We have both here, one doesn't invalidate the other. If those who can pay want private healthcare, they can get it. Just like America. The only difference is that the unemployed and no-insurance jobs get healthcare as well.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
My 84 year old grandmother beat stage 4 lymphoma. She's still independent, drives herself (mostly to the casino), and active. She received 6 children-sized Chemo treatments. She's been cancer free for 3 years.
Who are you to say she can't get treatment? With your dumbass death panel, she'd have missed the birth of 2 Great Grand Children, at least 2 more Christmases, and a Codex: DeathWatch release.
Errr....we do have private care too? Odds are, she'd have had exactly the same treatment, only at half the price. The existence of the NHS depresses the prices of private care in the UK, y'see.
I'm not sure who you are replying to? My grandmother had public healthcare (Medicaid/MediCare). But a grown man still acting like an "edgy" teenager wants her put down like she's a dog that pissed on his carpet.
Ketara wrote: I really don't get the fight to the death over public v private. We have both here, one doesn't invalidate the other. If those who can pay want private healthcare, they can get it. Just like America. The only difference is that the unemployed and no-insurance jobs get healthcare as well.
This is not a bad thing.
Agreed. Competition helps consumers, monopolies (private or public) hurt consumers. Having the government in the marketplace isn't inherently a bad thing and done well can be very helpful to consumers. Having the government control the market is bad because all monopolies are inherently bad. The debate here in America ends up being binary because it's another negative effect of only having 2 viable political parties stripping nuance and compromise away from important issues and making them either-or situations. Two parties mean that the argument is dumbed down to the question of whether or not the government should take over everything instead of trying to figure out the most productive way for the government to be present in the marketplace.
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Dude... the states who hasn't expanded are geniuses right now.
The who has expanded are going to have to raise taxes a feth ton or reduce services for everyone.
Why?
More residents enrolled in Medicaid means more money the state has to spend on them and that money has to come from somewhere so it's either cut funding to other things to free up money or raise taxes.
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Dude... the states who hasn't expanded are geniuses right now.
The who has expanded are going to have to raise taxes a feth ton or reduce services for everyone.
Why?
More residents enrolled in Medicaid means more money the state has to spend on them and that money has to come from somewhere so it's either cut funding to other things to free up money or raise taxes.
I thought the point of the expansion was that the FedGov was paying for it?
Ketara wrote: I really don't get the fight to the death over public v private. We have both here, one doesn't invalidate the other. If those who can pay want private healthcare, they can get it. Just like America. The only difference is that the unemployed and no-insurance jobs get healthcare as well.
This is not a bad thing.
Agreed. Competition helps consumers, monopolies (private or public) hurt consumers. Having the government in the marketplace isn't inherently a bad thing and done well can be very helpful to consumers. Having the government control the market is bad because all monopolies are inherently bad. The debate here in America ends up being binary because it's another negative effect of only having 2 viable political parties stripping nuance and compromise away from important issues and making them either-or situations. Two parties mean that the argument is dumbed down to the question of whether or not the government should take over everything instead of trying to figure out the most productive way for the government to be present in the marketplace.
This is the thing. Right now, everyone is screaming the Government should take back the Southern rail franchise, and it keeps boiling down to 'Should the Government nationalise all the railways again?'
But it's daft. The logical solution is for the government to permanently operate two or three franchises to ensure that the State is familiar with the costs and business of operating a railway. This gives them a nucleus of trained personnel and expertise to draw upon. Then, if a franchise holder starts playing silly buggers, be it through poor service, ridiculous prices, or whatever scenario, the Government can step in smoothly and seize control of the franchise in the name of the public good. Having done that, they can then put one of their prior controlled franchises back up for private operation to let it get fresh rolling stock and capital injected.
The principle could be applied to water, electricity, arms, sewage, phone cables, bus services, and so on. These nationalised systems only start to go wrong when they get too ingrained, secure, and large. If you're constantly rotating which areas are government controlled, and have the state play as a competitor of last resort for when commercial companies play silly buggers, you get best of both worlds. It keeps public costs to a minimum and extracts the best result for the public.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
As it is a government funded and run program, it should be prioritized by voter. Sorry hipsters and unmarried 20 year olds but you losers don't vote. Us old farts will get the platinum plan but you...well we've had to make some cutbacks....
That's what Obamacare was trying to do with the penalties, etc. Except, for many people, the penalty is cheaper, and it's paid in April of next year. Those punks aren't entirely stupid, and they're voting against Obamacare with their wallets.
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Dude... the states who hasn't expanded are geniuses right now.
The who has expanded are going to have to raise taxes a feth ton or reduce services for everyone.
Why?
More residents enrolled in Medicaid means more money the state has to spend on them and that money has to come from somewhere so it's either cut funding to other things to free up money or raise taxes.
I thought the point of the expansion was that the FedGov was paying for it?
