The Case For Obamacare

C-NICE · 07-02-2012, 10:28 AM

I know I am probably a minority in this view, but there are some arguments for Obamacare if you are HOH. We incur a fair bit of medical expenses(Audiologist, Ents, HAs & possible CIs later on). Insurance has been of spotty assistance to me at best with all this and also being a Type 1 Diabetic I have had just about enough of medical expences but this is just my personal view.

**DeafBadger** · 07-02-2012, 02:09 PM

Quote:

Originally Posted by C-NICE

I know I am probably a minority in this view, but there are some arguments for Obamacare if you are HOH. We incur a fair bit of medical expenses(Audiologist, Ents, HAs & possible CIs later on). Insurance has been of spotty assistance to me at best with all this and also being a Type 1 Diabetic I have had just about enough of medical expences but this is just my personal view.

Rest assured, you are not a minority in that view.

At this point, I am personally a bit undecided on the merits of the Affordable Care Act, but I'm not nearly as freaked out as some conservatives seem to be. Overall, I think the Act *could* be a good thing. I'm just in the process of learning more about it.

But there are plenty of people who support the Act. You are not a minority in that view.

airportcop · 07-02-2012, 02:51 PM

I understand the need for healthcare reform to an extent, but to force Americans to purchase government insurance or be fined in taxes is just plain wrong. That part and some other parts should have been found unconstitutional as well. How are we going to pay for this as individuals and as a nation? Forcing certain provisions on churches and religious institutions that they do not support is wrong as well. How can the government properly run healthcare when it can't run itself?

**Foxrac** · 07-02-2012, 03:02 PM

Quote:

Originally Posted by airportcop

I understand the need for healthcare reform to an extent, but to force Americans to purchase government insurance or be fined in taxes is just plain wrong. That part and some other parts should have been found unconstitutional as well. How are we going to pay for this as individuals and as a nation? Forcing certain provisions on churches and religious institutions that they do not support is wrong as well. How can the government properly run healthcare when it can't run itself?

1) You are not FORCED to buy government insurance. You have choice to buy insurance from your workplace or insurance from state exchange. The insurance from exchanges are private with government subsidies. If you have insurance from your workplace so you will not subject to 1% tax/penalty.

2) US Supreme Court has ruled ACA as constitutional and they recognized individual mandate as tax.

airportcop · 07-02-2012, 03:12 PM

Quote:

Originally Posted by Foxrac

1) You are not FORCED to buy government insurance. You have choice to buy insurance from your workplace or insurance from state exchange. The insurance from exchanges are private with government subsidies. If you have insurance from your workplace so you will not subject to 1% tax/penalty.

2) US Supreme Court has ruled ACA as constitutional and they recognized individual mandate as tax.

Why should the government force anyone to buy insurance if they don't want it?! What if they are very comfortably wealthy and choose to pay their bills off in cash or when they are received? Why should they be penalized? What if these people have been healthy all their lives and saved for serious illness just in case but choose not to waste money on insurance premiums? Why should they be penalized?

What is next? You can't eat that Big Mac and french fries with the large Coke or Chocolate shake!? You can't drive that car that only gets 12 MPG even though you can afford the gas and it is a classic that you have as a hobby?! Some people will simply still not be able to pay for the insurance or the fine in taxes! What about them???!!! America the free? Not so free anymore!?

**Foxrac** · 07-02-2012, 03:20 PM

Quote:

Originally Posted by airportcop

Why should the government force anyone to buy insurance if they don't want it?! What if they are very comfortably wealthy and choose to pay their bills off in cash or when they are received? Why should they be penalized? What if these people have been healthy all their lives and saved for serious illness just in case but choose not to waste money on insurance premiums? Why should they be penalized?

What is next? You can't eat that Big Mac and french fries with the large Coke or Chocolate shake!? You can't drive that car that only gets 12 MPG even though you can afford the gas and it is a classic that you have as a hobby?! Some people will simply still not be able to pay for the insurance or the fine in taxes! What about them???!!! America the free? Not so free anymore!?

Individual mandate is necessary to put massive people in insurance's pool to cut the health care cost and the insurance could go bankrupt if they only cover sick people. It is very expensive for insurance to cover sick people only and the hospitals lost a lot of money to treat uninsured patients that force us to pay a piece for uninsured patients. The insurance premiums are used to treat general patients and the medical care will not slap with any hardship when deal with uninsured patients who couldn't afford to pay medical bill that push medical care to increase the cost.

