The point of the individual mandate was never that it was good for the individuals, but rather that it avoids ‘adverse selection’ where healthy people see the price and decide they can’t afford it but the mom with MS who has a kid with spinal deformation thinks ‘what a bargain!’
In the long run, it's trying to avoid the adverse selection death spiral where the price keeps rising to match the costs, and squeezing more people out of the pool.
For comparison, in New Zealand, assuming you are earning NZD180k (well into the top 1%[1]):
Your taxes are about NZD70k in total. About $12k of that goes towards heath[2].
The most expensive family plan (2adults 3kids) to top up your cover (beyond the normal care everyone gets by the state) is NZD700 per month (the major health insurance provider in NZ[3]).
Thanks for this break down. Very interesting to see how the health insurance cost is similar to the US but the payer is different.
In the US, if you are lucky, your employer pays the bulk of the premium. If you aren’t, you try and find a cheaper ‘death and dismemberment’ plan (only covers tragic events ) so you aren’t bankrupted if something really bad happens.
The terrible part is for those folks, there is no state plan to fall back on. Insurance and providers are more than happy to bill you into crushing debt.
"Empirical evidence of adverse selection is mixed. Several studies investigating correlations between risk and insurance purchase have failed to show the predicted positive correlation for life insurance, auto insurance, and health insurance. On the other hand, "positive" test results for adverse selection have been reported in health insurance, long-term care insurance, and annuity markets."
> Obamacare did away with "preexisting condition", and the mandate was meant to replace it.
The Obamacare "fix" already existed in several states. You believe that such a policy has certain consequence - can you identify those states by looking for that consequence?
Note that pretty much every state had "if you keep your care, you can change providers", so the problem was only for folks who dropped coverage and then wanted back in.
If you have a relevant condition, dropping coverage seems like an odd thing to do.
In one sense we were a can't-turn-down state. No limit on the premium, though, and note the response I received from an insurance application. The can't-turn-down option wasn't meaningful.
No, sorry. Implying that adverse selection is "managed" by excluding people from having health insurance implies that the system actually works. Since large numbers of people are, by definition, excluded from having health insurance under such a system, it de facto does *not* work.
This is not an opinion; it's a fact. A system that, by design, fails those who need it the most in order to syphon money off from those who need it the least is a failure.
It used to be that if you had health issues you simply couldn't buy insurance, period. My former employer failed in the housing collapse, trying to get private "Please feel free to reapply when you have a diagnosis." I'd love to have even a real diagnosis, but I do not expect I ever will.
All health plans in the USA must fully cover an annual physical and other preventative services (like shots and some kinds of screenings) under the ACA.
So if you schedule a visit to a doctor without a specific problem and they give you your yearly shots and do routine tests, and all of that is covered by insurance, what do you call it?
Would you share a bit about your efforts to find such a plan? We other commenters are experiencing cognitive dissonance reading your comments, because in our experience, all the plans we've been on since ACA, cover an annual exam with no questions asked..
> And also notice “most”, “depending on your age”, and “may”.
You say that like you think those are being used as weasel words. But they're just allowing for a more concise summary that does not need to recite every nuance of the requirements, which rightfully are not written as one size fits all. Factors like your age truly do matter to the question of what preventive care makes sense, and it would be a bad public policy to require insurers to cover care as preventive in situations where it does not have preventive value.
It's close enough. That "most" truly is "all" when discussing plans offered through the Healthcare Marketplace.
And since you still haven't provided any clarification about your claimed inability to find such a plan being offered to you, I don't think I need to bother digging up details on whatever obscure products require the statement about preventive care to be qualified. If you're being at all honest about your experiences with health insurance, you can more readily identify some exceptions than I can.
Every plan that was offered to me through the marketplace stated that annual checkups were out of pocket but I could count them against my deductible. I don’t know how to be more clear than that.
You really aren't putting much effort into being clear and convincing, especially given how you've been shown that people are finding your claims quite hard to believe. You are still not offering any specifics such as which state these plans are offered in, what level(s) of plans you looked at (catastrophic/bronze/silver/gold), what (if anything) in the way of preventive services they do purport to cover, what services you expect from an annual checkup that would not be covered.
There are lots of obvious ways you could have been much more forthcoming to bolster your credibility, but instead you've been more or less evasive.
Silver (and bronze) plans in a southeastern state.
I would like to go to the doctor and not have to pay out of pocket for my annual checkup. I understand that the checkup may raise tests and procedures that would cost, but first visit fees and annual checkup fees and some level of basic blood work shouldn’t be out of pocket like they were in the plans offered to me. (I’d even be fine with a copay of $10-25)
Beyond that I don’t actually care if you believe me. This is what happened to me
They do, but beware fun fees: I've spent hours of my life disputing a psych evaluation charge (under 5 minutes of a pediatrician asking a kid how they are feeling, without any paternal prompting), which the insurance company claimed it wasn't covered in the free physical. So you go to a supposedly fully covered appointment, and come back home to a bill you have to pay, or argue with.
