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View Diary: Vast Majority Will Pay Less And Get Better Coverage Under ObamaCare (51 comments)

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  •  I just never thought this is a convincing (4+ / 0-)

    argument to people who are going to be paying more, for several reasons.

    While this leaves "29 percent of the customers in this market, or more than 4 million people, who may see higher rates go up without the benefit of financial assistance," those people will be getting better polices for their money.  And that does not take into account the general slowing of increased costs created by ObamaCare.
    1.  "Getting better policies" for their money -- well, maybe so, but they don't necessarily NEED those "better policies."  For example, women past childbearing age don't need maternity or pediatric coverage.  So, saying to them, yes, you are paying more, but look, you are now getting coverage in all those areas" is singularly unconvincing if they don't need, or want, coverage in those areas they are now paying for.  

    2.  "Getting better policies" for their money is also problematic because it is essentially the government telling people what's "good" for them in terms of spending their own money.  It says, "you don't know what's best for you, but the government does, so the government will tell you how to spend your own money in a way that the government thinks best."  That's an offensive argument to many people.  It's sort of the health insurance equivalent of Mayor Bloomberg banning big gulp soft drinks.  If the government is spending the money, I think many people are ok with the government deciding how it needs to be spent, but I think people here underestimate the resentment of someone being told they have to spend an extra $1000 or $2000 a year of their own money because the government thinks it's good for them.  I know people who had policies that they were perfectly happy with, that served their needs completely (and yes, they were covered in the event of a big disaster or illness) and who are now resentful that they must buy more expensive policies with the "10 essential areas," some of which they neither need nor want.  

    3.  "Slowing of increased costs caused by Obamacare" - yes, the rate of growth in health care spending has slowed.  But there's no demonstrated proof -- and no consensus -- as to whether the ACA CAUSED that, or how the ACA would have caused that.  It's true that it happened about the time of the ACA, but it also happened about the time of a really tepid economy.  But of course, especially in economics, correlation does not equal causation.  Which one -- or both -- caused the slowing of the increase in costs, and what's the proof?  And that "well, costs are slowing" kind of rings hollow when your own bill for your own insurance has just gone up dramatically.  

    Look, people need to stop making these excuses in an attempt to ignore the truth behind the ACA:  some people (young, people, healthy people, people who only wanted catastrophic type policies with big deductibles but then full coverage on certain areas, excluding certain areas, for example) were always going to be required to pay more so that other people (older people, sicker people, people with pre-existing conditions, for example)  were going to be able to pay less.  That's the truth of the matter.  

    The problem is in the way it was sold to the country.  It was sold to the country as, "we're going to add all these people to health insurance, we're going to get coverage (or coverage at an affordable rate) for people who are older, sicker, and have pre-existing conditions, and there won't be any down side for those of you who like the coverage you have!"  That's the basic problem here.  The "if you like your plan, you can keep your plan" was intended to send the message that there would be no down side to anybody, especially to those who had coverage they liked.  That was never going to be true, and the Administration always knew (even when they said it) that it was never going to be true.  The ACA was ALWAYS structured so that some would have to pay more, and/or buy more expensive policies, so as to balance out costs for the older and sicker.

    Given that these people who are now finding that they are among the ones who have to pay more so as to benefit the older and sicker legitimately feel mislead, and angry about that, I don't think further misleading sales pitches will help those people.  I think the American public is entitled to honesty about what's going on.  It won't quell all of the anger by people who are finding that yes, for them there is a big downside so as to get other people insured, but at least it will bring back some credibility to the discussion.

