geojanes wrote:

Ray Jay wrote:one of the new rules under the ACA is that insurance companies can no longer modify rates based on a company's health history or expectation. For example, in the past a white collar employer (e.g. insurance company) would have lower rates than a blue collar employer (say oil and gas exploration company) for the same age employee demographic. The insurance companies have a sense of some demographic groups having lower health care costs. This created a dynamic whereby insurance companies would provide lower rates for different employer types. The insurance company would also be motivated to instruct employers and employees on lifestyle changes such as weight loss for long term benefit. Now insurance companies can only price based on age and smoking rates for small employers.

In my view this is not a bad thing. A huge problem for small employers is that if you employ a high ratio of expensive people your health insurance can be outrageous compared to your competitors. In New York (and probably a few other states) all small employers pay the exact same rate per person--depending on the coverage offered, of course. The net affect is that small employers become one large group, which is not a bad thing: that's a good thing, and from what I can tell ACA is moving the country in that direction.

We need a Federal law to do what States can do if they think it will help them?

Why do you suppose other States have not adopted the brilliance of NY? Outright jealousy? Or, maybe because they don't like what they see?

Here's what happens: say you employ people who have poor health/expensive chronic conditions, business people are forced to make decisions on who to employ that are not based upon business reasons but reducing their health exposure. So not only is the current system in most states wrong, it's bad for business, in my opinion.

How much more when small businesses are forced to offer healthcare to ALL employees with more than 29 hours per week. If "reducing their health exposure" is a concern, why not "reducing their insurance exposure as mandated by the ACA?"

Doctor Fate wrote:How much more when small businesses are forced to offer healthcare to ALL employees with more than 29 hours per week. If "reducing their health exposure" is a concern, why not "reducing their insurance exposure as mandated by the ACA?"

Indeed. In low skill businesses this will be a very serious issue. In higher skill businesses, however, it's a non-issue.

As far as individual choices the states make, you know it's like sausage-making, the presence or absence of a policy does not provide any evidence that it's a good or bad policy.

Does everyone agree with the premise that the ACA exacerbates the high expense of our existing health care system by strengthening the main economic forces that result in those high costs, namely that insurance is tax free and through one's employer. In addition to creating complexity between employee and employers, this strengthens 3 separate interest groups between the employee and their doctor: insurance company, U.S. government, and employer. It also creates a hodge podge of regulation and private interest that drives the U.S. health care system's expense relative to the rest of the world. Any positive provisions in ACA are window dressing relative to the main economic effect of a distorted health care marketplace.

Ray Jay wrote:Does everyone agree with the premise that the ACA exacerbates the high expense of our existing health care system by strengthening the main economic forces that result in those high costs, namely that insurance is tax free and through one's employer. In addition to creating complexity between employee and employers, this strengthens 3 separate interest groups between the employee and their doctor: insurance company, U.S. government, and employer. It also creates a hodge podge of regulation and private interest that drives the U.S. health care system's expense relative to the rest of the world. Any positive provisions in ACA are window dressing relative to the main economic effect of a distorted health care marketplace.

Yes.

Ray Jay wrote:Does everyone agree with the premise that the ACA exacerbates the high expense of our existing health care system by strengthening the main economic forces that result in those high costs, namely that insurance is tax free and through one's employer. In addition to creating complexity between employee and employers, this strengthens 3 separate interest groups between the employee and their doctor: insurance company, U.S. government, and employer. It also creates a hodge podge of regulation and private interest that drives the U.S. health care system's expense relative to the rest of the world. Any positive provisions in ACA are window dressing relative to the main economic effect of a distorted health care marketplace.

