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ACA Fail Fractal
ACA Health Insurance Rates Set to Skyrocket
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  • Frank Natoli

    Covering pre-existing conditions is not insurance. Insurance implies some uncertainty. Once there is a certainty, for pre-existing conditions that the “insured” will immediately collect, for single males required to have maternity and pediatric coverage that will never collect, it’s a Democrat dictated game, and it’s not insurance. Democrats knew this all along. Destruction of the private health insurance and private health care system was always the goal, about to be achieved. Thank you, Democrat voters!

    • FriendlyGoat

      Covering pre-existing conditions is not the classic definition of insurance from an insurance company’s point of view. If you’re an actual person who has been sick or injured, or your wife or child has been sick or injured, you “suddenly” take a more sensible view of definitions. If you had asked Abraham Lincoln if he was trying to keep a “government of the insurance companies, by the insurance companies and for the insurance companies” from perishing on earth, he would have wondered what you were talking about. So do I.

      • Josephbleau

        LLoyds of London’s definition of insurance is that shippers pay an amount based on average risk of sinking to arbitrage the cost of loss. In Obamacare world, ships that are going to sink tomorrow can sign up to have the destroyed cargo paid for by taxpayers.

        • FriendlyGoat

          Please, please. please go out and tell EVERYONE under $40K a year that they are “ships with damaged hulls which are going to sink tomorrow” in the event they have already had an illness or injury in their families.
          Tell them that because Lloyds of London will not insure damaged ships that Republicans of America think their medical risks should not be insured either. Be sure to mention Republicans by name, so that the 2016 election question is a clear matter in terms of people’s real lives.

          You are making a better point than most of the candidates.

          • Josephbleau

            The point is that no one should pretend that aca is an insurance system that will break even on expenses. Your post establishes that it is an income transfer scheme from large Heath care consumers to small health care consumers. It is welfare. That may be what everyone wants but don’t pretend it is insurance.

          • FriendlyGoat

            It would be fine with me if we adopted a single-payer plan and called it “Health Care” instead of “insurance”. But it, in my opinion, is not at all like Lloyds of London making bets on whether ships will sink en route to somewhere.

          • JR

            So what you are saying is that people like having somebody else pay for something they consume. And that you can buy their vote by telling them they have a right to somebody else’s money. I don’t think anyone is disputing either fact.

          • FriendlyGoat

            What I am saying is that health care is a collective responsibility for the nation which claims itself to be “exceptional”. I agree with the conservatives on that word, by the way, but the interpretations for carrying out that role are all over the map, as you know.

      • Frank Natoli

        More sensible view of being sick or injured…while previously refusing to subscribe for medical insurance, do I understand you correctly?
        Like more sensible view of wrecking your car…while previously refusing to subscribe for collision and/or comprehensive insurance?
        Like more sensible view of death…while previously refusing to subscribe for life insurance?
        Like more sensible view of your house burning down…while previously refusing to adequately insure your house?
        Nobody in his or her right mind would dream of suggesting someone could apply for life insurance after the death of an individual, but your “sensible view” of health insurance is exactly that.
        Are there cases of “pre-existing conditions” that are special cases? Yes, of course. I have a nephew who had some severe medical problems in his youth. His father, my brother, covered him at the time. The nephew should be permitted to transition to a “normal” health insurance policy on reaching adult status. But that is a very special case. What Democrat voters and Obama and Pelosi and Reid have done is make no special cases but rather everyone dumped on insurance companies, i.e., on insurance company subscribers.
        You think “pre-existing conditions” should be a consideration of the unlimited welfare state? Fine. Then legislate an unlimited welfare state consideration for it. But leave private health insurance companies to write insurance.

        • FriendlyGoat

          Sorry, but I do not agree with allowing the policy standards in 49 states to dilute down to the least-possible policy standards in whatever 50th most-Republican backwater. That is ALL that “selling insurance across state lines” is about. The idea that the insurance company from Oklahoma—–which DOES NOT AND CANNOT EVEN HAVE A PROVIDER NETWORK IN NEW YORK—–is going fix health care costs for New Yorkers with “competition” is worse than a joke. It’s just an egregious lie, similar to most the the rest of the economic crap spun from Republicans every day of the week.

          I am perfectly comfortable with a powerful government telling insurance companies exactly what they can write or not write, and NOT AT ALL comfortable with placing the financial futures of all families into any fine print that can be passed for the benefit of the insurers in the most red state.

          As for thanking Democrats, everyone should.

          • Frank Natoli

            United Healthcare is based where? Minnesota. Does Minnesota have a provider network in New York? Uh, no, but United Healthcare, to your utter astonishment, is able to negotiate arrangements with New York doctors. Ditto Aetna. Ditto Cigna. Ditto all the companies. The issue is whether each of the 50 states, plus the Leviathan in DC, should dictate every last detail of every health insurance policy. You are determined to maintain absolute control. Congratulations on your results, see the subject article.

          • FriendlyGoat

            I’m of the opinion that residents of any state will be better off dealing with their in-state carrier than with United, or Cigna or Aetna. I also believe the providers will be better off dealing with in-state insurers who often are not making as much off of both the providers and the citizens than United and the gang.

            You don’t have to thank me personally for ACA, because I “didn’t build that”. Lots of people “built that.”

  • http://www.janetheactuary.blogspot.com Jane the Actuary

    The impact of Solvadi is going to be huge. The company is running full page ads in the newspapers, and the expectation seems to be that insurers aren’t going to be able to limit the Hep C drugs to those with only the most severe need for treatment. In my line of work, I’m not a healthcare actuary, but I listen in on training calls for the healthcare practice, and for retiree medical assumptions, and the expectation is that this one class of drugs is going to, in itself, cause a major bump in healthcare costs.