Per the ACA from 2014-2016 the Federal govt will pay 100% of the cost of Medicaid for enrollees under the new expansion, then the rate decreases annually down to 90% in 2020. Then it gets vague with uncertainty about if the Feds will continue to pay the 90% indefinitely or if the law will push the rate down to the standard FMAP rate that the rest of Medicaid enrollees get in that state or if Congress will change the law to something else.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
As it is a government funded and run program, it should be prioritized by voter. Sorry hipsters and unmarried 20 year olds but you losers don't vote. Us old farts will get the platinum plan but you...well we've had to make some cutbacks....
That's what Obamacare was trying to do with the penalties, etc. Except, for many people, the penalty is cheaper, and it's paid in April of next year. Those punks aren't entirely stupid, and they're voting against Obamacare with their wallets.
That plus the provision that lets you stay on your parents' insurance until your 26. Why pay for something yourself if you can get mom and dad to do it for you? Especially when it's likely cheaper and better coverage.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
As it is a government funded and run program, it should be prioritized by voter. Sorry hipsters and unmarried 20 year olds but you losers don't vote. Us old farts will get the platinum plan but you...well we've had to make some cutbacks....
That's what Obamacare was trying to do with the penalties, etc. Except, for many people, the penalty is cheaper, and it's paid in April of next year. Those punks aren't entirely stupid, and they're voting against Obamacare with their wallets.
That plus the provision that lets you stay on your parents' insurance until your 26. Why pay for something yourself if you can get mom and dad to do it for you? Especially when it's likely cheaper and better coverage.
Cheaper for them, individually, yes...But not cheaper overall. I've seen stated a couple times that insurance is cheaper through their job than through the exchange. That is not really true, it's just you don't consider how much of it your employer pays. That's wages that you never see and can't decide a better way of spending it (Which might be an insurance plan off the marketplace).
I am not a lawyer, but... The Justice Department can, in a manner of speaking. In this case, they are using Anti-Trust laws. Further, if it's blatant and/or the DA is ambitious enough, the perpetrators can be tried for extortion or something similar.
As an individual, you can sue anyone for anything. However, if you actually wanted to win, you'd have to demonstrate that they:
1. Actually blackmailed the government.
2. That blackmail directly affected you, your family, or your dog personally in someway.
But not your grandmother. If she's over 80, she has no rights.
It's not blackmail. Aetna is saying that the only way for their company to make enough money to make staying in the exchange worthwhile is to expand so they want to merge with Human. The Dept of Justice doesn't want the merger to happen because they believe it will make Aetna too big and violate anti trust laws. Therefore Aetna is telling the DoJ that if they block the merger Aetna will have to leave he exchanges. That's not blackmail at all.
But not your grandmother. If she's over 80, she has no rights.
She probably makes some mean biscuits though.
Its hard to see how anyone could prosecute or sue them for blackmail. What they are describing is a legal act. The inability to merge will have have consequences. As noted, Aetna is not the only one dropping out.
When an 80-year old woman is diagnosed with breast cancer, a well-run panel will say that she ONLY receives hospice care, with NO treatment for the cancer itself. That way, the enormous cost of her treatment can be spent on providing universal preventive and emergency care. And, because it is single payer, that hospice care is relatively inexpensive, as the ONLY pain medication she will get will be generics sourced at the lowest possible price due to the massive monopoly buying power of the state.
As it is a government funded and run program, it should be prioritized by voter. Sorry hipsters and unmarried 20 year olds but you losers don't vote. Us old farts will get the platinum plan but you...well we've had to make some cutbacks....
That's what Obamacare was trying to do with the penalties, etc. Except, for many people, the penalty is cheaper, and it's paid in April of next year. Those punks aren't entirely stupid, and they're voting against Obamacare with their wallets.
That plus the provision that lets you stay on your parents' insurance until your 26. Why pay for something yourself if you can get mom and dad to do it for you? Especially when it's likely cheaper and better coverage.
Cheaper for them, individually, yes...But not cheaper overall. I've seen stated a couple times that insurance is cheaper through their job than through the exchange. That is not really true, it's just you don't consider how much of it your employer pays. That's wages that you never see and can't decide a better way of spending it (Which might be an insurance plan off the marketplace).
Yes, the overall cost of insurance for the employed parent and his/her employer to cover an entire family including a healthy 23 year old child is more expensive than the cost of that healthy 23 year old being insured as an individual. However, given the common financial situation of 23 year olds currently (many are unemployed) it is much cheaper for the 23 year old to stay on the parent's policy than to buy an individual policy. That scenario has the opposite effect of what was intended by the ACA, it increases the cost of insurance and removes the healthy young person as a buyer in the market.
Ketara wrote: I really don't get the fight to the death over public v private. We have both here, one doesn't invalidate the other. If those who can pay want private healthcare, they can get it. Just like America. The only difference is that the unemployed and no-insurance jobs get healthcare as well.
This is not a bad thing.
Agreed. Competition helps consumers, monopolies (private or public) hurt consumers. Having the government in the marketplace isn't inherently a bad thing and done well can be very helpful to consumers. Having the government control the market is bad because all monopolies are inherently bad. The debate here in America ends up being binary because it's another negative effect of only having 2 viable political parties stripping nuance and compromise away from important issues and making them either-or situations. Two parties mean that the argument is dumbed down to the question of whether or not the government should take over everything instead of trying to figure out the most productive way for the government to be present in the marketplace.
