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ACA Running Thread

I didn't ask you a question. You didn't answer one if I did.
 
I didn't ask you a question. You didn't answer one if I did.

Stick to being wrong. No reason to compound it with being dishonest.

You asked me to delineate which policies 24 year olds need. I told you the ones they wanted to buy, which they could formerly freely choose before this disaster was rushed through on reconciliation and upheld as the tax its proponents swore it wasn't stripped that choice away.
 
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http://m.washingtonpost.com/blogs/w...ministration-settles-on-a-definition/?print=1


"When the Obama administration releases health law enrollment figures later this week, though, it will use a more expansive definition. It will count people who have purchased a plan as well as those who have a plan sitting in their online shopping cart but have not yet paid."

lol...it would suck to be in charge of spinning this.

And in spite of the Curry math they are throwing at this thing, they still only hit 3% of their target enrollment numbers at this stage of the implementation.
 
I told someone else to ask you a question if they wanted to do so. DeacMan's beef was with you not me. I haven't made any statement about what insurance a 24 year old needs just what they can do under obamacare. They can be under their parents' coverage.
 
"Curry math"

That's great stuff. I had to think back through two other Currys to get to Ron. Don't even remember the original reference.
 
I told someone else to ask you a question if they wanted to do so. DeacMan's beef was with you not me. I haven't made any statement about what insurance a 24 year old needs just what they can do under obamacare. They can be under their parents' coverage.

And people love it. Just ask Kay Hagan; private citizen in waiting.
 
A fairly spot on analysis from a Euro based economist. Even if I personally don't like the idea of a single payor system, it is hard to argue with the conclusions he reaches on this piece of crap. A poorly designed law that will deliver a lot of bad results for most of the posters on this Board. No wonder the old guys here have their undies in a ball from excitement. They are fleecing their own bed at the expense of all the young folks here. Enjoy.


Dear friends,

Please pardon this long email, but after reading endless drivel on Obamacare, I needed to write this.

I'm afraid almost all discussions on the left and right regarding the Affordable Care Act (ACA) miss some very basic things. So I hope this email will explain a few economic ideas and put them into perspective for you, whether you're on the left or right and whether you like Obamacare or not.

Before I do that, though, let me say that I'm a raging capitalist and I'm in favor of universal healthcare coverage. I'm indifferent as to having either (1) a 100% government-guaranteed single-payer system or (2) a 100% private solution where the government guarantees that the poor are fully covered. Each has its pros and cons. For countries like Spain and the UK, a single-payer national system works. (I've lived in both countries almost all my life, and their healthcare systems work. The only time I've ever paid $250 for an aspirin was in a US hospital.) On the other hand, private solutions work very well for Singapore and Switzerland. So one model is purely public, and it works; and the other is purely private, and it works. There is a lot of demand for healthcare, so you have to ration medical care via price or quantity. That's basic economics. It is for voters and politicians to decide what they prefer. I'm indifferent to the solution, as long as it is well thought out and implemented and in fact provides universal coverage. The problem is that the ACA takes the worst elements of public and private and fails to provide universal coverage for millions of people.

Now, let's look beyond good intentions and see how the ACA works in practice.

The main egregious problem with the ACA is that it increases concentration in the insurance and medical markets. It forces consumers to buy into oligopolistic and monopolistic marketplaces. Insurance and medical companies stocks have all gone up since Obamacare passed. (They've gone up twice as much as the S&P this year.) What these companies are all telling us is that the act is good for their business and good for their margins.

Before the ACA, the US health insurance market was extremely uncompetitive, as this article in the NY Times notes:

As a general rule, the larger, more densely populated states have the most choice — and even the biggest insurer controls only a minority share of the market. According to statistics from the American Medical Association, the leading insurance provider in California covers 24 percent of the population, while in New York the figure is 26 percent and in Florida, 30 percent.

But there are nine states where a single insurer covers 70 percent or more of the people. In Hawaii, one insurer covers 78 percent. In Alabama, it’s 83 percent. And in at least 17 other states one insurer covers at least half the population.

Some members of the Senate Finance Committee, which is taking a lead on health care legislation, come from states where the insurance market is highly concentrated. The Democratic chairman, Senator Max Baucus, is from Montana, where 75 percent of people are covered by one major insurer, Blue Cross Blue Shield of Montana. For Senator Charles E. Grassley, Republican of Iowa, the figure is 71 percent, by Wellmark. For Senator Olympia Snowe, Republican of Maine, it’s 78 percent, by WellPoint.