For wealthily people, they could afford to pay 1% tax/penalty to not have an insurance and having an insurance will save money than spill all money on medical care.

For 2nd paragraph, I'm not going debate because it is irreverent to topic.

airportcop · 07-02-2012, 03:36 PM

Quote:

Originally Posted by Foxrac

Individual mandate is necessary to put massive people in insurance's pool to cut the health care cost and the insurance could go bankrupt if they only cover sick people. It is very expensive for insurance to cover sick people only and the hospitals lost a lot of money to treat uninsured patients that force us to pay a piece for uninsured patients. The insurance premiums are used to treat general patients and the medical care will not slap with any hardship when deal with uninsured patients who couldn't afford to pay medical bill that push medical care to increase the cost.

For wealthily people, they could afford to pay 1% tax/penalty to not have an insurance and having an insurance will save money than spill all money on medical care.

For 2nd paragraph, I'm not going debate because it is irreverent to topic.

So you think it is okay to penalize perfectly healthy people who choose not have have or buy insurance? How is that fair?

**DeafBadger** · 07-02-2012, 03:41 PM

Just want to point out that the 'individual mandate' has been used for decades in legally mandating that all drivers purchase auto insurance. (For which there are good reasons.) It is not really an unusual concept to require citizens to purchase insurance. It is the first time to require citizens to purchase health insurance, though.

Quote:

Originally Posted by Foxrac

For 2nd paragraph, I'm not going debate because it is irreverent to topic.

I think you meant to say 'irrelevant'?

**DeafBadger** · 07-02-2012, 03:44 PM

Quote:

Originally Posted by airportcop

So you think it is okay to penalize perfectly healthy people who choose not have have or buy insurance? How is that fair?

Perfectly good drivers who have never been in an auto accident are still required to buy auto insurance. Does that mean they should not be required to buy auto insurance?

Because I am currently taking Intro to Statistics, this debate is interesting. It seems that by increasing the population covered by insurance, it would probably have the overall effect of lowering premiums/costs for every one. If the population of insured was smaller, it would be more difficult to spread the cost and risk.

Spreading the cost and risk makes costs cheaper and risks lower for everyone, which is, of course, the way insurance of any kind is designed to function.

airportcop · 07-02-2012, 03:45 PM

Quote:

Originally Posted by DeafBadger

Just want to point out that the 'individual mandate' has been used for decades in legally mandating that all drivers purchase auto insurance. (For which there are good reasons.) It is not really an unusual concept to require citizens to purchase insurance. It is the first time to require citizens to purchase health insurance, though.

I think you meant to say 'irrelevant'?

Yes, but in most states you can also have something called proof of financial responsibility in place of insurance. That is how it is in Missouri.

**DeafBadger** · 07-02-2012, 03:59 PM

Quote:

Originally Posted by airportcop

Yes, but in most states you can also have something called proof of financial responsibility in place of insurance. That is how it is in Missouri.

One would have to be a multi-millionaire before one could begin to consider self-insuring their own automobile liability. I have heard of this option regarding auto insurance, but I have never heard of anyone actually exercising this option.

Even if I were a multi-millionaire, I wouldn't self-insure. Why? It makes more sense for my personal finances to spread the risk and cost to a whole pool of insurance purchasers. A nasty accident could potentially cause me to be liable for over a million dollars if someone was killed or maimed. Why would I want to fork over a million dollars of my own money, when I could have purchased auto insurance and spread the risk to a larger pool?

Even if I had the option of self-insuring, I wouldn't take it.

Do you think that Warren Buffett (a billionaire) self-insures, or do you think he purchases auto insurance (he drives himself around)? This is a man who is a master at protecting his wealth. I think he would buy insurance because he would protect a couple million dollars of his wealth as much as he would protect a couple billion dollars of his wealth.

**Foxrac** · 07-02-2012, 04:09 PM

Quote:

Originally Posted by airportcop

So you think it is okay to penalize perfectly healthy people who choose not have have or buy insurance? How is that fair?

Go re-read my post.

The insurance need mixed of healthy people and sick people in their pool to cut the medical cost.

Yup, if healthly people don't want health insurance so they will be penalized, of course.

