(Updated) Obamacare insurance exchanges may not be good deal for young and healthy

We’ve been treated to a lot of left-side whooping and cheering about insurance soon to be available on the Obamacare (ACA) exchanges, how they will bring prices down, and so on. I admit that hearing them, I was feeling optimistic myself, and my overall reaction to the ACA could generously be called “mixed at best.”

In fact I hate the ACA for what it does to Medicare — it makes sure that actual single-payer health insurance will never be available to people under 65. In basketball, they call that occupying the lane and blocking out the opponent.

For example, see here — “Barack Obama’s economic legacy: His four must-have items” — and check out item one. Yep, there it is, sitting right on top:

How can we afford not to focus on health care?  We can’t.1. Health care “reform” — a privatized alternative to Medicare expansion
2. A “grand bargain” in which social insurance benefits are rolled back
3. Plentiful oil & gas and passage of the Keystone Sludgepipe (KXL pipeline)
4. Passage of the Trans-Pacific Partnership (TPP) trade agreement

It’s the first thing he tackled with his big Congressional majority, and he won. Big Insurance and Pharma were provided for; legacy item one accomplished; next up, taking away your Social Security benefits.

Now comes RJ Eskow, who along with people like Wendell Potter, actually knows this stuff. Among other things, he was a numbers guy at AIG, which despite what you’ve heard, was once an actual insurance company, and a huge one. For more on Eskow and his analytical skills, go here. He’s quite good with health care data.

Which is why I was interested to discover this, a short clip from a recent Virtually Speaking Sundays show, this one with RJ Eskow and Cliff Schecter. Here they discuss the coming rollout of ACA insurance on the exchanges.

Host Jay Ackroyd asks Eskow if the ACA insurance is a good deal — because if it’s not, then healthy people will opt not to buy it and choose the penalty instead. (This is called “adverse selection” — selecting not to do something — and it’s a big deal in health insurance circles, since it leaves companies covering only sick people.)

Eskow’s answer: If you’re healthy and young, no, it’s not a great deal. Here’s the clip. It’s short (five minutes) and eye-opening:

Popular Health Internet Radio with Jay Ackroyd on BlogTalkRadio

Note, by the way, that there are four “levels” of plan available on the exchanges: bronze, silver, gold, platinum. There’s a reference to these plan levels in the clip. (I’m surprised there’s not a “cardboard” plan for the really cash-strapped, but maybe they’ll add that later.)

Note also Eskow’s point about being roundly attacked for putting forward this data. There are a few partisans on the Dem side who really do want to protect the “idea” of Obamacare more than they want to deal with its reality. Shame on them, say I.

The whole show is here, and it’s a good one. The first half discusses the ACA in much more detail, and the second half discusses Syria, the president, and the way various outcomes could influence the 2016 election.

Your bottom line — According to Eskow, if a healthy 25-year-old chooses not to buy ACA insurance, that could easily be a “rational decision,” as opposed to a political one. Our Betters and their campaign-donating friends — gotta love them. Or not.

UPDATE: Just to be clear, the problem I have isn’t with the idea of health insurance and the need for the covered pool to include the healthy. The problem is the way that pool is created.

As my recent twitter conversation with Sean-Paul Kelley discussed, there are two ways to get healthy people into the insurance pool:

Make it a requirement (as in Medicare)
Offer incentives (as in Obamacare)

If you offer incentives, you have to live with the fact that people will opt out. And Eskow is pointing out just that — based on the incentives designed into the plan (i.e., the high prices), people will opt out. Bad news.

That is, he’s not recommending that people do opt out. He’s pointing out the danger that people will opt out. “Adverse selection” kills insurance plans, and Obamacare has an “adverse selection” hole in it because it’s designed, first and foremost, to protect insurance company profits, and second, to create a covered pool. Medicare is just the opposite. Sorry that wasn’t as clear as it could have been.

UPDATE 2: Eskow adds via email:

Some of the commenters seem to think it’s a telling point that “auto insurance isn’t a good deal until you have an accident,” or “they’ll be glad to have insurance when they get sick.”

But that misses the key point: The question isn’t whether insurance is a good idea. The question is whether this is good insurance at a good rate. Young people won’t be “glad” they have this insurance if they get sick and the discover they have to pay $10,000 in out-of-pocket costs after thinking they were insured.

Good insurance at a good rate, decisions we all make. Thanks for the clarification, Richard.


To follow or send links: @Gaius_Publius

Gaius Publius is a professional writer living on the West Coast of the United States.

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182 Responses to “(Updated) Obamacare insurance exchanges may not be good deal for young and healthy”

  1. Whitewitch says:

    Hope the hangover is not too bad…good cause though.