“For many Americans, the idea that they have a choice of health plans is about as mythical as unicorns,” said Jacob Hacker, professor of political science at Yale University.

In theory, the ACA could have improved things, and many supporters think it does through exchanges. Unfortunately, it didn't. Under the Affordable Care Act there will be far fewer choices and less competition. Don't take my word for it; read this NY Times article.

Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.

This is truly staggering, when you consider it. Citizens will now be forced to buy insurance from oligopolies and in many cases monopolies. They're not getting healthcare from the government; they're being forced to buy from private companies that have pricing power and market dominance. Insurance companies are still exempt from anti-trust supervision. This would never happen in other industries. You don't need to know anything besides basic economics to understand that oligopolies and monopolies are bad for consumers. Consider having to pay for phone services from one or two phone providers. (Wait, we already had that, and Ma Bell was broken up...)

Medical companies are also exempt from fair pricing laws. If you go to a hospital, you'll get a different price depending on whether you're uninsured or Medicaid pays for you or your insurance pays for you. You can't drive into a gas station and be charged an arbitrary cost after you've filled your car, but you can be charged an arbitrary number by a hospital. (Imagine: a black, a WASP, and a Jew go to a gas station, and they all get different prices. Wait, we got rid of that injustice too...) In theory, the ACA fixes fair pricing laws, but it doesn't apply to most hospitals. See "Federal health law falls short of a goal" in the Boston Globe.

In the 21st century, states still control and regulate insurance, which means fragmentation, very high barriers to entry, and local oligopolies. It is insane that the Federal government regulates banks at a national level via the Federal Reserve and the FDIC but allows insurers to have local market dominance. (The law that allows this is the 1945 McCarran-Ferguson Act.) If you're curious about how insurance companies are oligopolies, read here. And read this‪ … and this.‪

You can ship and sell Coca Cola across state lines, but you can't sell insurance across state lines. Some argue that you could get one lax insurance regulator in North Dakota, and then insurance companies would all set up shop there and start selling across state lines. That has an easy solution: have one national regulator and let insurance companies compete across state lines.

Not only is there a lack of competition among insurers, there is a lack of competition among hospitals. This has happened because antitrust policy has been so inadequate for so long in the health sector. See "Health Care Needs Stronger Market Forces" in Forbes. (Here is a more in-depth paper, if you're curious.)

The problems that arise from a lack of competition are rife on the pharmaceutical and medical side as well. Obamacare will do almost nothing to change that. See "How a Cabal Keeps Generics Scarce" in the NY Times. It should come as no surprise that medical and pharma companies helped draft the ACA. Who said Congress won't turn a few tricks for the right price? See "ObamaCare's Secret History" in the WSJ.

In theory, the ACA will control costs and won't let insurance companies and hospitals gouge us, but these types of regulations haven't worked in the past. Howard Dean is a doctor and a Democrat. His very thoughtful views on how pricing regulations haven't worked are presented here. If you think costs will fall and insurers won't profit, I've got a bridge to sell you in Brooklyn. The law is complex, badly written, and will be gamed. See "The Coming Clash over Insurers’ Compliance with Obamacare" from the Independent Institute and "HHS Releases Final Medical Loss Ratio Regulations" in the WSJ.

I highly recommend you read Matt Taibbi's chapter on Obamacare in his book Griftopia. The book is highly worth buying and reading. It is informative, entertaining, and extremely infuriating. Your blood will boil after you read it. Taibbi establishes the point that the Affordable Care Act will screw Americans. This case is also made by the Institute of Economic Affairs, in "The scourge of Obamacare."

In the United States, one of the most protuberant and harmful political myths — one shared by subscribers to almost all political persuasions — is the odd, naive idea that big business and big government are permanent antagonists. As a historical and empirical matter, of course, nothing could be further from the truth, a reality thrown into sharp relief by the political machinations underlying Obamacare. The new law is fundamentally anti-competitive and anti-small business, riddled with onerous regulations and handouts to favoured corporations. As usual, the relationship between big business and big government is not one of rivalry, but of symbiosis, routing genuine free markets in favour of collusion.

The ACA won't cover everyone, and it will force people seeking coverage to buy from monopolists. Many people will get subsidies for their new insurance policies, and many people who didn't have coverage will now have coverage. This is great news. However, it would be hard to design a worse system if you tried. There are simpler ways by which we could have covered everyone without forcing people to participate in private oligopolies and monopolies.