It's not just the insurance company in that case though, the doctor's office would have submitted an additional billing code for the appointment (which for something like you describe should probably be treated as fraud).
The original idea with insurance providers was that they were more educated than their customers, and since they were paying, they would be incentivized and better capable of negotiating with medical providers.
Of course, this has proven not to be the case. Part of the reason is that insurance providers are legally prohibited from making profits beyond a certain proportion to what they actually pay for medical services. So now, they are actually incentivized for _higher_ medical costs.
Other than as part of an overall plan what would be the point? The cost would be the cost of an annual checkup. Other than if you could pay it with pre-tax dollars what would be the point? Insurance is about risk, not about certainty.
It's so very weird reading this as a UK citizen. It feels like reading about some kind of dystopian future. Despite the UK government's best efforts to the contrary, even the poorest in society can still access health care locally at no cost... except the hospital car parking fees, that's a killer.
I live in Switzerland. I had a skiing accident and got stretchered down to the main station, then an ambulance down the mountain to the hospital. Since at that point I hadn't filed my accident insurance claim yet, they sent the full bill to me.
Want to know how much it was, in the land of $25 pizzas? Under $300. And of course, I forwarded it to my accident insurance, so my out-of-pocket was $0.
Also in Switzerland: an ambulance was called for me in the middle of Zurich, they arrived after driving only a few kilometers, performed an EKG, and didn’t transport me anywhere. I was billed over $700 for that, which I had to pay out-of-pocket as the theoretical 50% insurance coverage was below my deductible.
Most likely it didn’t have to pay any money because you either payed your full deductible for the year already, or most likely it was payed by the accident insurance and not the regular health insurance
Make sure you stay vigilant and keep fighting for the NHS.
Our public healthcare in Australia has been slowly eroded over the past decade (if not longer), and I'm starting to wonder if the next generation will even be able to enjoy "full" coverage at all.
This isn't propaganda or hyperbole. When my wife had a miscarriage earlier in the year, we were billed $150 for the privilege of being told we'd lost our child.
This should not happen in Australia, but it did. Don't follow in our footsteps.
From paper: “Of the 4.5 million households who met the criteria for inclusion in this pilot program, 3.9 million were randomly selected to receive the intervention.”, “The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals.”
Those in the treatment group were 1.3[1] percentage points more likely to enroll in coverage in the year following the intervention than those in the control group: about 50,000 extra households (~100,000 extra people) were signed up due to the letter.
So, about 200 died because they didn’t receive the letter (But that was offset by the 8 billion lives that were saved by something else that didn’t happen that day.).
[1] “those in the treatment group were 1.3 percentage points more likely to enroll in coverage in the year following the intervention than those in the control group, a 2.8% relative increase. On average, each letter increased coverage among this group by 0.14 months during 2017, or one additional year of coverage per 87 letters sent. We document larger effects among individuals who lacked any coverage during the prior year and among older non- elderly adults.”
Edited: corrected numbers - mistook households for individuals.
Not to be a nihilist, but 200 seems like a ridiculously and surprisingly low number for impact of such an expensive and broad program. Does it really validate what the author posits?
Bear in mind nearly all of the people receiving letters should be <65. I quickly skimmed the paper and it seems like the authors don't have enough data to come up with a quality adjusted life-year type of statistic like the NHS uses.
On second thoughts, that should be 100: I stuffed up mixing households versus individuals.
“The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals. Individuals in the sample were randomly assigned to receive a letter (86%) or to a control group (14%). One letter, addressed to the taxpayer(s), was sent per return. Hence, randomization was conducted at the household level.”
So 86% of 4.5 million households were sent a letter, and that led to a 1.3% percentage point increase in signups compared to the 14% of households that were not sent a letter. They are then saying that those 1.3% of extra signups led to saving ~700 lives. There is the risk of a selection bias because we don’t know why those extra 1.3% signed up versus those that didn’t.
The actual paper uses months, since everyone dies, so zero lives can be saved in the long term.
> the first rigorous experiment to find that health coverage leads to fewer deaths, a claim that politicians and economists have fiercely debated in recent years
Living in Europe I must have missed this debate. Is it not self-evidently true? What are the arguments against it?
No no. They say -mortality- isn't affected. Like, people don't die more often without health insurance. There are all sorts of measured benefits of health insurance, quality of life, lower prevalence of medical debt, etc. It's just that a lack of it doesn't lead to people dying sooner.
Which kind of makes sense; the cost even with insurance ensures people don't go to the doctor as often as they should, until something is concerning them. And if it is sufficiently concerning, even someone without insurance goes. And if it's going to prove lethal without treatment, even those without insurance will probably still get the treatment, since better to be alive and in debt the rest of their life than dead.
Someone else linked https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim... and it's a good example; it calls out that those with coverage are less likely to have medical debt sent to a collecitons agency, which implies that those without coverage are still seeking treatment...they just are going into debt for it.
In the US you still get emergency medical care without insurance but then have to deal with the bill. Sometimes that means bankruptcy, sometimes its forgiven.