  2. Kim says:

    I had to play a dangerous game… Massachusetts has this wonderful thing called Romneycare… When I lived in Florida, I purchased a catastrophic plan (as a just in case) it cost me $120 a month and I would pay out of pocket for the first $2500 of my medical care. I did discover the plan would pay for those annual visits- so I scheduled all of those on the same day so BC/BS of Florida would pay. I move back to Massachusetts and I’m told the same plan is $300 a month and the first $5000 out of pocket!!!! With my crappy jobs, I could swing the $120 a month but $300 was a no-go. cost 3x more for half the coverage!

    What I did was telling BC/BS of Florida that of course, I’m still living in Florida… then fly down once a year to all my scheduled visits in one day. With the cost of all of that was less money then paying for the equivalent in Massachusetts.

    Thank god I have a full time job that offers health insurance!

    Here’s what I think would help more than the ACA. Let people purchase their own health insurance from whomever or where ever they want too! As in, if they live in Massachusetts- let them purchase health insurance in Florida, or California. I think that would help cost wise. Yes health insurance companies can fleece you for money (I’m dreading the cost for the event monitor for a month!). However, it can help you find the best companies/best states for you individually.

    I’m not saying it is perfect but I don’t think Obamacare is the way to go! There are too many flaws and nonsense built into the bill- like needing to tell your employer how much money the household makes (I’m sure they will report it to the IRS). Which if you are struggling to make ends meet to begin with- that $50 more at the end of the year might qualify you to pay an extra $200 a month in coverage… Or if your employer gives you great coverage that will be called a cadillac plan and you’ll be taxed to death for accepting it. Although, I think all the politicians should be required to go on this health care coverage and I’m positive that they system won’t be nearly as bad!

  3. Ford Prefect says:

    Thank you again. Just got back from the second go ’round and everything looks good, so no worries at all, except we may have a slight hangover tomorrow. But wow. Your story is hardly unique and I can’t help but lament how much an already traumatic situation was made worse by all the “business” crap. I’m glad you not only survived it, but also retained that which makes you “good people” in the face of such indignities.

    Kudos to you.

  4. Whitewitch says:

    Totally understand. My thoughts are with you. Double mastectomy here 5 years ago….my share (after insurance) was horrible and that was without having them reconstructed (Good Side Note – No More BRA!!! Yeah!!). And even when I thought I had paid something off, there was the anesthesiologist or the lab for testing, or some surgical assistant. Goddess what a nightmare – I cried for months…and worse that was when they did it as an Outpatient procedure…can you imagine removing two breasts, and sending you home the same day? Thankfully my surgeon found “a problem” which required I stay over night…without my companion I would not have made it – a gentle and kind soul that one.

    I am hoping someday we have single payer!

    Follow this wee advice – try not to worry too much it will make you ill. Good luck Sister, give your companion a hug from me! Take good care!

  5. Ford Prefect says:

    Thank you so much! The timing of all this has been nerve-rattling. She just had a mammogram and the report came back with “benign circumscribed growth.” The doctor and several friends say it’s no big deal and “I’ve had several of those.” So we’re going to get the follow-up and you know what the one Big Issue is that’s keeping us up at night? It’s not the report, but the insurance, because they say, “We won’t take anyone with cancer,” and we’re in the process of applying right now, so Fear & Loathing at home.

    With Single Payer, you just get it taken care of. With Insurance, it’s a nightmare. What the elites are doing to us all is a crime. And oh, I just read this and it’s a great rebuttal to all the trolling taking place at the moment. You’ll definitely get some use out of this one:


  6. Whitewitch says:

    You know Ford Perfect – I think I am falling in love with you!!! Yes I am. This is Perfection. I wish I had my thinking and words together enough to put it as sweetly as you have here…and I hope the young J.M. Baker will read this as well.

  7. Ford Prefect says:

    Or as this commenter remarks:

    so! 27 year old in peak health in 40hr/$7.25 job is mandated to pay $214-328/mo with $290/wk gross wage????? i’ll take the unspecified, unenforceable “tax penalty.”from s/s stmt (over 65 late medicare enrollment penalty of 25%) $1558.80 = $129.90/mo.

    nuff said.


    PPACA was signed into law in the spring of 2009. Here we are in late 2013 and no one can say with certainty what anything will cost or how it will affect people’s bottom lines, much less address the delivery or non-delivery of actual healthcare. Subsidies? Sure. But if you get a $.25 raise that puts you even one dollar over the subsidy line, then the IRS will come back next year and clawback the previous year’s subsidies, which will run into the thousands. And with credit agencies determining MAGI, instead of using IRS AGI, anyone care to bet they’ve been incentivized to push people out of subsidy territory with their funky accounting? Bonus time!

    At this point, I’m starting to think in terms of how the chaos of all this is adding hardship, above and beyond the money questions. So like you, I take bland assertions of “subsidies” with a truck-load of salt. My partner and I had our insurance canceled to be dumped into “Obamacare” and for the life of us, we can’t figure out how all this really works, what it costs and what it will cover, if anything. We’re literally losing a lot of sleep over this and I doubt we’re unique in any sense at all. We’re in limbo and it hurts.

