Giantone
12-18-2019, 12:50 PM
This thread has plenty of shots being taken, some humorous, some trifling, but in an effort to actually have meaningful discussion in here, I'll try to touch on why Chico's right that this won't work (even though he probably has no idea why it won't work). Sorry Chico, had to take a trifling shot in the spirit of the thread.
With Obamacare, the exchanges gave people an option they could choose to gain coverage, sometimes with subsidies, for cheaper rates than they could otherwise find on the market. The penalty for not having some form of coverage was a tax penalty. It was a good idea in theory but the costs of the plans offered on the exchanges skyrocketed after a few years, and many insurers pulled out of the exchanges altogether because they grew unprofitable. Why?
Think through the types of people who might be interested in signing up for the plans on the exchanges. To keep it simple for illustrative purposes, I'll bucket everyone into two groups:
- The healthy that didn't have insurance before
- The unhealthy that didn't have insurance before
The healthy folks looked at the cost of the plans on the exchanges, and they weighed it against the cost of paying the tax penalty for not having the insurance. They said hey, I never use the doctor or the hospital, I don't get sick, I'm good. While maybe not the most forward-thinking view, they determined it was cheaper and better for them to just pay the tax penalty.
Meanwhile, the unhealthy folks who used the doctor and the hospital and the pharmacy, they've been struggling to pay for their healthcare and they viewed the exchanges as a godsend. They rejoiced, FINALLY MORE AFFORDABLE INSURANCE, and they jumped at the chance to sign up for the exchanges. For them, the cost of paying the premiums for the exchange plan was pennies in comparison to paying the tax penalty plus the cost of paying for doctors and medicines out of pocket. So they signed up right away.
So now think about those two groups of people from the insurance plan's perspective. The plan goes: hey we just got a whole bunch of people signing up who need healthcare services. They're going to the doctor, they're getting prescriptions, they're at the hospital, and now we have to pay for those claims. Meanwhile, we didn't have as many of the healthy folks signing up as we thought we might. So we don't have them paying premiums into the plan. Insurers love healthy people who pay premiums into the plan - they collect the premium and they never have to pay for healthcare claims.
You can see. That's a mix destined for failure. It's a heavy mix of high-cost patients rushing into the plan, and not enough premium revenue coming in from healthier people. The plan can't sustain itself, insurers say hey we either need to double the premiums or we need to exit this market.
Failure.
The failure occurred because the healthy people weren't incentivized enough to sign up for the plan. Either the tax penalty needed to be more severe, severe enough to make them say hey signing up for the plan is actually cheaper. Or the law needed to just say you have to get insurance or criminal charges of some kind.
The idea was fine but the execution wasn't there.
Similar situation here with Warren. If she gives people the choice of whether to sign up for Medicare For All, she better make sure there are some nasty incentives to make people do it. Otherwise the sick will sign up, and the healthy won't, and this time instead of insurers failing and bailing on the exchanges, Medicare will fail and destroy our safety net.
Her plan carries immense risk, far more risk than Obamacare did. She'd be better off revisiting Obamacare and tweaking the law. But that horse is likely out of the barn, politically.
I'm a financial executive who works for a healthcare provider. My views expressed here are my own and should not in any way be viewed as representative of the views of my employer, who shall remain nameless in these forums.
I agree with you !
Second I think this is the way to go.............
"................. far more risk than Obamacare did. She'd be better off revisiting Obamacare and tweaking the law. But that horse is likely out of the barn, politically."
It shouldn't be and trump has chopped it up enough were people don't give a crap about it but the general idea of Obamacare was good the law definitely need to be twerk ,it wouldn't have taken much but republican law makers were never going to fix it Mitch said as much,that made to much sense.
With Obamacare, the exchanges gave people an option they could choose to gain coverage, sometimes with subsidies, for cheaper rates than they could otherwise find on the market. The penalty for not having some form of coverage was a tax penalty. It was a good idea in theory but the costs of the plans offered on the exchanges skyrocketed after a few years, and many insurers pulled out of the exchanges altogether because they grew unprofitable. Why?
Think through the types of people who might be interested in signing up for the plans on the exchanges. To keep it simple for illustrative purposes, I'll bucket everyone into two groups:
- The healthy that didn't have insurance before
- The unhealthy that didn't have insurance before
The healthy folks looked at the cost of the plans on the exchanges, and they weighed it against the cost of paying the tax penalty for not having the insurance. They said hey, I never use the doctor or the hospital, I don't get sick, I'm good. While maybe not the most forward-thinking view, they determined it was cheaper and better for them to just pay the tax penalty.
Meanwhile, the unhealthy folks who used the doctor and the hospital and the pharmacy, they've been struggling to pay for their healthcare and they viewed the exchanges as a godsend. They rejoiced, FINALLY MORE AFFORDABLE INSURANCE, and they jumped at the chance to sign up for the exchanges. For them, the cost of paying the premiums for the exchange plan was pennies in comparison to paying the tax penalty plus the cost of paying for doctors and medicines out of pocket. So they signed up right away.
So now think about those two groups of people from the insurance plan's perspective. The plan goes: hey we just got a whole bunch of people signing up who need healthcare services. They're going to the doctor, they're getting prescriptions, they're at the hospital, and now we have to pay for those claims. Meanwhile, we didn't have as many of the healthy folks signing up as we thought we might. So we don't have them paying premiums into the plan. Insurers love healthy people who pay premiums into the plan - they collect the premium and they never have to pay for healthcare claims.
You can see. That's a mix destined for failure. It's a heavy mix of high-cost patients rushing into the plan, and not enough premium revenue coming in from healthier people. The plan can't sustain itself, insurers say hey we either need to double the premiums or we need to exit this market.
Failure.
The failure occurred because the healthy people weren't incentivized enough to sign up for the plan. Either the tax penalty needed to be more severe, severe enough to make them say hey signing up for the plan is actually cheaper. Or the law needed to just say you have to get insurance or criminal charges of some kind.
The idea was fine but the execution wasn't there.
Similar situation here with Warren. If she gives people the choice of whether to sign up for Medicare For All, she better make sure there are some nasty incentives to make people do it. Otherwise the sick will sign up, and the healthy won't, and this time instead of insurers failing and bailing on the exchanges, Medicare will fail and destroy our safety net.
Her plan carries immense risk, far more risk than Obamacare did. She'd be better off revisiting Obamacare and tweaking the law. But that horse is likely out of the barn, politically.
I'm a financial executive who works for a healthcare provider. My views expressed here are my own and should not in any way be viewed as representative of the views of my employer, who shall remain nameless in these forums.
I agree with you !
Second I think this is the way to go.............
"................. far more risk than Obamacare did. She'd be better off revisiting Obamacare and tweaking the law. But that horse is likely out of the barn, politically."
It shouldn't be and trump has chopped it up enough were people don't give a crap about it but the general idea of Obamacare was good the law definitely need to be twerk ,it wouldn't have taken much but republican law makers were never going to fix it Mitch said as much,that made to much sense.