Re: HDBS

1

My theory is that the muckity-mucks realize that the Obamacare rollout is going to be a period of chaos and confusion so they might as well grab the opportunity to gouge while they can. More charitably, there's a lot of uncertainty right now, which factors into the pricing.


Posted by: togolosh | Link to this comment | 11-21-13 3:57 PM
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Hip Deep Blue Suburb?


Posted by: nosflow | Link to this comment | 11-21-13 3:59 PM
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Do they, like most HDHP's, still cover preventative care completely without paying the deductible? (IME, plans are stingy about defining "preventative", but still, that's the concept.)

I'm pretty sure my family plan annual deductible is $6,000. Not sure about the individual plans. And yeah, it sucks.

Also, are the premiums really the same on the two plans, or is it just that the employees' contributions towards the premium are the same?


Posted by: urple | Link to this comment | 11-21-13 4:02 PM
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If the previous coverage was very generous and / or the Heebie U risk pool is especially costly, it's possible that there is an ACA impact at work here, namely the plan sponsor putting on the brakes on benefits to avoid triggering the "Cadillac tax" in a few years time.

More likely it was a totally routine benefit buydown to limit the annual increase in premium the employer faces. The average deductible for single coverage in an employer-sponsored plan is over $1,000, and more than a third of insured lives in the group market are in high deductible plans. This is what most Americans with employer-sponsored coverage have these days -- and they are the lucky ones (under age 65, anyway).

If you took the high deductible option, you should be sure to enroll in and fund to the maximum extent you can afford a Health Savings Account (HSA), so at least you can pay those out of pocket bills with pre-tax dollars.


Posted by: kermit roosevelt, jr. | Link to this comment | 11-21-13 4:12 PM
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Do they, like most HDHP's, still cover preventative care completely without paying the deductible?

Yes, that's the law.* THANKS, OBAMACARE!

*different rules apply to individual "catastrophic" coverage and to grandfathered policies.

IME, plans are stingy about defining "preventative"

It's not up to the health plans. The U.S. Preventive Services Task Force (genuinely independent expert panel) decides what goes on the list. Services with well-established cost effectiveness are on the list. THANKS, OBAMACARE!


Posted by: kermit roosevelt, jr. | Link to this comment | 11-21-13 4:31 PM
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Our health insurance options at my college have changed to two plans, one of which is the same as the old plan with slightly lower premiums, and the other one has MUCH lower premiums but you have to pay out of pocket instead of having co-pays and you also get an HSA which the college puts free money into.

Even so, the informational session was fraught with stress. People kept saying "I know that you know what the best plan for me is, because at a certain cutoff point one becomes better than the other. Why won't you just tell me which plan I should have?"


Posted by: Cryptic ned | Link to this comment | 11-21-13 4:35 PM
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The potential benefits and costs are so confusing, so hidden from the public, and so impenetrably and needlessly complicated that even well informed, well-intentioned attorneys and math professors have absolutely no idea what benefits the major social program of the day does or does not provide!! THANKS OBAMACARE.


Posted by: Robert Halford | Link to this comment | 11-21-13 4:38 PM
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YOU'RE WELCOME!


Posted by: OPINIONATED OBAMACARE | Link to this comment | 11-21-13 4:40 PM
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Stupid health plans. We've been on one of those 3k a year deductible plans for a couple years, but the city does help sell the plan by front loading 1500 bucks into your HSA each year. The city's fiscal year goes from July to July so when my bicep decided to fly apart in the second week of July naturally my out of pocket tally had reset back to 0. What's weird to me is that my wife is teaching in SLC's school district and I'm working for the city and the health and dental plans are nothing alike. My health plan is way cheaper but our family dental is 90 bucks a month. My wife's health family plan would be hundreds more a month but family dental is free, with better coverage than mine. WTF. I mean, it's going to work out great for us but that is bizarre. We're going to briefly keep both dentals because it looks like it'll enable to just pay for my younger daughter's braces up front with the double coverage and like 0 out of pocket. Wooo!


Posted by: gswift | Link to this comment | 11-21-13 4:45 PM
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I think I've mentioned it before, but here we have a bizarrely awesome HDHP. The premiums are low (if you don't smoke it's below $100/month for a family) and the employer contributes $1250/adult to the HSA. Since this is the amount of the deductible this means the "high deductible" can't hurt you, it can only help. It's weird, because it's a clearly conservative health care plan that was implemented by a very conservative republican governor, but totally uncharacteristically actually tries to be successful rather than just screwing over the non-rich.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 11-21-13 4:53 PM
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HSA

Let me get this straight. A significant part of the insurance system is just stuffing money in a box, aka the opposite of the notion of insurance?


Posted by: Alex | Link to this comment | 11-21-13 4:55 PM
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Also keep in mind the out-of-pocket max, since the deductible will not be the end of your spending in case of some acute event.


Posted by: Minivet | Link to this comment | 11-21-13 4:56 PM
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Oh boy!


Posted by: Robert Halford | Link to this comment | 11-21-13 4:57 PM
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11: A TAX-FREE box. TAX-FREE! It's like they're just giving money away, being Tax-Free is such an incentive.

The only thing economists like more than improving our lives through freedom by forcing us to make choices that real people cannot make in an informed fashion because there are only 24 hours in the day, is trying to incentivize behavior by creating tax loopholes that real people don't bother to take advantage of.


Posted by: Cryptic ned | Link to this comment | 11-21-13 4:59 PM
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If you don't use the $1250 it stays in your magic box until you do spend it at some future point, right?
I don't think I have a deductible, just co-pays and an out of pocket max. Which have gone up in recent years, of course. A deductible can't be far behind.
"The average deductible for single coverage in an employer-sponsored plan is over $1,000"
And what percent of people reach that deductible?


Posted by: SP | Link to this comment | 11-21-13 5:01 PM
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For "Tax-Free" read "Pre-Tax".


Posted by: Cryptic ned | Link to this comment | 11-21-13 5:02 PM
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Oh, plus I just found out that the $150 (increasing next year to $300) yearly fitness benefit can be used on kids' sports registration fees or swimming classes. Which pissed me off because I lost the benefit for several years because I always thought it was only gym memberships and we don't belong to a gym, but hey, free money.


Posted by: SP | Link to this comment | 11-21-13 5:03 PM
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Only 24 hours in a day was not enough for me to figure out which of my fourteen health plan options suited my predicted needs for next year best. I spent four work days on it (thank you taxpayers!), called people who should know, and ended up defeated. Inertia won, but I'm afraid I missed out on a plan that would help me a lot next year.


Posted by: Megan | Link to this comment | 11-21-13 5:07 PM
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I spent more than a full day trying to decide whether or not it made sense for my wife to come onto my health insurance when we got married, and still couldn't figure it out, involving calling multiple people and reviewing multiple documents. Also I hate the HSA so much -- it's hard to remember when and where and how to use it. JUST GIVE ME INSURANCE THAT PAYS FOR HEALTH STUFF SO I DON'T HAVE TO WORRY ABOUT IT.


Posted by: Robert Halford | Link to this comment | 11-21-13 5:19 PM
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15: Yes, and at 65 it just becomes a retirement account.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 11-21-13 5:19 PM
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The one I really hate is FSAs, the evil of which we've discussed previously. Sure, I'll guess how many doctor visits, prescriptions, ER and hospital admissions we'll have in the next year, and if I'm wrong I lose the money! (At least it used to be If I'm wrong, I buy $300 worth of Advil!)