    •  well (5+ / 0-)

      it's all about trade-off's isn't it? For example, do they want to make sure they can't be dropped?  Do they want to make sure that OOP costs are capped?  Do they want to make sure that they won't be excluded for a pre-existing condition?  Then they have to accept that they will pay for coverage for things they don't use.  And how much does adding those things really increase their premium?  The Mpls Star Tribune put it this way:  

      Those complaining, however, should realize that they’re demanding special treatment. Americans who get their coverage through employers generally don’t get to pick and choose what care their plans cover. Nor do younger workers pay less than older workers, even though older workers are likely to incur more costly care. The ACA applies these same standards to the narrow individual market, bringing with it critical consumer protections such as those for preexisting conditions.
      As for the govt telling them what's good for them, it's a bogus argument.  Govt sets standards when the private sector screws people over.  And because there are so many unscrupulous insurance companies selling crap and excluding people for no good reason then they need to be regulated.  They may not have thought they had crap but finding out when you actually need it is too late after you've paid years worth of premiums for nothing.  They should be offended at the insurers.
      •  "Then they have to accept that they will pay ..." (3+ / 0-)

        Did you tell them that or did you tell them it was the Affordable Care Act?

        The point is you tricked people.

        I mean you could have sold the Quality Care Act in Minnesota.  We like quality.  We like to be above average, you betcha.  

        But we don't like to be tricked because being above average and all we don't like to be treated like we are too stooooopid to know what's good for us.  

        That's why I so liked Dayton's campaign.  If you elect me I am going to tax the rich.  I love it!  I love it when you just plain tell people the truth and ask them to buy into it.  

        Oh, but that's not triangulating centrism.  Oh, no.  They've got to con the rubes.

        •  nobody is telling them (1+ / 0-)
          Recommended by:

          they are stooooopid.    The insurers were the ones tricking them.

          It still is the Affordable Care Act.  Even for the people who have to pay more in premiums it's more affordable when you take into account the caps on out of pocket costs and that deductibles, copays, and coinsurance all count toward the out of pocket maxiumum when that wasn't the case pre-ACA.  

          •  Just be sure not trip over your narrow network (2+ / 0-)
            Recommended by:
            Neuroptimalian, Nada Lemming

            or you'll find the fine print in that OOP max.   Just saying, with healthcare, you have to be particularly careful to tell people the whole truth.  Not you, but too many still want to spin this.  It's the spin that created the problem.

            •  sure because (1+ / 0-)
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              insurers were never narrowing their networks pre-ACA.

              •  Not nearly as much as now. (1+ / 0-)
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                Prior to the ACA, the biggest things insurers could do to control risk and potential cost to them was what was called "medical underwriting" (charging significantly more to people who were higher risk, like people with pre-existing conditions); and narrowly defining plans so that every plan did not cover every thing.  No, people did not like it, but those things were how they stayed profitable.

                The ACA took those tools away from them.  So, now they have to use other tools to keep premiums reasonable and remain profitable.  Restricting networks to doctors and hospitals that accept lower reimbursements is one way to do that.

      •  Some people had this before (5+ / 0-)
        ? For example, do they want to make sure they can't be dropped?  Do they want to make sure that OOP costs are capped?  Do they want to make sure that they won't be excluded for a pre-existing condition?  
        at lower prices, because they don't want or need things like maternity care or pediatric care.

        I've mentioned before, but I have California relatives, with one college-aged son, who were paying about $750 a month for a catastrophic type plan, very high deductible, but after that was met had full coverage.  Essentially, they carefully looked at the terms of what was and was not covered, what they would expect to pay out of pocket versus the increased premiums with less out of pocket, did the calculation and were economically better off paying routine doctor visits, etc., out of pocket, and kept those lower premiums for a policy that would only be used in the event of a serious problem.  Now they will be paying about double, still a high deductible, and a smaller network of doctors so they will be losing doctors.  But yes, they get those "10 essential areas" including coverage for things like maternity and pediatric care that they don't want or need.

        They realize that they are paying more to offset the costs of others.  But they are not happy about it.  They feel as though they were arbitrarily singled out to bear the costs because they were in the individual market.  