**Foxrac** · 07-02-2012, 04:28 PM

Quote:

Originally Posted by DeafBadger

Just want to point out that the 'individual mandate' has been used for decades in legally mandating that all drivers purchase auto insurance. (For which there are good reasons.) It is not really an unusual concept to require citizens to purchase insurance. It is the first time to require citizens to purchase health insurance, though.

I think you meant to say 'irrelevant'?

Yup, I means to say irrelevant.

Thank you for correct my spelling and tsk tsk to Mac auto-correction.

**TXgolfer** · 07-02-2012, 05:04 PM

Quote:

Originally Posted by DeafBadger

Just want to point out that the 'individual mandate' has been used for decades in legally mandating that all drivers purchase auto insurance. (For which there are good reasons.) It is not really an unusual concept to require citizens to purchase insurance. It is the first time to require citizens to purchase health insurance, though.

I think you meant to say 'irrelevant'?

Driving is a privilege. No comparison

**TXgolfer** · 07-02-2012, 05:11 PM

Quote:

Originally Posted by DeafBadger

Perfectly good drivers who have never been in an auto accident are still required to buy auto insurance. Does that mean they should not be required to buy auto insurance?

Because I am currently taking Intro to Statistics, this debate is interesting. It seems that by increasing the population covered by insurance, it would probably have the overall effect of lowering premiums/costs for every one. If the population of insured was smaller, it would be more difficult to spread the cost and risk.

Spreading the cost and risk makes costs cheaper and risks lower for everyone, which is, of course, the way insurance of any kind is designed to function.

That is why they call it "Intro". Lol j/k. Factor in the number of people who will go in drug seeking and for every ache and pain not to mention the shortage of Dr's and costs will skyrocket. The costs are already going up. My "wife"s just went up $650/year. This will be a bigger mess that Social Security and Medicare combined. IMO. Unless we kill it of course.

**Reba** · 07-02-2012, 05:32 PM

Quote:

Originally Posted by DeafBadger

Perfectly good drivers who have never been in an auto accident are still required to buy auto insurance. Does that mean they should not be required to buy auto insurance?...

The difference is, the auto insurance that's required is for liability. Health insurance isn't a liability insurance.

deafdrummer · 07-02-2012, 05:52 PM

Quote:

Originally Posted by DeafBadger

Spreading the cost and risk makes costs cheaper and risks lower for everyone, which is, of course, the way insurance of any kind is designed to function.

Problem is, this is called "socializing the risk and expenses to everyone else." The car insurance thing is just one layer of socialization of America. How many layers of taxation can we have before we have a Greek situation? Look at Greece's 45% taxation rate as well as a proposed increase to send that over 50% (I think it was 52% being proposed). How would you like half your income going to the Feds?

Let me clue you in on something. In 2012, a family member, who works for the government, has taken trips to California, Costa Rica, several states and touristy things, has done zip lining, gone to all kinds of social functions, and now, she's heading to visit family several states over. At your dime. At my dime, too, since I work and pay taxes. Even though she's family, I don't think that's right, since she does not do anything PRODUCTIVE. I travel out of state ONCE a year and have to pay for it over 6 months.

It would be interesting to see if there is an America 10 years from now, at the rate we're going. The last President of the United States, whether it be next year or 20 years from now, would probably have to sign a similar document that Gorbachev signed in late 1991, which turned the final page on the USSR and closed the Chapter on that stage of history. Through history, ALL empires have fallen. It didn't matter how bright the fires burned during the Imperialist periods of these civilizations.

Only we are doing it much faster than the British empire did it through paper money (as we have digital money today), and even faster than the Romans did it because they didn't have the printing press that had been invented nearly two thousands years later. It took hundreds of years for Rome to collapse. Archaeology bears this out with analysis of Roman coins minted at different times through its history.

And today, very few people have any idea what is happening, never mind why.

Look at Europe as an example of utter incompetence and thievery that exists at the highest level of government on down. Look at Moldova, a communist country that is in dire straights today.

Another problem is that this economy (as it is a CENTRALLY PLANNED ECONOMY - COMMUNISM) misallocates natural resources, capital, and human talent into areas where it is not needed. China is getting to be a good example of it, with money having disappeared into 1) the real estate market and several UNOCCUPIED cities built there, 2) spools of industrial metal sheets sitting in warehouses, even near streets in places, and 3) employment that will definitely fall because you cannot build nor produce for the sake of building and producing. There has to be an economic need for supply and demand. I've NEVER forgotten this lesson I learned in my high school political science class in the 80s.

