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View Diary: Republican nightmare begins: Obamacare is 'a godsend' for people getting coverage (199 comments)

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  •  The ACA is a godsend for those who were locked (2+ / 0-)
    Recommended by:
    boadicea, DMentalist

    out of coverage before.

    It's also a blessing (to various degrees) for those who have felt locked into a job for fear of health problems.

    I haven't yet figured out if it's good for me, because the exchange costs are pretty hefty where I live, but it's clearly good for some people.

    The big question: Will the young and healthy people on whom the rates rely step up and buy insurance?

    Will those who did not buy insurance before buy it now, even though it is likely to be more expensive because of the need to subsidize those with pre-existing conditions, and (for men) the abolition of gender-based pricing differences?

    This first year is not a very good test as penalties are so low.  That may turn out to be a blunder, too -- Will insurance companies pull out of the exchanges in a year when the incentive for healthy young people to sign up is lower than it will be in subsequent years?

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Tue Dec 10, 2013 at 07:47:32 AM PST

    •  Medical costs should not be "forgiven" for those (1+ / 0-)
      Recommended by:
      LMS44

      who refuse to buy insurance. A young man would have to pay his costs for however many years to pay back the hospital if this working person refused to be insured

      "The poor can never be made to suffer enough." Jimmy Breslin

      by merrywidow on Tue Dec 10, 2013 at 07:51:39 AM PST

      [ Parent ]

      •  Why would they be forgiven? (1+ / 0-)
        Recommended by:
        DMentalist

        Well, actually, there is a reason -- at least for a portion of the costs:

        No pre-existing condition exclusion.

        Lots of young people do that risk calculation -- they tend not to need a lot of expensive health care.

        I suppose you could remove medical expenses from the list of things that are dischargable in bankruptcy, but that seems like a terrible thing to do:

        1. It saddles somebody with crushing debt for a long time
        2. It rewards the criminals at hospitals who so relentlessly charge rates that have little to do with reality.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Tue Dec 10, 2013 at 08:02:28 AM PST

        [ Parent ]

        •  they saddled themselves with crushing debt (2+ / 0-)
          Recommended by:
          DMentalist, LMS44

          i am seeing the premiums for young people and they are absurdly low so low you really have to be penalized for not signing up

          "The poor can never be made to suffer enough." Jimmy Breslin

          by merrywidow on Tue Dec 10, 2013 at 09:15:49 AM PST

          [ Parent ]

          •  So we continue a trend that excuses the debts (0+ / 0-)

            of the wealthy but holds the poor accountable?

            Great thinking.

            We already have things like this as non-dischargable:

            1. Income tax is dischargable in bankruptcy, but payroll tax isn't.  Of course, payroll taxes may be the biggest tax burden carried by low income workers, but relatively small to non-existant for the wealthy.

            2. Student loan debt -- much bigger problem for kids of the not-so-well-to-do than for kids of the wealthy who are able to go on mommy and daddy's dime.

            Yup. You're right. Better punish the crap out of those working class folks.  The rich, however, need special understanding.  it's so hard being rich!

            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

            by dinotrac on Tue Dec 10, 2013 at 09:47:49 AM PST

            [ Parent ]

            •  Off point here. a young man who does not pay (0+ / 0-)

              $50 a month to be insured should not expect to have someone else pay for his care....period.

              "The poor can never be made to suffer enough." Jimmy Breslin

              by merrywidow on Tue Dec 10, 2013 at 11:35:51 AM PST

              [ Parent ]

              •  $50 a month? (0+ / 0-)

                Maybe where you live.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Tue Dec 10, 2013 at 12:52:40 PM PST

                [ Parent ]

                •  A second thought: How does $50 a month (0+ / 0-)

                  contribute to keeping insurance costs down for those with pre-existing conditions, those who are older, or, for that matter, those who are female?

                  There can't be a whole lot to spread around from a number like that -- especially as some of it has to go to administration and some to the actual costs of doctor visits and health care.