The elderly (65+) have universal care through the government account for most mortality.
So with those combined, it means the impact of coverage on mortality is small enough that its hard to measure. Of course avoiding financial catastrophe is also a good reason for some kind of universal coverage even if the direct health benefits are low.
Right, but none of the two methods you mention will get you treatment for any cancer your get in your 40s, right?
Is the argument that before 65 people just don't die from anything medical, except things emergency room will treat?
But then there's also the secondary effects, like losing your house because of medical bills. And we know that even with universal health care (every civilized country except the US) health is associated with money.
Another reply asserted that studies say it doesn't help much, but... that's just so counter intuitive to me that the the studies that were replied there saying actually it does help can be summarized by "well, duh".
But I've thought "well, duh" about false things in the past, which is why I want to know.
Obamacare was likely the only politically viable solution at the time. I wish we would use it as a stepping stone to more comprehensive coverage for all US residents.
In retrospect, Obama seems to have made a terrible mistake with the Obamacare framework. He made the original sin of acquiescing that there would be no single payer, thereby relinquishing his only true leverage over an obstinate Senate clinging to a skin Democratic majority.
The compromise was not a good one. It never made great sense for any of the parties. It was a victory of pragmatism over function, and no Republican voted for it anyway.
And yet now this accidental experiment exists because of Obamacare which settles a longstanding debate in the US as to whether healthcare coverage actually saves lives -- while Europeans go "Well, duh? Why was this ever a question?"
Yeah, but had he not compromised and instead just pushed through a single payer solution ("medicare for all"), it would have passed along the same lines, given us the same data, and have been harder for Republicans to gut since it would have given no individual mandate, or high priced low coverage marketplace plans, to attack.
He didn’t support a single payer system or a public option, he just made mouth noises to that effect. Look at the recent failure in California to bring a single payer bill to a vote, despite the Governor’s ostensible support and Democrats’ 75% super majority in the Senate. Perennial incompetence isn’t a plausible explanation; rank corruption is.
Edit: to add a bit of evidence that Obama specifically is corrupt, here is an article titled ‘Barack Obama Got Paid $400,000 for a Speech to Health Care Execs. Here's What He Told Them’:
I don’t get it. The same article said he made $60 million from a book deal. $400K is a nothing burger. He would have made money from the speaking circuit regardless.
I don’t understand, you say $400k is nothing, but then say he would have made money from the speaking circuit regardless, as if he didn’t do just that, and as if taking vast sums from powerful corporate interests whose interests he’d manifestly served during his time in office isn’t the definition of corruption. I’ve read claims that he makes about 50 speeches per year, which seems plausible, given that Bill and Hillary Clinton made 729 speeches between 2001 and 2016 for a total of $153 million ($210k average).
I want to go back to the $400k speech to the healthcare industry. First, the notion that this isn’t corruption because he made so much more money in a less unseemly manner is pretty curious. Does it not then follow that the very rich, so long as their original fortunes are not ill gotten, are incapable of corruption in principle ? Second, $400k is precisely the annual salary of the President(!). For maybe an hour of work. It’s not just egregious, it’s super on the nose. Third, imagine he’d put every bit of political capital at his disposal into the fight to create a single payer system, and against the odds (and the money of those executives to whom he gave the speech) succeeded. Do you think the healthcare industry (or the part that’d still exist) would still pay $400k for an hour of his time?
He had no political capital against the lobbyist who had the democrats in their pocket too. Clinton also tried passing health care reform with a Democratic majority and failed miserably.
At least Obama got something passed. Now, even though I personally would pay a decent chunk of change for health care if I decided to go into independent consulting, at least it’s an option now. It wasn’t before.
He would have made money on the speaking circuit from some group of people regardless of what he did.
Your theory is that Obama pushed through a complicated health care plan that affects millions of Americans and acts as the centerpiece of his legacy, and it was all to set up a $400k speaking fee a year after leaving office?
He makes it clear he’s the sort to play ball, so he gets the money for the campaign. He plays ball, so he gets paid. And it’s not $400k, it’s $10-20 million per year indefinitely. See my other comment—-the Clintons made $150 million on speeches alone between 2001 and 2016.
As President, no matter what you do, somebody benefits. Also, somebody will be willing to pay you six figures for speaking fees. Sometimes those parties are the same.
I guess I just subscribe to Hanlon's Razor on this one. I think he should have advocates for single payer, but I think it was a strategic error, and not a selfish manipulation of the system.
Obama cares about his legacy as much as anyone else would in that situation.
As President, no matter what you do, somebody benefits. Also, somebody will be willing to pay you six figures for speaking fees. Sometimes those parties are the same.
Presidents have no business accepting speaking fees from anyone. They receive a lifetime pension and various other benefits worth millions of dollars after leaving office. Even if these fees were accepted in good faith, they still have the appearance of corruption, which undermines public confidence in the political system, and cannot but instill in the corrupt the belief that for corrupt acts in office they stand to gain tremendously. My understanding is that the presidential pension was created to avoid the embarrassment of a destitute former president, specifically Harry Truman. Harry Truman conveniently had an opinion on the subject:
No young man should go into politics if he wants to get rich or if he expects an adequate reward for his services. An honest public servant can't become rich in politics. He can only attain greatness and satisfaction by service.