    Perhaps they should give us a year’s supply of anti-anxiety meds to help us cope with their “system?”

  8. Whitewitch says:

    Did you elect to respond to me 3 days after my post – just to lecture me? Or are you out hunting for anything that might be imply that the ACA might not work….like a WH undercover guy?

    Seriously…I get the problem. I also get that what is being subsidized won’t cover single moms who make just a wee bit too much to qualify. “Back in the Day” my experience was what I said, I think I was clear that now I am covered through work. And back then as a single mom, I did not qualify for any food stamps or medicare..even though I was living a poverty level…so I struggled and struggled to make ends meet.

    I get “young man” that the cost is low, in your mind. However, even a small premium of say $200 to $300 would not be doable for many single moms and dads that are just getting by – with little or nothing left over at the end of the month and IT WILL BE A HARDSHIP FOR THEM. Yes – and they will have to make a call about what will have to be cut to pay said premium.

    Are you so naive that you don’t get that $200 is a lot to a family barely making it? Dude relax – I am not your enemy.

  9. J.M. Becker says:

    @Whitewitch:disqus : In which time period are you currently living? “as a single mom back in the day when insurance was truly expensive and not available through work” That’s not ‘back in the day’ that’s reality today. Insurance is truly expensive, and often not available through work, that’s one of the many reasons we have a problem.

    On the flipside, a single cash strapped mom will be granted a significant subsidy. To make healthcare less expensive than paying the penalty.

  10. Whitewitch says:

    If you don’t have $10k, it might as well be $100k…you will never pay it off and will be ruined credit-wise while they send the Collection Hounds after you….it is really relative.

  11. Whitewitch says:

    thank you Tata..as a single mom back in the day when insurance was truly expensive and not available through work…I worried myself sick that my son would become ill and I would not be able to get him care. Paying a premium is not an option for many moms….even at a greatly reduced rate…if you don’t have the small premium – you simply don’t have it…unlike car insurance where you can opt to not drive/own one (I rode a bike to work with my son in the kiddie seat when he was your because I could not afford car insurance), you will be mandated to purchase health insurance…and even if the premiums is $250 a month – where does a single mom find it.

  12. sameerr allii says:

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  13. lambert says:

    ultraviolet_uk: You feel that treating all Americans equally is nuts? No doubt. Smarter Obots, please.

  14. ultraviolet_uk says:

    So after demanding single payer, you now bemoan the fact that for one class of people, the ACA mandates a single payer scheme.

    That’s just nuts.

  15. ultraviolet_uk says:

    One thing that the “this is health insurance not healthcare” crowd don’t seem to get is that this is exactly how universal coverage works in most of Europe. The UK is rare in having fully publicly funded healthcare.

  16. lambert says:

    Depends on whether it’s good insurance at a good price.

  17. lambert says:

    Huh? That’s like saying people are “rewarded” by the First Amendment’s guarantee of free speech when they say something stupid.

  18. lambert says:

    Since ObamaCare was designed explicitly to head off single payer, how on earth do imagine you’ll each your goal?

    Let’s take a hypothetical: Suppose you’re ignorant of the history of how ObamaCare came to be, and as a result making policy recommendations that would deny millions care. Should THEY have mercy on YOU? Why?

  19. lambert says:

    “There but for the grace of God go I.” Nonsense to you, perhaps. Are you sure you wouldn’t be happier with the Randroids?

  20. karmanot says:

    God forbid we enjoy life. I am thing about that sour old Puritan story of the grasshopper and the ant.

  21. karmanot says:

    That works :-)

  22. Kim_Kaufman says:

    Lambert – where do you think bottled water comes from???

  23. JEngdahlJ says:

    Communicating healthcare reform: Helping navigate the waters.

  24. tata says:

    When I was 24 and a single parent with a toddler, it was hand to mouth and I desperately wanted health insurance for my daughter. The premiums here are not a little too much, but *much* too much and the coverage is not at all reassuring. I would not have been able to come up with that no matter how hard I tried. My only option under these conditions would have been to pay the penalty – which still would have been a blow to my meager finances – and hope nothing terrible happened to me

    I think you will see a lot of people under 30 say this in one form or another.

  25. Bill_Perdue says:

    It’s a step away from socialized medicine as comment after comment has shown.

    This is not the era of reforms, this is the era when the right, Democrat and Republican, is taking away or dismantling reforms. Voting for or promoting rightists like Obama or Romney is not just a minor political error, it’s an attack on working people and especially elderly workers.

  26. zorbear says:

    Oh, okay. Is that anything like “You’re all heart — what part ain’t ass, that is…”?

  27. StraightGrandmother says:

    I am actually for Socialized Healthcare.
    I look at Obamacare as just the first step towards that ultimate goal.