Nobody said anything about this - WHERE IS THE MONEY TO FUND THIS PROGRAM going to come from? The US Gov't is already operating in a deficit unheard of in American history!! It gets printed up. Or how about, digitized into the computer? That's even faster! Just hit a few numbers plus 12 ZEROS and you have your $1.5T deficit.

**DeafBadger** · 07-02-2012, 06:13 PM

Quote:

Originally Posted by TXgolfer

Driving is a privilege. No comparison

Do you mean to suggest that health care is not a privilege, then? If it isn't a privilege, would that suggest that health care is of greater importance than driving?

Quote:

That is why they call it "Intro". Lol j/k. Factor in the number of people who will go in drug seeking and for every ache and pain not to mention the shortage of Dr's and costs will skyrocket. The costs are already going up. My "wife"s just went up $650/year. This will be a bigger mess that Social Security and Medicare combined. IMO. Unless we kill it of course.

But don't health insurers do everything they can to quibble with medical offices over costs and charges, and deny claims they feel are extravagant, such as drug-seeking? (My sister used to work for a health insurance company -- it sounds like they contest nearly every claim unless an employer pays extra for the extra-special package, like Microsoft does. (Microsoft's employees have virtually every claim paid for, no questions asked.)) My work insurance definitely has mechanisms in place to detect and prevent this sort of activity. I imagine it wouldn't be different under the ACA, since these too are private health insurers who aim to limit their costs and reduce waste. The bulk of this insurance will be handled by private insurers, if I understand correctly.

I'm really curious what the experience in Massachusetts has been of the similar program put in place by Governor Romney. It's been in operation for a number of years now, I'd like to see how their costs have fared in the long run. Surely that would give a good idea of what the rest of the country can expect.

**Foxrac** · 07-02-2012, 06:22 PM

Quote:

Originally Posted by Reba

The difference is, the auto insurance that's required is for liability. Health insurance isn't a liability insurance.

Not having health insurance and inability to pay medical bill held us to liable for increase the medical cost.

**DeafBadger** · 07-02-2012, 06:22 PM

Quote:

Originally Posted by Reba

The difference is, the auto insurance that's required is for liability. Health insurance isn't a liability insurance.

Why do you feel this changes the nature of the insurance and the justification for a legal mandate to purchase coverage? Txgolfer said that driving is a privilege, as distinct from healthcare, which implies to me that perhaps healthcare is not a privilege. If healthcare then is not a privilege, does that mean it is a necessity? If healthcare is a necessity, does that mean health coverage/insurance is of bigger importance than auto insurance?

It seems to me that whether it is a liability or not is besides the point. Both are costs. Driving is perhaps an avoidable cost depending on your living situation, but health care is not an avoidable cost. If one lives long enough, their health costs will materialize and probably increase dramatically as a result of aging and related health problems.

(Sincere questions here.)

**TXgolfer** · 07-02-2012, 06:23 PM

Quote:

Originally Posted by DeafBadger

Do you mean to suggest that health care is not a privilege, then? If it isn't a privilege, would that suggest that health care is of greater importance than driving?

But don't health insurers do everything they can to quibble with medical offices over costs and charges, and deny claims they feel are extravagant, such as drug-seeking? (My sister used to work for a health insurance company -- it sounds like they contest nearly every claim unless an employer pays extra for the extra-special package, like Microsoft does. (Microsoft's employees have virtually every claim paid for, no questions asked.)) My work insurance definitely has mechanisms in place to detect and prevent this sort of activity. I imagine it wouldn't be different under the ACA, since these too are private health insurers who aim to limit their costs and reduce waste. The bulk of this insurance will be handled by private insurers, if I understand correctly.

I'm really curious what the experience in Massachusetts has been of the similar program put in place by Governor Romney. It's been in operation for a number of years now, I'd like to see how their costs have fared in the long run. Surely that would give a good idea of what the rest of the country can expect.

No, because driving is a privilege one can simply decide not to drive and avoid paying for insurance. No such luck with the Obamacare mandate.

By many accounts Romneycare has been a disaster. That being said Romney never felt the plan should be implemented on a National level.