This is the thing. Right now, everyone is screaming the Government should take back the Southern rail franchise, and it keeps boiling down to 'Should the Government nationalise all the railways again?'
But it's daft. The logical solution is for the government to permanently operate two or three franchises to ensure that the State is familiar with the costs and business of operating a railway. This gives them a nucleus of trained personnel and expertise to draw upon. Then, if a franchise holder starts playing silly buggers, be it through poor service, ridiculous prices, or whatever scenario, the Government can step in smoothly and seize control of the franchise in the name of the public good. Having done that, they can then put one of their prior controlled franchises back up for private operation to let it get fresh rolling stock and capital injected.
The principle could be applied to water, electricity, arms, sewage, phone cables, bus services, and so on. These nationalised systems only start to go wrong when they get too ingrained, secure, and large. If you're constantly rotating which areas are government controlled, and have the state play as a competitor of last resort for when commercial companies play silly buggers, you get best of both worlds. It keeps public costs to a minimum and extracts the best result for the public.
If politicians could ever get their gak together and implement smart policies like that it would be great. As you said it creates a pool of experienced workers/experts for the government to rely on for advice/testimony and creates a profit free baseline for the costs of running a utility which helps govt determine when a privately run utility is price gouging or being incompetently run. Of course it's hard to motivate voters to turn out for elections by offering up smart pragmatic plans and it's unfortunately easy to motivate people by fear mongering with ideas like private insurance companies will let you die to save money and nationalized insurance companies will kill you with death panels.
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Dude... the states who hasn't expanded are geniuses right now.
The who has expanded are going to have to raise taxes a feth ton or reduce services for everyone.
Why?
More residents enrolled in Medicaid means more money the state has to spend on them and that money has to come from somewhere so it's either cut funding to other things to free up money or raise taxes.
I thought the point of the expansion was that the FedGov was paying for it?
Per the ACA from 2014-2016 the Federal govt will pay 100% of the cost of Medicaid for enrollees under the new expansion, then the rate decreases annually down to 90% in 2020. Then it gets vague with uncertainty about if the Feds will continue to pay the 90% indefinitely or if the law will push the rate down to the standard FMAP rate that the rest of Medicaid enrollees get in that state or if Congress will change the law to something else.
Actually... there's nothing in the ACA law that stipulates Federal payment beyond 2020. So, it WILL be the states to cover all of it... and they're not going to be ready for it.
OK, I'm reporting for Rule 1, because you know how to spell my name, and you're deliberately choosing not to. Repeatedly.
Totes fixed your name.
You're welcome!
I am going to keep calling you Kronkster though. And find out if your grandmother ships those biscuits for me. Tell her a Texan son hasn't had proper biscuits and gravy since his mom passed. :(
skyth wrote: Considering the states that refused the medicaide expansion and kept voting red...yes, I feel pretty confidant at underestimating them.
Dude... the states who hasn't expanded are geniuses right now.
The who has expanded are going to have to raise taxes a feth ton or reduce services for everyone.
Why?
More residents enrolled in Medicaid means more money the state has to spend on them and that money has to come from somewhere so it's either cut funding to other things to free up money or raise taxes.
I thought the point of the expansion was that the FedGov was paying for it?
Per the ACA from 2014-2016 the Federal govt will pay 100% of the cost of Medicaid for enrollees under the new expansion, then the rate decreases annually down to 90% in 2020. Then it gets vague with uncertainty about if the Feds will continue to pay the 90% indefinitely or if the law will push the rate down to the standard FMAP rate that the rest of Medicaid enrollees get in that state or if Congress will change the law to something else.
Actually... there's nothing in the ACA law that stipulates Federal payment beyond 2020. So, it WILL be the states to cover all of it... and they're not going to be ready for it.
It's probably more likely that the Feds cover those Medicaid enrolless in accordance to FMAP ratios rather than nothing at all but it's definitely possible that the Feds could leave the states on the hook for the whole thing. Of course that's one way for Congress to bend that cost curve back downward, pass the responsibility for the payments over to the states and voila instant decrease in Federal Medicaid spending.
In case you Americans wonder, any problem tneva is experiencing must, if it is indeed real, be a problem with Finland rather than the system concept.
In Sweden it works beautifully. Prisons do not have an incentive to be revolving doors, doctors do not have an incentive to treat you as poorly as possible without you noticing in order to max profits, and so on.
The whole competition = better for consumer is an unvalidated assumption and pretty much ignores things like military and police forces, essential utilities, etc. It also presumes that profit is the primary motivator of human activity and ignores other motivators. It also ignores that industries with high barriers to entry and a few large actors tend to behave more like oligarchies anyway and resist competition.
jmurph wrote: The whole competition = better for consumer is an unvalidated assumption
There's plenty of evidence to support that competition keeps prices low, which is generally good.