  28. StraightGrandmother says:

    You would! LOL!

  29. Solid State Max says:

    Best article on the TRUTH about ACA so far. Thing is, the “public option” in 2009 was never really a public option since all it did was give 100% to the insurance thugs while government would keep its hands-off thingy as always. As for single payer, have you visited HHS ‘cuz as a self-employed contractor, I had a chance. The offices are health hazardous and the fed employees are Ayn Randian classists madaf*kers enjoying their “single payer” while telling everyone else to “eat dirt” – something that would make Marie Antoinette and Adolph Hitler blush. I’ll never forgive the Demo Party for purposely allowing PPACA, bloated from the get go, to become a complete Repug giveaway.

  30. iamlegion says:

    The way private insurance companies profit is by denying claims by any means necessary. They’re not in business to keep people healthy and/or keep them from dying, bankrupt in the streets; they only want to make money. If people die to get them that next quarter’s mark, they genuinely don’t care _and_ there’s not a damn thing you can do about it. But a government _has_ to be answerable to all its citizens; not just one company’s shareholders. That’s why the social contract model applies to the public program, not the current private systems.

  31. NCMan says:

    One more time, this article is about buying insurance from the exchange or opting out and paying the penalty because you don’t think it’s a good deal. The article was not a discussion of whether we should have passed medicare for all. OF COURSE WE SHOULD HAVE.

  32. NCMan says:

    what do you mean by a small number of people? It seems to me that you are actively advocating for everyone to opt out and that would create more than a small number.

    I think a recent grad delivering pizza for a living is
    going to qualify for a full subsidy and get insurance at no cost based
    on income. And, one more time, I’ve always stated that I’m talking about those who can afford the insurance and choose not to buy it.

    I do go off on corporations that don’t pay their taxes. But, I do that in threads that are on that topic. Nice move though of bringing up something completely off topic to try to throw people off.

  33. Bill_Perdue says:

    Or move to Cuba, England, or some other country with decent health care.

  34. Bill_Perdue says:

    Democrats are Republicans in disguise.

  35. Bill_Perdue says:

    I like your sister.

  36. Ford Prefect says:

    My point is that’s a stupid way to administer a so-called “healthcare system.” Simply create one where there is no “opt-out” except in terms of not using it. That, by the way, is everyone’s right. You’re so worried about slackers “not chipping in” you miss the entire point. Lastly, you’re focusing on a small number of people to scapegoat for a system that will fail on its own, thank you very much. Go off on slackers all you want. It makes no difference at all.

    And while you’re at it, why not go off on all the rich people who owes hundreds of billions in taxes they’re so busy not paying. You think a recent college grad with student loans and a job delivering pizzas is a major problem for the system because they’re not “paying their fair share?” No dude. It’s the corporations that are the problem.

  37. NCMan says:

    Individual’s taxes pay for the fire department to be there for EVERYONE when they need it. As long as this person is paying her taxes, that would be the same as paying her health insurance premiums. The cost of treating cancer is vastly in excess of what an individual cancer patient pays in premiums. That’s what cost pooling is all about.

    I understand you think we should have medicare for all and should treat health care in the same way that we treat fighting fires. That way everyone pays their taxes and everyone gets healthcare. I agree with that.

    But, that isn’t what we have. And, this article was a discussion of the decision of whether to buy insurance from the exchange or to go without and pay the fine. Those are the two options we have. There wasn’t an option 3 to repeal and replace Obamacare with medicare for all.

    For me, then the discussion goes to the next step of what to do about those WHO CAN AFFORD to purchase the insurance but choose not to, remembering that there is no option number 3.

  38. karmanot says:

    That works! :-)

  39. mirror says:

    The thought that finally popped into my head about the traveling sister when I got to your comment was “At least somebody is out there doing something useful!”

  40. karmanot says:

    I disagree. Medicare for all.

  41. karmanot says:

    A terrible system.

  42. NCMan says:

    And, those who want to opt out of buying insurance and have their future health care costs covered by tax payers wouldn’t be able to “opt out” of paying their fair share of taxes that would be used to pay for universal healthcare. Again, you are talking about preferring medicare for all over Obamacare. But, this post was originally a discussion of the choice between buying insurance through Obamacare or opting out and paying the penalty.

  43. karmanot says:


  44. mirror says:

    I’m totally with you. I’m not just thinking about me. I want a system that just straight up insures everybody without making them beg. I’m willing to pay more for that, but looking at places like France, it is clear that we are already paying more for what we have. I’m not motivated by a wish to punish the lazy and incompetent that is sufficient to overcome my own self-interest.

    The paperwork and multiple bills now already require college level processing skills or higher in order to have any idea what is happening. All this making people beg for something that in the end will just make them feel cheated and insulted contributes to a less stable, just society.

  45. karmanot says:

    “—why should the taxpayers foot medical bills so that people can leave an inheritance to their children?” What nonsense and specious rubbish.