**Reba** · 07-02-2012, 06:26 PM

Quote:

Originally Posted by Foxrac

Not having health insurance and inability to pay medical bill held us to liable for increase the medical cost.

That's not what liability insurance means.

Liability means being responsible for the expenses of others in an accident. That is, liability auto insurance pays for the damages and injuries of the other person that was hit.

**Foxrac** · 07-02-2012, 06:45 PM

Quote:

Originally Posted by Reba

That's not what liability insurance means.

Liability means being responsible for the expenses of others in an accident. That is, liability auto insurance pays for the damages and injuries of the other person that was hit.

For medical care, it is different way for liability.

If patients don't have insurance and inability to pay medical bill? Who will take money from? you and me because we have to pay higher medical cost and the insurance premiums have went up too.

**DeafBadger** · 07-02-2012, 07:03 PM

I found this discussion on Massachusetts' health care law, which seems to be well-rounded and well-informed. Does anyone see anything in this document that is wrong, or anything they'd like to comment on?

FactCheck.org : ‘RomneyCare’ Facts and Falsehoods

(Edit: Here's another link from Romney supporters: http://mittromneycentral.com/resources/romneycare/ )

My feeling at this point, tentatively, is that the supposed 'negative' effects of the Affordable Care Act are probably overblown. If the document linked-to is correct, it seems we can expect, nationally, some rising costs, followed by a moderation of costs, especially for individual policies, as the insurance companies gain a better understanding of how the new law affects their business. Currently, the insurance companies are less certain, so they raise prices to compensate for that uncertainty. Once they get a couple years of data, the Massachusetts' experience suggests that they'll moderate prices.

The individual mandate itself doesn't particularly bother me, just like an auto-insurance mandate doesn't bother me.

The tax penalty gives me pause, but then I wonder how else would an individual mandate be enforced? The auto-insurance mandate also has a penalty, that of not being issued a driver license.

The argument that the Supreme Court decision allows congress to penalize any behavior with a tax also gives me pause. But repealing the ACA would not solve this particular problem, since the Supreme Court decision would still stand regarding that particular 'power of Congress.'

And besides, since when has Congress felt restrained in their ability to tax and prescribe regulations? I'm not sure the Supreme Court fundamentally changed the nature of Congress' power in this case.

I'm willing to hear what others have to say about the whole thing though.

**Reba** · 07-02-2012, 07:23 PM

Quote:

Originally Posted by Foxrac

For medical care, it is different way for liability.

That's why I said that you can't apply the same reasoning for medical insurance and auto insurance. The requirement for auto insurance is for liability insurance. Medical insurance is not a liability insurance. They can't be compared.

Quote:

If patients don't have insurance and inability to pay medical bill? Who will take money from? you and me because we have to pay higher medical cost and the insurance premiums have went up too.

That has nothing to do with my statement about auto liability insurance.

**DeafBadger** · 07-02-2012, 07:26 PM

Quote:

Originally Posted by TXgolfer

No, because driving is a privilege one can simply decide not to drive and avoid paying for insurance. No such luck with the Obamacare mandate.

I have to admit this is not really a sticking point for me. I recognize that other people may be bothered by this distinction, though.

Quote:

By many accounts Romneycare has been a disaster.

How, specifically, has it been a 'disaster'? Please review the link I posted that seems to be a non-biased review of the Romneycare experience. Do you have information that they do not? I'd sincerely would like to review it myself.

Quote:

That being said Romney never felt the plan should be implemented on a National level.

Of course he would say that. He is running for President and needs to somehow disavow Romneycare. But did he, and does he, really believe that? Incidentally, I don't believe that Romney will repeal the ACA. I think he is saying that to try to get elected. I don't think he will follow through with it.

**DeafBadger** · 07-02-2012, 07:42 PM

Quote:

Originally Posted by Reba

That's why I said that you can't apply the same reasoning for medical insurance and auto insurance. The requirement for auto insurance is for liability insurance. Medical insurance is not a liability insurance. They can't be compared.

The reason auto-insurance was mentioned was to show that there are 'individual mandates' for insurance already, albeit for a different type of insurance. It suggests that perhaps an 'individual mandate' isn't as politically 'bad' as some people think.