Further, Jimmy Carter rarely accepts speaking fees, and when he does he donates them to charity.
I guess I just subscribe to Hanlon's Razor on this one. I think he should have advocate[d] for single payer, but I think it was a strategic error, and not a selfish manipulation of the system.
This is certainly not dispositive, but I wonder what you think about Obama’s extraordinary intervention in the 2020 democratic primary. Right before Super Tuesday he worked (successfully) to convince Pete Buttigieg and Amy Klobuchar to drop out, endorse Biden, and exhort their supporters to vote for Biden over Sanders. If Obama was so convinced of the need to reform the medical insurance system that he made doing so his highest legislative priority, and if he did believe that in theory a single payer system was preferable to the ACA, but made as you say, a strategic error in not at least advocating for it initially, then isn’t it somewhat curious that he would work so hard to ensure that Sanders, who was the only candidate who plausibly would have attempted to pass a single payer system, lost, and Biden, who not only did not support a single payer system, but said that if by some miracle it came across his desk he would veto it, won?
Seeing how seatbelt laws and restaurant safety permits were used to justify COVID lockdowns shows why anti-libertarian ideology should not be given even an inch. Anti-libertarians will use that inch to take more and more of people's human rights, since in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.
> “in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.”
That is why there isn’t much anti-libertarian ideology unless it is redefined to be “anyone not buying all libertarian views” but instead what there actually are is a lack of people taking libertarian principles seriously because those are apparently things like seat belts equals arbitrary home confinement and also seem to be against seat belts and collective pandemic responses.
You have the same belief that you are now lampooning libertarians over. That is what your initial comment implied:
>>Don’t wear seatbelts either huh?
The implication here is that someone who on principle, opposes mandated health care, may as well oppose seatbelt laws.
In fact I saw many proponents of mandates prohibiting private citizens from providing a wide range of services to unvaccinated people, cite society's acceptance of restaurant sanitary permits, to justify these mandates. So this belief - that there is
no principled difference between any restriction on private interaction - appears to be widely held among anti-libertarians.
>>That is why there isn’t much anti-libertarian ideology
Anti-libertarian ideology is the belief that we as a society have a right to impose our will on peaceful people, and in doing so deny them the right to their person, property and liberty, for the greater good.
To give a mundane example, it means restaurants having to meet mandatory minimum health standards, even if there are patrons who are willing to dine at restaurants which don't meet those standards.
Once that principle is accepted, then anything can be accepted, even locking 150,000 elderly people in their room for over a year, for their own safety:
Health insurance and seatbelts are comparable concepts, that is what the seat belt comment was about.
Seat belts and 3 months of Shanghai style quarantines are way different.
The other points raised are like asking someone if they like hot sauce and when they say yes, spraying bear spray in their eyes and their kids eyes and their dogs eyes because “it’s the same conceptually” in an absurdist way since both are spicy. Hence back to the earlier point, people aren’t anti-libertarian but rather find much of what is espoused in the name of libertarianism is too absurd to take seriously.
>>Health insurance and seatbelts are comparable concepts, that is what the seat belt comment was about.
A mandate to have health insurance is orders of magnitude more impactful on the unwilling than a mandate to wear a seatbelt. But because of some commonality in the principle behind both mandates, you believe a person must accept the latter if they accept the former, to be morally consistent.
>>Hence back to the earlier point, people aren’t anti-libertarian but rather find much of what is espoused in the name of libertarianism is too absurd to take seriously.
What I encountered when denouncing mandates that turned unvaccinated people into second class citizens is people using our society's acceptance of sanitary permits for restaurants as justification for such mandates. It is a rejection, on principle, of the right to one's own person, property and liberty. For that reason, I conclude anti-libertarianism animates laws that violate the right to private property, bodily autonomy, and personal freedom, whether that be mandatory minimum restaurant safety standards, the Income Tax Act, vaccine mandates or lockdowns.
>>Seat belts and 3 months of Shanghai style quarantines are way different.
Of course they're way different. But the former opens the door to the latter, because there is no hard principle to prevent the latter when you accept the principle that justifies the former. That is how Canada ended up confining 150,000 elderly people in their room for over a year. There was no principled reason not to confine innocent people for the greater good, so once the cost-benefit analysis determined it was the correct policy, the restriction was imposed.
You only oppose "3 months of Shanghai style quarantines" because you view the restrictions as being disproportionate to the public benefit they produce. Not because you oppose restrictions limiting personal autonomy on principle.
> there is no hard principle to prevent the latter when you accept the principle that justifies the former.