  46. Ford Prefect says:

    No doubt that’ll be BK Reform 2.0.

    As it is now, if you go to a hospital, they’re going to run a credit check on you at admittance. Too bad if you’re bleeding out with a score of 400.

  47. karmanot says:


  48. karmanot says:


  49. NCMan says:

    What is your definition of “routine stuff”? It’s my understanding that routine stuff, such as preventive care and annual physical exams are covered at 100% with no deductible.

  50. karmanot says:

    Hi Zorby! He means that the politics of resentment trumps logic and compassion.

  51. karmanot says:

    Yep, that works!

  52. NCMan says:

    Yes, medicare for all WOULD HAVE BEEN BETTER. But, that’s not what we have, is it? The choice being discussed here is between buying the insurance offered in the exchanges or paying the penalty and going without and rolling the dice.

  53. mirror says:

    Holy fuck, this is a rat fuck. I’m gettin more worried…

  54. NCMan says:

    and, you have already admitted that you don’t currently have any idea of what the quality of this health insurance is going to be. But, all of your other comments assume it will be bad.

  55. mirror says:

    Watch they have to pass laws adding health care bills to cc and student loans as unforgivable under bankruptcy….

    I’m a 52 about to have to buy individual insurance after 20 years of being covered under my partner’s plan. The “bronze” looks affordable, but I know I won’t be able to take the massive deductible and percent responsibility if I get badly ill. It would wreck our lives, so I have to figure out some way to get into the better plan. These “bronze” plans aren’t truly catastrophic because they still don’t protect you against bankruptcy.

  56. NCMan says:

    First, let’s get this straight. I’m not punishing anyone. I’ve stated over and over again that I’m talking about people WHO CAN AFFORD THE INSURANCE and choose not to buy it. Why is everyone having so much trouble understanding that concept?

    Secondly, what do you think should happen to someone who gets ill without health insurance when they had a large enough income to afford the insurance? Do you think they should be rewarded for this?

  57. mirror says:

    You are making the magic assumption that parents have employer provided family plans. Lots of wild assumptions underlying justification for Obamacare.

  58. Ford Prefect says:

    You couldn’t be more wrong about that. We eliminated polio and smallpox by vaccinating every child, not just those who could afford it–think about the socio-economic benefits of that, like productivity and not having to put people in iron lungs where they produce nothing but anguish. We almost completely eliminated Tuberculosis by improving public health programs. Your idea of “personal health” completely ignores all the various social and economic impacts of healthcare.

    Now, TB is coming back, that’s to our shitty healthcare system. Illnesses that cause financial ruin are a massive economic problem in this country. If you have an accident that requires physical therapy you can’t afford, we’ll just throw you under the bus and put you on a paltry SSI and let you suffer. People undergo unnecessary surgery because GREED. Households lose their “breadwinners” and thusly their standard of living because of “personal health” our system does not care to address–we even let them die because treating them is deemed unprofitable. Ever rising rates acts as a tax on society, confiscating ever larger sums from our pockets with nothing in return but lowered standards of living. All this is just so executives and other powerful interests can live like kings at our expense.

    The rest of the advanced economies figured all this out after WW2. They are all better off because of it. That also partly explains why their lifespans are growing and ours has been steadily falling for almost two decades now.

    So basically, bootstrapping is great if you want your kids’ lives to be shorter, less prosperous and subject to more disease, disabilities and so on. Healthcare is a common good. More civilized countries understand that. WE apparently are too dumb to figure that out.

  59. Whitewitch says:

    Whether truth or not…when you are living on the margins – a lottery ticket is often your only hope. Me…if I can work until the day I die I will be okay…if the unfortunate happens and I am not able to – all hope is lost.

  60. StraightGrandmother says:

    True, true, but aren’t those tangible things we all share in common? We all use the roads, we all might need the fire department. Our health is not shared in common, it is our personal health.

  61. Ford Prefect says:

    We’re looking at Bronze. Not sure what it will actually cost, as the rates are currently just guesses (thanks again to Lambert for helping us figure that out). Our reaction to the “plan” thus far is, “We have to pay that much for a shit sandwich?” Of course, we were saying that before too.

    In California, masses of people are being dumped from their individual policies and herded into the “exchange.” It’s going to piss off a lot of people. In this sense, everyone who doesn’t have a spiffy plan will be “rolling the dice” with their lives. We get to pay through the nose for stuff that likely won’t help us when we need it. And we’re relatively healthy people.

    Healthcare as a Roullette table.