One of the biggest problems in the US are medical costs. We spend far more than any other country, almost twice the OECD average. This problem will not be fixed by Obamacare and indeed will only get worse due to the spiralling of price increases between insurance companies and hospitals, given the lack of competition.


Source

Furthermore, as you can see from this interactive table, we spend trillions of dollars more than other countries do, yet we don't achieve better outcomes.

Chile, Hong Kong, and Singapore, for example, spend one fourth what we do and achieve better outcomes and longer lifespans. So spending more money isn't a solution. In fact, imagine what we could do if we cut our healthcare spending in half. We'd free up over a trillion dollars for other things. That's what economists call consumer surplus. Even in crazy Washington, where congressmen think money grows on trees, a trillion is a large number.

In America one subject that is taboo is healthcare before death. Almost all healthcare costs are incurred in the last twelve months of people's lives. Modern medicine tends to delay natural death rather than extend healthy life. That is why doctors consume less healthcare than the average person. They understand what medicine can do and can't do. I highly recommend reading this article in the WSJ. Ask any doctor, and they'll confirm this.

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive — specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Furthermore, 5% of patients create 50% of costs. These costs are all in the last days of life. See this article in Forbes.

Dr. Susan Dale Block, Chair and Director of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute and Brigham and Women’s Health Care, recently shared some data with her colleagues. In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise. In lay terms (because trying to explain the data and methodology requires about 100 IQ points that I don’t have) the study found that the less money spent in this time period, the better the death experience is for the patient.

It seems that no matter how much money you use during that last year/month, if the person is sick enough, the effort makes things worse. A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis. The patient’s quality of life is being sacrificed by increasing the cost of death.

We will all die. There is no way around that. Until we have an adult conversation about how we die and recognize that we spend too much on medicine we don't need, we won't reduce our costs.

Sorry for such a long email. These are a few brief thoughts on the key issues that the press neglects to mention. I'd have to write a book to discuss all the relevant issues. I've provided more links in the postscript to my email if you're curious about the problems of oligopoly, market concentration, and local regulation in the US insurance and healthcare sectors.

While the US lines the pockets of insurance companies, I'll be enjoying the socialized medical system in the UK. My guess is that Obamacare has been made purposefully grotesque in order to make people clamor for a single-payer system. I'm sure the US will eventually get one. Personally, I think congressmen and -women are too stupid and venal to do anything good. Until then, we'll have to wait for the ACA to derail before we see any genuine reform.
 
Dear friends,

Please pardon this long email, but after reading endless drivel on Obamacare, I needed to write this.

I'm afraid almost all discussions on the left and right regarding the Affordable Care Act (ACA) miss some very basic things. So I hope this email will explain a few economic ideas and put them into perspective for you, whether you're on the left or right and whether you like Obamacare or not.

Before I do that, though, let me say that I'm a raging capitalist and I'm in favor of universal healthcare coverage. I'm indifferent as to having either (1) a 100% government-guaranteed single-payer system or (2) a 100% private solution where the government guarantees that the poor are fully covered. Each has its pros and cons. For countries like Spain and the UK, a single-payer national system works. (I've lived in both countries almost all my life, and their healthcare systems work. The only time I've ever paid $250 for an aspirin was in a US hospital.) On the other hand, private solutions work very well for Singapore and Switzerland. So one model is purely public, and it works; and the other is purely private, and it works. There is a lot of demand for healthcare, so you have to ration medical care via price or quantity. That's basic economics. It is for voters and politicians to decide what they prefer. I'm indifferent to the solution, as long as it is well thought out and implemented and in fact provides universal coverage. The problem is that the ACA takes the worst elements of public and private and fails to provide universal coverage for millions of people.

Now, let's look beyond good intentions and see how the ACA works in practice.

The main egregious problem with the ACA is that it increases concentration in the insurance and medical markets. It forces consumers to buy into oligopolistic and monopolistic marketplaces. Insurance and medical companies stocks have all gone up since Obamacare passed. (They've gone up twice as much as the S&P this year.) What these companies are all telling us is that the act is good for their business and good for their margins.

Before the ACA, the US health insurance market was extremely uncompetitive, as this article in the NY Times notes:

As a general rule, the larger, more densely populated states have the most choice — and even the biggest insurer controls only a minority share of the market. According to statistics from the American Medical Association, the leading insurance provider in California covers 24 percent of the population, while in New York the figure is 26 percent and in Florida, 30 percent.