Relying on the classic joke “you said you’d sleep with them for $x million, so we’ve established what you are in principle and now we’re just bargaining over price” as the the arguments for libertarian views is not going to persuade anyone but the choir. Especially when the $x million that gets the first “sure” is not just a larger amount of the same thing, but different like as an extreme example: “would your do xyx if it stopped earth being destroyed by an asteroid, yes? Then we established you’re for xyz in principle”
Once again, back to my repeated observation about why libertarian arguments are not taken seriously, they literally are the form of a classic joke. It would be easy to make the same flawed arguments against anything, including libertarian views but I’m not going to make flawed arguments like that because they always backfire. For example in this comment chain, that reasoning has made libertarianism look like its build on a bad logic and rotten foundations
>>as the the arguments for libertarian views is not going to persuade anyone but the choir
Once again, you miss my point, that you yourself have subscribed to this line of argument, where you argue one must accept the greater application of a principle if they accept the lesser application, when you made your snide remark that the original commenter must also reject seatbelt laws. You're also completely ignoring my claim that I've repeatedly witnessed many other anti-libertarians doing the same in relation to COVID restrictions.
Anti-libertarianism is a cause, movement and ideology, and it enables any level of rights violation, subject to the conditions that society finds itself in, because as an ideology, it rationalizes away the principle that we do not have a right to violate human rights. Libertarianism is the absence of this ideology that attempts to rationalize undermining human rights, leaving only the principle that it is morally inexcusable to violate human rights.
Imagine A libertarian exercised his freedom by not masking on the subway and due to that gave Covid to an older passenger who later died, depriving him of right to life.
How could we ever have seen that different individuals’ rights can conflict?! Impossible! Couldn’t be imagined! it’s morally inexcusable. How impolite of peoples rights to not all be compatible 100% of the time. Life shouldn’t be nuanced like that! It’s inexcusable. Wait that’s awkward, apparently that’s one of the core tenets of libertarianism alongside the core logic that giving an inch is the same as giving a light year in terms of principles.
I don’t take libertarianism seriously because of blatant things like that usually being core to proponents. I struggle to even believe they believe there arguments.
At the end of 2017, Congress passed legislation eliminating the health law’s fines for not carrying health insurance, a change that probably guarantees that the I.R.S. letters will remain a one-time experiment.
I still get a form from my employer proving that I had health insurance, so even with a financial penalty there's no reason that the letters can't continue to be sent out to the uninsured to remind them of options.
> The experiment, made possible by an accident of budgeting, is the first rigorous experiment to find that health coverage leads to fewer deaths,
It, of course, does not prove this. It proves that within this specific set of circumstances, within the specifics of our current health care system, that increasing coverage lead to fewer deaths. You can't just automatically extrapolate that to health coverage in general.
And there exists at least one field in Scotland in which there exists at least one sheep, at least one side of which is black.
Look, this was literally a randomized controlled study of the entire US population. You know, the gold standard for generalizability. And what other point of comparison would possibly be relevant besides "the specifics of our current health care system?" What more do you want?
I'm not complaining about the study methodology. I'm just saying this isn't the right takeaway.
Just because a study is randomized and has a good sample size doesn't automatically prove every hypothesis of the study. You have to actually look at what the data is saying and isn't saying.
And nothing about this data says anything regarding some universal truth regarding the benefits of some universal thing called "health coverage".
* More people obtained health insurance after receiving the letters than those who didn't.
* Among the people who received a letter, fewer people died than those who didn't.
* Since we're agreed that the study was properly randomized, there were no other differences between the treatment and control populations.
What conclusion are we to draw, if not that having health insurance prevents deaths?
Literally the only differences are that the treatment group got a letter, more of them purchased this thing which then existed called "health insurance" than in the control group, and fewer people in the treatment group died over the course of the study. Are you going to sit there and tell me that people who were already less likely to die went out and bought the thing that at the time of the study was called "health insurance" just because they got a letter? That doesn't pass the smell test.
Are you trying to tell me that health insurance is somehow different now than it was before? Also doesn't pass the smell test.
I am at a loss for what you are actually trying to say. Could you please just say it, rather than being oblique to the point of opacity about it?
> Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."
I fear for things mostly managed in primary care like diabetes, hypertension, etc. the period of this study is just not long enough to get adequate amount of mortality data.
If you read the paper, it is not an accident at all. It was an intentional program where 14% of households fined under ACA received a letter to tell them how to enrol. A little sad the US Govt fined the rest but didn't provide this info to them.
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[ 4.0 ms ] story [ 220 ms ] threadYour taxes are about NZD70k in total. About $12k of that goes towards heath[2].
The most expensive family plan (2adults 3kids) to top up your cover (beyond the normal care everyone gets by the state) is NZD700 per month (the major health insurance provider in NZ[3]).
[1] https://www.ird.govt.nz/about-us/tax-statistics/revenue-refu...
[2] https://www.treasury.govt.nz/information-and-services/financ...
[3] https://join.southerncross.co.nz/quote
In the US, if you are lucky, your employer pays the bulk of the premium. If you aren’t, you try and find a cheaper ‘death and dismemberment’ plan (only covers tragic events ) so you aren’t bankrupted if something really bad happens.