Beyond that, you are right, liability and health insurance are two different types of insurance. But it is useful to note that individual mandates have been used by governments before without controversy.

**TXgolfer** · 07-02-2012, 08:01 PM

Quote:

Originally Posted by DeafBadger

How, specifically, has it been a 'disaster'? Please review the link I posted that seems to be a non-biased review of the Romneycare experience. Do you have information that they do not? I'd sincerely would like to review it myself.

I go mainly by the experiences reported by my friends in the area....This is something I have posted before

Quote:

5 painful health-care lessons from Massachusetts

Lesson 1: The Massachusetts plan does not control costs.

When Massachusetts launched its reform program in 2006, it already had the highest medical costs in the nation. Today, the burden is still rising far faster than wages or inflation, from those already lofty levels. A report from that state attorney general in March -- remember, this is a Democratic administration -- asked rhetorically "Can we expect the existing health-care market in Massachusetts to successfully contain health-care costs?" The report concluded, "To date, the answer is an unequivocal 'no.'"

Costs are rising relentlessly for both families and for the state government. The median annual premium for family plans jumped 10% from 2007 to 2009 to $14,300 -- again, that's a substantial rise on top of an already enormous number. For small businesses, the increase was 12%. In 2006, the state spent around $1 billion on Medicaid, subsidies for medium-to-lower earners, and other health-care programs. Today, the figure is $1.75 billion. The federal government absorbed half of the increase.

Hence reform's proponents boast that expenses have risen only $354 million or around 6% a year. But the real increase is double that, including the federal share. And it's highly possible that given the current budget pressures, the U.S. will reduce the contribution that has encouraged the state to spend so lavishly.

Lesson 2: Community rating, guaranteed issue and mandated benefits swell costs.

How did costs in Massachusetts get so big to begin with? A major reason is the adoption of guaranteed issue and community rating in the mid-1990s. The new federal bill would expand those rules to the entire nation. Under guaranteed issue, insurers must accept all enrollees regardless of their medical condition; under community rating, they must charge all customers similar premiums, even if their costs are far different. The result is that prices rise steeply for young, healthy customers, who must pay far more than their actual costs. It also give them a strong incentive to drop insurance; then they can "game the system" by signing up any time they need surgery or get diabetes.

Hence the pool of insured people gets older and sicker as the healthy drop out. That's what happened in Massachusetts, and it contributed to soaring premiums. The 2006 reform plan was supposed to solve the problem by requiring that everyone buy coverage or pay a fine of around $1,000. It worked, but only in part: Of the 600,000 uninsured in 2005, around 450,000 are now covered. But a large share of 150,000 who still lack coverage are young residents who choose to pay the fine instead of high premiums. Insurers are also getting socked by people who sign up for insurance to get expensive care mandated under state law, including hospitalization for childbirth or hip replacements, and then depart once the procedure is completed.

In the federal bill, the fines for going uninsured are even lower than in Massachusetts -- and anyone who can't find an inexpensive plan is exempted from all penalties. Hence the "adverse selection" problem could prove far worse.

Lesson 3: Huge subsidies for low-to-medium earners could prove extremely expensive.

One of the most fascinating features of the Massachusetts plan is that it introduced a system of subsidized policies, sold through an insurance "exchange" that's extremely similar to the one in the new federal plan. Under Commonwealth Care, the state subsidizes plans -- offered by private carriers -- for residents who earn up to $66,150 who are not covered by employers. The aid is extremely generous. At $44,000, families pay around $1,000 a year in premiums. At the $66,150 maximum, they contribute around $3,000.

The problem is that the actual annual cost of these plans is around $10,000, so the subsides are enormous -- that's 90% for families earning $44,000. And while the costs keep going up, the share paid by the enrollee barely budges. Says Michael Tanner, an economist at the conservative Cato Institute: "It's a situation where the entire escalation in costs is paid by the government, not the people receiving the care."

The federal plan also subsidizes care provided through state-run exchanges. The patients' contributions are bigger than in the Mass. plan: A family earning $66,000 would pay $6,300 a year. But the federal plan offers subsidies far higher along the income scale, aiding families of four making up to $88,200. And surprisingly, the federal plans would probably prove a lot more costly than the ones in Massachusetts, where the state prides itself on restraining what they pay by squeezing providers, who then shift the added costs to private customers.