Posted by: SP | Link to this comment | 11-21-13 5:24 PM
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Followed by the goddamn paperwork hoops. Yes, the $20 at "XX medical associates" really was a copay, do you really need a receipt to prove it wasn't a restaurant?


Posted by: SP | Link to this comment | 11-21-13 5:25 PM
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21: That's right! FSAs! Our high-premium plan has an FSA. and our new low-premium plan has an HSA. My wife and I both started laughing trying to compare these things. The FSA is apparently the same thing as the HSA except that the money vanishes at the end of the year. It's all so stupid.


Posted by: Cryptic bned | Link to this comment | 11-21-13 5:26 PM
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Huh. I didn't realize there was a difference between FSAs and HSAs. I think I've been avoiding the plans with HSAs because I thought the money always got eaten at the end of the year.


Posted by: essear | Link to this comment | 11-21-13 5:29 PM
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I've always thought FSA's were for crazy people. Oooh, I'm going to get to spend hours and hours of hair pulling time all year long to dodge income tax on a small fraction of my overall income? No fucking thank you.


Posted by: gswift | Link to this comment | 11-21-13 5:30 PM
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Actually, I think I just kind of picked my health plan according to really stupid criteria: something like "the cheapest one probably sucks somehow, the most expensive one seems like overkill, so I'll just go with one of these random things in the middle!" Plus, my general principle is that rent is an order of magnitude larger than any other single expense so I shouldn't waste much energy thinking about where my money goes; if I ever decide I'm spending too much I should just move to a cheaper apartment.


Posted by: essear | Link to this comment | 11-21-13 5:32 PM
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Yeah, FSAs suck majorly. I once did some quick expected value calculation showing that the risk of losing the money very easily outweighs the tax advantages of having the account. Though some people have regular expenses like childcare that can be covered.

At least pretty soon employers will be allowed to roll over up to $500.


Posted by: Minivet | Link to this comment | 11-21-13 5:45 PM
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On comparing plans: there is a federally-produced spreadsheet that calculates actuarial value (what percent of an average person's health expenses a plan will cover) based on the data in the ACA-mandated Summary of Benefits and Coverage. Right now it's a pain, and the SBC can take some digging to find on one's intranet, but perhaps it will be put into a web tool at some point, or people could press for it to be disclosed up front by employers.


Posted by: Minivet | Link to this comment | 11-21-13 5:49 PM
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Well, this year we had two ER visits, a hospital admission, several unexpected prescriptions at the highest copay, and assorted non-preventative doctor's visits. If I'd known about all those in advance and contributed to an FSA it would have saved about $300 in taxes. So now do I anticipate something similar next year, maybe minus the hospital admission? Or do I skip it since i might lose the money?
Oh, childcare FSA is a no brainer, we use the $5k within about 45 days, and employer contributes $1000 of that. It's the health one I hate.


Posted by: SP | Link to this comment | 11-21-13 5:51 PM
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The beauty of an HSA is that it gives you a financial incentive to refrain from seeking medical care when you get sick.


Posted by: Spike | Link to this comment | 11-21-13 5:52 PM
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Deductibles, Co-pays, out-of-pockets, out-of-networks, balance billing.

I'm stocking up on popcorn.


Posted by: bob mcmanus | Link to this comment | 11-21-13 5:53 PM
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Right, have you seen those ads for retirement investing where they say "That $1500 gold watch looks good on you, but it will cost you... $7500 in retirement savings." They just need to update that for HSAs to make it about paying for an MRI, and add "...although you might not make it to retirement if you skip the scan!"


Posted by: SP | Link to this comment | 11-21-13 5:54 PM
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I lost about $800 one year when the company managing my FSA screwed up the paperwork and there was nothing I could do about it.


Posted by: Spike | Link to this comment | 11-21-13 5:54 PM
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31 gets it right. Oh why did Obamacare create all these things? It was so simple before.


Posted by: Cryptic bned | Link to this comment | 11-21-13 5:54 PM
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29 is a moot point, open enrollment already passed so I went with $300 FSA, which come to think of it really isn't worth the stress for the tax savings.


Posted by: SP | Link to this comment | 11-21-13 5:55 PM
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Come to think of it, it was the childcare FSA that I lost the money on. Why make me jump through all the hoops of taking money out of my paycheck and making me mail in a bunch of receipts to some company so I can get the money back, instead of just giving me a regular old tax deduction for the cost of childcare?


Posted by: Spike | Link to this comment | 11-21-13 5:58 PM
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I blame the Democrats.


Posted by: Spike | Link to this comment | 11-21-13 5:59 PM
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"a regular old tax deduction for the cost of childcare"
You get that too.


Posted by: SP | Link to this comment | 11-21-13 6:00 PM
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You get a small deduction, that gets phased out. Even the bigger deduction you get with the FSA doesn't put a whole lot of dent in the overall cost of sending your kid daycare, though, which is stupid expensive.

Why not just take the two childcare tax deductions and tie them together instead making things administratively difficult and slicing off a lucrative piece of the action to the financial industry? Oh, right....


Posted by: Spike | Link to this comment | 11-21-13 6:19 PM
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15: If you don't use the $1250 it stays in your magic box until you do spend it at some future point, right?

Right. But I have been confused on one point with HSAs: do you deduct from your taxes just how much you've spent out of it in the past year? Or how much is actually in it? It must be the former, I'd have thought. And yet I've been confused because the tax document I receive from my HSA makes no mention of how much I've spent of it: it just cites my total contribution into it for the year, and the Fair Market Value of that. Huh?

I've only had this HSA for a year, and have no idea what to do tax-wise regarding it.


Posted by: parsimon | Link to this comment | 11-21-13 6:21 PM
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Luckily it is the middle of the night there so the Brits are sleeping and not laughing at us.


Posted by: md 20/400 | Link to this comment | 11-21-13 6:25 PM
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30: The beauty of an HSA is that it gives you a financial incentive to refrain from seeking medical care when you get sick.

I don't understand this at all. Help. Is the money suddenly not tax-deductible if you spend it? Huh? Help, please explain.


Posted by: parsimon | Link to this comment | 11-21-13 6:26 PM
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To the OP- economists would say take the additional money you would have spent on higher premiums, save it in your HSA, and spend it down against your deductible. But human brains don't work that way, it's stressful to have to make decisions about spending additional money even if it's the same amount you would have spent on a weekly basis. It might make sense for some people with cars to get rid of them and spend the gas/maintenance/insurance on taxi rides when needed, but then every choice of paying for a taxi is additional stress that isn't there when the alternative is an upfront or automatic payment.
Our ER and admission copays went up to $200/$500 (from $100/$200 last year and $50/$0 before that) but I'd rather pay higher monthly premiums so I'm not debating whether it's worth spending money when my kid is dripping blood on the floor or the baby has had a fever for 5 days. Did the $500 copay make us wait another day longer than we would have with the $0 copay, possibly leading to more serious heart damage because her treatment was delayed? (Fortunately looks like all the damage has repaired itself, but fuck the "freedom" to decide whether spend money on emergency health care.)


Posted by: SP | Link to this comment | 11-21-13 6:27 PM
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40- I thought the deduction is when you contribute, like a 401k or traditional IRA.
42- No, if you don't spend HSA you get to save it up and invest it possibly until it supplements your retirement. Also don't get sick when the market is down! (Doesn't apply to FSA, that actually encourages you to spend money if you're about to lose it which is actually similar to the BS conservatives always complain about with people will choose elective colonoscopies if they're too covered.)