But there are nine states where a single insurer covers 70 percent or more of the people. In Hawaii, one insurer covers 78 percent. In Alabama, it’s 83 percent. And in at least 17 other states one insurer covers at least half the population.

Some members of the Senate Finance Committee, which is taking a lead on health care legislation, come from states where the insurance market is highly concentrated. The Democratic chairman, Senator Max Baucus, is from Montana, where 75 percent of people are covered by one major insurer, Blue Cross Blue Shield of Montana. For Senator Charles E. Grassley, Republican of Iowa, the figure is 71 percent, by Wellmark. For Senator Olympia Snowe, Republican of Maine, it’s 78 percent, by WellPoint.

“For many Americans, the idea that they have a choice of health plans is about as mythical as unicorns,” said Jacob Hacker, professor of political science at Yale University.

In theory, the ACA could have improved things, and many supporters think it does through exchanges. Unfortunately, it didn't. Under the Affordable Care Act there will be far fewer choices and less competition. Don't take my word for it; read this NY Times article.

Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.

This is truly staggering, when you consider it. Citizens will now be forced to buy insurance from oligopolies and in many cases monopolies. They're not getting healthcare from the government; they're being forced to buy from private companies that have pricing power and market dominance. Insurance companies are still exempt from anti-trust supervision. This would never happen in other industries. You don't need to know anything besides basic economics to understand that oligopolies and monopolies are bad for consumers. Consider having to pay for phone services from one or two phone providers. (Wait, we already had that, and Ma Bell was broken up...)

Medical companies are also exempt from fair pricing laws. If you go to a hospital, you'll get a different price depending on whether you're uninsured or Medicaid pays for you or your insurance pays for you. You can't drive into a gas station and be charged an arbitrary cost after you've filled your car, but you can be charged an arbitrary number by a hospital. (Imagine: a black, a WASP, and a Jew go to a gas station, and they all get different prices. Wait, we got rid of that injustice too...) In theory, the ACA fixes fair pricing laws, but it doesn't apply to most hospitals. See "Federal health law falls short of a goal" in the Boston Globe.

In the 21st century, states still control and regulate insurance, which means fragmentation, very high barriers to entry, and local oligopolies. It is insane that the Federal government regulates banks at a national level via the Federal Reserve and the FDIC but allows insurers to have local market dominance. (The law that allows this is the 1945 McCarran-Ferguson Act.) If you're curious about how insurance companies are oligopolies, read here. And read this‪ … and this.‪

You can ship and sell Coca Cola across state lines, but you can't sell insurance across state lines. Some argue that you could get one lax insurance regulator in North Dakota, and then insurance companies would all set up shop there and start selling across state lines. That has an easy solution: have one national regulator and let insurance companies compete across state lines.

Not only is there a lack of competition among insurers, there is a lack of competition among hospitals. This has happened because antitrust policy has been so inadequate for so long in the health sector. See "Health Care Needs Stronger Market Forces" in Forbes. (Here is a more in-depth paper, if you're curious.)

The problems that arise from a lack of competition are rife on the pharmaceutical and medical side as well. Obamacare will do almost nothing to change that. See "How a Cabal Keeps Generics Scarce" in the NY Times. It should come as no surprise that medical and pharma companies helped draft the ACA. Who said Congress won't turn a few tricks for the right price? See "ObamaCare's Secret History" in the WSJ.

In theory, the ACA will control costs and won't let insurance companies and hospitals gouge us, but these types of regulations haven't worked in the past. Howard Dean is a doctor and a Democrat. His very thoughtful views on how pricing regulations haven't worked are presented here. If you think costs will fall and insurers won't profit, I've got a bridge to sell you in Brooklyn. The law is complex, badly written, and will be gamed. See "The Coming Clash over Insurers’ Compliance with Obamacare" from the Independent Institute and "HHS Releases Final Medical Loss Ratio Regulations" in the WSJ.

I highly recommend you read Matt Taibbi's chapter on Obamacare in his book Griftopia. The book is highly worth buying and reading. It is informative, entertaining, and extremely infuriating. Your blood will boil after you read it. Taibbi establishes the point that the Affordable Care Act will screw Americans. This case is also made by the Institute of Economic Affairs, in "The scourge of Obamacare."