The problem is that we assume the only means for companies to operate in a market is to compete. Take a look at certain industries, and you see instead a desire to avoid competition (because why compete in a game of best price when you can maneuver around it?). Cable companies are one example. They make little market zones where only one provider is active, and thus doesn't have to compete. You have to go to larger urban areas to find multiple active providers, and the price points aren't much different. Drug companies don't directly compete with one another, which is one reason why drug prices are so high. Even companies that make the same drug will sell it in different doses/delivery methods such that specific dose/delivery method of a drug only has one (two tops) providers.
Competition = better for the consumer isn't an unvalidated assumption. That companies will compete with one another is. Not every market is going to be conductive to competition anyway (computer operating systems for example)*. Why compete when you can build a new niche and control it? Why enter a competition with a competitor that will simply force you into a pricing race when you can avoid it? There are plenty of markets with direct competition like insurance providers, and generic consume goods (peanut butter, detergent, that kind of stuff). There are a number of markets where there is no competition at all, because the companies involved avoid it. Then there are markets where despite competition, "prices" don't seem to go down because of the way the product is sold to the consumer (automobiles).
*I say this because having fewer providers is actually better in some cases. Computer Software is a messy business. More operating systems introduces a lot of waste in debugging, developing drivers, and trouble shooting for different platforms that are not necessarily any better than one another. That two companies dominate the market (Apple and Microsoft + the various Unix based freeware OS'), actually benefits us more than having five or six. It makes the Operating System development business very uncompetitive, but it leaves the broader tech industry much more open and available for consumers and businesses, which is an overall net gain.
This survey asked NY state businesses on how the ACA has affected them, including questions about health coverage costs, how health plans would change under the ACA, and how the Cadillac Tax would apply to their current health care plans.
-About 60 percent of respondents to the surveys said they are making at least some changes to their health care plans in response to the ACA law.
-Number of manufacturers who said they were cutting jobs totaled 20.9 percent.
-About 13 percent of the manufacturers said they would increase the proportion of employees working part-time.
-About a third of these manufacturers said they would increase prices they charge on their customers due to the ACA.
-About 20 percent of manufacturers in NY said they were reducing the number of their employees due to the ACA.
-Number of service sector firms were asked the same questions and found that 16.8 percent of them would cut workers, 21.4 percent would raise prices due to Obamacare, and 15 percent said they would increase the proportion of employees working part-time.
jmurph wrote: The whole competition = better for consumer is an unvalidated assumption
There's plenty of evidence to support that competition keeps prices low, which is generally good.
The problem is that we assume the only means for companies to operate in a market is to compete. Take a look at certain industries, and you see instead a desire to avoid competition (because why compete in a game of best price when you can maneuver around it?). Cable companies are one example. They make little market zones where only one provider is active, and thus doesn't have to compete. You have to go to larger urban areas to find multiple active providers, and the price points aren't much different. Drug companies don't directly compete with one another, which is one reason why drug prices are so high. Even companies that make the same drug will sell it in different doses/delivery methods such that specific dose/delivery method of a drug only has one (two tops) providers.
Competition = better for the consumer isn't an unvalidated assumption. That companies will compete with one another is. Not every market is going to be conductive to competition anyway (computer operating systems for example)*. Why compete when you can build a new niche and control it? Why enter a competition with a competitor that will simply force you into a pricing race when you can avoid it? There are plenty of markets with direct competition like insurance providers, and generic consume goods (peanut butter, detergent, that kind of stuff). There are a number of markets where there is no competition at all, because the companies involved avoid it. Then there are markets where despite competition, "prices" don't seem to go down because of the way the product is sold to the consumer (automobiles).
*I say this because having fewer providers is actually better in some cases. Computer Software is a messy business. More operating systems introduces a lot of waste in debugging, developing drivers, and trouble shooting for different platforms that are not necessarily any better than one another. That two companies dominate the market (Apple and Microsoft + the various Unix based freeware OS'), actually benefits us more than having five or six. It makes the Operating System development business very uncompetitive, but it leaves the broader tech industry much more open and available for consumers and businesses, which is an overall net gain.
You would agree that lower prices are not the sole metric of good for the consumer, yes? So you might say that competition in certain industries produces lower prices. But that can also be a race to the bottom in quality. Which may not be desirable result.
Sometimes competition produces desirable results, sometimes it doesn't. I think in order to have meaningful economic analysis, you have to be much more specific, and blanket mantras like competition=good for consumers or capitalism = exploitation are so broad as to be worthless.
In regards to health insurers, there are numerous states protections that deter meaningful competition and large players seem to control the field nationally. This has produced inefficient systems that are expensive and provide poor coverage on the whole.The question is what steps could improve the situation. A laissez-faire approach is not viable, and the ACA did little to reduce obstacles to competition or provide greater regulation of industry pricing. Essentially, it just mandated that everyone able must purchase the service or face penalties. Large players supported that seeing a huge captive audience. Now, they are trying to use their influence to lessen competition in the field further.
whembly wrote: This is an interesting report for kronk (he's in manufacturing industry... right?):
-About 60 percent of respondents to the surveys said they are making at least some changes to their health care plans in response to the ACA law.
