Health care game changer?

[Torie]

Yes, I must give credit to the Dems for structuring the law so the ripe hanging fruit in the Garden of Eden can be so easily plucked before the election (not only this but that you can hang with your parents' policy that sbane is want to coo about), with the thorns saved for after. But apparently voters see the thorns behind the fruit anyway, even if they might not be the thorns that they should really be worrying about.

[Torie]

Yes Torie, keeping those who are in internships or graduate school on health plans where their costs are lower due to employer contributions is a good thing. Employer contributions into health care for everybody is necessary for the system to stay solvent. Whether you do that with payroll taxes followed up by subsidization of care or through schemes like keeping people on their parents plans till 26 is your choice. I prefer the former since it helps out everyone and not just those whose parents have insurance, bu the Republicans haven't proposed that have they? And speaking of which, have the Republicans proposed a plan that will ensure most of the uninsured get insured?

Mittens is chatting about insurance premium subsidies. He will need to flesh something out. But yes, the Pubs have not been particularly helpful on this. Granted I am not that familiar with the Ryan plan, or what it encompasses, but I think it just caps stuff, probably because the details of how to achieve some cap in real life through triage is just to politically toxic at the moment.

In any event, sbane, you are an adult and should have your own plan, with subsidies if impecunious (obviously temporary in your case). Tying adult kids to their parents' hip does not fit into my sense of aesthetics.

[Torie]

In any event, sbane, you are an adult and should have your own plan, with subsidies if impecunious (obviously temporary in your case). Tying adult kids to their parents' hip does not fit into my sense of aesthetics.

didn't you say your parents paid for 8 years of college?

Yes, they did, college, business school and law school (and I know I am very fortunate, yes I do), with their own money, not someone else's through statutorily imposed non means tested cross subsidies.

[Torie]

In any event, sbane, you are an adult and should have your own plan, with subsidies if impecunious (obviously temporary in your case). Tying adult kids to their parents' hip does not fit into my sense of aesthetics.

didn't you say your parents paid for 8 years of college?

Yes, they did, college, business school and law school (and I know I am very fortunate, yes I do), with their own money, not someone else's through statutorily imposed non means tested cross subsidies.

Money is fungible. If the government mandates that people will be paid more in the form of mandatory health insurance, this will translate into lower cash compensation over time. But since the numbers involved are fairly minimal no one's going to notice.

In the case of being on a parents' plan until 26, without having to pay a market based premium, that means somebody is subsidizing that discounted premium, in this case other insureds, to wit a cross subsidy. I agree with your post of course as to the effect of requiring folks to have a certain level of coverage through the vehicle of an employer plan, as opposed to an individual plan, where the money goes into the employee's pocket, and then out the other to pay the premium.

Anyway, there are two issues here - one is requiring folks to have insurance with some minimum coverage to avoid/mitigate the moral hazard problem, and the second is the cross subsidy issue. Conflating the two leads to confusion.

[Torie]

In any event, sbane, you are an adult and should have your own plan, with subsidies if impecunious (obviously temporary in your case). Tying adult kids to their parents' hip does not fit into my sense of aesthetics.

didn't you say your parents paid for 8 years of college?

Yes, they did, college, business school and law school (and I know I am very fortunate, yes I do), with their own money, not someone else's through statutorily imposed non means tested cross subsidies.

Money is fungible. If the government mandates that people will be paid more in the form of mandatory health insurance, this will translate into lower cash compensation over time. But since the numbers involved are fairly minimal no one's going to notice.

In the case of being on a parents' plan until 26, without having to pay a market based premium, that means somebody is subsidizing that discounted premium, in this case other insureds, to wit a cross subsidy. I agree with your post of course as to the effect of requiring folks to have a certain level of coverage through the vehicle of an employer plan, as opposed to an individual plan, where the money goes into the employee's pocket, and then out the other to pay the premium.

So you are saying that kids who are covered under their parent's plans are being subsidized by others who are insured under that group plan? You do realize family plans cost more than individual plans?

I don't know why you are having such a hard time understanding this since it's quite simple, but the subsidy for the premium is coming from the company and is a part of the compensation package. There is no cross-subsidization of the premium costs. Where there is cross-subsidization, which will occur in any health plan, is from the healthy to the sick. So a healthy 24 year old's premium (subsidized in part by the company as compensation for their parent) will be paying for the sick olds who work for the company and are part of the same group.

When you can keep you kids on a plan until 26, paying less than if the kid got his own insurance, because the company has to do it, and cannot charge a market rate for it (if it could, then of course why not?), that sbane my man is a subsidy which someone is paying, in this case other insureds. And then when you hit 26, the field reverses, and you get to subsidize others (e.g., moi!) as opposed to you/your parents being subsidized. Wonderbar!

[Torie]

Presumably the employers pay market rates, and if the law does not allow insurance companies to charge market rates for employers due to kids up to age 26 being covered, then somebody else has to pay.

You do get the point, that if insurers could offer plans at market rates that cover kids up to age 26, and there was a demand for it, then obviously they would offer the product. But I think Obamacare forced insurers to cover kids up to age 26 without a premium increase, which means to stay in business they must get the revenue from elsewhere. There is no free lunch!

[Torie]

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Isn't this a subsidy, to wit not being "allowed to" charge market rates?  I will take a look at your link. The assumption that with government involvement, "administrative costs" will just magically disappear or at least be slashed, is one that I question of course.

[Torie]

What are the market inefficiencies, other than those perhaps caused by government regulation, to wit, one cannot shop for plans outside one's own state?

[Torie]

The scope changed, but not the price. That suggests a subsidy. This administrative cost issue does deserve study of course. I do know that the billing system through insurance companies is expensive and time consuming, and needs to be revamped. In fact the way medical services are delivered needs to be revamped, using HMO's and having telephone consults, and everything getting computerized, and so forth.