The terrible part is for those folks, there is no state plan to fall back on. Insurance and providers are more than happy to bill you into crushing debt.
https://en.wikipedia.org/wiki/Adverse_selection
Much like how you can't sign up for fire insurance when your house is already burning, you couldn't get insurance only after you need care.
Obamacare did away with "preexisting condition", and the mandate was meant to replace it.
With nothing at all acting as a backstop, AFAIK, I assume this is now baked into the ever exploding "cost disease" of US health care.
The Obamacare "fix" already existed in several states. You believe that such a policy has certain consequence - can you identify those states by looking for that consequence?
Note that pretty much every state had "if you keep your care, you can change providers", so the problem was only for folks who dropped coverage and then wanted back in.
If you have a relevant condition, dropping coverage seems like an odd thing to do.
Can you identify the "can't turn down" states by looking for the predicted health outcomes of such a policy?
You can describe things without stating an opinion about the things!
This is not an opinion; it's a fact. A system that, by design, fails those who need it the most in order to syphon money off from those who need it the least is a failure.
>Most plans must over [sic] a set of preventive services – like shots and screenings – at no cost to you.
>For example, depending on your age, you may have access to no-cost preventive services such as:
And goes on to list many things but not an annual check up. And also notice “most”, “depending on your age”, and “may”.
You say that like you think those are being used as weasel words. But they're just allowing for a more concise summary that does not need to recite every nuance of the requirements, which rightfully are not written as one size fits all. Factors like your age truly do matter to the question of what preventive care makes sense, and it would be a bad public policy to require insurers to cover care as preventive in situations where it does not have preventive value.
And since you still haven't provided any clarification about your claimed inability to find such a plan being offered to you, I don't think I need to bother digging up details on whatever obscure products require the statement about preventive care to be qualified. If you're being at all honest about your experiences with health insurance, you can more readily identify some exceptions than I can.
You really aren't putting much effort into being clear and convincing, especially given how you've been shown that people are finding your claims quite hard to believe. You are still not offering any specifics such as which state these plans are offered in, what level(s) of plans you looked at (catastrophic/bronze/silver/gold), what (if anything) in the way of preventive services they do purport to cover, what services you expect from an annual checkup that would not be covered.
There are lots of obvious ways you could have been much more forthcoming to bolster your credibility, but instead you've been more or less evasive.
I would like to go to the doctor and not have to pay out of pocket for my annual checkup. I understand that the checkup may raise tests and procedures that would cost, but first visit fees and annual checkup fees and some level of basic blood work shouldn’t be out of pocket like they were in the plans offered to me. (I’d even be fine with a copay of $10-25)
Beyond that I don’t actually care if you believe me. This is what happened to me
Of course, this has proven not to be the case. Part of the reason is that insurance providers are legally prohibited from making profits beyond a certain proportion to what they actually pay for medical services. So now, they are actually incentivized for _higher_ medical costs.
Would this have been legal/ethical to do intentionally?
The ambulance ride cost me $2000 out of pocket.
Want to know how much it was, in the land of $25 pizzas? Under $300. And of course, I forwarded it to my accident insurance, so my out-of-pocket was $0.
Fix your system.
Our public healthcare in Australia has been slowly eroded over the past decade (if not longer), and I'm starting to wonder if the next generation will even be able to enjoy "full" coverage at all.
This isn't propaganda or hyperbole. When my wife had a miscarriage earlier in the year, we were billed $150 for the privilege of being told we'd lost our child.
This should not happen in Australia, but it did. Don't follow in our footsteps.
What? The IRS can fine you for not having health insurance?
https://www.healthinsurance.org/glossary/individual-mandate/
Those in the treatment group were 1.3[1] percentage points more likely to enroll in coverage in the year following the intervention than those in the control group: about 50,000 extra households (~100,000 extra people) were signed up due to the letter.
So, about 200 died because they didn’t receive the letter (But that was offset by the 8 billion lives that were saved by something else that didn’t happen that day.).
[1] “those in the treatment group were 1.3 percentage points more likely to enroll in coverage in the year following the intervention than those in the control group, a 2.8% relative increase. On average, each letter increased coverage among this group by 0.14 months during 2017, or one additional year of coverage per 87 letters sent. We document larger effects among individuals who lacked any coverage during the prior year and among older non- elderly adults.”
Edited: corrected numbers - mistook households for individuals.
“The final sample consists of 4.5 million returns, corresponding to 8.9 million individuals. Individuals in the sample were randomly assigned to receive a letter (86%) or to a control group (14%). One letter, addressed to the taxpayer(s), was sent per return. Hence, randomization was conducted at the household level.”
So 86% of 4.5 million households were sent a letter, and that led to a 1.3% percentage point increase in signups compared to the 14% of households that were not sent a letter. They are then saying that those 1.3% of extra signups led to saving ~700 lives. There is the risk of a selection bias because we don’t know why those extra 1.3% signed up versus those that didn’t.
The actual paper uses months, since everyone dies, so zero lives can be saved in the long term.