Posted by: SP | Link to this comment | 11-21-13 6:30 PM
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Wow, linkedin looks exactly like facebook now.


Posted by: SP | Link to this comment | 11-21-13 6:33 PM
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44.1: Okay. I do need to figure this out. What confuses me is that if the deduction is what you contribute, why is anyone asking for proof (receipts) for what you spent on health care out of it? Why does anyone care about that? Who is asking for these receipts?

44.2: if you don't spend HSA you get to save it up and invest it possibly

I continue to fail to understand, I'm afraid: my HSA is basically just a (non-interest-bearing, I think, or minimally so) bank account. Are you saying I can take money out of it in order to invest it?


Posted by: parsimon | Link to this comment | 11-21-13 6:37 PM
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30: No, the money is gone if you spend it. Just because its in an account doesn't mean its not real money. You can still take that money out and stick in in the bank, you just end up paying a taxes on it.

I figured this out once I realized I'd be having to pay $150 a month out of my HSA for asthma meds, which basically blew away any possibility of actually saving money year-to-year. So I ended up cashing out my HSA and mooching off my mom's Advair stash, which had been paid for by a real insurance plan.


Posted by: Spike | Link to this comment | 11-21-13 6:37 PM
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47 to 40, not 30.


Posted by: Spike | Link to this comment | 11-21-13 6:37 PM
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40: 42 is right. Spending from your HSA doesn't have tax implications, it just means you, you know, don't have that money anymore.


Posted by: Minivet | Link to this comment | 11-21-13 6:38 PM
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42, actually. I'm having trouble with numbers this evening.


Posted by: Spike | Link to this comment | 11-21-13 6:38 PM
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You need to prove the spending was a valid expense, if it's not you have to reimburse the HSA. I assume the HSA administrator is harassing you which is what they're paid all those fees for.
I'm not sure about investing, I thought you could (didn't Rmoney have a ridiculous amount in both IRAs and HSAs because of tricks involving low basis contributions of founder shares?)


Posted by: SP | Link to this comment | 11-21-13 6:40 PM
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Googling HSA investment brings up shady organizations plugging how to invest your HSA so apparently it's a thing but might depend on the rules of your particular plan.


Posted by: SP | Link to this comment | 11-21-13 6:41 PM
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46: There's a penalty for spending it on nonmedical stuff.


Posted by: Minivet | Link to this comment | 11-21-13 6:41 PM
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49: 42 is right. Spending from your HSA doesn't have tax implications, it just means you, you know, don't have that money anymore.

Well, if I'm understanding this correctly, duh. I mean, duh, if you spend the money you don't have it any more. As long as spending it (out of the HSA account) doesn't mean you have to deduct less from your taxes, what's the diff? If I'm understanding correctly, you still get to deduct your contribution to the HSA, whether you've spent it or not.

So I'm not seeing how an HSA is a disincentive to seek medical care when you need it.

Realize. Those with employer-provided health insurance are always, and have been already, enjoying some portion of their insurance coverage tax-free. Those of us without employer-provided coverage hadn't been: an HSA, as far as I can tell, provides some of that tax-free benefit. Somehow I get the sense that people with employer-provided coverage don't realize any of this.


Posted by: parsimon | Link to this comment | 11-21-13 7:06 PM
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Its a disincentive because it costs money to get healthcare. The taxes are incidental.

Really, its the high deductible plan that's the disincentive, though I tend to run that together with an HSA in my mind, because the two tend to be paired together, with the HSA being used to justify the existence of the high deductible.


Posted by: Spike | Link to this comment | 11-21-13 7:18 PM
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This is left over from earlier:

15: "The average deductible for single coverage in an employer-sponsored plan is over $1,000"
And what percent of people reach that deductible?

It doesn't take much to get to $1000 in medical payments, to reach that deductible. An MRI or CT scan plus a few less than common blood tests. A broken foot with some physical therapy. A mammogram that shows something funny, calling for followup. And you're there.

I'm a little surprised that people would think that a $1000 individual / $2000 family deductible counts as a catastrophic plan.


Posted by: parsimon | Link to this comment | 11-21-13 7:19 PM
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So I ended up cashing out my HSA and mooching off my mom's Advair stash, which had been paid for by a real insurance plan.

I do this with my dad for allergy medications. And good thing: I was just looking through the pile of crap my new insurance just sent me, and the only eye drops that work for my seasonal allergies are on a special list of drugs only to be prescribed after something like 6 other alternatives have been tried. Fuck that, I'll just get the extras from my dad's sweet federal employee retirement plan.


Posted by: Blume | Link to this comment | 11-21-13 7:26 PM
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Somehow I get the sense that people with employer-provided coverage don't realize any of this.

1. Realize what? Your health insurance is deductible from your income tax regardless. It's just easier with employer provided because they're deducting it out of your check pre tax. 2. You really think people don't realize the benefits of corporate and govt. jobs and are what, taking them because they're the fulfillment of childhood dreams?


Posted by: gswift | Link to this comment | 11-21-13 7:26 PM
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I'm a little surprised that people would think that a $1000 individual / $2000 family deductible counts as a catastrophic plan.

Two full time incomes at minimum wage is 30K a year. Two grand sure as hell is going to feel catastrophic.


Posted by: gswift | Link to this comment | 11-21-13 7:35 PM
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|| "If you bring up any political subject you are engulfed by a smug liberal consensus that borders on outright bigotry and brutal intolerance towards dissent." Name the world-class fuckwad who is oh-so-injured by New York City's brutal intolerance towards dissent! |>


Posted by: snarkout | Link to this comment | 11-21-13 7:45 PM
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Okay uh uh I got this Martin Amis?

No wait that cab driver that delegs people.

No uh shit. Bernard Goetz? The naked cowboy?


Posted by: Sifu Tweety | Link to this comment | 11-21-13 7:49 PM
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I just cannot stand the suffocating, provincial parochialism any more. The city is a vast, ugly, brutal, incompetent metropolis which compensates for all its manifold flaws in a fathomless welter of self-regard.


Posted by: OPINIONATED FUCKWAD | Link to this comment | 11-21-13 7:55 PM
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58: I think you, gswift, do realize all of this.


Posted by: parsimon | Link to this comment | 11-21-13 7:56 PM
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60: As many dumb stupid things as he's said over the years, I think his preference for DC's sidewalk etiquette over NY's may be high on the list of the stupidest.


Posted by: potchkeh | Link to this comment | 11-21-13 7:59 PM
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Your health insurance is deductible from your income tax regardless.

True only in the alternative universe where President Romney and VP Ryan are hosting the White House correspondents' dinner.


Posted by: kermit roosevelt, jr. | Link to this comment | 11-21-13 8:16 PM
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65: I'm basing that statement off of what I've seen on the IRS's website in past years. Am I missing something?


Posted by: gswift | Link to this comment | 11-21-13 8:22 PM
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66: That only applies if you're self-employed. If you're not self-employed and don't get your insurance through an employer, I think it's just a medical expense deduction and that only kicks in over a certain amount.


Posted by: potchkeh | Link to this comment | 11-21-13 8:27 PM
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66: I read "your" as more expansive than parsimon and her fellow self-employed people. If that's all you meant, it's correct; just not of wage- and salary-earners.


Posted by: kermit roosevelt, jr. | Link to this comment | 11-21-13 8:29 PM
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Yeah, specifically parsimon. But everyone else gets hosed by that "only expenses over 10 percent of your income" or whatever the hell nonsensical rule it is now.