-Number of manufacturers who said they were cutting jobs totaled 20.9 percent.
-About 13 percent of the manufacturers said they would increase the proportion of employees working part-time.
Yep. I can only speak from my personal experience.
Over the last few years, we've gone from 85% copay to 75% copay (Depending on the plan, I've always been on the cheaper plan as I'm healthy and have no kids), our monthly deductions increases have exceeded inflation for the last 6 years. I can't say if that's due to ACA or rising health care costs because all of the damn Baby Boomers are finally retiring and they treated their bodies like Keith Richards!
My company has not cut jobs due to ACA nor moved towards increasing temporary vs full time employees because of ACA. We were already pretty lean after the housing bubble burst, however. My company is a major building supply company.
However, I am aware of some of our suppliers and customers that have moved towards more temps versus full time in the last 4 years. Again, I can't attribute that to ACA versus other costs pressures they're experiencing, and it's anecdotal, at best.
The move to more temps predate the ACA. The problem with asking businesses if regulations would cause them to cut back on employees they will always answer yes even if it means lying. After all they don't want any regulations.
skyth wrote: The move to more temps predate the ACA. The problem with asking businesses if regulations would cause them to cut back on employees they will always answer yes even if it means lying. After all they don't want any regulations.
Speaking of lying...
If you like your doctor, you will be able to keep your doctor. Period.
If you like your health care plan, you'll be able to keep it.
Obamacare will reduce cost by $2,500 per family per year.
kronk wrote: But not your grandmother. If she's over 80, she has no rights.
K-Ronk, when I'm dictator for life, all grannies will be on the approved list. The world is a better place with grandmas in it.
Forum trolls will of course move to the top of the black list, which I expect will get me showered with rose petals by the masses.
I'm all for guaranteeing health care for grandmas as long as we have the condition that we don't let them drive anymore. Grandmas can live to be 100 as long as she stops holding up traffic with her ridiculously slow driving with the blinker on. Everybody wins.
skyth wrote: The move to more temps predate the ACA. The problem with asking businesses if regulations would cause them to cut back on employees they will always answer yes even if it means lying. After all they don't want any regulations.
Similarly, businesses are always going to blame regulations for cutting jobs/benefits if they can instead of admitting "we did this because we can benefit our shareholders at the expense of our employees".
kronk wrote: But not your grandmother. If she's over 80, she has no rights.
K-Ronk, when I'm dictator for life, all grannies will be on the approved list. The world is a better place with grandmas in it.
Forum trolls will of course move to the top of the black list, which I expect will get me showered with rose petals by the masses.
I'm all for guaranteeing health care for grandmas as long as we have the condition that we don't let them drive anymore. Grandmas can live to be 100 as long as she stops holding up traffic with her ridiculously slow driving with the blinker on. Everybody wins.
I can accept that. She just spends her pension at the casino, anyway.
It's not blackmail. Aetna is saying that the only way for their company to make enough money to make staying in the exchange worthwhile is to expand so they want to merge with Human. The Dept of Justice doesn't want the merger to happen because they believe it will make Aetna too big and violate anti trust laws. Therefore Aetna is telling the DoJ that if they block the merger Aetna will have to leave he exchanges. That's not blackmail at all.
But it is twisted that way to make the headline more interesting as usual...
"You can keep it" and "you'll be able to keep it" are two different sentences. Quotes are supposed to be verbatim.
Not to mention the part where your own source points out that Obama apologised for the statement. Your attempt at deflection is laughably transparent. Changing the subject just to attack Obama is an example of the type of posts that have caused a large part of this forum to consider you little more than a partisan hack.
• White House Web page: "Linda Douglass of the White House Office of Health Reform debunks the myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them. " (Spanish-language version.)
•White House Web page: "If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan."
• President’s weekly address, June 6, 2009: "If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold."
• Town hall in Green Bay, Wis., June 11, 2009: "No matter how we reform health care, I intend to keep this promise: If you like your doctor, you'll be able to keep your doctor; if you like your health care plan, you'll be able to keep your health care plan."
• Remarks at the American Medical Association, June 15, 2009: "I know that there are millions of Americans who are content with their health care coverage — they like their plan and, most importantly, they value their relationship with their doctor. They trust you. And that means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period. No one will take it away, no matter what."
• Presidential press conference, June 23, 2009. "If you like your plan and you like your doctor, you won't have to do a thing. You keep your plan. You keep your doctor."
• Rose Garden remarks, July 15, 2009. "If you like your doctor or health care provider, you can keep them. If you like your health care plan, you can keep that too."
• Remarks at a rally for New Jersey Gov. Jon Corzine, July 16, 2009: "if you've got health insurance, you like your doctor, you like your plan — you can keep your doctor, you can keep your plan. Nobody is talking about taking that away from you."
• Presidential weekly address, July 18, 2009: "Michelle and I don’t want anyone telling us who our family’s doctor should be – and no one should decide that for you either. Under our proposals, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period, end of story."
• Rose Garden remarks, July 21, 2009: "If you like your current plan, you will be able to keep it. Let me repeat that: If you like your plan, you'll be able to keep it."