                  LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                  by dinotrac on Tue Dec 10, 2013 at 12:54:48 PM PST

                  [ Parent ]

                  •  That is how insurance works. nt (0+ / 0-)

                    "The poor can never be made to suffer enough." Jimmy Breslin

                    by merrywidow on Tue Dec 10, 2013 at 01:10:26 PM PST

                    [ Parent ]

                    •  Sorry, but actuarial principles are another (0+ / 0-)

                      part of how insurance works.

                      That $50 a month has to cover the actual costs associated with that person's health care AND subsidize the health insurance costs of others.

                      So -- if I am entitled to $400 a month in subsidies, it will take an awful lot of healthy young men to pay for that.
                      Even if you assumed that the actual costs that fellow's insurance were only $25 a month, that would require 16 healthy young me to cover my subsidy.

                      And -- if that young man's health costs, spread out over the pool of  young men, were really only $25 a month, I could understand him deciding that health insurance is a rip-off.  It's certainly a bad bet, with an expected return of only 50 cents on the dollar.

                      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                      by dinotrac on Tue Dec 10, 2013 at 03:17:35 PM PST

                      [ Parent ]

                      •  WE are all subsidizing someone else's costs (0+ / 0-)

                        and then one day, YOU will need a $100,000 bone marrow transplant and others will subisdize YOUR care

                        "The poor can never be made to suffer enough." Jimmy Breslin

                        by merrywidow on Wed Dec 11, 2013 at 05:39:03 AM PST

                        [ Parent ]

                        •  I have certainly subsidized a lot of health (0+ / 0-)

                          care over the years since I entered the work force, and that's fine.  I understand that.

                          But that has nothing to do with the question of $50 a month health care, which isn't going to subsidize much of anything.

                          Young men, in particular, are being called on to subsidize other young men, which has always been the case.  They are also being called on to subsidize to a greater degree than ever, young women, people with pre-existing conditions, and older people of both genders.

                          A lot of those young men need to sign up and they need to pay more than $50 a month if those subsidies are going to be covered.

                          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                          by dinotrac on Wed Dec 11, 2013 at 07:37:20 AM PST

                          [ Parent ]

                          •  Ins companies dont voluntarily screw themselves (0+ / 0-)

                            so I imagine their actuaries figured this out

                            do you NOT believe in insurance of any kind? I have never had a traffic accident or crash so I have paid for lots of other people but that is how it works

                            "The poor can never be made to suffer enough." Jimmy Breslin

                            by merrywidow on Wed Dec 11, 2013 at 08:44:03 AM PST

                            [ Parent ]

                          •  You are missing the real questions: (0+ / 0-)

                            1. How many of those young men are being asked to pay just $50 a month (without a subsidy)

                            2. How many young men are getting insurance.

                            Last I read, only about half as many young healthy men are signing up on the California exchange as expected.

                            That could be a problem.

                            LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                            by dinotrac on Wed Dec 11, 2013 at 09:14:11 AM PST

                            [ Parent ]

          •  the false assumption here (0+ / 0-)

               Is that the cost of medical care without insurance is reasonable.  If I travel to London and break my leg, I can go to a hospital to treat my broken leg without it costing an arm AND a leg, even though I'm not a citizen of Britain and I've never paid taxes there.  It's been a similar scenario in virtually every country I've traveled to.   In some countries medical care is more expensive than others, but nowhere is it so absurdly high as in the US.  That's why there is a thriving industry called "medical tourism." Throughout the developed world, most people can get access to medical care, even without insurance, without going bankrupt.  So why is it considered reasonable that in America a single trip to the emergency room will cost THOUSANDS of dollars?  And that will be the tab even if all you do is wait for eight hours, see a doctor for five minutes, and the doctor doesn't even order any tests or perform any procedures.  