  62. Zorba says:

    I have no damned idea why this country ever thought that leaving health care (well, of a kind, since health “insurance” is not health “care”) up to health insurance corporations. (Yes, I realize that there are HMO’s and a few others that are not technically “for-profit,” but they seem to be acting more and more like the for-profit insurers.)
    Insurance companies exist to make a profit. And, in fact, they would be remiss in their fiduciary responsibilities to their share-holders if they were generous in paying every claim that they receive, and the executives of such a company would be booted to the curb and replaced by people who would maximize profits. They don’t give a flying rat’s ass about their paying customers’ health. They care about their bottom lines.
    This is a totally stupid way to handle providing health care.
    Universal Health Care. Single-Payer. Medicare for All. Whatever you call it, this is what we should have, like most other civilized countries. Or, at the least, the Switzerland model, where the health insurance companies are severely restricted and monitored. Or, at the very, very least, an affordable public option.


  63. StraightGrandmother says:

    Ford, I have to agree that is a pretty shitty plan.
    What are the price option for you, Gold Silver & Bronze?

  64. Ford Prefect says:

    I’m not sure if I understand your question. The insurance company will allegedly pay 60%. But what if, through no fault of your own, you end up in ICU for a few days after an accident and you have to cough up 40% of $200K? It’s off the the poor house, assuming they don’t cut off your treatment because they figure you’ll default on it and let you die as a cost-saving measure. Don’t laugh, as that does happen.

  65. StraightGrandmother says:

    karmanot, some people in fact deserve the punitive incentive.

  66. Ford Prefect says:

    Not that I’m aware of. The literature thus far simply states that 40% of all costs are to be borne by the “customer.” That’s their way of simplifying it. But that 40% can be massive if you have an accident or something. You might lose everything, but they’ll still make their profits!

  67. Ford Prefect says:

    Just take a moment to consider all the ways taxpayers foot bills you couldn’t possibly pay yourself. Imagine if you had to pave your own street on your own, without the help of taxpayers not on your street. Or your sewer system. Or trash pickup. Or the fire and police departments–imagine how crappy those services would be if those costs weren’t spread out. Even your bank account is made “safe” by “taxpayers footing the bill,” to make them so.

    You’re missing the forest for the trees. You even think you’re not being subsidized by others!

  68. StraightGrandmother says:

    But isn’t this true, should you become ill and require hospitalization, the hospital and doctors are guaranteed at least 60% It is a serious question I am asking, thank you.

  69. StraightGrandmother says:

    May I ask a question Ford P. You say the Bronz plan pays out 60% and you pay 40%, Is there no “up to a certain limit” and then insurance pays 100%?

  70. Ford Prefect says:

    Take out the profit margin and you’ve just saved 20-30%. How’s that for starters? Treat medicines like public utilities and cap profit margins. There’s a cool Trillion over ten years right there, maybe. Paperwork would be reduced by something on the order of 90%. Maybe more. How much labor would be saved not having to deal with a couple dozen corporate bureaucracies’ different forms and procedures? (Think of all the Person-hours involved with that) Nurses could spend time with patients, instead of policing paperwork. You could reduce admin costs directly with that alone.

  71. StraightGrandmother says:

    I agree with you. The real working poor get subsidies. I have no tolerance for the ones who want to roll the dice, have guessed wrong and then file bankruptcy on the subsequent costs. The ones who say, “It is cheaper for me to pay the tax penalty than to buy the insurance so I’ll roll the dice” When they have a catastrophic illness I have no mercy.

  72. StraightGrandmother says:

    That is right. None of know, that is why we all should carry insurance.

  73. Ford Prefect says:

    Well, lacking a good argument to defend the policy, scapegoating is a time honored tradition! I especially like the argument that enjoying life is irresponsible and worthy of scapegoating. Given the way things are at the moment, it’s just a good thing we’re a big country with lots of potential scapegoats. To help things out, I’m going to start traveling more and drink more ale.

  74. StraightGrandmother says:

    But I guess on the other hand, why should the taxpayers foot medical bills so that people can leave an inheritance to their children? Shouldn’t people’s assets go towards their support before the general tax payers have to kick in?

    If Medicare paid for a ton of your medical costs and did not ask you to sell your home, once you pass away is it wrong for Medicare to take some or even all of the proceeds from the sale of your home once you are deceased?
    I KNOW these are hard discussions and I hope that I am conducting myself in a civil manner.

  75. lambert says:

    “It’s been known” for private health insurance. That’s one of the ways they profit (in addition to investing the money, or playing the ponies, or whatever they do).

    Why are you applying a private business model to a public program?

  76. Ford Prefect says:

    I’m not sure it’s “uniquely American,” but the phrase “exceptionally” works for me. Yeah, advocating nuking Saigon was a really level-headed move of that campaign. Kinder and gentler is a bit of a stretch though! And if her job is to get Dems elected, then she ought to be facing retirement in 2014, so at least we have that to look forward to!

  77. Naja pallida says:

    They say that the lottery is a tax on people who are bad at math… so then, what does that make insurance? :)

  78. Ford Prefect says:

    Indeed. The Politics of Resentment. Oh by the way, I just want to thank you for all your work on this issue. It’s made an otherwise opaque labyrinth of bullshit more understandable as we try to figure all this out. We have to, because we’re losing our insurance this year to be dumped into ACA.