The big problem arises if far more people sign up for these exchange-offered plans than anticipated. That's been the case in Massachusetts. And as we'll see in a moment, it could still get a lot worse there. A potential disaster threatens the federal plan if employers staring dropping coverage, since a flood of newcomers would rush into the state-funded pools.

Lesson 4: The exchanges reward people for working less and earning less.

Data is lacking on how damaging these perverse incentives are in practice. But it's clear in Massachusetts that low-to-medium earning families often suffer financially if they get a raise, work overtime, move to a higher paying job -- or if a spouse rejoins the workforce. For example, a family earning $33,000 pays no premium at all under Commonwealth Care. But if their pay goes to $46,000, they're obligated to contribute about $2,400. That's an effective tax rate of 18.5% on that $13,000 raise. A pay increase of $44,000 to $46,000 is mostly erased by higher premiums alone.

The federal bill is plagued by the same weakness. For example, a $55,000 earner contributes $4,400 a year towards insurance. At $65,000, the bill is $6300; so the family is paying a "tax" of $1,900 or 19% on that $10,000 raise. After payroll taxes, those Americans would face a marginal rate of around 35%, a number that's heretofore been the territory strictly for high-earners.

Lesson 5: The generous plans and added mandates give employers an incentive to drop health insurance.

In charting the future of health-care costs, the biggest danger by far is that companies will drop their coverage. It's also the one that's the most difficult to handicap, both for Massachusetts and the entire nation. The problem is simple: If employers stop paying for health care, employees will flood into the government-subsidized programs, enormously raising the cost to already fragile budgets.

Surprisingly, health reform in Massachusetts has actually increased the number of workers covered by employers. Over 100,000 more employees are covered by corporate plans today than when the program debuted in 2006. The main reason is that the plan imposed a $1,000 fine on employees who refused their employers' plans. Then, families were paying around $3,600 a year towards their company policies. Many decided that, when faced with a fine, the better choice was paying the extra $2,600 for full coverage. The plan was shrewdly calibrated by the administration of then-governor Mitt Romney to tilt the market towards company-provided care.

The Massachusetts plan also bans any employee from getting coverage from Commonwealth Care if his or her company offers coverage. Hence it would appear that corporate coverage is solidly entrenched. But that's by no means certain, either in Massachusetts or under the Obama plan. The reason is the fast escalation in costs, for both companies and employees. From 2007 to 2009, the employee contribution for family policies rose a steep 17%, or $624 a year, to $4,200.

Employees can only move into Commonwealth Care if their employers drop their plans. The danger is that the incentives are tilting in that direction as the costs of coverage for employer, and the price of premiums to employees, keep climbing. The point is rapidly approaching where both will pocket big savings if employers drop their plans and workers buy their policies through the heavily subsidized exchanges.

In Massachusetts, the state government is pushing toward that tilt point by adding heavy mandates to a list of more than 40 already on the books. In 2009, it required insurers to cover prescription drugs. An expensive autism mandate is now being debated in the state legislature. The list of mandates under the federal plan is bound to mirror the ones in Massachusetts, and once again, the added expense severely weakens companies' incentive for providing coverage.

Cracks are already starting to appear. Part-time workers can get coverage under Commonwealth Care for a fraction of what they'd pay as full-timers. So they "game the system" by working ten or fifteen hours a week for two or three companies. Or they find that it pays to switch from full- to part-time work. PHI, an organization that represents home health-care workers, states that one-fourth of the home care agencies in Massachusetts are reducing workers' hours so they're eligible for state-subsidized care.

The federal plan will encounter the same problem -- perhaps a more acute one since its penalties are lower and its subsidies go much higher on the income scale.

Starting in 2017, the states will have the option of allowing companies that drop their plans to shift workers into the subsidized, state-run exchanges. That choice doesn't exist now in Massachusetts. It's not that employers are likely to dump their plans en masse. What's far more probable is a progressive erosion that relentlessly and systematically raises government spending.

The incentives are there, both in the federal plan, and its prototype in the Bay State. And when the incentives are that big -- and when subsidies inevitably get bigger, not smaller -- no amount of regulatory tinkering can stop America's employers and employees from taking the government's money, and saving their own.

5 painful health-care lessons from Massachusetts - Jun. 15, 2010

Quote:

Of course he would say that. He is running for President and needs to somehow disavow Romneycare. But did he, and does he, really believe that? Incidentally, I don't believe that Romney will repeal the ACA. I think he is saying that to try to get elected. I don't think he will follow through with it.

