ray

My insurance has gone from $1,046 per month to $1,400 per month ... it's not a particularly good insurance plan ... no adult dental, high deductible and copays, limited prescription benefits. Last year our out of pocket was $6,000 on top of the above insurance cost.

Without the ACA would this be better? Why?

Compare?
I pay about 36% of my income in provincial and federal tax.
I get most of my health insurance as part of that. No dental and no prescriptions. (Ontario is not nearly as good as BC where you are covered for more)
I pay another $140 a month for my wife and I to have a crappy dental/prescription plan with 20% co-pays and an annual cap at $12,000. (self employed, so I do better on my taxes but no company benefits...)
What are you taxes on top of your insurance? As Bernie says,,,, compare the whole picture.

I think most European nations out do this by some distance...
That would be because of "big government" I guess.
Trump has said he would negotiate better prices from pharmaceutical companies. Sensible actually. But his party has consistently worked to deny Medicare from being able to do this... SO maybe by challenging some conservative conventional thinking he's serving a purpose,

rickyp wrote:Fate

Aren't you thankful for big government?

What solutions offered by "limited government" have ever worked to
1) insure everyone has access to health care.
2) insured that that access is affordable for everyone
3) kept costs from escalating beyond average inflation rates?

If you wanted to look at places where "big government" has been able to deliver on these 3 goals...you'd have to look at places other than the US/. Well every other Western nation.
OR for points 1 and 2 at the Medicare system in the US. Which is also providing better cost containment than private insurance and a private health care system,

Hey Big Government, RJ is talking "facts on the ground" and you are talking theory.

Why don't you try proving RJ wrong?

Ricky:

Without the ACA would this be better? Why?

The ACA ceded all of the power to the insurance companies ... it mandates that I have insurance ... then it offers to pay some of that insurance if I have low income (and I'm willing to take the Government's money) ... it penalizes me if I don't take insurance ... so I'm forced to buy a product ... the insurance companies are motivated to raise rates ... if I (or my employer) can afford it, they get the money... if I can't afford it, then the state pays what they charge ... meanwhile they have all the negotiating power against the health providers ... their agreement is that these health providers pass on savings to them, but keep high list prices ... the health providers tend to merge to give them a little market power. Meanwhile, the insurance companies cannot compete among state boundaries so the government has created an oligopoly ... the government favors litigants in the courtroom (as do the juries since they hate the insurance companies) resulting in large payouts to attorneys and their clients for malpractice ... thereby raising my rates again ... meanwhile congress is heavily lobbied by the insurance companies and trial attorneys to retain this system. Rinse, hose, repeat, rinse, hose, repeat.

It's clearly not only the ACA's fault, but the ACA did exacerbate the problem by mandating insurance. It certainly didn't make things better. Although I've had double digit increases before, I've never seen anything like a 34% increase in insurance rates.

rayjay

Meanwhile, the insurance companies cannot compete among state boundaries so the government has created an oligopoly

.States were free to allow insurers from other states to sell to their citizens before Obamacare, and they are still free to do so today. What Obamacare did was establish an "essential benefits package" -- basic minimum standards that all individual policies must meet, no matter where they're sold.
Indeed, many states have explored the idea of allowing insurance companies from other states to sell within their borders; 18 looked into allowing out-of-state insurance sales before Obamacare became law, and 13 have considered it since. But very few have actually decided to do so. And the ones that have report unanimously that it has accomplished nothing.
Why? Because a license to sell insurance in a given state isn't the only thing insurance companies need in order to be able to actually sell insurance. They need to learn the state, analyze the health care needs of its population, recruit participants, build a network of providers, negotiate rates, and more.
If you're a huge insurance company like Blue Cross, you might have the resources to replicate this effort in states across the country, which is why you can get Blue Cross insurance in multiple states. But smaller insurance companies based in a single state have found again and again that, even when offered the opportunity to sell across state lines, it simply isn't worth the hassle.
And that's why allowing cross-border insurance sales has failed miserably in every state where it's been tried