    • MartyH

      I tried estimating how much Sovaldi would cost to cure the population:

      From the CDC:

      http://www.cdc.gov/hepatitis/C/cFAQ.htm

      “How common is acute Hepatitis C in the United States?

      In 2012, there were an estimated 21,870 cases of acute Hepatitis C virus infections reported in the United States.

      How common is chronic Hepatitis C in the United States?

      An estimated 3.2 million persons in the United States have chronic Hepatitis C virus infection. Most people do not know they are infected because they don’t look or feel sick.

      How likely is it that acute Hepatitis C will become chronic?

      Approximately 75%–85% of people who become infected with Hepatitis C virus develop chronic infection.”

      To treat all 22,000 chronic cases at $100K each would cost $2.2 billion minus the cost savings of other treatment. This would be a worst case annual cost. As a percentage of overall healthcare spending, that’s a rounding error.

      The scare stories (like those in the article about treating CA’s prison and med-Cal population linked below) assume that you treat chronic and acute patients-including those who will be asymptomatic their entire lives. But they’re not doing that now-CA only spent $12.4 million on Hep-C for its prison population in 2013. To generate the giant scary numbers you have to dramatically increase both the cost and the number of people treated.

      http://ww2.kqed.org/stateofhealth/2014/08/26/high-priced-drug-sovaldi-coming-to-california-prisoners-with-hepatitis-c/

      So, to summarize: if we treat Sovaldi like a vaccine and give it to everyone with Hep-C, it’s going to be stupidly expensive. If we reserve it for acute cases (at least until the patents expire in fifteen years) the costs will be manageable.

      • http://www.janetheactuary.blogspot.com Jane the Actuary

        That’s the issue though. We’re talking chronic/latent, not acute cases. That’s why Solvaldi is buying the full-page ads.

        • MartyH

          It almost sounds like the bootleggers and Baptists.

          The maker of Sovaldi wants as many people using the drug as possible. Single payer proponents (and other people I will loosely term anti-capitalists) use the worst possible scenario (maximum people covered at highest possible cost) to drive their political points home. In the meantime, a rational approach to addressing this issue (ensuring the people who will benefit from using the drug will get it while managing the cost) is not discussed-at least publicly.

          • FriendlyGoat

            Too “loosely”.

          • Andrew Allison

            What’s being discussed here is the very real possibility that ACA might lead to overuse, i.e. for patients whose disease is managable with conventional therapy, and crippling costs.

  • Anthony

    So, what are Americans to do, viz healthcare delivery and costs? A current revelation: % of adults having trouble paying medical bills declined – thehill.com/policy/healthcare/242922-study-9-million-fewer-people-cant-pay-medical-bills

    • Boritz

      From the article within the linked article:
      “People who have high deductibles do tend to skimp on healthcare,” the study’s lead author, Sara Collins, told reporters”
      That could account for some savings and improved ability to pay. This ‘success’ promises to be offset by the issue in the first sentence above: “In 2016, insurance premiums could go through the roof as big insurers across the country apply for large rate increases for their ACA plans.”
      What is needed is an actuarial calculation of how much healthcare skipping and skimping would be needed to continue the downward trend in the ‘having trouble paying” percentage after a 51% rate hike is granted.

      • Anthony

        So, what do Americans… sans attitude on ACA? Healthcare in America is robust and growing operation of immense size, scope, and scale – it is very well fed. Again, what do Americans do?

        • Andrew Allison

          Per Jacksonian Libertarian above: “the only way to fix the Healthcare Insurance industry is to forbid Employers from paying for it, and allowing only High Deductible Health Insurance. Offering tax free Health Savings accounts to help with the Deductible would make it palatable to the consumer. This would get both the Healthcare providers and Health Insurance companies competing for the consumers business, and Quality, Service, and Price would all quickly improve.”

  • FriendlyGoat

    “Controlling costs” has to be about something other than 1) Rationing who can get medical care based on their income or assets, or 2) rationing what care they can get based on income or assets, or 3) Demanding that providers do a certain amount of completely-uncompensated care and bill the cost of that to those who happen to be paying.

    We do know that political conservatism has not suggested anything really worthwhile, EXCEPT (after their revolt against Hillarycare) the elements of the pieced-together ACA approach which we finally adopted after 15 years of conservatives doing nothing else.

  • Jacksonian_Libertarian

    “Affordable” healthcare was supposed to change the huge yearly increases in rates. What an incredible lie! Anyone that thought taking a limited monopoly industry like Health Insurance, and giving it to the Government Monopoly would reduce costs, is an Idiot. The only form of human organization that improves over time is the Free Market. This is because the “Feedback of Competition” forces continuous improvements in Quality, Service, and Price in Free Markets.
    This means the only way to fix the Healthcare Insurance industry is to forbid Employers from paying for it, and allowing only High Deductible Health Insurance. Offering tax free Health Savings accounts to help with the Deductible would make it palatable to the consumer. This would get both the Healthcare providers and Health Insurance companies competing for the consumers business, and Quality, Service, and Price would all quickly improve. Something could also be done with the Medicare/Medicaid by providing a yearly account to pay for the deductible, and any monies left over would go to the recipient at the end of the year. This would put the unemployed and retired into spending their vast amounts of time shopping and increasing the competition and thereby increasing the force for improvements.

  • Josephbleau

    1. Berkeley Labs creates a new element in the cyclotron called Immunium 135. 2. Blind tests show that Immunium allows folks to live until 150. Immunium costs 100K per week at effective dose level. 3. Supreme Court decrees that ACA language requires coverage for all 4. Decision published on Oct 31 of presidential election year. Pre Existing condition was average death at 82 years. QED.

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