In the United States, one of the most protuberant and harmful political myths — one shared by subscribers to almost all political persuasions — is the odd, naive idea that big business and big government are permanent antagonists. As a historical and empirical matter, of course, nothing could be further from the truth, a reality thrown into sharp relief by the political machinations underlying Obamacare. The new law is fundamentally anti-competitive and anti-small business, riddled with onerous regulations and handouts to favoured corporations. As usual, the relationship between big business and big government is not one of rivalry, but of symbiosis, routing genuine free markets in favour of collusion.

The ACA won't cover everyone, and it will force people seeking coverage to buy from monopolists. Many people will get subsidies for their new insurance policies, and many people who didn't have coverage will now have coverage. This is great news. However, it would be hard to design a worse system if you tried. There are simpler ways by which we could have covered everyone without forcing people to participate in private oligopolies and monopolies.

One of the biggest problems in the US are medical costs. We spend far more than any other country, almost twice the OECD average. This problem will not be fixed by Obamacare and indeed will only get worse due to the spiralling of price increases between insurance companies and hospitals, given the lack of competition.


Source

Furthermore, as you can see from this interactive table, we spend trillions of dollars more than other countries do, yet we don't achieve better outcomes.

Chile, Hong Kong, and Singapore, for example, spend one fourth what we do and achieve better outcomes and longer lifespans. So spending more money isn't a solution. In fact, imagine what we could do if we cut our healthcare spending in half. We'd free up over a trillion dollars for other things. That's what economists call consumer surplus. Even in crazy Washington, where congressmen think money grows on trees, a trillion is a large number.

In America one subject that is taboo is healthcare before death. Almost all healthcare costs are incurred in the last twelve months of people's lives. Modern medicine tends to delay natural death rather than extend healthy life. That is why doctors consume less healthcare than the average person. They understand what medicine can do and can't do. I highly recommend reading this article in the WSJ. Ask any doctor, and they'll confirm this.

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive — specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Furthermore, 5% of patients create 50% of costs. These costs are all in the last days of life. See this article in Forbes.

Dr. Susan Dale Block, Chair and Director of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute and Brigham and Women’s Health Care, recently shared some data with her colleagues. In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise. In lay terms (because trying to explain the data and methodology requires about 100 IQ points that I don’t have) the study found that the less money spent in this time period, the better the death experience is for the patient.

It seems that no matter how much money you use during that last year/month, if the person is sick enough, the effort makes things worse. A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis. The patient’s quality of life is being sacrificed by increasing the cost of death.

We will all die. There is no way around that. Until we have an adult conversation about how we die and recognize that we spend too much on medicine we don't need, we won't reduce our costs.

Sorry for such a long email. These are a few brief thoughts on the key issues that the press neglects to mention. I'd have to write a book to discuss all the relevant issues. I've provided more links in the postscript to my email if you're curious about the problems of oligopoly, market concentration, and local regulation in the US insurance and healthcare sectors.

While the US lines the pockets of insurance companies, I'll be enjoying the socialized medical system in the UK. My guess is that Obamacare has been made purposefully grotesque in order to make people clamor for a single-payer system. I'm sure the US will eventually get one. Personally, I think congressmen and -women are too stupid and venal to do anything good. Until then, we'll have to wait for the ACA to derail before we see any genuine reform.

Coming out of a self imposed hiatus to "like" this opinion. Pretty much my exact view. Either go completely private and encourage competitive pressure or go with a complete government solution that can be fully regulated. What we have created is the worst of both worlds and it will do nothing to solve the real problems. In fact it will make them worse. We can cover 100% of the population in a much more effective manner than ACA and do it without all the terrible side effects.

It could easily be that ACA will turn out to be such a huge failure that we are forced to change our stride. The long term outlook for our healthcare system is pretty bleak under the ACA in my opinion.

Edited to Add that I prefer government run just making that clear. I don't think the US healthcare system is properly set up for a free market ...

[lurks back into the shadows]
 
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I'm hard pressed to think of a way you could screw things up more in terms of failing to lower costs. They should have called this the healthcare redistribution and monopoly act.

You could stick with the current system that was failing to lower costs?
 
LOL. That actually would be better. All this law does is take that same pie of supply and divide it up among 20 million more people. More demand, less supply and no competitive reform (e.g. insurance still can't be sold across state lines) = higher costs and more mediocre care for everyone. Good work!!
 