Posted by: gswift | Link to this comment | 11-21-13 8:35 PM
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Well, if I'm understanding this correctly, duh. I mean, duh, if you spend the money you don't have it any more. As long as spending it (out of the HSA account) doesn't mean you have to deduct less from your taxes, what's the diff? If I'm understanding correctly, you still get to deduct your contribution to the HSA, whether you've spent it or not.
So I'm not seeing how an HSA is a disincentive to seek medical care when you need it.

Because of the desire to save money! "When you need it" is not unambiguous or predictable. If you pass up a prescription or checkup, you have more money left in the account for a big hospital bill that might come in the future.

Studies do show that when people are in plans that make them feel more of the cost up front, they consume less health care in general. The problem is that the individual is not really in a position to effectively distinguish necessary from unnecessary care, and a whole lot of care is "purchased" involuntarily.

The Rand Health Insurance Experiment supposedly showed that there was still no long-term impact on health from random assignment to high cost-sharing plans, and everyone fell to their knees worshiping that result, but that was less true among the poor, and everyone in that study had a catastrophic cap that was low by today's standards.


Posted by: Minivet | Link to this comment | 11-21-13 8:43 PM
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The UC system has decided that, given that it's in the health care business, its employees should receive their health care through UC outlets. This is not an entirely unreasonable position to take, as we -- the aforesaid employees -- are an untapped revenue stream in a moment when revenue is increasingly scarce.

Unfortunately, the shift in health care options has been bungled about as badly as anyone could possibly imagine. For our campus, just to offer one example, there are no pediatricians accepting patients within a ten-mile radius. On the one hand, we should just suck it up. A ten-mile drive really isn't the end of the world, right? On the other hand, not only are we losing access to our beloved pediatricians, we're also being told that we have to travel what passes here for a long distance to access health care. Not to mention that this undercuts the university longstanding and deeply held conviction that we should all be biking everywhere -- to stay healthy and green. I'd say that it's silly, but it's much worse than that.

And we're relatively lucky. Other campuses aren't near UC health facilities at all. Those people are being well and truly screwed, as the other, no-UC health plans suck quite a lot of cock. And then of course there's the fact that it's impossible to figure out which is the right plan to choose. My healthcare professional wife has spent several full days trying to understand the fine print, and she's still completely flummoxed. When we call the people on campus who are supposed to help, their voicemail boxes are full.

In the end, this is just the latest installment of "WE NEED A UNION ALREADY!!!" But of course faculty aren't workers, we're management. Not to mention, unions are bad and will make our lives worse not better. I'd blame Obama, but Janet Napolitano is closer at hand and thus a more convenient scapegoat.


Posted by: Von Wafer | Link to this comment | 11-21-13 8:51 PM
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Studies do show that when people are in plans that make them feel more of the cost up front, they consume less health care in general.

Bleahhh! Bleah bleah wokkawooka Holy Shit! Mein Gott.

Yes, if people notice their payments more, they're less likely to go the doctor. Is this supposed to be a good outcome? Is it really the case that high health care costs are a result of people going to the doctor more than they need to?

I say No Fucking Way. That is not why health care costs in this country are higher than they need to be. So let's cut that shit out: discouraging people from seeking health care is not the answer to this problem.


Posted by: parsimon | Link to this comment | 11-21-13 8:54 PM
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70: yeah, I hear the "insured patients don't have enough. skin in the game" canard on a more than daily basis, and none of these geniuses seems to realize that the modal insured American has pretty fucking substantial skin in the game (i.e. financial exposure to healthcare costs) at this point in our history, yet the consumer-driven paradise posited by the theory has notably failed to materialize.

Truth be told, my actual policy preferences are indistinguishable from Halford's, but that doesn't stop me from appreciating the ACA as a dramatic improvement over the status quo ante, and a compromise well worth making.


Posted by: kermit roosevelt, jr | Link to this comment | 11-21-13 8:58 PM
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Minivet, I should clarify: I'm not yelling at you. You're an ally and a friend, and I value your knowledge, with sincerity and a fist-bump or a high-five or something. I just get frustrated, y'know.


Posted by: parsimon | Link to this comment | 11-21-13 9:01 PM
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72/73: Agreed, it's shit policy.


Posted by: Minivet | Link to this comment | 11-21-13 9:04 PM
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I haven't noticed what Halford's policy preference is. Single-payer? Bacon? Every man for himself?


Posted by: parsimon | Link to this comment | 11-21-13 9:05 PM
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I agree that the ACA was and is a very good thing given reasonable alternatives available at the time! I just wish it wasn't so fucking complicated, or that there had been at least a minimal effort on the part of the wonkocracy to make it comprehensible or attractive to ordinary people. Or maybe they should have just sent a $1000 check to every American, financed out of hypothetical savings.


Posted by: Robert Halford | Link to this comment | 11-21-13 9:05 PM
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Actually, I think it's about time people realize how complicated it is, and learn about it. (Car insurance isn't comprehensible or attractive either, to my mind, but people deal.) The ACA is completely reworking the way risk pools work for health insurance, and a lot of prior free-ish riders are shocked, shocked that their previous low rates are no longer viable. I want them to adjust their thinking, and learn how a risk pool works long term. They'll benefit when they're 50.


Posted by: parsimon | Link to this comment | 11-21-13 9:13 PM
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Or maybe they should have just sent a $1000 check to every American, financed out of hypothetical savings. who gives a fuck how.


Posted by: Sifu Tweety | Link to this comment | 11-21-13 9:14 PM
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Or, they'll benefit when they're sick.


Posted by: parsimon | Link to this comment | 11-21-13 9:15 PM
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I'm amused by Millennials getting pissed about paying for insurance that they claim they have no need for, because they are young and indestructible. Never going to get old, are you?


Posted by: Spike | Link to this comment | 11-21-13 9:15 PM
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A ten-mile drive really isn't the end of the world, right? On the other hand, not only are we losing access to our beloved pediatricians, we're also being told that we have to travel what passes here for a long distance to access health care.

I would be so fucking angry if our health plan made us drive ten miles (five miles! Okay, three miles!) to bring Zardoz to a pediatrician holy goddamn.


Posted by: Sifu Tweety | Link to this comment | 11-21-13 9:16 PM
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Actually, I think it's about time people realize how complicated it is, and learn about it.

Wait, why?


Posted by: Sifu Tweety | Link to this comment | 11-21-13 9:17 PM
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Actually, I think it's about time people realize how complicated it is

Do you think most people haven't noticed that insurance is complicated? The problems are that they don't understand the complications -- because they are both complicated and deliberately (thanks to insurers) obscure. The complaint here is that part of what a better national health care scheme could and should do would be to uncomplicate it significantly. I don't think it's productive to blame people for being overwhelmed by the complications, when you could be blaming insurers for being so complicated (and the system for not stopping them).


Posted by: redfoxtailshrub | Link to this comment | 11-21-13 9:19 PM
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Not to mention that health insurance is the most needlessly complicated of all insurances. As complicated as car insurance is, it's still just a deductible. You pay your premium, and if you fuck up you might also pay expenses up to your deductible. No co-pays, no co-insurance, no HSA/FSA bullshit, no "we'll pay for this but we won't pay for that" (OK, some, but not much). It's almost like it's designed to be so complicated that large numbers of people end up in non-optimal plans and thus pay more than the actuarial value of their plan....