• Remarks in Shaker Heights, Ohio, July 23, 2009: "Reform will keep the government out of your health care decisions, giving you the option to keep your coverage if you're happy with it."
• Town hall in Raleigh, N.C., July 29, 2009: "I have been as clear as I can be. Under the reform I've proposed, if you like your doctor, you keep your doctor. If you like your health care plan, you keep your health care plan. These folks need to stop scaring everybody. Nobody is talking about you forcing … to change your plans."
• Presidential weekly address, Aug. 8, 2009: "Under the reforms we seek, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan."
• Town hall in Portsmouth, N.H., Aug. 11, 2009: "Under the reform we're proposing, if you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan."
• Town hall in Belgrade, Mont., Aug. 14, 2009: "If you like your health care plan, you can keep your health care plan. This is not some government takeover. If you like your doctor, you can keep seeing your doctor. This is important."
• Presidential weekly address, Aug. 15, 2009: "No matter what you’ve heard, if you like your doctor or health care plan, you can keep it."
• Town hall in Grand Junction, Colo., Aug. 15, 2009: "I just want to be completely clear about this. I keep on saying this but somehow folks aren't listening — if you like your health care plan, you keep your health care plan. Nobody is going to force you to leave your health care plan. If you like your doctor, you keep seeing your doctor."
• Remarks to Organizing for America, Aug. 20, 2009: "No matter what you've heard, if you like your doctor, you can keep your doctor under the reform proposals that we've put forward. If you like your private health insurance plan, you can keep it."
• Presidential weekly address, Aug. 22, 2009: "Under the reform we seek, if you like your doctor, you can keep your doctor. If you like your private health insurance plan, you can keep your plan. Period."
• Remarks on health care reform, March 3, 2010: "If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor. Because I can tell you that as the father of two young girls, I wouldn’t want any plan that interferes with the relationship between a family and their doctor."
• Presidential weekly address, March 6, 2010: "What won’t change when this bill is signed is this: If you like the insurance plan you have now, you can keep it. If you like your doctor, you can keep your doctor. Because nothing should get in the way of the relationship between a family and their doctor."
• Remarks in Glenside, Pa., March 8, 2010: "If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor."
• Remarks in St. Charles, Mo., March 10, 2010: " If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor."
• Remarks in St. Louis, Mo., March 10, 2010: "If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor. I’m the father of two young girls –- I don’t want anybody interfering between my family and their doctor."
• Remarks in Strongsville, Ohio, March 15, 2010: "If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor. I don't want to interfere with people’s relationships between them and their doctors."
• Remarks in Fairfax, Va., March 19, 2010: "If you like your doctor, you’re going to be able to keep your doctor. If you like your plan, keep your plan. I don’t believe we should give government or the insurance companies more control over health care in America. I think it’s time to give you, the American people, more control over your health."
Obama’s comments between the law’s signing and the release of the HHS regulations
• White House web page: "For those Americans who already have health insurance, the only changes you will see under the law are new benefits, better protections from insurance company abuses, and more value for every dollar you spend on health care. If you like your plan you can keep it and you don’t have to change a thing due to the health care law."
• Remarks in Iowa City, Iowa, March 25, 2010: "You like your plan? You’ll be keeping your plan. No one is taking that away from you."
• Remarks in Portland, Maine, April 1, 2010: The critics will "see that if Americans like their doctor, they will keep their doctor. And if you like your insurance plan, you will keep it. No one will be able to take that away from you. It hasn’t happened yet. It won’t happen in the future."
• White House blog post by Stephanie Cutter, May 18, 2010: "A key point to remember is that while the Act makes many changes to the individual market, it specifically allows those who want to keep their current insurance to do so. Most of the Act’s protections apply only to new policies, allowing people to stick with their current plan if they prefer."
After the release of the HHS regulations
• Kathleen Sebelius blog post, June 14, 2010: "The bottom line is that under the Affordable Care Act, if you like your doctor and plan, you can keep them."
• White House blog post by Stephanie Cutter. "Another important step we’ve taken is to fulfill President Obama’s promise that ‘if you like your health plan, you can keep it.’ Last week, Secretary Sebelius and Secretary of Labor Hilda Solis announced a new rule that protects the ability of individuals and businesses to keep their current plan. It outlines conditions under which current plans can be ‘grandfathered’ into the system, minimizing market disruption and putting us all on the path toward the competitive, patient-centered market of the future."
• Remarks on the Affordable Care Act Supreme Court ruling, June 28, 2012: "If you’re one of the more than 250 million Americans who already have health insurance, you will keep your health insurance — this law will only make it more secure and more affordable."
• Campaign event in Pittsburgh, July 6, 2012: "If you have health insurance, the only thing that changes for you is you’re more secure because insurance companies can't drop you when you get sick."
• Campaign event in Virginia Beach, Va., July 13, 2012: "If you already have health care, the only thing this bill does is make sure that it’s even more secure and insurance companies can't jerk you around."