. Wyoming, Rhode Island, Washington, Georgia, Kentucky, Maine.
http://www.huffingtonpost.com/al-franke ... 32508.html
rayjay

the government favors litigants in the courtroom (as do the juries since they hate the insurance companies) resulting in large payouts to attorneys and their clients for malpractice

Torte reform in texas did nothing to alleviate either health care cost inflation or physicians leaving the State.
http://healthcare.dmagazine.com/2012/08 ... ing-costs/

Rayjay

It's clearly not only the ACA's fault, but the ACA did exacerbate the problem by mandating insurance

.
Without the mandate, what do you get?
Start with the fact that people without health insurance, get their health care primarily from emergency rooms, where by law, they can't be turned away. Huge bills were left unpaid by these people, and were paid for by increasing charges to patients who do have insurance.
You also end up with people waiting longer to seek treatment, usually meaning their treatment is more expensive and often less effective. Preventative care for those without insurance doesn't happen.
The mandate made sure that healthy people, who previously gambled that they wouldn't get sick, now don't get to gamble. Some of them, by gambling, managed to avoid big health care costs. Some lost the gamble and incurred crippling bills.
... But today their insurance premiums help keep everyone's premiums lower, and they can seek earlier treatment and are secure in knowing they won't be bankrupt by a car accident. Its no different than any other insurance pool. Only other insurance pools are for people who are required to have such to drive a car for instance.
The difference with health insurance is that everyone participates in the cost of service delivery whether they are insured or not. And the law means that the uninsured do eventually have their costs covered as the providers pass the losses from providing care to the uninsured to the insured....

The mandate also allowed people previously uncovered to seek care earlier and in less expensively delivered methods, like doctors offices and clinics. It will save lives as a result.

Please explain how this isn't an improvement over years before the ACA?
The ACA is a deeply flawed system. And you are right that it hasn't been as effective against health care inflation as many hoped. But certainly better than your personal experience. (see below) Mostly because it still disallows many of the levers that national health insurance plans allow that do keep health care costs lower.
But the notion that previously there was anything resembling competition on pricing in health care is erroneous. Nor that any of the proposed fixes (insurance across state lines, malpractice torte reform) will have any significant effect.
Sanders offers the only solution that can effectively lower health care costs. Clinton accepts the monstrosity that is the lobbying and legislation morass that gave birth to the ACA. And Republicans have nothing but repeal of the ACA. and "I won't let people die in the street".
Repeal would remove coverage from millions, allow insurance companies to bring back basically worthless insurance, (essentially legalizing fraud), allow people to be uninsured which means their care costs would be backstopped by others anyway, and does absolutely nothing to attack the costs from providers... The evidence for this is a review of the conditions that pre-existed.

Rayjay

Although I've had double digit increases before, I've never seen anything like a 34% increase in insurance rates

.
http://kff.org/health-reform/issue-brie ... ketplaces/

The average increase last year , according to Kaiser, was 2% for Silver and 4% for Bronze plans.

Thanks for the data on 2015 ... I'm living here in 2016 ... I'm basically focused on one data point, but it's the most credible one that I've seen so far.

Ray Jay wrote:Thanks for the data on 2015 ... I'm living here in 2016 ... I'm basically focused on one data point, but it's the most credible one that I've seen so far.

Is there any significant thing that may in your case have been pertinent - any medical conditions for those covered, or changes to the coverage in terms of risk (eg, age, etc)

I think it is clear by now that the ACA took a broken system for many and fixed it for them, breaking it for others.