Posted by: F | Link to this comment | 11-21-13 9:26 PM
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Our particular HSA bullshit is that the non-HSA plan has co-pays (fixed dollar amounts), whereas the HSA plan has co-insurance (you pay a fixed percentage of costs). How the fuck am I supposed to know what it's going to cost so I can figure out what 10% of $bullshit is?


Posted by: F | Link to this comment | 11-21-13 9:28 PM
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I'm not blaming people for being overwhelmed: I do think they should learn, rather than whine. Part of this sentiment on my part is coming from the fact that I've had non-employer-provided health insurance for some 10 years now, and I had to take responsibility for learning about it. I don't have a lot of sympathy for those accustomed to employer-provided insurance who protest that they're all confused and can barely manage.

That said, I realize I'm being irritable. And obviously defining clarity and transparency *down* to what it has been for the self-employed (and part-time employed, which is worse in a way) is not a desirable outcome.

Let's settle on the notion that we can get a glimpse into realities experienced by other people here, and the goal is to make things better for those who'd been grappling with this crap for years, even though it might make things more confusing, at least short-term, for those who haven't.


Posted by: parsimon | Link to this comment | 11-21-13 9:32 PM
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82: I have barely scratched the surface of the fucked-uppedness of the situation. I think the worst part, in addition to the fact that we'll all be paying considerably more for worse healthcare, is that we're being told this shit is shinola. And when some of us say, "actually, no, it's shit," they look at us like we're insane. We need to be able to bargain collectively with our bosses. Unlike health insurance, it's just not complicated at all.


Posted by: Von Wafer | Link to this comment | 11-21-13 9:34 PM
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87: as much as I respect your rugged individualism, like I said above, my wife is a healthcare professional. She's also really fucking smart. And she's spent days and days trying to figure out the finer points of just three possible options. She simply cannot do it, because the various plans are constructed in such a way that even a smart person with expertise in the field can't make sense of them.


Posted by: Von Wafer | Link to this comment | 11-21-13 9:38 PM
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86: I would always go for co-pays.


Posted by: parsimon | Link to this comment | 11-21-13 9:39 PM
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Also, isn't a large part of the purpose of insurance so that you can make reasonable forecasts about future costs? But if your future plans may or may not include paying a $10,000 deductible, it seems like the benefit of stability in financial planning goes right out the window.


Posted by: Spike | Link to this comment | 11-21-13 9:43 PM
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Realizing 86 was the moment at which I realized I had no idea whatsoever whether or not it was a good idea for my wife to come on my insurance.


Posted by: Robert Halford | Link to this comment | 11-21-13 9:46 PM
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I'm not blaming people for being overwhelmed: I do think they should learn, rather than whine.

Don't blame. Judge.


Posted by: Sifu Tweety | Link to this comment | 11-21-13 9:47 PM
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Oh my God Parsi are you seriously lecturing us because you went through the exciting hardship of being a small business type who bought insurance from a broker.


Posted by: Robert Halford | Link to this comment | 11-21-13 9:48 PM
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87 Let's settle on the notion that we can get a glimpse into realities experienced by other people here

Says the person who has just expressed a lack of sympathy for people who don't share her perspective on health insurance. So, you're saying we should settle on the notion that everyone else should get a glimpse into your reality?


Posted by: essear | Link to this comment | 11-21-13 9:51 PM
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So, you're saying we should settle on the notion that everyone else should get a glimpse into your reality?

A greater comity.


Posted by: Sifu Tweety | Link to this comment | 11-21-13 9:52 PM
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It wasn't exciting. It was torture, and I've been paying $527/month premium for a plan with a $2000 annual deductible. I cannot agree with those who feel that we'll all be paying considerably more for worse health care.


Posted by: parsimon | Link to this comment | 11-21-13 9:55 PM
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So, you're saying we should settle on the notion that everyone else should get a glimpse into your reality?

Actually, yes. Everyone should have more insight into the realities other people experience on a regular basis. Sorry. That does *not* mean, though, that the health insurance market I'm familiar with should become the norm. Not at all. And I don't think the ACA will lead to that. It's early days (or years) yet. What's happening now is a more widespread distribution of the costs and limitations that have thus far been borne by a few. The theory is that this will lift all boats eventually.


Posted by: parsimon | Link to this comment | 11-21-13 10:02 PM
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Sorry your life sucks, parsi.

For the record, I don't blame Obamacare for the shittiness of choosing between complicated health plans. The insurance companies are 1000% responsible for that shit. Of course, we wouldn't have to do this if we had single payer. Alternatively, I could have my pet unicorn choose my plan for me.


Posted by: F | Link to this comment | 11-21-13 10:04 PM
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I must not be able to communicate as clearly as I think I can.


Posted by: essear | Link to this comment | 11-21-13 10:09 PM
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xox.


Posted by: redfoxtailshrub | Link to this comment | 11-21-13 10:09 PM
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Everyone, be less clueless than parsimon!


Posted by: gswift | Link to this comment | 11-21-13 10:23 PM
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I don't know how I've been unclear or clueless, to be honest. The zoo of health insurance coverage plans is a zoo, and has been for some time. That some are experiencing this for the first time and are freaking out is unfortunate, and it's too bad. I can't really tell if people think this means the ACA is a bust.

As F says in 99, this is on the insurance companies in large part, for their deliberate obfuscation. The narrowing of provider networks under the ACA, at least at the moment (there's pushback in various states on this) is a problem, but again, not anything entirely new or shocking. I've been saying that many people have been cushioned from all of this. Is that inaccurate?


Posted by: parsimon | Link to this comment | 11-21-13 10:34 PM
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The zoo of spousal abuse is a zoo, and has been for some time. That some are experiencing this for the first time and are freaking out is unfortunate, and it's too bad.

Spousal abuse is a problem, but again, not anything entirely new or shocking. I've been saying that many people have been cushioned from all of this. Is that inaccurate?


Posted by: F | Link to this comment | 11-21-13 10:41 PM
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Seriously? Spousal abuse? Okay, I am not laughing my head off at at how insane a violation of the analogy ban this is.

I've said over and over again that I do not endorse spousal abuse for all citizens.


Posted by: parsimon | Link to this comment | 11-21-13 10:54 PM
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Spousal abuse for some, miniature American flags for others?


Posted by: essear | Link to this comment | 11-21-13 10:55 PM
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Spousal abuse for some, warm, soft caresses for others, I'm guessing.


Posted by: parsimon | Link to this comment | 11-21-13 11:00 PM
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Have we ever had a fight between parsimon and Britta? That would be quite a sight to see.


Posted by: teofilo | Link to this comment | 11-21-13 11:21 PM
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On the narrowing of provider networks in exchange-mediated health insurance plans, this WaPo piece is worth a read.

Short version: plans are limiting the networks of providers covered because many of the now excluded providers charge twice as much for the same procedure. It's part of the cost-cutting mandate involved in the ACA.


Posted by: parsimon | Link to this comment | 11-21-13 11:22 PM
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Wow. The goal of universal health care coverage (a goal that is shared by all liberals/progressives, I'm pretty sure?) now descending into petty sniping, and ugly analogies, and the politics of resentment (over who pays how much, and who gets how much in subsidies, and who has been taking a free ride, and who needs to stop "whining," and who should be sent to a re-education camp...). Thanks, Obamacare! for not actually being a universal social programme along the lines of Social Security, but we're supposed to pretend that you are, because: Ted Cruz and the teapot dictators...