Living in Europe I must have missed this debate. Is it not self-evidently true? What are the arguments against it?
Everyone agrees this is counterintuitive, but that's been the data so far. This study adds some weight to the other side.
I can't speak to "most" having not seen all of them, but studies have shown it matters.
https://www.theguardian.com/us-news/2017/jun/24/us-healthcar...
These came up a year later:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323087/
https://news.gallup.com/poll/268094/millions-lost-someone-co...
Seems there has been some prior evidence for supporting the idea that health insurance (the only way to get affordable healthcare in the US) matters.
What are examples of studies that show it has little to no impact?
Which kind of makes sense; the cost even with insurance ensures people don't go to the doctor as often as they should, until something is concerning them. And if it is sufficiently concerning, even someone without insurance goes. And if it's going to prove lethal without treatment, even those without insurance will probably still get the treatment, since better to be alive and in debt the rest of their life than dead.
Someone else linked https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim... and it's a good example; it calls out that those with coverage are less likely to have medical debt sent to a collecitons agency, which implies that those without coverage are still seeking treatment...they just are going into debt for it.
"Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures"
So with those combined, it means the impact of coverage on mortality is small enough that its hard to measure. Of course avoiding financial catastrophe is also a good reason for some kind of universal coverage even if the direct health benefits are low.
Is the argument that before 65 people just don't die from anything medical, except things emergency room will treat?
But then there's also the secondary effects, like losing your house because of medical bills. And we know that even with universal health care (every civilized country except the US) health is associated with money.
Another reply asserted that studies say it doesn't help much, but... that's just so counter intuitive to me that the the studies that were replied there saying actually it does help can be summarized by "well, duh".
But I've thought "well, duh" about false things in the past, which is why I want to know.
The compromise was not a good one. It never made great sense for any of the parties. It was a victory of pragmatism over function, and no Republican voted for it anyway.
Edit: to add a bit of evidence that Obama specifically is corrupt, here is an article titled ‘Barack Obama Got Paid $400,000 for a Speech to Health Care Execs. Here's What He Told Them’:
https://money.com/barack-obama-speech-400000-health-care-con...
How is that anything but a payoff?
See: https://www.cnn.com/2016/02/05/politics/hillary-clinton-bill...
I want to go back to the $400k speech to the healthcare industry. First, the notion that this isn’t corruption because he made so much more money in a less unseemly manner is pretty curious. Does it not then follow that the very rich, so long as their original fortunes are not ill gotten, are incapable of corruption in principle ? Second, $400k is precisely the annual salary of the President(!). For maybe an hour of work. It’s not just egregious, it’s super on the nose. Third, imagine he’d put every bit of political capital at his disposal into the fight to create a single payer system, and against the odds (and the money of those executives to whom he gave the speech) succeeded. Do you think the healthcare industry (or the part that’d still exist) would still pay $400k for an hour of his time?
At least Obama got something passed. Now, even though I personally would pay a decent chunk of change for health care if I decided to go into independent consulting, at least it’s an option now. It wasn’t before.
He would have made money on the speaking circuit from some group of people regardless of what he did.
I guess I just subscribe to Hanlon's Razor on this one. I think he should have advocates for single payer, but I think it was a strategic error, and not a selfish manipulation of the system.
Obama cares about his legacy as much as anyone else would in that situation.
Or yes, maybe Obama is the equivalent of a single issue voter.
> “in principle, there's no difference in mandating you use a seatbelt, and mandating that you stay in your home for three months.”
That is why there isn’t much anti-libertarian ideology unless it is redefined to be “anyone not buying all libertarian views” but instead what there actually are is a lack of people taking libertarian principles seriously because those are apparently things like seat belts equals arbitrary home confinement and also seem to be against seat belts and collective pandemic responses.
>>Don’t wear seatbelts either huh?
The implication here is that someone who on principle, opposes mandated health care, may as well oppose seatbelt laws.
In fact I saw many proponents of mandates prohibiting private citizens from providing a wide range of services to unvaccinated people, cite society's acceptance of restaurant sanitary permits, to justify these mandates. So this belief - that there is no principled difference between any restriction on private interaction - appears to be widely held among anti-libertarians.
>>That is why there isn’t much anti-libertarian ideology
Anti-libertarian ideology is the belief that we as a society have a right to impose our will on peaceful people, and in doing so deny them the right to their person, property and liberty, for the greater good.
To give a mundane example, it means restaurants having to meet mandatory minimum health standards, even if there are patrons who are willing to dine at restaurants which don't meet those standards.
Once that principle is accepted, then anything can be accepted, even locking 150,000 elderly people in their room for over a year, for their own safety:
https://www.cbc.ca/news/canada/toronto/long-term-care-covid-...
Or taxing people of 50 percent of their income.
Seat belts and 3 months of Shanghai style quarantines are way different.
The other points raised are like asking someone if they like hot sauce and when they say yes, spraying bear spray in their eyes and their kids eyes and their dogs eyes because “it’s the same conceptually” in an absurdist way since both are spicy. Hence back to the earlier point, people aren’t anti-libertarian but rather find much of what is espoused in the name of libertarianism is too absurd to take seriously.