If you can find where I ever wrote that the US has the best health care system in the world, putting aside the uninsureds or otherwise, I will give you one of  my properties. I am confident that I didn't, because I think our current system sucks. Cheers.

[Torie]

What are the market inefficiencies, other than those perhaps caused by government regulation, to wit, one cannot shop for plans outside one's own state?

If you can shop for plans outside your state, all insurance companies will relocate to the state (South Dakota, Delaware, take your pick) that offers it the least regulation and croniest enforcers, and decline to offer policies adhering to higher standards, and that will be all that's in the market. We can rule that out.

The market is inefficient because:
1. Customers are woefully underinformed about what procedures to get and what they should cost, and it's not realistic for them to become experts
2. People often need health care at times where it's an emergency and they can't comparison shop or do their homework
3. The tax provisions which tie insurance to compensation mean that many companies have oligopsonistic power which hurts everyone outside of them
4. Similarly, with health care as a form of compensation, individuals don't have incentive to know or care what things cost
5. People value life and health in bizarre ways that break market analysis
6. Yes, government regulation
7. Adverse selection
8. Moral hazard

Well yes, you need national standards. That goes without saying, if you are going to subsidize premiums up to a certain level of coverage. So you say, well we have found vendors on a competitive bid basis or whatever (probably most of them HMO's, so if someone wants a PPO, they will have to pay the additional cost because it won't be subsidized), who will charge a premium not to exceed X for this level of coverage, which we will subsidize on a means tested basis (well everyone would get a tax credit if they have insurance, but folks of means will be paying more taxes to offset the credit), so now go out there and shop nationwide for the best deal you can get, and hey, if you can get it cheaper, from a company that is sound, and performs well, with the given level of coverage, you get to keep the savings.

Price transparency and performance results, all on line, would mitigate a lot of the lack of information issue. Health care needs to be severed from the employer, and insureds need an incentive because they will be paying out of pocket, to comparison shop. I did not mean to suggest that the current system does not have market inefficiencies, but rather that they are not so much inherent to the product, but more due to dumb rather than smart government intervention or tax policies or the like, or the way we handle the care of lack thereof of the impecunious, and/or feckless.

This should not be about ideology. It should be about pragmatism. Ideology in this realm really, really sucks. I hate it!

[Torie]

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Part of it is a government subsidy because the "compensation" is not taxed (while the poor individual has to use after tax dollars), but otherwise presumably yes, it is a part of compensation. And then suddenly for the same price insurance companies have to keep covering the rug rats until age 26 rather than 18 or 21 or whatever. That suggest a subsidy, because if that rule did not screw them, why wouldn't they just do that on their own? So since all insurance companies have to do this, they recover their additional costs through raising premiums on others.

Anyway, those are my factual assumptions and reasoning. I hope I answered your f'ing question! 

[Torie]

We start anew, and if some parts of Obamacare are the best way to go, then sure. For example, how to deal with the uninsured sicks, and how folks can move from insurance company to insurance company after they get sick, is a hideously complex problem potentially. Obamacare might have some mechanisms that might prove useful.

As to the 26 years old thing, it seems that next to nobody understands the complex cross subsidy issues, except myself and that lawyer Clement who argued that Obamacare was un-Constitutional before SCOTUS, with that being its Achilles Heel legally. So your internet anecdote does not surprise me at all. Obamacare makes zero logical sense here for the reasons that I outlined, but then much of what we end up doing doesn't.

[Torie]

You are certainly wrong about insurance companies being forced to cover more people for the same money. Completely wrong.

What did Clement say btw? I am interested in reading or hearing that. Which day of the oral arguments was that?

I still don't understand why I am wrong, but whatever. I am just obtuse I guess. But I explained my reasoning.  In fact I think that was one thing that was mention by Anthem in one of their rate increase letters - the mandatory to age 26 thing. I guess it could be researched.

I have to run now, but I will discuss Clement later. I think I have some posts up about it, which you might do a search for. Once you have cross subsidies, you can't have a clear limiting principle to the degree of the erosion of what remains of the limits of the reach of the commerce clause is the gist of it. Without the cross subsidies, I think you can as to the mandate, even though the solicitor general was too incompetent to explain that, and Clement clearly was not going to help him. Clement was ready to pounce on the cross subsidy aspect of the mandate, like a cat near a big fat wounded bird limping along on the ground. That left poor Ruth Bader Ginsburg muttering well, social security has a cross subsidy too, and yes it does. But guess what?  SS is a tax!  Game, set and match.

[Torie]

Oh I remember that, but that was not dealing with keeping adult children on their parent's insurance, but rather cross subsidies from the young who purchased their plans to the old.

Also it looks like if you have an individually purchased family plan, insurers would be required to keep on your kids until the age of 26. Of course you would still be paying the premium for the family plan so I don't see what the problem is. If covered by your employers, you and the employer would be paying the premiums on a shared basis.

This is what is confusing you I think....this is what the department of labor says.

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https://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html

I am not sure what the bolded part means exactly, or its intent. This will just have to be researched as to whether insurance companies are losing money on these 18 to 26 year olds.

[Torie]

Obamacare was as far left as it can go with the complete socialization of healthcare

Is this a joke?

It probably should be infractable to use the word "socialism" or "socialization." These days they are just contentless expletives, and should be inksable.

[Torie]

It would be a pleasure to buy you a drink anvi.  And btw, just because the US health care system has some plus points vis a vis Britain, or did, or whatever, does not mean it is anywhere near getting out of the land of suckdom. I have been ranting about how silly and dysfunctional it is since about the time you kissed your first girl.