        And this argument is condescending and insulting:  

        As for the govt telling them what's good for them, it's a bogus argument.  Govt sets standards when the private sector screws people over.  And because there are so many unscrupulous insurance companies selling crap and excluding people for no good reason then they need to be regulated.  
        They may not have thought they had crap
        but finding out when you actually need it is too late after you've paid years worth of premiums for nothing.  They should be offended at the insurers.
        This is essentially an argument that people are too stupid to know what they are buying.  That's condescending and insulting.  Maybe you  did not read the terms of something you spent thousands of dollars for, but a lot of people did (even before the ACA, the way an insurance company had to spell out the terms of your policy was very regulated) and I assure you that there were lots of people out there who were not too stupid to know what they were buying, and for people to keep saying that, if you had a plan that doesn't meet the new requirements of the ACA, you were too stupid to realize what you were spending thousands of dollars for were really crosses the line.

        Some people DID know what they had, because they chose it after analyzing premiums, coverage, and  a balancing of the costs.  And to imply that they were too stupid to figure that kind of thing out, so government has to tell them what they need, is condescending and insulting.  What makes you, or anyone else, know better than they do what's good for them?  

        •  bs (1+ / 0-)
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          in what universe did people in the individual market have any of those consumer protections?  There was absolutely no assurance that the college-aged son couldn't be dropped if he got sick or injured or then would be able to find coverage after he was.  As the Strib article pointed out the smaller individual market is being brought under the same standards as the larger employer market.  

          The argument about not knowing what is actually covered is not condescending nor insulting when it's very easy to find stories pre-2010 that confirm that.  Maybe not for your relatives but govt policies are not individualized to every single persons experience.

          Insurance companies spelling out the terms of their policies is very funny indeed especially when those terms and conditions are not written in a manner that is easily understood.  Again, it's not because people are stoooopid, it's because insurers are only interested in a sale.  And then it's in their best interest to avoid payment or make people jump through so many hoops that they give up.  

          The only people I've seen make this argument about treating people as if they are stupid are the ones who only have negative things to say about the ACA.

          •  You have no idea what you are talking about, of (4+ / 0-)

            course, because you don't know these people or what policy they had.  You don't have to believe me, because you don't know me, but you certainly can't make definitive assertions about the pre-ACA policies of people you know nothing about.  And  you have no credibility when you pretend to "know" what was, or was not, in their policies.

            Believe it or not, there are people out there who, even before the ACA, would actually read what was covered and would actually take the time to understand it.  Some people liked to do that kind of thing before they spent thousands of dollars.  Yes, insurance companies are trying to sell something.  So are people selling a house, or a car.  We don't assume that everyone who buys those are too stupid to understand what they are buying.  Instead, the government mandates what must be disclosed, and then lets people make up their own minds.  And that was EXACTLY the state of affairs before the ACA -- there were government mandates on what must be disclosed, how it had to be disclosed, and yes, people who took the time to read what they were buying DID know what they were buying.  

            I do not have "only" negative things to say about the ACA.  Certainly, as I said, it benefits many people, especially the older and sicker (who, through community rating and other provisions, do not pay premiums that are as disproportionately high as they were, if they could get insurance at all.)

            Where I fault the Administration is in not being honest in the selling of the ACA.  The "lie" told to many people was that we could do all these good things for people who didn't have coverage, people with pre-existing conditions, etc., without any down side for anyone who already liked the coverage they had  ("if you like your plan, you can keep your plan, period").  The Administration was honest about the "upside" for some.  The Administration was not honest about the "downside" for others.  

            It is that dishonesty, not necessarily the ACA itself, that is causing the Administration the problems, in my opinion.  

            •  Anecdotal Logic Fallacy (2+ / 0-)
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              Tonedevil, glynis

              You have a story about your California relatives that sounds compelling. With your knowledge and intelligence, you know very well that their experience isn't indicative of the experience many other people have had.

              In a country of 316 million people nothing is ever going to be uniform. There are always outliers in much smaller sets of data.

              It's disingenuous to pretend that outliers are emblematic of an entire population. That's why you'll never get anywhere with your argument.