A mandate to have health insurance is orders of magnitude more impactful on the unwilling than a mandate to wear a seatbelt. But because of some commonality in the principle behind both mandates, you believe a person must accept the latter if they accept the former, to be morally consistent.
>>Hence back to the earlier point, people aren’t anti-libertarian but rather find much of what is espoused in the name of libertarianism is too absurd to take seriously.
What I encountered when denouncing mandates that turned unvaccinated people into second class citizens is people using our society's acceptance of sanitary permits for restaurants as justification for such mandates. It is a rejection, on principle, of the right to one's own person, property and liberty. For that reason, I conclude anti-libertarianism animates laws that violate the right to private property, bodily autonomy, and personal freedom, whether that be mandatory minimum restaurant safety standards, the Income Tax Act, vaccine mandates or lockdowns.
>>Seat belts and 3 months of Shanghai style quarantines are way different.
Of course they're way different. But the former opens the door to the latter, because there is no hard principle to prevent the latter when you accept the principle that justifies the former. That is how Canada ended up confining 150,000 elderly people in their room for over a year. There was no principled reason not to confine innocent people for the greater good, so once the cost-benefit analysis determined it was the correct policy, the restriction was imposed.
You only oppose "3 months of Shanghai style quarantines" because you view the restrictions as being disproportionate to the public benefit they produce. Not because you oppose restrictions limiting personal autonomy on principle.
Relying on the classic joke “you said you’d sleep with them for $x million, so we’ve established what you are in principle and now we’re just bargaining over price” as the the arguments for libertarian views is not going to persuade anyone but the choir. Especially when the $x million that gets the first “sure” is not just a larger amount of the same thing, but different like as an extreme example: “would your do xyx if it stopped earth being destroyed by an asteroid, yes? Then we established you’re for xyz in principle”
Once again, back to my repeated observation about why libertarian arguments are not taken seriously, they literally are the form of a classic joke. It would be easy to make the same flawed arguments against anything, including libertarian views but I’m not going to make flawed arguments like that because they always backfire. For example in this comment chain, that reasoning has made libertarianism look like its build on a bad logic and rotten foundations
Once again, you miss my point, that you yourself have subscribed to this line of argument, where you argue one must accept the greater application of a principle if they accept the lesser application, when you made your snide remark that the original commenter must also reject seatbelt laws. You're also completely ignoring my claim that I've repeatedly witnessed many other anti-libertarians doing the same in relation to COVID restrictions.
Anti-libertarianism is a cause, movement and ideology, and it enables any level of rights violation, subject to the conditions that society finds itself in, because as an ideology, it rationalizes away the principle that we do not have a right to violate human rights. Libertarianism is the absence of this ideology that attempts to rationalize undermining human rights, leaving only the principle that it is morally inexcusable to violate human rights.
How could we ever have seen that different individuals’ rights can conflict?! Impossible! Couldn’t be imagined! it’s morally inexcusable. How impolite of peoples rights to not all be compatible 100% of the time. Life shouldn’t be nuanced like that! It’s inexcusable. Wait that’s awkward, apparently that’s one of the core tenets of libertarianism alongside the core logic that giving an inch is the same as giving a light year in terms of principles.
I don’t take libertarianism seriously because of blatant things like that usually being core to proponents. I struggle to even believe they believe there arguments.
I still get a form from my employer proving that I had health insurance, so even with a financial penalty there's no reason that the letters can't continue to be sent out to the uninsured to remind them of options.
It, of course, does not prove this. It proves that within this specific set of circumstances, within the specifics of our current health care system, that increasing coverage lead to fewer deaths. You can't just automatically extrapolate that to health coverage in general.
Look, this was literally a randomized controlled study of the entire US population. You know, the gold standard for generalizability. And what other point of comparison would possibly be relevant besides "the specifics of our current health care system?" What more do you want?
Just because a study is randomized and has a good sample size doesn't automatically prove every hypothesis of the study. You have to actually look at what the data is saying and isn't saying.
And nothing about this data says anything regarding some universal truth regarding the benefits of some universal thing called "health coverage".
* More people obtained health insurance after receiving the letters than those who didn't.
* Among the people who received a letter, fewer people died than those who didn't.
* Since we're agreed that the study was properly randomized, there were no other differences between the treatment and control populations.
What conclusion are we to draw, if not that having health insurance prevents deaths?
Literally the only differences are that the treatment group got a letter, more of them purchased this thing which then existed called "health insurance" than in the control group, and fewer people in the treatment group died over the course of the study. Are you going to sit there and tell me that people who were already less likely to die went out and bought the thing that at the time of the study was called "health insurance" just because they got a letter? That doesn't pass the smell test.
Are you trying to tell me that health insurance is somehow different now than it was before? Also doesn't pass the smell test.
I am at a loss for what you are actually trying to say. Could you please just say it, rather than being oblique to the point of opacity about it?
https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experim...
> Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."