Obamacare / Affordable Care Act : classic or dud?

lol is iphone insurance the only kind of insurance you've had tracer?

also you might want to examine yr phone insurance, it probably doesn't cover what you think it covers.

so did anyone read this? The "you" in the headline seems to openly address the quiddities stockbroker readership.

Tom Scully, 56, is slightly taller than average and has tousled graying hair, an athletic build and a lopsided smile. He typically projects a combination of confidence and bemusement, but on this rainy September afternoon, he was frenzied. Scully was scheduled to deliver the keynote address at an event hosted by the Potomac Research Group, a Beltway firm that advises large investors on government policy (tag line: “Washington to Wall Street”)....

Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. “No way,” Scully said. “Way more — way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work.” Another asked if Scully was worried about Congressional repeal. “It’s just not going to happen,” he said. “Don’t pay attention to Rush Limbaugh.” When Scully finally began his speech, he noted that the prevailing narrative among Republicans — assuming that many in the room were, like him, Republican — was incorrect. “It’s not a government takeover of medicine,” he told the crowd. “It’s the privatization of health care.” In fact, Obamacare, he said, was largely based on past Republican initiatives. “If you took George H. W. Bush’s health plan and removed the label, you’d think it was Obamacare.”

Scully then segued to his main point, one he has been making in similarly handsome dining rooms across the country: No matter what investors thought about Obamacare politically — and surely many there did not think much of it — the law was going to make some people very rich. The Affordable Care Act, he said, wasn’t simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed.

Scully, who has spent the last 30-some years oscillating between government and the private sector, is hoping to be his own best proof of the Obamacare gold mine. As a principal health policy adviser under President George H. W. Bush, he helped formulate many of those past Republican initiatives... During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it.

http://www.nytimes.com/2013/11/03/magazine/the-president-wants-you-to-get-rich-on-obamacare.html

lol is iphone insurance the only kind of insurance you've had tracer?

rumbled

actually i have renter's insurance too but that's it

did read it but if the point is that obamacare created a new generally for profit utility then yes, i was awake in 2009 also

didn't rather

i guess people like their catastrophic only, high deductible, limited doctor visit, no copay plans more than the president bargained for?

Stepping up to a plan that wasn't absolutely terrible, even w/ tax credit subsidy, would have cost me about 40% of what I spend on rent per month.

I'll pay the fine, fuck it. The plans I could afford would have done almost nothing for me in the event of an emergency - I can't pay $5k any more than I can pay $15k.

:-/

no offense but that sounds kind of short sighted

does any other kind of insurance work like this? like yeah, i've got car insurance except that i have to pay the first $5000 of repairs. how is that insurance???

― TracerHandVEVO (Tracer Hand), Wednesday, November 6, 2013 4:31 AM (7 hours ago)

actually yes! And it depends on what kind of car you have and how old it is. Unless I get hit by someone with insurance and their insurance company agrees they are at fault, all repairs to my car are out of pocket for me because my car is almost 25 years old. However, applying the concept of "salvage value" and "totalling" to a human life would be pretty "small o underscore capital o"

Possibly, but I see no upside to paying $125/month (I think) for a high deductible, shit co-pay plan for my two doctor visits/year that I average.

Going to $250-260/month got co-pays in the realm of $30 and deductibles down to $2500-3000 - but, again, I go to a doc in a box twice a year at the most.

It just doesn't make financial sense for me. If I needed a long hospital stay or a major surgery I'd be fucked in any case, so I'll just go to the county hospital and they can try to squeeze the money out of me.

are you self-employed?

If I needed a long hospital stay or a major surgery I'd be fucked in any case, so I'll just go to the county hospital and they can try to squeeze the money out of me.

i don't get this. surely you'd rather owe $5k than $15k?

Milo, would you declare bankruptcy over 5k in medical debt?

That's a pretty big hypothetical Matt.

Also, good luck with this one, Milo.

milo what if you get a hernia? etc etc? i understand being annoyed at the cost but without insurance you could literally end up bankrupting not just yourself but your relatives.

that was what finally made me realize why insurance was kind of non-negotiable: my parents were like, who do you think is going to have to pay for it if you get clipped by a taxi and need surgery?

That's a pretty big hypothetical Matt.

Not really, no

well, insurance doesn't mean that you won't have to pay a large amount of $ if something horrible happens to you. A friend of mine, who was insured through Healthy San Francisco, got hit on his bike by a city vehicle and his medical bills are probably up to a million dollars at this point.

Milo don't you shoot guns as a hobby?