No, it is a fundamental belief that states should be responsible for health care rather than the feds.

**Foxrac** · 07-02-2012, 08:13 PM

Quote:

Originally Posted by DeafBadger

I have to admit this is not really a sticking point for me. I recognize that other people may be bothered by this distinction, though.

How, specifically, has it been a 'disaster'? Please review the link I posted that seems to be a non-biased review of the Romneycare experience. Do you have information that they do not? I'd sincerely would like to review it myself.

Of course he would say that. He is running for President and needs to somehow disavow Romneycare. But did he, and does he, really believe that? Incidentally, I don't believe that Romney will repeal the ACA. I think he is saying that to try to get elected. I don't think he will follow through with it.

Yup, Romney probably to simplify the ACA to throw some complication policies out.

whatdidyousay! · 07-02-2012, 08:25 PM

Quote:

Originally Posted by airportcop

So you think it is okay to penalize perfectly healthy people who choose not have have or buy insurance? How is that fair?

I do not like making health insurance mandatory , the government should stay out of our life !

07-02-2012, 10:28 AM	#1 (permalink)
C-NICE Registered User Join Date: Nov 2008 Posts: 441	The Case For Obamacare I know I am probably a minority in this view, but there are some arguments for Obamacare if you are HOH. We incur a fair bit of medical expenses(Audiologist, Ents, HAs & possible CIs later on). Insurance has been of spotty assistance to me at best with all this and also being a Type 1 Diabetic I have had just about enough of medical expences but this is just my personal view.

07-02-2012, 02:51 PM	#3 (permalink)
airportcop Registered User Join Date: Nov 2011 Location: Springfield, MO Posts: 1,088	I understand the need for healthcare reform to an extent, but to force Americans to purchase government insurance or be fined in taxes is just plain wrong. That part and some other parts should have been found unconstitutional as well. How are we going to pay for this as individuals and as a nation? Forcing certain provisions on churches and religious institutions that they do not support is wrong as well. How can the government properly run healthcare when it can't run itself? __________________ Romans 12:12 (NIV) Be joyful in hope, patient in affliction, faithful in prayer.

07-02-2012, 07:03 PM	#24 (permalink)
DeafBadger Ad Astra Per Aspera Join Date: Aug 2011 Posts: 1,423 Blog Entries: 1	I found this discussion on Massachusetts' health care law, which seems to be well-rounded and well-informed. Does anyone see anything in this document that is wrong, or anything they'd like to comment on? FactCheck.org : ‘RomneyCare’ Facts and Falsehoods (Edit: Here's another link from Romney supporters: http://mittromneycentral.com/resources/romneycare/ ) My feeling at this point, tentatively, is that the supposed 'negative' effects of the Affordable Care Act are probably overblown. If the document linked-to is correct, it seems we can expect, nationally, some rising costs, followed by a moderation of costs, especially for individual policies, as the insurance companies gain a better understanding of how the new law affects their business. Currently, the insurance companies are less certain, so they raise prices to compensate for that uncertainty. Once they get a couple years of data, the Massachusetts' experience suggests that they'll moderate prices. The individual mandate itself doesn't particularly bother me, just like an auto-insurance mandate doesn't bother me. The tax penalty gives me pause, but then I wonder how else would an individual mandate be enforced? The auto-insurance mandate also has a penalty, that of not being issued a driver license. The argument that the Supreme Court decision allows congress to penalize any behavior with a tax also gives me pause. But repealing the ACA would not solve this particular problem, since the Supreme Court decision would still stand regarding that particular 'power of Congress.' And besides, since when has Congress felt restrained in their ability to tax and prescribe regulations? I'm not sure the Supreme Court fundamentally changed the nature of Congress' power in this case. I'm willing to hear what others have to say about the whole thing though. __________________ "Ad Astra Per Aspera" - Through hardships, to the stars. severe-to-profound in both ears, since birth. My Blog Pale Blue Dot (cc: Select Italian captions, then Translate Captions to English--English) "Labels are mentally lazy ways by which people assert they know you without knowing you." ~ Neil deGrasse Tyson Last edited by DeafBadger; 07-02-2012 at 07:36 PM.

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