LOL. That actually would be better. All this law does is take that same pie of supply and divide it up among 20 million more people. More demand, less supply and no competitive reform (e.g. insurance still can't be sold across state lines) = higher costs and more mediocre care for everyone. Good work!!

It's a bit more complex than that. Which competitive reforms would you like to see?
 
It's a bit more complex than that. Which competitive reforms would you like to see?

Only in the intricacies of its failures. At some point, you have to draw the nexus between limited supply and rising costs. This law doesn't even try to do that. It took health insurance that was working for people, and despite its promises, broke it so that it worked better for other people. There was no need to do that. You should have at least focused on the people who weren't happy with what they had and left well enough alone (as repeatedly promised).

First, increasing access to care (be increasing the amount of available care) brings costs down. Increasing access to insurance actually pushes cost up. Letting insurers compete across state lines (with a full array of products that providers and consumers are free to choose) would have been a good start.
 
It's a bit more complex than that. Which competitive reforms would you like to see?

It really isn't all that complex unless you are talking about how complicated the law actually makes things. As for reform, you could start by letting insurers sell across state lines. The very fact the NY Times cited that in 58% of all counties coverage is only going to be offered by one or two companies under Obamacare is a big time problem. In some states well over half the population is being served by just one insurer. And you expect costs to go down?

None other than Bill Clinton is now on record saying Obama should make sure his promise to the American people is kept. There's one problem with said promise - it can't be kept without completely restructuring the law.
 
It really isn't all that complex unless you are talking about how complicated the law actually makes things. As for reform, you could start by letting insurers sell across state lines. The very fact the NY Times cited that in 58% of all counties coverage is only going to be offered by one or two companies under Obamacare is a big time problem. In some states well over half the population is being served by just one insurer. And you expect costs to go down?

None other than Bill Clinton is now on record saying Obama should make sure his promise to the American people is kept. There's one problem with said promise - it can't be kept without completely restructuring the law.

Which states?
 
Which states?

See long post above.

"Before the ACA, the US health insurance market was extremely uncompetitive, as this article in the NY Times notes:

As a general rule, the larger, more densely populated states have the most choice — and even the biggest insurer controls only a minority share of the market. According to statistics from the American Medical Association, the leading insurance provider in California covers 24 percent of the population, while in New York the figure is 26 percent and in Florida, 30 percent.

But there are nine states where a single insurer covers 70 percent or more of the people. In Hawaii, one insurer covers 78 percent. In Alabama, it’s 83 percent. And in at least 17 other states one insurer covers at least half the population.

Some members of the Senate Finance Committee, which is taking a lead on health care legislation, come from states where the insurance market is highly concentrated. The Democratic chairman, Senator Max Baucus, is from Montana, where 75 percent of people are covered by one major insurer, Blue Cross Blue Shield of Montana. For Senator Charles E. Grassley, Republican of Iowa, the figure is 71 percent, by Wellmark. For Senator Olympia Snowe, Republican of Maine, it’s 78 percent, by WellPoint.

"For many Americans, the idea that they have a choice of health plans is about as mythical as unicorns,” said Jacob Hacker, professor of political science at Yale University.

In theory, the ACA could have improved things, and many supporters think it does through exchanges. Unfortunately, it didn't. Under the Affordable Care Act there will be far fewer choices and less competition. Don't take my word for it; read this NY Times article.

Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.

This is truly staggering, when you consider it. Citizens will now be forced to buy insurance from oligopolies and in many cases monopolies. They're not getting healthcare from the government; they're being forced to buy from private companies that have pricing power and market dominance. Insurance companies are still exempt from anti-trust supervision. This would never happen in other industries. You don't need to know anything besides basic economics to understand that oligopolies and monopolies are bad for consumers. Consider having to pay for phone services from one or two phone providers. (Wait, we already had that, and Ma Bell was broken up...)"

We took an already bad situation and we actually made it worse.
 
It's a bit more complex than that. Which competitive reforms would you like to see?

Side note: If you've never heard Adam Carolla go off on the "It's more complex than that..." rejoinder, you should. Hilarious and true. His exchange with the HuffPo set it off in his case, but he's used it several times with great effect since then.
 
I think we need to look at why insurers didn't opt to play on the exchanges, esp the large for profit nationals. In NC, there are 2 exchange options but nearly 10 off exchange carriers. Why is this?

And I really think the idea of "selling across state lines" given the way health care is delivered (locally) is a total red herring, esp when you consider we have universal rating rules, std benefits, same regs.
 
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