The plans I could afford would have done almost nothing for me in the event of an emergency

So presumably the subsidies for low-income earners either didn't apply to you or the amount was inadequate to make the insurance affordable. If it's the first case, then you may need to look at your finances and figure out how to lower your expenses. If it's the second, then the subsidy levels in the law may not be generous enough to accomplish its stated goals.

If it's the second, then the subsidy levels in the law may not be generous enough to accomplish its stated goals.

Um, pretty sure it's the latter! No surprises there!

Not really, no

What if he only had $5k in med debt but $15k in revolving credit debt? Or $100k in mortgage debt + $5k in med debt?

Aimless OTM.

xp

Supposedly, the fines for refusing insurance will help fund the subsidies for those who participate. If there is a massive refusal, then the subsidy funding ought to be readjusted to reflect that fact, since the revenues from the fines should be much higher than anticipated.

i think you can be exempt from the fine if insurance is 40% or more of your adjusted gross income or if you are not required to file a federal tax return. I think the original idea -- or one that bleeding hearts like me wanted to be the original idea -- was that Medicaid/Medicare would cover the lower income people who couldn't afford the cheaper plans

/Not really, no/

What if he only had $5k in med debt but $15k in revolving credit debt? Or $100k in mortgage debt + $5k in med debt?

Aimless OTM.

xp

But that's not what he said, he said that 5k in debt was functionally the same for him as 15k (and of course it could be much more than that).

I think there is something to Milo's point here - if you can only afford the cheapest plans, you migh also probably not the kind of person who has an easy time keeping an extra $5k in dry powder in case of a catastrophe. If anything, the low-cost, high-deductible plans are probably more ideal for a young healthy person with good income/assets who just doesn't care about anything other than catastrophic events.

That said, not having 5K lying around doesn't mean that 5K = 15K = 100K in terms of the consequences.

well, insurance doesn't mean that you won't have to pay a large amount of $ if something horrible happens to you. A friend of mine, who was insured through Healthy San Francisco, got hit on his bike by a city vehicle and his medical bills are probably up to a million dollars at this point.

That's why the caps on out of pocket pay are the second best part of the law.

xp - well if you are barely scraping by financially as it is, and you are healthy enough not to need medical care on a regular basis, then paying for health insurance that you don't immediately need, and potentially being penalized for not doing so -- that's adding insult to injury. It feels like being penalized for being poor.

That said, not having 5K lying around doesn't mean that 5K = 15K = 100K in terms of the consequences.

this is key

perceptually, though, any of those amounts would equal being financially fucked

you can't afford not to afford care

Medicaid/Medicare would cover the lower income people who couldn't afford the cheaper plans

They do to some degree, right?

I think this was discussed either way upthread or in a politics thread, but some states are not complying with this

If I needed a long hospital stay or a major surgery I'd be fucked in any case, so I'll just go to the county hospital and they can try to squeeze the money out of me.

I'm not understanding why you'd be fucked if you had insurance

because he can't afford an insurance plan that would cover enough of the costs to make it so he isn't financially fucked!

even if ACA works as intended, our system is such a ridiculously fucked up one, only a matter of time before it needs another major overhaul. which is why I'm getting fuck out of health care industry asap.

there are debt relief options out there and obviously debt relief is more effective for 5k than 100k

for any non-emergency condition, he could just go out and get insurance and then get the surgery or whatever, and then cancel coverage.

which is why ACA is flawed. Insurance works on either risk management or the vast majority of a population buying in. I think private insurers should be able to decline offering insurance to anyone they deem to be a bad risk BUT there needs to be valid public option for those declined to fall into.

and a public option that is affordable (even free) to poor people

takers!

I think private insurers should be able to decline offering insurance to anyone they deem to be a bad risk BUT there needs to be valid public option for those declined to fall into.

so it's structurally baked in that the government takes care of the expensive cases and the private insurers take care of the cheap cases? hmm

not to mention the incentive for private insurers to bump the expensive cases they already have OFF their roles -- the govt will take em!

well, that's why it's called the Affordable Care Act. The concept of insurance has been warped for a long time.

so it's structurally baked in that the government takes care of the expensive cases and the private insurers take care of the cheap cases? hmm

either way we are all paying for everyone else's healthcare, whether it's premiums or taxes. Something like Germany's system seems far better than anything we've come up with.

not to mention the incentive for private insurers to bump the expensive cases they already have OFF their roles -- the govt will take em!

you can't just "bump" expensive cases off your roles

like even before ACA, you couldn't do that

I'm admittedly in the same boat as milo. don't qualify for medicare, and the cheapest plan available for me through the state marketplce is $300 a month, which is a big chunk of my income. Want to support the system but it might just make more sense to pay the fine