                 The truth is, I helped to pay for that hospital that charges me thousands of dollars for an ER visit.  My tax dollars contributed to the education of the doctors who work there.  My tax dollars contributed to the research that resulted in the cures and treatments that hospital offers.  My tax dollars contributed to the development of the medical technologies available at that hospital.  My tax dollars contributed to the Medicare system responsible for much of that hospital's income.  So why is it reasonable that the medical industry, which owes its existence largely to public financing, is entitled to act as a monopolist, charging whatever it likes, price-gouging patients, maximizing its own profits, and giving NOTHING back to the public which makes its very existence possible?

                 I don't disagree with you that anyone who can afford medical insurance should buy it, and so I believe the mandate penalty in the ACA is justified.  But a person who chooses not to buy affordable insurance and take the risk of being bankrupted by a single accident or illness is merely STUPID.  On the other hand, the system which ALLOWS it to be possible for a person to be bankrupted by a single accident or illness is EVIL.  If you leave your keys in your car and it gets stolen, then it's fair to say that you're an idiot.  But the person who STOLE your car is STILL a THIEF.  

            •  Really cheap insurance means you are irresponsible (1+ / 0-)
              Recommended by:
              DMentalist

              for not signing up, expecting others to pick up the cost...so if you are insured you can't be bankrupted, how about that?

              "The poor can never be made to suffer enough." Jimmy Breslin

              by merrywidow on Tue Dec 10, 2013 at 11:34:51 AM PST

              [ Parent ]

              •  Like I said... (0+ / 0-)

                    I agree that people should get insurance if they can afford it, and that it is justifiable to impose a penalty if they don't.  

                     But I am a bit wary of the "personal responsibility" argument, because that's what you usually hear from the right-wingers.  It doesn't sound much different to me than arguing that we should have no compassion for lung cancer patients, because they chose to smoke, even though every cigarette package is labeled with a clear warning from the Surgeon General, or that we should have no compassion for AIDS patients, because they may have chosen to engage in unprotected sex, even though they knew there was a risk in doing so.  I went off a bit on my aversion to this "personal responsibility" argument as it relates to health insurance a bit more in this comment on another diary: Not a new argument

                     It's not yet clear to me that the ACA means that insurance really will be affordable for everyone.  Some states took the Medicaid expansion, and others didn't.  The cost of insurance varies WIDELY from state to state, and is much more expensive in states like California than elsewhere.  I'd also wager that it costs more to buy insurance on the individual market than it does for those lucky enough to have an employer-provided plan.  So if I can't afford insurance because of the state I live in, does that make me less "responsible" than someone who can afford it because he lives in a different state or has an employer with a decent benefits package?

                     The diary we are commenting on here was followed a few hours later by another diary: 30% of Americans now skip some medical care.  Since that figure includes people that do have insurance, it's obvious that having insurance does not solve the problem of out-of-control medical costs.  If the cost of an international airline ticket, a 2-week hotel or hospital stay, and 2 weeks worth of meals in a foreign country, COMBINED with the cost of a medical procedure in that country still comes out to be substantially LESS than the cost of that same procedure in the U.S., there is something wrong with that picture.  If we believe that there is a line between honest lending and exploitative usury, why should there not be a similar line between reasonable medical costs and exploitative profiteering?  If it's illegal for banks to charge 500% interest rates on a loan, why is it legal for hospitals to bankrupt you for merely getting sick?

                     Yes, it is stupid not to buy insurance, and you can even say it's irresponsible.  Just like if a person has lung cancer or AIDS, it might be the result of stupid or irresponsible behavior.  But I would not deny a person with lung cancer or AIDS relief from their suffering if it is possible to provide such relief.  I think if a young person makes a stupid and irresponsible decision not to buy health insurance when he can afford it, and must pay a penalty as a result, that is a reasonable consequence.  Bearing the financial burden of reasonable medical bills would also be a reasonable consequence.  But to be bankrupted, to have one's entire life ruined by crushing, inescapable debt that only serves to increase the medical industry's obscene profit margins?  That doesn't seem like a reasonable consequence to me.  Such a punishment really doesn't fit the "crime" of getting sick.  

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