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[Health Care Reform] and you.
chidona
Registered User regular
Registered User regular
First of all, apologies if the old thread is still kicking around - I did a search and it didn't pop up, so here goes.
Right, so Health Care Reform is here. Well, more specifically, phase 1 of the affordable care act is being rolled out across the country. But let's step back for a second, why does the US need reform at all? What does the reform do? Well, both these questions are answered by this sublime video done by the Kaiser Family Foundation, and I implore you all to watch it and share with family and friends:
http://healthreform.kff.org/the-animation.aspx
http://www.youtube.com/watch?v=3-Ilc5xK2_E&feature=player_embedded
So it all sounds fairly dandy, right? Well, as noted at the end of the video, the 'mandatory health care insurance' provision is highly contentious; Republicans hate the idea of forcing people to purchase what, in their eyes, is a commodity. The Government should focus on incentives to achieve the optimal level of coverage, not top down regulation.
And so this happened: http://news.yahoo.com/s/afp/20101213/ts_alt_afp/ushealtheconomycourt
The big problem with letting mandatory insurance go is that the entire reform hinges around it. By far the largest problem the US faces vis-a-vis health care insurance is what economists call 'adverse selection'; the insurer finds it very difficult to ascertain the 'riskiness' of individuals in certain groups. Because high risks (that require high premiums) will always be better off mixing with low risks (who only require low premiums), insurers that offer plans to low risks will also attract high risks. This forces up the average cost of the premium (as the riskiness of the group rises), and low risks may drop out as they think they'll be better off without it. Once again, this raises the riskiness of the group and forces the premium up - this continues until the premium is sky high and the plan, effectively, breaks. The whole phenomena is given the rather cool name of: the 'adverse selection DEATH SPIRAL'. People with pre existing conditions have no chance of even getting that far; insurers deal with uncertainty and risk, but they can't handle certainty due to the nature of the actuarial model.
Hence, mandating premiums is needed to prevent people dropping out of schemes, allowing insurers to better gauge the riskiness of a certain population and charge a stable premium. If the mandating clause gets dropped then the reform will only be partial; people with pre existing conditions will be able to get insurance, but limited between a higher average population risk and an inability to raise premiums, insurance companies will struggle to provide any sort of decent coverage.
A little background about me: I'm actually from the UK, but am currently doing my undergraduate dissertation on the US health care reform - in part due to being interested in the debate it provoked here. It was interesting to see what Americans thought about their own system and where they thought the failings were, and what they wanted from reforms. So, because this board played a (small) part in stoking my interest in this subject, I felt I'd give back a little as well.
So, after all that; what do you feel about the reform package, a couple of months down the line? Have you been affected already? What about this mandating insurance thing that's going on?
Right, so Health Care Reform is here. Well, more specifically, phase 1 of the affordable care act is being rolled out across the country. But let's step back for a second, why does the US need reform at all? What does the reform do? Well, both these questions are answered by this sublime video done by the Kaiser Family Foundation, and I implore you all to watch it and share with family and friends:
http://healthreform.kff.org/the-animation.aspx
http://www.youtube.com/watch?v=3-Ilc5xK2_E&feature=player_embedded
So it all sounds fairly dandy, right? Well, as noted at the end of the video, the 'mandatory health care insurance' provision is highly contentious; Republicans hate the idea of forcing people to purchase what, in their eyes, is a commodity. The Government should focus on incentives to achieve the optimal level of coverage, not top down regulation.
And so this happened: http://news.yahoo.com/s/afp/20101213/ts_alt_afp/ushealtheconomycourt
Yahoo wrote:Judge rules Obama health reform unconstitutional
A US judge Monday ruled that a key provision in the Obama administration's landmark health care reform requiring all Americans to have medical insurance was unconstitutional.
It was the first major legal blow to President Barack Obama concerning the radical overhaul of the nation's health care system, which he has made a cornerstone of his administration.
The ruling by Judge Henry Hudson of the Eastern District Court in Richmond, Virginia, found that the new law's mandate that Americans must buy insurance or pay a fine goes beyond federal authority and violates the Commerce Clause, a key component of the US Constitution.
"Neither the Supreme Court nor any federal circuit of appeals has extended Commerce clause powers to compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market," Hudson wrote in his opinion.
Hudson, who was appointed by former president George W. Bush, ruled the provision "would invite unbridled exercise of federal police powers."
The big problem with letting mandatory insurance go is that the entire reform hinges around it. By far the largest problem the US faces vis-a-vis health care insurance is what economists call 'adverse selection'; the insurer finds it very difficult to ascertain the 'riskiness' of individuals in certain groups. Because high risks (that require high premiums) will always be better off mixing with low risks (who only require low premiums), insurers that offer plans to low risks will also attract high risks. This forces up the average cost of the premium (as the riskiness of the group rises), and low risks may drop out as they think they'll be better off without it. Once again, this raises the riskiness of the group and forces the premium up - this continues until the premium is sky high and the plan, effectively, breaks. The whole phenomena is given the rather cool name of: the 'adverse selection DEATH SPIRAL'. People with pre existing conditions have no chance of even getting that far; insurers deal with uncertainty and risk, but they can't handle certainty due to the nature of the actuarial model.
Hence, mandating premiums is needed to prevent people dropping out of schemes, allowing insurers to better gauge the riskiness of a certain population and charge a stable premium. If the mandating clause gets dropped then the reform will only be partial; people with pre existing conditions will be able to get insurance, but limited between a higher average population risk and an inability to raise premiums, insurance companies will struggle to provide any sort of decent coverage.
