dailycarbs wrote:What the aca has done is to make sure the insurance company can't refuse to cover you due to a pre-existing condition. This is huge!
It is true that the aca does not allow insurance companies to refuse coverage to people. But it that was the end of it, it would be meaningless.
Think about it. Say I am the CEO of Spiral Health Insurance. Some guy with cardiovascular disease (already had a heart attack) comes to me and wants to buy a health insurance plan from me.
"The new law, the aca, says that you can't turn me down," says this person who wants health insurance.
"That's exactly right. I can't turn you down. If you want health insurance from me, your premium will be 10,000 dollars per week. Your deductible will be 1 million dollars."
Now, obviously, simply telling insurance companies that they can not refuse to enter into a contractual relationship with someone would not be much comfort, as the above thought experiment indicates.
So, what does the aca do to prevent Spiral Health Insurance from dancing away from this "no excluding pre-existing conditions" regulation? They limit the differential between how high the premium can be for a old, sick person compared to a young, healthy person. That's how.
This has positive and negative impacts, though. If a health insurance company can set its own premiums, without government regulation, it will offer lower premiums to the young and healthy and higher premiums to the old and sick. Under the aca, the health insurance corporations can still do this, but to a lesser extent. The differential between the most expensive premiums and the least expensive premiums can not be too high.
So, let's say you have a young and healthy 25 year old. He finds out that health insurance is going to cost more than he or she is willing to pay, partly because the health insurance corporations are forbidden from giving this young and healthy person as large of a price break for being young and healthy as was possible prior to the passage of the aca.
So, many young and healthies will say, "I don't think I will buy health insurance." Now, if a young, healthy person has an employer who will pay for a significant percentage of his health insurance premium, he'll probably go for it anyway, because it will be a decent deal for him, even in the short run. But someone who isn't offered much support or no support from his employer will want to pass on health insurance. After all, in some sense, he is being asked to pay part of the health insurance premium for someone older and sicker than he. And he's trying to save money to buy his first house or perhaps sock away some money for retirement.
That's where aca has both a carrot and a stick. The carrot is government subsidies for certain people. The stick is the individual mandate, a fine on people who decide not to purchase health insurance.
But where is the real increase in health insurance coverage happening? In Medicaid. Most of the people who were not previously covered with health insurance but who are covered now have signed up for Medicaid, which was expanded under the aca.
Sounds great, doesn't it. "Hey, I now have health insurance through Medicaid." Problem is that a large percentage of doctors don't take Medicaid patients. Why? Because the reimbursement rates are so low, many doctors feel that they actually lose money on every Medicaid patient they serve.
What about single payer? Why haven't we adopted that plan? Well, the way Medicaid actually works gives us a hint as to why we haven't adopted single payer. We could just say that everybody in the United States gets Medicaid coverage and then when trying to figure out how to pay all of those bills, just cut the reimbursement rates to doctors and hospitals even lower than they are now.
This way, in theory, everyone is covered. But in practice, it's very difficult to find a doctor or hospital who will give you health care due to you being a Medicaid patient.
This gets back to Jim's point. When (nearly) everyone is in need of very expensive health care treatments due to their unhealthy lifestyles and when (nearly) everyone does not want to or is unable to pay more for the health care that they want, the government has to find a way of making people
feel as though they are getting more health care than they are actually getting. The Medicaid expansion is an example of this. You might have to call a dozen doctors before you will finally find one who will take you as a patient if you have Medicaid. What if you don't really like that one doctor? Tough.
This isn't to say that our health care system was a bed of roses before the passage of the aca. There were all kinds of huge distortions in our health care system before the aca. The aca simply added a bunch more distortions to try to counter-act some of the existing distortions.
I personally think that we should go back to the principle that people should pay for their own health care and their own health insurance and that no one has the right to force anyone to provide them health care or health insurance. Health care and health insurance must be earned, not simply demanded as a right based on the ability of someone to have a pulse and a set of vocal chords. But my opinion is in the minority. So, we will continue with this clever dance where the government pretends to provide more health care to more people with the same (or slightly higher) amount of money, hoping no one will notice that the new health care system is just as dysfunctional as the old health care system.
My plan? Eat potatoes and stay away from the chicken wings.