  79. lambert says:

    No. That assumes the quality of the plan and actual payout, as others have said.

  80. lambert says:

    Saving $500 billion a year in insurance company overhead is a very good start. Having a single payer purchased gives a single payer system a lot of leverage on costs, too. Put a sane system architecture in place, and then you can start experimenting and tinkering with nudge-style incentives if you like. Trouble is, ObamaCare puts the cart before the horse by starting out with the experimentation and tinkering.

  81. lambert says:

    Sort of amazing how many ObamaCare apologists are motivated by petty hatreds of people they’d like to punish (the sister; beer drinkers). I never would have expected this. It’s bizarre. What a weird basis for public policy.

  82. zorbear says:

    Daddy sez that’s only half a sentence and that youngsters always leave off the second half of that sentence, possibly because they’ve never heard the whole thing. But you, karmanot, don’t have that excuse…What does he mean by that?


  83. lambert says:

    Yes, if you can afford a lawyer and have a suitable nominee. Also, the ethical point remains. What kind of a system is it that forces choices like this on people?

  84. lambert says:

    Yes, as I point out, I’m “making my point” by exposing the false assumptions in your argument. Smarter ObamaCare apologists, please.

  85. lambert says:

    So, what exactly are YOU doing to make that happen? Aside from punishing beer drinkers?

  86. lambert says:

    Right, but they were. So again, why not give the rest of us the same privilege? So you can get your rocks off punishing beer drinkers? (Gawd knows I’d like to, but I don’t make the petty hatreds I cherish the basis for pubic policy.)

  87. lambert says:

    “Prod people into obsessing about punishing others.” Reminds of that story about the genie who appears to a peasant and grants them one wish. The peasant considers for a moment, and then says: “I would like my neighbor’s cow to die.”

    There’s a lot of that going around.

  88. dula says:

    Nah you are critical of Obama because he’s a war mongering tool of the oligarchs, not because he’s black and a Democrat.

  89. dula says:

    Lol yes but she tries to spin her father’s policies as the kinder and gentler conservatism. Of course, she makes no mention of his Southern strategy. Now it is her job is to get Democrats elected, not to maintain any sort of political integrity. It is uniquely American to put your career ahead of your fellow Americans.

  90. lynchie says:

    Any form of insurance, health, auto, home, is good until you have a claim and see if they pay the bills. Hospitals and doctors will continue to extra bill patients having been paid less than they think is right and the patient’s insurance goes along and the patient is still moved towards financial ruin.

  91. lynchie says:

    Who are you to judge how someone else chooses to live. You still have to have cash to buy the policy and hope that you get a rebate in your taxes. Sorting through what you get for your money will be a monstrous chore and if you believe that the insurance companies are going to offer low cost, low deductible, low co pay policies you are delusional.

    In any case it is not always the cost but what they cover. I work for a huge multinational company. They just changed our health plan. A single person pays the first $3000 families pay the first $6,000. For me being single that is an extra $500 a month if I get sick on top of the $358 a month for the policy. You have to go to their in network doctor. My GP} and cardiologist aren’t in the network so they won’t pay. The closest surgeon is 45 miles away. Kids aren’t stupid. They see what is happening to their parents and so say screw it. The plan is flawed and all it did was deliver 45 million new people to the insurance companies with no cap on cost, coverage or freedom to see any doctor you want.

  92. Ford Prefect says:

    Well, she should know eh? Her father was Barry Goldwater’s running mate back in the day. So growing up Republican certainly gives her the insight she needs to know how they criticize people. I just love it when recent converts to the Democratic Party tell (we, who have decades of anti-GOP activities under our belts) what to think, even though her militarism tends to show her up as a closet Republican anyway.

  93. karmanot says:

    Nothing like the old punitive incentive. Everybody suffer….how sick (pardon the pun) and schadenfreude is that?

  94. karmanot says:

    Well sister, if you ever have to be hospitalized and they charge you $4.89 for a cue tip—-get back to me on how hospitals have to get enough money to operate. In France that cue tip would cost you about $.08.

  95. ronbo says:

    Like Karmanot, I had trouble with BC/BS. After paying for an individual plan for 7 years, I had to have surgery for a hernia. BC/BS refused to pay for it, calling it a “pre-existing condition”. I paid for both the surgery AND the insurance. BC/BS saw me as a profit-center cost, nothing else.

  96. karmanot says:

    “do everything possible to manipulate your declared income so that you stay in ObamaCare” explore trusts…….

  97. chris10858 says:

    I imagine most people, even if they are young and healthy will end up paying more for actual insurance, even if it’s just a catastrophic plan than to simply pay the penalty. I used to work in a trauma ER unit and I couldn’t count how many otherwise healthy 20-somethings came in due to a car wreck, accidental gunshot wound, or other stupid things that stupid 20-somethings do to land themselves in the hospital.