A little background about me: I'm actually from the UK, but am currently doing my undergraduate dissertation on the US health care reform - in part due to being interested in the debate it provoked here. It was interesting to see what Americans thought about their own system and where they thought the failings were, and what they wanted from reforms. So, because this board played a (small) part in stoking my interest in this subject, I felt I'd give back a little as well.
So, after all that; what do you feel about the reform package, a couple of months down the line? Have you been affected already? What about this mandating insurance thing that's going on?
chidona on
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3 of my family members (Including myself) have Crohns, so it's nice about the preexisting conditions.
Also, isn't there a clause about how they can't deny children coverage now? That seems like a good thing all around.
From what I have seen, it seems most people who disagree with the health care bill just don't understand what it does. Like when people argue against Net Neutrality that aren't employees of Comcast. Maybe there are negative sides, but I personally haven't been witness to them.
Yeah, gotta love the media.
One judge upholds the law. Newspapers/sites quietly mention it.
Another judge upholds the law. Newspapers/sites quietly mention it.
Another judge challenges the law. IS THIS THE END OF HEALTH CARE REFORM!?!?!?!111111
the "no true scotch man" fallacy.
Yeah, but it's still early days as there are more rulings pending. The economist ran an interesting article about the whole thing:
http://www.economist.com/node/17733377
In the OP I essentially went with a hypothetical situation where the mandate was struck down. I'm unfamiliar with the specifics of US law however, so I don't really know how likely the ruling is to hold up - I can only suggest what the economic repercussions of such a ruling would be.
Which would probably be the best result in the long term. I wouldn't want to be around during the fallout, though.
the "no true scotch man" fallacy.
Yes, there are more rulings pending, but there are also the fact that so far, it's two for, one against, and that the one against ruling is pretty hideously flawed. Not to mention that these cases go after the one bit of healthcare reform Big Insurance likes.
As for how the ruling stands, what happens in the worse case is you have what's called a split decision, where a higher court (in this case, one of the Circuit Courts of Appeals) has to rule who's right. Again, this means that as things stand the against side is screwed because they have fewer wins, plus their win is exceptionally weak.
Protecting the health insurance industry was the main reason why an insurance mandate was originally proposed by Congressional Republicans during the Clinton-era debate on heath care, and why it's part of Romneycare.
Oh, I've seen many arguments. They're all specious.
"The government can't make you buy something."
Oh yeah? How about Social Security?
"That's offered by the government, not a private company."
So when GWB was talking about privatizing SSI, was he arguing for something unconstitutional?
When the government outsources a tax-paid service (like defense) to private contractors, is that unconstitutional?
"The government can't penalize inaction."
Oh yeah? How about not filing your taxes? Or registering for Selective Service?
"Health insurance isn't covered by the interstate commerce clause because insurance companies don't operate across state lines."
Raich v. Gonzales disagrees with you.
Besides, you really want to argue that companies like Aetna and Kaiser don't operate across state lines?
the "no true scotch man" fallacy.
Technically they don't (except for UHC which actually does have national plans) but in 2014 they'll be able to under the ACA. State's can merge to create regional pools for exchanges, rather than leave it restricted within the State, and I'm pretty sure insurance companies can opt to go under OPM rules in order to be universally accepted by exchanges similar to how banks can be State regulated or Federally regulated.
As for me, personally, I
Well, the health insurance companies benefit the most from the individual mandate due to adverse selection, so if that reasoning is followed they will likely uphold the law as is.
I have family that think the individual mandate is unconstitutional, which seems pretty silly, especially given that the only penalty for failing to get health insurance is a fee. By that standard there would be a ton of other stuff that the Federal government does with tax and other law that would also be unconstitutional.
This is pretty interesting; I've come across authors who see that any system that attempts to stay 'private' will inevitably have features that resemble that of a social insurance system. The reforms in the ACA really do seem to go a pretty far way, thanks in a large part due to the mandate. The question therefore arises; will the ACA reforms lead to a stable 'private' system, or are they just a half way house between a private health care market that's full of holes, and a social insurance system reminiscent of the ones in Western Europe?
Either that or a gradual or not-so-gradual lowering of the Medicare eligibility age.
Can you elaborate here?
Or a not-so-gradual relaxation of Medicaid eligibility guidelines.
the "no true scotch man" fallacy.
They have a policy of admitting the fuckup ASAP, and working to rectify it. This results in a tiny fraction of the malpractice claims you get in comparable civilian programs. It turns out that clamming up and pretending you're infallible isn't very helpful.
It's not like it could get any MORE expensive >.>
It also helps to have an authority with the power to investigate and remediate medical errors before they go to litigation. In a managed care system (like the VA, or NHS, or Kaiser) if your doctor fucks up, you can go to your doctor's boss or the hospital's medical director; there's a bureaucratic ladder to climb. This provides the possibility of seeing results (or getting a reality check) before lawyering up.
In any case, malpractice suits are responsible for a tiny fraction of healthcare costs in the US.
the "no true scotch man" fallacy.
I think he was meaning it more from the patient well being standpoint than financial concerns.
The review board also has the authority to sanction practitioners who fuck up, including revoking the practitioner's license.
They also have caps on damages, which I don't entirely agree with.
Here's a pretty good article on it: http://www.facs.org/fellows_info/bulletin/2004/adelman0104.pdf
Moniker: ah, gotcha. Yeah, makes sense.
the "no true scotch man" fallacy.