              There is no existence without doubt.

              by Mark Lippman on Fri Nov 22, 2013 at 11:14:18 AM PST

              [ Parent ]

              •  I am certainly not implying that they (1+ / 0-)
                Recommended by:

                are emblematic of an entire population.  In fact, I was using them as an example to counter the notion of other that all the pre-ACA policies that were cancelled were "junk" only people didn't know it.  My point is that I'm sure there are some like that, but there are also some people out there who had legitimate policies that served their needs who are now going to have to pay more,and it is disingenuous to pretend those kinds of situations don't exist as well.

                Supporters of the ACA point to situations were people are better off under the ACA, while the opposition points to people who are not better off. The truth is that both situations exist -- some people pay less, some people are going to have to pay more -- because the ACA was designed that way.  

                What I was saying is that the arguments presented are not going to be persuasive to those people like my California relatives.  I don't pretend that they are emblematic of the entire population, but I don't believe they are the only ones in that situation, either.

          •  The equity argument though is another good one (0+ / 0-)

            The people who are absorbing the higher costs on this are people already in the individual market.   They are essentially being singled out to be taxed to pay for those who have preexisting conditions instead of spreading these costs over all taxpayers particularly and progressively on those with higher incomes.  

            It's eat your peas centrism.  Shift the costs around but don't make the substantial commitment of government resources needed to make sure this moves us to sustainable universal healthcare.

            But hey, in the words, of our Senator Amy, "universal healthcare is unrealistic" so why would I expect her to deliver it?

            •  it is spreading the cost (0+ / 0-)

              in their insurance market as a group in the exchange.  

              •  Yeah but that's just playing insurance games (1+ / 0-)
                Recommended by:
                Nada Lemming

                in the "free" market.  We get the government involved to deliver the equity that the free market never provides.  We do if we're liberals.  There are always losers in a free market.  That's pretty much the whole premise.  If you believe healthcare is a human right, you shouldn't be depending on the market to provide equity.  


      •  Mpls Star Tribune is wrong (2+ / 0-)
        Recommended by:
        coffeetalk, Neuroptimalian

        Quote in comment said:

        Americans who get their coverage through employers generally don’t get to pick and choose what care their plans cover. Nor do younger workers pay less than older workers, even though older workers are likely to incur more costly care.
        It is actually very common for employees to choose from several plans and young people do pay less than older employees.

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Fri Nov 22, 2013 at 10:35:17 AM PST

        [ Parent ]

      •  What about the working poor? (0+ / 0-)

        What about the five member carpet crew whose boss is hoping the 20 year old van or truck lasts another year? What about the framing crew that uses a circular saw with guards removed because they can't afford a jamb saw? What about the tile crew that has to use a super soaker because the water pump on their wet saw went bad? I KNOW people like that and under the ACA, there is never going to be an employer mandate but the penalties will still apply. It's deeply ironic to me that a bunch of middle and upper middle class Americans think that 29 percent mostly working poor in red states = a successful program, when the most they know about the working poor is what kind of job they did painting their homes or trimming their hedges. What money exactly are they going to use to buy insurance? How is the father who had to put off the heating bill during the cold snap last week in order to buy formula going to find the extra cash to spend another more than 500 bucks per month on a crappy insurance policy? Guess they should have had the good sense to be born to parents who could have sent them to college.

        "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

        by MargaretPOA on Fri Nov 22, 2013 at 11:41:55 AM PST

        [ Parent ]

    •  response (3+ / 0-)
      Recommended by:
      Tonedevil, TomP, Aquarius40

      1)You can't pick and choose for what is included or excluded in policies.  I don't need mammography screening but you don't see me bitching about the fact that my insurance plan will cover it.  This is just a lame ass argument.  Old people don't need to be paying taxes to help fund public schools either.  But they do.  

      2)Another lame ass argument.  If the gov't doesn't lay certain minimum requirements for the insurance companies then we're left with the insurance companies deciding what to cover and not to cover.  If left to their own devices as they have been for far too long, we get crappy policies that cover jack shit.  It's no different than the government telling us we need certain coverage for auto insurance.  I don't really see anyone bitching about the fact that they have to get a policy which covers a certain minimum amount of bodily injury.  