Posted by: Just Plain Jane | Link to this comment | 11-21-13 11:26 PM
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Count me among those who never realized there was a difference between HSAs and FSAs.


Posted by: heebie-geebie | Link to this comment | 11-21-13 11:38 PM
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Jane, I really hope I haven't been engaging in a politics of resentment, but if I have, I'll stop and think. I'd hoped that I was merely pointing out gross disparities in social benefit in the status quo ante. I don't have much resentment about it.


Posted by: parsimon | Link to this comment | 11-21-13 11:39 PM
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Too late, parsimon. You've already paved the way for the tea party victory and now I have to pass out on the floor in a drunken stupor while watching Dexter.


Posted by: gswift | Link to this comment | 11-21-13 11:52 PM
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All right, the second part of that was probably going to happen anyway.


Posted by: gswift | Link to this comment | 11-21-13 11:57 PM
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I'm curious what the monthly premium is? I feel like my university has a terrible bullshit family plan option for grad students, but I'm curious as to how out of line it is. A student plus 2 or more dependents has to pay premiums + additional mandatory fees that add up to over $15,000/year, and then on top of that there are deductibles and co-pays and so forth.

The Kaiser calculator for the same zip code and family size of 2 adults and 3+ children on a plausible income would pay a bit over $4,000 on a yearly premium a bit over $8,000. For a 3 person family, the payment would be the same but the original premium would be $5,000 or so. To get a number over $15,000 on the Kaiser calculator, the household would need 6 adults and 3+ kids.


Posted by: Britta | Link to this comment | 11-22-13 2:05 AM
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My pet unicorn is a drunk. I wouldn't let him decide where I should have lunch, let alone what health insurance to buy.


Posted by: Walt Someguy | Link to this comment | 11-22-13 2:30 AM
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The last time I went to the doctor I had to pay £2.40. Those buses aren't free, you know.


Posted by: ajay | Link to this comment | 11-22-13 3:10 AM
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We might start bitching about energy bills. Would that help?


Posted by: Alex | Link to this comment | 11-22-13 3:41 AM
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"Oh, what a tangled web we weave when first we practice to find a political solution that is acceptable to Republicans."


Posted by: parodie | Link to this comment | 11-22-13 3:42 AM
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I guess there is a case for relatively young people to chip in, on the grounds that having a lower premium because you're young is a kind of economic rent and also works against the whole idea of risk-pooling insurance.

But then I also guess that a whole succession of state-level single payer campaigns now some sort of backstop is in place would be awesome and probably a better use of time than arguing about whether Lily Allen or George Zimmermann is the better racist.


Posted by: Alex | Link to this comment | 11-22-13 3:45 AM
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state-level single payer
Now that you mention it, why wasn't this ever an alternative to the ACA? With all the Democratic states, the best reform managed was Romneycare?


Posted by: Eggplant | Link to this comment | 11-22-13 4:10 AM
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But then I also guess that a whole succession of state-level single payer campaigns now some sort of backstop is in place would be awesome and probably a better use of time than arguing about whether Lily Allen or George Zimmermann is the better racist.

Do you mean the US in general or the readers of this blog? Because for the latter, I'm not sure if that's actually the case.

Now that we've eliminated the filibuster, could we repass Obamacare with a public option? I would almost start thinking Obama was good president if the events of the past month were all to lull the Republicans into doing something against their best interests and then being like, PSYCH, MOTHERFUCKERS, WE'RE REPASSING THE ACA WITH A PUBLIC OPTION, TRY TO FILIBUSTER THIS!


Posted by: Britta | Link to this comment | 11-22-13 4:20 AM
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121: Or Vermont?
http://www.thesolutionsjournal.com/node/23903

122: Filibuster's gone for appointments only so far, I think, though there's no reason to suppose that it won't go for bills too. But Obamacare with a public option might have a tricky time getting through the House.


Posted by: ajay | Link to this comment | 11-22-13 4:24 AM
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But Obamacare with a public option might have a tricky time getting through the House.

Yeah, this is the problem. Next step needs to be undoing gerrymandering.


Posted by: Britta | Link to this comment | 11-22-13 4:29 AM
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Now that we've eliminated the filibuster, could we repass Obamacare with a public option?

Wouldn't this require convicting another 32 Representatives of possessing cocaine or something? Not to say it shouldn't be tried...


Posted by: chris y | Link to this comment | 11-22-13 4:31 AM
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Vermont is adopting single payer. Are there any others?


Posted by: Spike | Link to this comment | 11-22-13 4:38 AM
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Owned by 123.


Posted by: Spike | Link to this comment | 11-22-13 4:39 AM
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123: I was thinking pre-ACA, and Vermont's won't even become operational until 2017, assuming they get the ACA waiver.


Posted by: Eggplant | Link to this comment | 11-22-13 4:39 AM
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Vermont is adopting single payer. Are there any others?

Well, the US armed forces (current and former) have had single-payer for decades, but if the US military were a state, it would be the state that Vermonters looked at and said "ugh, look at that bunch of big-government socialists".


Posted by: ajay | Link to this comment | 11-22-13 4:48 AM
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123.2: Now that filibuster reform has made Obama dictator, it won't be a problem.


Posted by: Walt Someguy | Link to this comment | 11-22-13 5:01 AM
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130 au contraire

I am really getting the impression that Democrats and pundits expect Republicans to take the Senate in 2014.

a) I hope to fuck that means a whole of vetoin'

b) But the trogs are dumb, but not that dumb, so the national ban on abortion after 20 weeks will be attached to the budget bill or Obamacare subsidies, and oh boy, ain't we got fun for two years.

c) but then the peepul will see this, get rational, and in 2016 we will get 300 Dem congresscritters and 70 Dem Senate richfucks. Right?


Posted by: bob mcmanus | Link to this comment | 11-22-13 5:18 AM
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There should be travel agents for healthcare.


Posted by: k-sky | Link to this comment | 11-22-13 6:29 AM
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Are there still travel agents for travel?


Posted by: Moby Hick | Link to this comment | 11-22-13 6:32 AM
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Weirdly, yes.


Posted by: ajay | Link to this comment | 11-22-13 6:39 AM
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Maybe Obamacare will take their jobs.


Posted by: Moby Hick | Link to this comment | 11-22-13 6:43 AM
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There are also ineffectual and frustrating travel websites, so well ahead of you on that one.


Posted by: ajay | Link to this comment | 11-22-13 6:48 AM
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If you like your luggage, you can keep it.


Posted by: Moby Hick | Link to this comment | 11-22-13 6:50 AM
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If you don't want to pay an extra fee, you'd better keep all your luggage right with you there in the cabin.


Posted by: Moby Hick | Link to this comment | 11-22-13 6:51 AM
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132: Kentucky trained Kynectors to do just that, walk people through their options and make sure they get the coverage that meets their needs. I think if you call the national number, there are supposed to be people who play a similar role.


Posted by: Thorn | Link to this comment | 11-22-13 7:02 AM
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Now that you mention it, why wasn't this ever an alternative to the ACA? With all the Democratic states, the best reform managed was Romneycare?

Because the Democrats are a business-oriented party almost as much as the Republicans, just in a different mode?

The waivers Vermont would have to get for a single-payer system are a real stretch; I fear the state's engaging in wishful thinking.


Posted by: Minivet | Link to this comment | 11-22-13 7:39 AM
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I'm curious what the monthly premium is?

$100/indiv or $265/family. Which seems totally reasonable, and is the same as our old premium, except it used to include dental, which you now have to pay extra for.