• First presidential debate in Denver, Oct. 3, 2012: "If you've got health insurance, it doesn't mean a government takeover. You keep your own insurance. You keep your own doctor. But it does say insurance companies can't jerk you around."
• Remarks in Largo, Md., Sept. 26, 2013: "Now, let’s start with the fact that even before the Affordable Care Act fully takes effect, about 85 percent of Americans already have health insurance — either through their job, or through Medicare, or through the individual market. So if you’re one of these folks, it’s reasonable that you might worry whether health care reform is going to create changes that are a problem for you — especially when you’re bombarded with all sorts of fear-mongering. So the first thing you need to know is this: If you already have health care, you don’t have to do anything."
Your attempt at deflection is laughably transparent. Changing the subject just to attack Obama is an example of the type of posts that have caused a large part of this forum to consider you little more than a partisan hack.
I changed the subject?
All I said that it was a gak deal, and Obama/Democrats deserves every scorn over this law.
It's the pearl-clutching, Obama Whiteknighters™ that can't let go, because they know it to be gakky law.
And now you're making a strawman of what I said. I pointed out that Obama said "you can keep", not "you'll be able to keep" and that you should be more thorough when you quote people. At no point have I defended the statement.
And yes, you changed the subject. The fact that you're attacking Obama for unrelated statements in a thread about Aetna ought to illustrate that abundantly.
AlmightyWalrus wrote: And now you're making a strawman of what I said. I pointed out that Obama said "you can keep", not "you'll be able to keep" and that you should be more thorough when you quote people. At no point have I defended the statement.
O.o
First of all, in my initial response I didn't quote... a paraphrased. Hence why I didn't quote it initially.
So, why are you hung up on "you can keep" vs "you'll be able to keep"? They're functionally the same.
And yes, you changed the subject. The fact that you're attacking Obama for unrelated statements in a thread about Aetna ought to illustrate that abundantly.
Because PPACA is a gak law. That is a fact.
Aetna dropping out because they couldn't make money is because of this gakky law... EVEN within a captive market.
dogma was just being his usual pedantic-self, so... why are you so defensive?
Captive markets are markets where the potential consumers face a severely limited number of competitive suppliers; their only choices are to purchase what is available or to make no purchase at all. Captive markets result in higher prices and less diversity for consumers...
I have to admit, I am really confused why so many insurance companies are trying to drop out of Obamacare considering they practically wrote the darn thing.
It just gets us one step closer to single-payer, and do Insurance providers really want that?
Easy E wrote: I have to admit, I am really confused why so many insurance companies are trying to drop out of Obamacare considering they practically wrote the darn thing.
It just gets us one step closer to single-payer, and do Insurance providers really want that?
It's big pharma that's generally accused of writing the ACA. The whole thing was kind of a losing deal for insurance companies from the beginning.
Easy E wrote: I have to admit, I am really confused why so many insurance companies are trying to drop out of Obamacare considering they practically wrote the darn thing.
It just gets us one step closer to single-payer, and do Insurance providers really want that?
It's big pharma that's generally accused of writing the ACA. The whole thing was kind of a losing deal for insurance companies from the beginning.
This and the generic healthcare lobbying groups (AMA, etc...).
I do believe I mention on the original ACA thread that Romneycare was geared for that specific state and aimed at a certain percentage or some such. Total Goat Rope
whembly wrote: Because PPACA is a gak law. That is a fact.
Aetna dropping out because they couldn't make money is because of this gakky law... EVEN within a captive market.
I know you don't like Obama, Clinton, ACA or any other kind of blue coloured politics, and you want to believe anything bad about any of those things. I get that, it's part of the whembly experience here on dakka. But look what you've done in this case - you were so happy to believe something bad about ACA that you took a press release from a corporate insurer at face value. People who are paid to lie for a living said something, and you believed it because that let you confirm something you wanted to believe about ACA. That right there should be the wake up call to make you reconsider how you go about thinking about politics.
I'm sure right now you probably want to argue that Aetna did lose hundreds of millions so this time they're actually telling the truth. And while it is true that Aetna lost hundreds of millions, that's because it's a new market. Expanding in to a single new market can cost a fortune in research, product and provider development, and then once you've got your product you have to spend big on marketing and price discounting to get your piece of the market share. Expanding in to fifteen new markets as Aetna did will cost a small fortune. Here's Aetna's CEO back in April of this year explaining how it works;
“We have 911,000 members on the public exchange as individual. We have 1.2 million members that are exchange or ACA-compliant. If we were to go out and buy those members, it would cost us somewhere around $1.2 billion to acquire them. If we were to build out 15 markets, it would cost us somewhere between $600 million to $750 million to enter those markets and build out the capabilities necessary to grow that membership. So in the broad scheme of things, we are well, well below any of those numbers from the standpoint of losses we've incurred in the first two-and-a-half years of this program. So we see this as a good investment…”
It was a good investment in April. In July the DoJ rejected the proposed merger of Anthem and Aetna. Then in August the expansion in to those markets suddenly becomes a terrible investment.
And you believed them.
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Easy E wrote: I have to admit, I am really confused why so many insurance companies are trying to drop out of Obamacare considering they practically wrote the darn thing.