      3)There's no demonstrable proof other than the fact that healthcare costs were going up by double digits in terms of percentage year over year for as far back as we could see and then after the ACA was signed into law the rate of growth magically shrank.  Now if someone wants to be an argumentative asshole and state that one doesn't necessarily have anything to do with the other, then how the hell do you explain that coincidence?  The economy?  Well how does one explain the fact that the same thing happened in Massachusetts and it wasn't during an economic downturn?  If 'correlation does not equal causation' is the best you got then you don't have much.  

      The only problem with all this was that Obama was extremely naïve in thinking that the GOP and the Insurance Industry, which he bent over backwards and upwards to appease and include in the discussions, in the end would not seek to fuck him with a 2ft thick dildo.  Nobody anticipated this much level of sabotage by the Insurance Industry, who BTW wrote the fucking bill.  The Insurance Industry is the one who is kicking people off the plans.  They're the ones who are sending threatening letters to people telling them the policies are cancelled because of Obamacare and that they have to be moved into a more expensive plan because of Obamacare.  The actual amount of people being negatively affected is far less than being reported, especially in relation to those benefitting.  Nobody ever expected that everyone would be pleased, but there is a very concerted effort to hype those negatively affected with the explicit purpose of undermining the policy and the president.  If Obama was a stone cold Samuel l. Jackson type motherfucker he'd get on national TV and lay the blame squarely on those responsible so EVERYONE would know it's the Insurance companies who are out to screw them and it's the GOP who is out to make sure they don't get health care.  But he won't and that is probably his biggest mistake.

      This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

      by DisNoir36 on Fri Nov 22, 2013 at 10:02:37 AM PST

      [ Parent ]

      •  Under ACA, Insurance is no longer based on (0+ / 0-)

        insurance principles, but is in effect a national healthcare program designed to partially go through "insurance companies."

        Insurance principles in general prices coverage based on the expected cost of the customer plus expenses and cost of capital.  The estimate for the customer's cost was based on easily determined factors.  In this way, no customer subsidizes another customer (on an actuarial basis).  This is why rates or coverage considered pre-existing conditions, age, gender, home address, coverage selected, etc..

        ACA is designed so there are substantial subsidies for some while others pay for those subsidies.  Those getting the subsidies will generally like the change much more than those paying for the subsidies.  This is why great attention is paid to the young and healthy signing up for ACA health insurance - they are needed to subsidize others.  

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Fri Nov 22, 2013 at 11:18:58 AM PST

        [ Parent ]

      •  In other words Congress is full of idiots (0+ / 0-)
        Nobody anticipated this much level of sabotage by the Insurance Industry, who BTW wrote the fucking bill.
        Now that the American people will believe.
    •  Unlikely slower growth in healthcare spending due (0+ / 0-)

      to ACA.

      There has been a slowdown of healthcare spending in the industrialized world due to the weak global economy.

      There has been a large shift to higher deductibles and more copays in US insurance for the past few years.  This reduced the growth in insurance premiums.  In addition, combined with the weaker economy and higher out of pocket payments people have been delaying treatments and making greater efforts to stay in network.  None of this was part of ACA.

      As little or none of its features of ACA meant to reduce cost have come into effect, it is hard to credit ACA for lower cost growth.

      The most important way to protect the environment is not to have more than one child.

      by nextstep on Fri Nov 22, 2013 at 10:53:49 AM PST

      [ Parent ]

    •  If you are old enough to not need maternity (0+ / 0-)

      coverage, you are also old enough that your rate is partly subsidized by increased rates on young people. So it all evens out.

      All group insurance works like that. I am a man, and I have the same insurance (through my company) as my female coworkers. I don't need gynecological exams or maternity care. But the policy covers it and I pay the same amount as my female coworkers. This is nothing new. This is how group insurance works.

      •  While your employer may change the same (0+ / 0-)

        for employees, however the insurance cost the employer pays is different between men and women - pre-ACA.

        The most important way to protect the environment is not to have more than one child.

        by nextstep on Fri Nov 22, 2013 at 11:22:18 AM PST

        [ Parent ]

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