Posted by: heebie-geebie | Link to this comment | 11-22-13 8:34 AM
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That's just a bit over half of what we pay.


Posted by: Moby Hick | Link to this comment | 11-22-13 8:40 AM
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142: I thought everything was bigger in Texas.


Posted by: Annelid Gustator | Link to this comment | 11-22-13 8:46 AM
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Employer subsidies included, I guess.


Posted by: Moby Hick | Link to this comment | 11-22-13 8:47 AM
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I thought everything was bigger in Texas.

Well, one side effect of continually impoverishing large portions of your population (and having boatloads of space) is that it drives down the cost of goods and services.


Posted by: heebie-geebie | Link to this comment | 11-22-13 8:53 AM
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Not to go all parsi on you guys, but I think it would be useful to use the word "premium" to describe the amount of money an insurance company gets paid for covering a particular policyholder, and the term "employee contribution" to describe how much an employed person directly pays for coverage that comes through employment. They might be the same, in the case of a real asshole employer, obviously, but generally they'll be pretty different which makes comparisons to what the exchanges are doing somewhat alarming to clueless employees (many of whom seem to be employed in journalism, none of who are participating in this discussion).

Of course, if one wanted to really go apples to apples, one would have to take into account the tax treatment of self-employed people's premiums -- I never remember exactly how it works, except that I type a number into turbotax, along with a bunch of other numbers, and an end result gets spit out.


Posted by: CharleyCarp | Link to this comment | 11-22-13 8:54 AM
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It also probably helps to not have a self-aggrandizing, private, near-monopoly provider of health care.


Posted by: Moby Hick | Link to this comment | 11-22-13 8:55 AM
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Kynectors

Let's try not to give Kim and Kanye any baby-naming ideas.


Posted by: Todd | Link to this comment | 11-22-13 8:58 AM
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All told, my monthly premium will be $350 (after dental) for me and three kids.


Posted by: heebie-geebie | Link to this comment | 11-22-13 11:07 AM
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149: What's the gross premium, including employer contribution?


Posted by: Minivet | Link to this comment | 11-22-13 12:08 PM
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IIRC, $1100ish.


Posted by: heebie-geebie | Link to this comment | 11-22-13 1:00 PM
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Had to lock mine in today, too. Fortunately, my high deductible, HSA plan is entirely unchanged. Got lots of use out of that sucker this year. The deductible part stung a bit. The 100% coverage after deductible was spectacular.


Posted by: Di Kotimy | Link to this comment | 11-22-13 1:03 PM
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Parsimon's plan in 97 is a slightly higher premium than mine, lower deductible, and yet I have been thinking I have awesome insurance and it sounds like Pars is dissatisfied. It's all relative, I guess.


Posted by: Di Kotimy | Link to this comment | 11-22-13 1:17 PM
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Our high deductible family plan is 46 a month for the health, 90 a month for the dental, and the city fronts 1500 of the 3K deductible into our HSA. It's a 90/10 plan for most things after the deductible so not too bad a deal.


Posted by: gswift | Link to this comment | 11-22-13 1:32 PM
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The city is also kicking in a very large amount of your health insurance premium.


Posted by: Moby Hick | Link to this comment | 11-22-13 1:34 PM
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Yeah, I think the city's contribution is like 900 a month.


Posted by: gswift | Link to this comment | 11-22-13 1:38 PM
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I was thinking our contribution for this coming year was going to be pretty hideous, but we worked out that the higher deductible plan is not all that when weighed against the difference in monthly contribution ($5k, which is obviously not pocket change, but still) plus it's a 100/0 (!!) plan for most things after deductible, which is sweet. But man, gswift, that's a heck of a deal.


Posted by: redfoxtailshrub | Link to this comment | 11-22-13 1:40 PM
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I'm parsimon's worst nightmare. I don't think I've ever had any idea how much I was paying for health insurance, much less how much my employer was kicking in. I mean, I've picked plans, but any information about them has flown right out of my head as soon as I looked at it. Pretty much everything reasonable has always been covered after small copays. If only all other Americans could join me in my blissful ignorance.


Posted by: LizardBreath | Link to this comment | 11-22-13 1:44 PM
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If only all other Americans could join me in my blissful ignorance.

Preach it!


Posted by: redfoxtailshrub | Link to this comment | 11-22-13 1:49 PM
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I thought MA is supposed to be astronomically higher than everyone but I think my plan is cheaper than Heebie's, by benefit level. Total $1485/month (my contribution $300) covers two adults, four kids, copays 20 office/200 ER/500 admission, scripts 10/20/30, no deductible, out of pocket max 2000/4000.
Dental is separate too, $142/mo ($28 employee contribution)


Posted by: SP | Link to this comment | 11-22-13 1:55 PM
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160: Thank god for the differential in daycare costs.


Posted by: heebie-geebie | Link to this comment | 11-22-13 2:06 PM
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That was uncalled for.


Posted by: Sifu Tweety | Link to this comment | 11-22-13 2:09 PM
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But man, gswift, that's a heck of a deal.

It's definitely a reason I applied to that agency. Dad worked for LA County and always harped the point that everyone talks about their salary but long term benefits were where the action was.


Posted by: gswift | Link to this comment | 11-22-13 2:15 PM
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162: It's not that bad, I think your costs are only $200 more than ours?


Posted by: heebie-geebie | Link to this comment | 11-22-13 2:18 PM
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I'm curious about everyone's dental. Does it cover meaningful stuff? Mine costs me something like $25/month, but it covers almost nothing (think 50/50 on most common work, maybe less) except cleanings, which would be $75 out of pocket.

163: The boyfriend started a job like that in Jan. He was slightly miffed about the salary until he saw the "total compensation" part of the offer.


Posted by: ydnew | Link to this comment | 11-22-13 2:23 PM
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I'm curious about everyone's dental.

My lower, right third molar (aka wisdom tooth) hurts, but doesn't hurt bad enough that I've called the dentist yet. Thanks for asking.


Posted by: Moby Hick | Link to this comment | 11-22-13 2:25 PM
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From FB: "I think hospital gowns cover more than Obamacare does.."

THAT DOESN'T MAKE ANY SENSE.

I mean, if she were trying to assert that we were naked pre-Obamacare then it's astute, but trust me, she's not.


Posted by: heebie-geebie | Link to this comment | 11-22-13 2:27 PM
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166: Apparently not my day for precision. Thank goodness no one needed me to be smart.


Posted by: ydnew | Link to this comment | 11-22-13 2:29 PM
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Mexicans don't have wisdom teeth. Who knew?


Posted by: Moby Hick | Link to this comment | 11-22-13 2:30 PM
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Free cleanings twice a year*, and I forget what anything else ever cost.


*Most importantly, it was "two cleanings per year" and not "one cleaning per six months". The latter is unbelievable, but the receptionist always clarifies that point with me because they've got so many patients who cannot schedule their next visit to be 6-months-minus-one-day out.


Posted by: heebie-geebie | Link to this comment | 11-22-13 2:30 PM
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Our dental:
100% of diagnostic and preventive (x-rays, examps, cleaning, fluoride, sealants)
80% restorative- fillings, steel crown,oral surgery, priodontic surgery, root canals, bridge repair
50% dentures and bridges, crowns
$50/$150 deductible, waived for preventive & diagnostic
Max $2k/person/year
Orthodontics 50%, $2k separate lifetime max.


Are those $2k yearly or lifetime max the most that they will pay per year/lifetime, or an out of pocket max that's the most the patient pays? I always assumed the former because, hey, dental coverage sucks.


