On Thursday, June 22, 2017 at 1:47:04 PM UTC-4, Dene wrote:
> Pluses and minuses.
I've not read it yet to get into details.
> Pluses are that insurance companies can get creative with
> formulating plans that do not cover items that people want,
> such as mandatory mental health, maternity, etc. This will
> spur competition and lower cost.
I disagree.
What will happen is that people will pay less and get less,
and this "flexibility" will actually end up being how the
companies will create policies which initially appear to
look good, but are actually crap that doesn't pay anything.
Its the "Payday Loan" bit all over again, where the less
educated will be rip-off victims.
> Another plus...States will manage Medicaid and the expansion
> will be phased out. Medicaid should be a Band-Aid…not a
> long-term solution, especially for those recipients who
> are adults.
My understanding of Medicaid (right or wrong) was that it is
intended to be a safety net for the poor. Broadly, we're
seeing the Middle Class erode away and the trend has been
that four have gone down for every one that went up in income.
As such, the need for a safety net for the poor is growing,
not shrinking, so planning for future costs to be lower is
fiscally irresponsible.
> Downsides. Elimination of the individual mandate is a mistake.
Agreed.
> Older people will pay more for health insurance but younger
> people will pay less. I'm 58 so I can expect to pay more.
Is this a change in the allowed ratio (eg, 1:3 to 1:5)?
If so, I'm not optimistic that the rates will really decline
for the young by as much as they notionally should.
> Subsidies will not be solely based on income but on age.
> Conceivably, a millionaire could get a subsidy.
And is this observation a good or bad thing?
> Finally, Obama care taxes are being eliminated. That will
> not be a benefit to most Americans.
True, it is a tax cut for the rich (who also are getting
an age-based subsidy).
> If I were to write the bill, I would allow for insurance
> companies to be creative with coverages ...
I don't mind a certain degree of 'creativity', but I do have
concerns with not having minimum standards as well as the
consequences of inviting excessive complexity: from the
consumer's standpoint, simpler is better for cross-comparison
shopping. Trying to use the competitive forces of capitalism
simply doesn't work when it becomes harder to compare products.
Just look at shopping for a mattress: stores sell the same
brands, but with different model#s at each store, which makes
it impossible to price-shop for the same product.
> ...but maintain the individual mandate and the taxes, keeping
> subsidies for those who need it.
Agreed, don't roll tax cuts for the rich into this, and also
have some sort of "means test" for the poor. BTW, this also
means that tax credits are a horribly bad way to implement
this, since the poor don't have the free cash to float the
cost of a healthcare policy for a year (until tax time).
> I would do away with the expansion of Medicaid.
This one is problematic in that if the principle is that
Medicaid is for assistance to the poor, what is the plan
to have fewer poor people?
> Interesting times ahead.
Indeed it is.
> It's pathetic that the Democrats and their presstitutes will
> nitpick this to death without offering any solutions on their
> own. Perhaps a few will break away from their so-called leadership.
One of the things I notice in your post as apparently absent
is how any of these change initiatives will actually reduce the
real costs of medical services.
The only point that's even close to this is to permit insurance
companies to sell policies which have lower premiums because
they cover less, but that's a dodge because it does not actually
reduce the real costs of medical care ... its merely a transference
of who pays the bill from the Insurance Company back to the Individual.
OTOH, if this transference also comes with the Individual being able
to pay the lower rate that the Ins Co traditionally pays, then there
may be some potential for real cost reductions ... but that's another
example of where there's opportunities for the Insurance providers
to increase product complexity through schemes which aren't easy for
a consumer to assess the value of and cross-compare.
Thus, it still comes back to the basic question I asked months ago,
which was noting that for true costs to come down, someone has to
ultimately receive less money for their services - - "whose ox will
be gored?" was how I expressed it.
-hh