Yes

With all this speculation about the ACA, maybe we should look at the impact of a similar reform in Massachusetts? https://www.mahealthconnector.org/porta ... esults.pdf

By the way, the health reform law in Massachusetts is very popular (physicians support it, employers support it, and 2 out of 3 residents support it)--how is that possible (DF, RJ, Tom and Brad)
Btw Tom if the ACA is dropped the same forces responsible for defeating it will be aligned to defeat single-payer--so why would you expect single--payer to get passed? The ACA may be a stepping--stone to single--payer, but it will immeasurably harder to get single--payer if we haven't already gone through implementation of the ACA.

freeman3 wrote:With all this speculation about the ACA, maybe we should look at the impact of a similar reform in Massachusetts? https://www.mahealthconnector.org/porta ... esults.pdf

By the way, the health reform law in Massachusetts is very popular (physicians support it, employers support it, and 2 out of 3 residents support it)--how is that possible (DF, RJ, Tom and Brad)
Btw Tom if the ACA is dropped the same forces responsible for defeating it will be aligned to defeat single-payer--so why would you expect single--payer to get passed? The ACA may be a stepping--stone to single--payer, but it will immeasurably harder to get single--payer if we haven't already gone through implementation of the ACA.

It is not the same. Period.

2 out of 3 residents can't possibly explain it. No one knows anything in this State, which is why we have the Senator we have (and creaky Ed Markey in the builpen), the Congressmen we have, a LT Governor who just resigned, and more corruption than you can imagine.

How low are the healthcare costs in MA?

Why, lookie here: Massachusetts is better than . . . the District of Columbia??? Only? http://kff.org/other/state-indicator/he ... er-capita/

How short are the waits? http://www.forbes.com/sites/aroy/2011/0 ... ait-times/

http://commonhealth.wbur.org/2012/06/po ... sachusetts

In fact, my family has had to go hunting for doctors that are accepting patients. Why is that . . . if doctors love it so much? Shouldn't they already be lined up to open offices?

How good is "MassHealth?"

Anecdotally, the people I know don't get what they need.

agreed on the question a few above as well.
as far as single payer, no kidding this is simply a stepping stone in that direction. ACA is a mess, it's simply a stupid plan that will cost the majority more than they already pay. If your goal is to confuse people and make them so upset that so much of their money is going into healthcare expenses that they simply see no other options but a single payer plan, then this Omamcare is for you! That's exactly the plan, Americans have voiced almost no support for single payer so how do we make them want it? Baffle them, like to them, make the system so damned bad and broken and expensive the people will demand what you wanted all along! THAT is what we are getting into!

and the Massachusetts example is similar to Obamacare but not the same and not a fair comparison to most of America either. Massachusetts is not, was not, never would be similar to Alabama, Mississippi, or even Iowa and Kansas. Because it can work in an already incredibly liberal state does not mean it will work elsewhere unless, wait maybe it's similar ...another way to push the party line upon the masses? can't get what you like, then force it down peoples throats!?

Freeman,
Great question about the people of Massachusetts liking the reform in the state. Mass can have a plan that is desired by the people, and it can be supported by the electorate there. If you say the people can have the choice in Massachusetts, and what a great thing that choice is; why not allow the same polling data and choice for the other states. I would venture a guess that Wyoming or Alaska would not want the reforms in MA, let alone the ACA.

Are you saying that people should be allowed the choice of reform state by state? I am for that. Hopefully we have found another common ground position.

ray

Does everyone agree with the premise that the ACA exacerbates the high expense of our existing health care system by strengthening the main economic forces that result in those high costs, namely that insurance is tax free and through one's employer.

Exacerbates?
Today 78% of people get health insurance through their employer.
Under ACA that won't change. It didn't change in Massachusetts as noted in the information provided by Freeman3
So how can it be said that the ACA exacerbates ? (exacerbates means "makes worse " right?)

Moreover, Freemans information on slide 18 indicates that the employers share of health care premiums went down in Mass. . Why should that not go down when the same program is applied elsewhere? For the 22% of people not receiving insurance from employers its not more complicated. For the uninsured the ACA un-complicates things enormously.

Beyond that the high cost of health insurance is not due to the fact that insurance is provided by employers.. There are far more important factors, primarily things like fee for service, and the direct involvement in doctors in profit/loss and revenue generation. (The Mayo clinic is both one of the best medical institutions in the US and the most cost efficient. They did away with involving doctors in these kinds of influences in order to have them focus on patients outcomes and quality of life. ...)