Posted by: SP | Link to this comment | 11-22-13 2:36 PM
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Maximum is the maximum that they will pay and after which you're SOL. Isn't that the opposite of the meaning of the term in health insurance?

"maximum/ annual maximum/maximum benefit
The maximum payment Delta Dental will make within a given time period. Some plans have no maximum. Some maximums apply to the lifetime of the benefit plan; others apply to a particular time period (calendar year, benefit year, etc.) or to particular services (such as a separate maximum for orthodontic benefits)."


Posted by: SP | Link to this comment | 11-22-13 2:39 PM
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Dental coverage does suck. I wouldn't get it except that knowing I already paid for two check-ups a year is what keeps me going to the check-ups.


Posted by: Moby Hick | Link to this comment | 11-22-13 2:40 PM
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The boyfriend hit his (nicer) dental insurance's max benefit this past year. I can assure you we've WAY exceeded that number in out-of-pocket. It was a very sad day when we got that denial of benefits.


Posted by: ydnew | Link to this comment | 11-22-13 2:44 PM
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Holy mother of god! Some data points for those who might be interested.

I just completed my application for health insurance coverage via the Maryland exchange; haven't selected a plan yet, but have begun looking. Looking just at Silver plans at the moment, with deductibles from $1300 to $2500, the premium cost is from $300 to $350. This is with the same insurance company I've been covered under for 6 years or so: I've been paying, as noted upthread, $527/month with $2000 deductible.

I have yet to look into any troubling restrictions on participating providers in these exchange plans, but given that this is Maryland's largest insurance provider, I'm doubting there will be many.

Meanwhile, funnily, I received a renewal package from my current plan, letting me know that while my existing plan must be revised in order to be ACA-compliant, the nearest equivalent they can offer is a plan for $476/month premium with $1500 deductible, a nearly 10% reduction! (I actually feel badly for those who took their early renewal offer a few months ago at their exact same rates as last year.)

Question: the MD health exchange tells me I qualify for a subsidy of $169/month in Premium Tax Credit, and 73% in Cost Sharing Reduction.

I'd somewhat forgotten that there are two sorts of subsidies, the premium subsidy and this cost-sharing thing: what means the latter? If anyone has that knowledge readily to hand, I'd appreciate it.


Posted by: parsimon | Link to this comment | 11-22-13 7:36 PM
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Nevermind, I looked it up myself: cost-sharing subsidies.


Posted by: parsimon | Link to this comment | 11-22-13 7:45 PM
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Glad it looks like you'll be better off, parsi.


Posted by: Turgid Jacobian | Link to this comment | 11-22-13 8:06 PM
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I knew I would be. Thanks, Obamacare!

I walked my housemate through some of this -- because he really needs to begin his application procedure (he pays something like $175/month with a freaking $5000 deductible) -- and before he began yawning, he said I should broadcast my positive news.


Posted by: parsimon | Link to this comment | 11-22-13 8:19 PM
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and before he began yawning

That's not a pre-existing condition.


Posted by: Moby Hick | Link to this comment | 11-22-13 8:36 PM
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It's so interesting to me to read about people's impressions of their coverage in the real world since I have been immersed in the details for over a year now. As a health actuary me and my coworkers set and file the premium rates and formulas for Individual, Small Group and Large Group markets. The ACA hits large groups (not just because we are going wild with projecting costs) because there are a bunch of taxes and fees related to the exchanges and programs in the ACA (PCORI, Health Insurance Provider Fee, Transitional Reinsurance Fee) plus the out of pocket max is limited to $6350 and all of the copays, deductibles and coinsurance have to roll up to the out of pocket max - so before you could have unlimited number of copays on drugs that would never hit the out of pocket max for example. Anyways - there is a whole lot of change going on with the market that plays into how we have to set our rates :)


Posted by: RebeccaS | Link to this comment | 11-22-13 8:44 PM
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RebeccaS, I love you: tell us anything more you can. I'm particularly interested in how the insurance industry views the utter change involved in all this given that they can no longer (with society's approval, previously) throw sicker people under the bus. This is a great change, no?


Posted by: parsimon | Link to this comment | 11-22-13 8:52 PM
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That's great! With the subsidy, then, your premium's down to $130-180/month, if I'm following you correctly?


Posted by: LizardBreath | Link to this comment | 11-22-13 8:57 PM
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testing


Posted by: Bostoniangirl | Link to this comment | 11-22-13 9:00 PM
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Well, supposedly. I find that a little hard to believe, to be honest: it doesn't match the estimates I've found elsewhere, via the Kaiser subsidy calculator, for example. The jury's still out until I actually select a plan and subscribe to it and all that.

There's no way that I don't see some relief, though, and I knew that going in. I'll actually be able to save some money.


Posted by: parsimon | Link to this comment | 11-22-13 9:03 PM
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176: The OMB just determined that cost-sharing subsidies (in contrast with premium subsidies) are subject to the sequester. So that might not help by as much as billed - though it would only be a 7% cut to the subsidies.

151: Wow, that's rather a lot. I don't know, maybe you have a good provider network. But looking at Covered California offerings in a place with closeish cost of living to your area, for your household size but with a parent 40 years old in my attempt to reflect average employee age, silver plans with $4,000 family deductibles range in cost from $700-800 per month, and gold plans with zero deductibles are $800-1000.


Posted by: Minivet | Link to this comment | 11-22-13 9:06 PM
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In general the industry is just trying to cope with the massive amount of change and operational challenge of making all of these complicated new programs work. It is not an especially agile industry so the pace of changes and last minute nature of the details of implementation are straining every company. Obama had no idea the amount of angst and complication his last minute "keep your plan through 2014" proclamation made for the industry. We were fortunate in my state (WA) that the insurance commissioner came out right away and said he wasn't allowing it but it could still cause ripple effects for us if other parts of how the law is implemented change as a result of that. There are certainly going to be some interesting results from how everything plays out. In general everyone in the industry knew things were broken so its now about how do we make this thing work...


Posted by: RebeccaS | Link to this comment | 11-22-13 9:08 PM
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190: Ah, you aren't clustered with the other actuaries in the city of the reborn bird?


Posted by: Minivet | Link to this comment | 11-22-13 9:10 PM
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Obama had no idea the amount of angst and complication his last minute "keep your plan through 2014" proclamation made for the industry.

Agreed that that was pretty stupid on his part.

In general everyone in the industry knew things were broken

Really? I did not know that anyone in the industry knew that. How was it considered to be broken before passage of the ACA?


Posted by: parsimon | Link to this comment | 11-22-13 9:13 PM
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I don't know that companies openly promoted it - but it was common understanding that the rate of health care cost increase was causing the market to stagnate or decrease leading to more uninsured, more anti-selection, more cost-shifting by providers for bad debt onto the insured. The status quo was certainly not seen as a sustainable path.


Posted by: RebeccaS | Link to this comment | 11-22-13 9:28 PM
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Not just insurance. I have the impression that many or most in the health care industries see profits as normally coming from exploiting someone else: pharma foisting expensive drugs on payers with the half-connivance of doctors; insurers squeezing providers when they can and passing on cost increases when they can't; doctors and hospitals studying public and private payment systems for maximum gaming; mergers bolstering market power; and so forth. ACOs and similar reforms could play the role of forcing all the squabblers to work together, but we'll have to see.


Posted by: Minivet | Link to this comment | 11-23-13 9:07 AM
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