That's only a puzzle as long as you fail to reconsider the assumption that ACA was written by the insurers. As Lord of Hats mentioned, it was the pharmaceutical companies that played along with ACA and got a lot for themselves included in the bill. Not so much as they got out of GW Bush's $7 trillion drug benefit scheme, but they still did rather nicely.
The private insurers, on the other hand, made a decision to fight ACA every step of the way. They made this decision because while becoming part of the process would have given them a bill better suited to their interests and profits, it was never going to be a good bill for private insurers. This is because the core of ACA is about removing the right of insurers to deny someone coverage. Private insurers were never going to get a bill that increased their profits when they could no longer deny coverage.
So the insurers made a strategic decision, instead of being part of the process and trying to minimise the harm to their profits, they backed the effort to tank the bill.
whembly wrote: Because PPACA is a gak law. That is a fact.
Aetna dropping out because they couldn't make money is because of this gakky law... EVEN within a captive market.
I know you don't like Obama, Clinton, ACA or any other kind of blue coloured politics, and you want to believe anything bad about any of those things. I get that, it's part of the whembly experience here on dakka. But look what you've done in this case - you were so happy to believe something bad about ACA that you took a press release from a corporate insurer at face value. People who are paid to lie for a living said something, and you believed it because that let you confirm something you wanted to believe about ACA. That right there should be the wake up call to make you reconsider how you go about thinking about politics.
I'm sure right now you probably want to argue that Aetna did lose hundreds of millions so this time they're actually telling the truth. And while it is true that Aetna lost hundreds of millions, that's because it's a new market. Expanding in to a single new market can cost a fortune in research, product and provider development, and then once you've got your product you have to spend big on marketing and price discounting to get your piece of the market share. Expanding in to fifteen new markets as Aetna did will cost a small fortune. Here's Aetna's CEO back in April of this year explaining how it works;
“We have 911,000 members on the public exchange as individual. We have 1.2 million members that are exchange or ACA-compliant. If we were to go out and buy those members, it would cost us somewhere around $1.2 billion to acquire them. If we were to build out 15 markets, it would cost us somewhere between $600 million to $750 million to enter those markets and build out the capabilities necessary to grow that membership. So in the broad scheme of things, we are well, well below any of those numbers from the standpoint of losses we've incurred in the first two-and-a-half years of this program. So we see this as a good investment…”
It was a good investment in April. In July the DoJ rejected the proposed merger of Anthem and Aetna. Then in August the expansion in to those markets suddenly becomes a terrible investment.
And you believed them.
If there were money to be made, Aetna would've stayed in Seb. I can't believe I have to tell you that...
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Easy E wrote: I have to admit, I am really confused why so many insurance companies are trying to drop out of Obamacare considering they practically wrote the darn thing.
That's only a puzzle as long as you fail to reconsider the assumption that ACA was written by the insurers. As Lord of Hats mentioned, it was the pharmaceutical companies that played along with ACA and got a lot for themselves included in the bill. Not so much as they got out of GW Bush's $7 trillion drug benefit scheme, but they still did rather nicely.
The private insurers, on the other hand, made a decision to fight ACA every step of the way. They made this decision because while becoming part of the process would have given them a bill better suited to their interests and profits, it was never going to be a good bill for private insurers. This is because the core of ACA is about removing the right of insurers to deny someone coverage. Private insurers were never going to get a bill that increased their profits when they could no longer deny coverage.
So the insurers made a strategic decision, instead of being part of the process and trying to minimise the harm to their profits, they backed the effort to tank the bill.
When the business environment becomes more gakky because of the ACA/increased regulation, of course they're going to object to this law.
Again... if there were money to be made, these insurers would've stayed in and played ball.
whembly wrote: If there were money to be made, Aetna would've stayed in Seb. I can't believe I have to tell you that...
Except there is money to be made, and Aetna was happy to make a loss in the short term to make lots of money in the long term. Again, here's the Aetna CEO in April of this year;
"So in the broad scheme of things, we are well, well below any of those numbers from the standpoint of losses we've incurred in the first two-and-a-half years of this program. So we see this as a good investment…”
And then the DoJ ruling came down and suddenly Aetna changes its mind and it isn't a good investment. You believed it when they first told the lie, and now you're still believing even though you've been shown it's an obvious lie.
Aetna is also only pulling out of 11 states, but are more than happy to stick with the other states because it is those 11 states where they are losing money.
I wonder if those 11 states also chose to expand medicaid or were exchange delayers/deniers? That could also help explain why they are sub-optimal. i seem to recall reading that many of these 11 states were in the source, but can't source it at the moment.
Easy E wrote: I have to admit, I am really confused why so many insurance companies are trying to drop out of Obamacare considering they practically wrote the darn thing.
It just gets us one step closer to single-payer, and do Insurance providers really want that?
It's big pharma that's generally accused of writing the ACA. The whole thing was kind of a losing deal for insurance companies from the beginning.
), but just an attempt to point out why I think a single payer system is not the easy go to solution for the US that some would make it out to be.