So the system is still "broken". The true fixes seem to me to be more fundamental, but as you point out, the lobbying and political system obviates against such change.

finally got to chat with my insurance broker ... just Harvard Community Health Plan had the massive increase as they lost money last year ... other insurance companies have much more reasonable plans and did not have huge increases. I guess I jumped the gun ...

http://kff.org/health-reform/fact-sheet ... ketplaces/

Ray

Thanks for the data on 2015 ... I'm living here in 2016

I didn't think Kaiser would have 2016 yet. They do....

Average price increase nationally (Silver package) was 3.6% before the Tax Credit. And with the tax credit the cost actually went down 7/10th of a percent...

Its all remarkably complicated Ray. Another benefit of the Medicare for all solution would be the elimination of this stress in your life.
Hope it works out for you.
This should cheer you...
The Best Line from any of the Debates:

“We’re going to invest a lot in mental health,” Sanders quipped. “And if you watch these Republican debates, you know why we need to invest in mental health.

Ray Jay wrote:finally got to chat with my insurance broker ... just Harvard Community Health Plan had the massive increase as they lost money last year ... other insurance companies have much more reasonable plans and did not have huge increases. I guess I jumped the gun ...

So can you find another provider with a better offering? Hope so

danivon wrote:

Ray Jay wrote:finally got to chat with my insurance broker ... just Harvard Community Health Plan had the massive increase as they lost money last year ... other insurance companies have much more reasonable plans and did not have huge increases. I guess I jumped the gun ...

So can you find another provider with a better offering? Hope so

Yes, thanks ... in today's WSJ:

http://www.wsj.com/articles/lammed-by-o ... 1457395478

Our annual health-care cost risk was $274 x 12, plus $1,000 in deductibles for a total of $4,288. My individual risk (that is, my personal share, excluding my dependents) was $1,072. By 2009, those figures had jumped to $10,716 in annual premiums for our family of four, plus $2,000 in deductibles—a threefold increase in health-care cost risk.

Since ObamaCare became law, the increase has been more than fourfold. The kids are “OTP”—off the payroll; just my wife and me now. In December 2014, I shopped on the Internet (not so quaint) for new health insurance. I bought a Bronze plan for two people that cost $1,037 a month and had a $12,600 family deductible ($6,300 each). We were blessed last year; we didn’t have perfect health but never filed a claim.

So I was shocked when my 2016 renewal notice showed a 19% monthly premium increase to $1,231—with a higher deductible. All comparable Bronze plans were within dollars of each other, so I grudgingly renewed. My individual health-care cost risk for 2016? It is $1,231 x 12, plus $12,900 in deductibles, for a grand total of $27,672. My individual share is half—$13,836. Nearly 13 times more than the $1,072 of 1999.

I don't know if the ACA is going to really work long- term--it's always seemed like a Rube Goldberg contraption to me, with a lot of moving parts that have to come together. But the old system was built on the backs of the sick and poor ( remember Medicaid only used to mandate coverage for the disabled, those caring for dependent children , the elderly and pregnant women whose income was 133% of this poverty line-- everyone else in many states was excluded)and led the world by far in money spent on health care. In order to keep premiums from spiraling out of control insurance companies did not cover poor people or the many people who have pre -existing conditions (diabetes, cancer, heart disease, etc). What kind of Dicksonian society does that? The ACA represents the "compassionate conservative" free-market solution to getting everyone (well, almost everyone ) covered instead of going to single-payer which liberals want.

Do people who are seeing their health care premiums go up now want to go single-payer or do they want to go back to the old system where they had somewhat affordable premiums but many poor people and sick people were excluded? This is a moral question I think that cannot be avoided. It would not do I think for someone to say I want my old health care back--it's not my problem what happens to those with pre-existing conditions or to the poor. Whose problem is it then ? (To be clear, I am not making any negative commentary on anything RJ has said with regard to his premiums going up or implying that he has made the hypothetical assertions made above but simply putting the forth the proposition that there is a moral question involved in going back to pre-ACA for all of us.)