The problem with the US insurance industry is that it isn't structured to care about health care costs, whether its premiums are paid by employers or individuals...
.
And whether or not the ACA is on the table, current insurance companies have no real motivation in battling health care inflation when they always have the option of passing along any inflation and raising rates to maintain their margins.
In effect, as Freeman originally said, the current insurance industry is really operating on cost plus.... And thats how government contractors rake in the dough
. If one could remove the complexity of the current insurance system, and go to one payer, where the payer has a direct motivation in battling health care costs ... then employers would benefit hugely. (by getting rid of the need to buy insurance.) But thats not on the table.

But to say the ACA makes worse the current program, by sustaining it, makes one wonder where your opposition is coming from? Is it because it isn't a single payer system that you say it fails?

What I am saying Brad is that once the ACA is implemented it will become much more popular as many of the projected negatives will either not happen or won't be as bad. Just like in Massachusetts. It's not like many of the interests against the ACA are looking at it in a fair-minded way. I am quite sure the Cato Institute, the Heritage Foundation, etc would have thought the reform in Massachusetts would have been a disaster. Well, according to the people of Massachusetts they would have been wrong.
As for states deciding the issue I think health care at our level of economic development should be a basic human right and thus has to be guaranteed federally.

tom

Because it can work in an already incredibly liberal state does not mean it will work elsewhere unless

Why? Do Liberals get sick differently then conservatives?

Ray Jay wrote:Does everyone agree with the premise that the ACA exacerbates the high expense of our existing health care system by strengthening the main economic forces that result in those high costs, namely that insurance is tax free and through one's employer.

Tax free health insurance is the main cause of high health care costs in America? I had no idea.

Today 78% of people get health insurance through their employer.
Under ACA that won't change.

But that is not true now is it? Yes, this is what Obama had "promised" yet we should not let facts get in the way should we?
We already spoke of how employers will cut hours and how some already fully plan on this, that sir is a change. How about those employers who cover spouses? Many if not most companies do plan on cutting that as well, it may not be a cut back on workers but fewer will be covered, that also equals a change. yet another lie now isn't it?

and cute responses, they do not answer the question
If people in Massachusetts like this plan, why does that mean people in Montana will like the plan as well? It simply makes no sense that such a conservative area will embrace higher taxes as did a liberal area.
...Maybe liberals are simply mentally sick????

rickyp wrote:ray

Does everyone agree with the premise that the ACA exacerbates the high expense of our existing health care system by strengthening the main economic forces that result in those high costs, namely that insurance is tax free and through one's employer.

Exacerbates?
Today 78% of people get health insurance through their employer.
Under ACA that won't change. It didn't change in Massachusetts as noted in the information provided by Freeman3
So how can it be said that the ACA exacerbates ? (exacerbates means "makes worse " right?)

As usual, you're killin' it--and it's not in a good way.

First off, you went off and commented without knowing what a word meant. Had you bothered to look, you would have seen that your assumption is right, but you also might have thought about what it was making worse. Ray said it, but you don't address it: cost.

As I pointed out, we're 50 of 51 (States and DC) in per capita costs. So, is Romneycare helping?

Moreover, Freemans information on slide 18 indicates that the employers share of health care premiums went down in Mass.

.

Oops! You left out just a little text there. Let me help you: "AS PREMIUMS HAVE INCREASED, EMPLOYERS’ SHARE OF PREMIUMS HAS FALLEN OVERALL."

So, premiums are going up, employers are paying less . . . gee, who is paying for the increase?

Why should that not go down when the same program is applied elsewhere?

So, your point is that 78% of us paying more out of pocket for our premiums will be good for the economy . . . I don't get it. I thought the problem was a drop in demand. Taking money out of our pockets won't help that.
.

But to say the ACA makes worse the current program, by sustaining it, makes one wonder where your opposition is coming from? Is it because it isn't a single payer system that you say it fails?

You just made the argument that premiums are going up for the 78% with employer-based insurance. For those without insurance at all, anything is more expensive than nothing.

So, I think you've got a lot of explaining to do.

Good luck. Your keyboard will self-destruct in 10 seconds. Should you, or any of your MI team be captured . . .