Republicans clearly have no solution (regardless of what proposals they have half- heartedly floated around )--they just want to get rid of the ACA without having to replace it. The ACA just needs to survive long along to inculcate in American minds that everyone has a right to health care coverage. Just like after Medicare came along health care coverage for the elderly care became a right. The experience of other advanced western societies is that the best way to get everyone covered and keep costs under control is to go single-payer. Free market solutions do not lend themselves well to health care. Is over government / society so dysfunctional and controlled by special interests that we can't adopt the obvious solution that has been shown to work well in other Western countries ?

freeman3 wrote:I don't know if the ACA is going to really work long- term--it's always seemed like a Rube Goldberg contraption to me, with a lot of moving parts that have to come together. But the old system was built on the backs of the sick and poor ( remember Medicaid only used to mandate coverage for the disabled, those caring for dependent children , the elderly and pregnant women whose income was 133% of this poverty line-- everyone else in many states was excluded)and led the world by far in money spent on health care. In order to keep premiums from spiraling out of control insurance companies did not cover poor people or the many people who have pre -existing conditions (diabetes, cancer, heart disease, etc). What kind of Dicksonian society does that? The ACA represents the "compassionate conservative" free-market solution to getting everyone (well, almost everyone ) covered instead of going to single-payer which liberals want.

Do people who are seeing their health care premiums go up now want to go single-payer or do they want to go back to the old system where they had somewhat affordable premiums but many poor people and sick people were excluded? This is a moral question I think that cannot be avoided. It would not do I think for someone to say I want my old health care back--it's not my problem what happens to those with pre-existing conditions or to the poor. Whose problem is it then ? (To be clear, I am not making any negative commentary on anything RJ has said with regard to his premiums going up or implying that he has made the hypothetical assertions made above but simply putting the forth the proposition that there is a moral question involved in going back to pre-ACA for all of us.)

Republicans clearly have no solution (regardless of what proposals they have half- heartedly floated around )--they just want to get rid of the ACA without having to replace it. The ACA just needs to survive long along to inculcate in American minds that everyone has a right to health care coverage. Just like after Medicare came along health care coverage for the elderly care became a right. The experience of other advanced western societies is that the best way to get everyone covered and keep costs under control is to go single-payer. Free market solutions do not lend themselves well to health care. Is over government / society so dysfunctional and controlled by special interests that we can't adopt the obvious solution that has been shown to work well in other Western countries ?

I completely agree. Obamacare does suck, but it sucks a lot less bad than the old system, which actually killed some of the least fortunate of our fellow Americans. We need something else, but we certainly can't go back to the terrible old system. The worst thing about the GOP when they talk about Obamacare is that they don't have a clear alternative, and they refuse to recognize how sucky things were before Obamacare. That's a problem for them.

How about this:

Any one can go on Medicaid (their choice). Doctors can refuse Medicaid (their choice). People can pay whatever insurance they can choose to afford (their choice). Insurance can sell in any state they are licensed in (their choice).

A great many choices there.

Why did the government mandate what insurance coverages I get to choose between?

As to Freeman's question... Yes, I would rather go back to the previous system where people could select what insurance they could afford. There is Medicaid for the truly needy, as well as charitable institutions.

geojanes wrote:I completely agree. Obamacare does suck, but it sucks a lot less bad than the old system, which actually killed some of the least fortunate of our fellow Americans. We need something else, but we certainly can't go back to the terrible old system. The worst thing about the GOP when they talk about Obamacare is that they don't have a clear alternative, and they refuse to recognize how sucky things were before Obamacare. That's a problem for them.

So then, you're a Trump supporter? He says he'll repeal the ACA, but says everyone will be covered. He's praised Canada, Scotland, etc for their socialized medicine.

Any one can go on Medicaid (their choice). Doctors can refuse Medicaid (their choice). People can pay whatever insurance they can choose to afford (their choice). Insurance can sell in any state they are licensed in (their choice).

A great many choices there.

Not so many if you have an existing condition.