    Also, I got food poisoning a couple of years ago and had to go to the ER. All they did was to have the ER doc visit me for about 15 minutes total, gave me some morphine [to settle stomach] and a pink vomit bucket and I sat in the ER for about 8 hours. Total Price tag: $9,500. Thankfully, I have great insurance that negotiated their cost down to about $2,000.

  98. karmanot says:

    You’re all heart.

  99. karmanot says:


  100. karmanot says:

    “you are part of the far left who seek to criticize Obama like Republicans do.” Ironic that Dula—describes me to a ‘T.’ :-)

  101. karmanot says:

    Exactly. The corporate model is to violate contracts at all costs.

  102. karmanot says:

    I’ve said it before and I say it again GP, the quality you bring to these essays is just superb. I am someone, who experienced a catastrophic health event two months before my 65th birthday and lost my entire life savings, I am now under Medicare and because of ruin—under Medicaid. It is no mystery that the Obozoites have hidden and delayed the full substance of this monster of a health law. It is a cash mountain for the Insurance industry. I take no relief knowing that we seniors are covered while an entire generation or more, nor older folks under 65 are so vulnerable. Many of us hate it as much as the Repubs. I hate to say it this way, but there is some power behind the ‘death Panels’ histrionics and it has Obama’s name all over it. Obama betrayed the nation big time with this albatross, an albatross that has no cost controls. My opinion is still opposed to most it and I want full health care for all citizens. The regressive states have rejected it causing millions to suffer as a result.

  103. zorbear says:

    I will!

  104. Ford Prefect says:

    Having insurance is one thing. Having it payout when needed is another. How many people have been screwed by insurance companies and forced into suing them to have their “coverage” honored? Katrina anyone? Sandy? They’d rather lose the odd expensive lawsuit (ruining people along the way) than honor their contracts all the time.

    If having insurance guaranteed anything, that would make this easier. But they often just decide, “We aren’t paying because the shareholders will kill us if we do,” leaving people in the lurch. Whose terrible behaviors, after all, prompted the term, “murder by spreadsheet?” Insurance companies perhaps?

    This is why leaving healthcare in the hands of insurance companies always was a terrible idea. The Germans and Swiss regulate them within an inch of their lives, so it works there. Here? Regulation is apparently unAmerican or something.

  105. Whitewitch says:

    Case in point, a friend’s boyfriend who is 26 is suddenly dealing with colon cancer, quite expensive and unexpected. Sadly, illness is NOT just for the old and weak….it is a risk we all endure and it is not helpful for people like this Eskow guy to support the belief of the young that they won’t need health insurance. Legs break, accidents happen…get insurance (if you can afford it).

  106. Ford Prefect says:

    This is the problem with the whole discussion:

    Is the coverage any good and/or a decent value.

    It’s easier to determine what “good coverage” is than “decent value.” We’re not selling washing machines here. It’s insurance. If being sick or injured doesn’t cause one to lose one’s home, car and/or job, then coverage is probably pretty good. But if it’s still insanely expensive to get that coverage, then what does one say about it’s “value?”

    We already pay twice per capita for insurance what France pays for actual healthcare. They have the Number One system and we rank just ahead of Latvia and behind the Czech Republic, coming in at Number 27. ACA won’t really change that.

    ACA is going to fail and it will probably do so quickly. Once more people become educated as to the “new” system, most will likely hate it eventually. They’ll still see a huge portion of their income going to shitty corporations while getting little or nothing in return. I don’t see any value in that arrangement at all.

  107. Whitewitch says:

    In re the Flood insurance – it truly is a bitch when you don’t have it and you have a “flood” which is a result of your water pipes breaking and the insurance company says it is not covered because to them water = flood.

    I look at insurance as playing the Lottery – I buy tickets every Wed and Sat in hopes of winning, I have insurance (flood, car, health and life) in the hopes of never needing them.

  108. Ford Prefect says:

    With all due respect Becca, we’re talking about public policy here, not individual decisions. If rationality was an actual concern for public policy, they’d just expand Medicare to include everyone–IOW, make the policy rational, instead of coercing individuals to be “rational” in a way to will please shareholders. That would take the individual decision out of consideration entirely, unless one is a Christian Scientist or something. ;^)

    Still, the focus is on forcing individuals into doing things for the sake of some vague “greater good,” which is just about the profit margins of corporations in any case. The greater good in a better context would revolve around simply providing healthcare to all, rather than punishing recalcitrants who refuse to act as rent paying “customers” to rapacious corporations.

    But isn’t it great the ruling elites can prod people into obsessing about punishing others, rather than demanding healthcare for all?

  109. Ford Prefect says:

    Indeed, it was all intended to prevent Single Payer from becoming reality in the first place.

  110. Drew2u says:

    How does no cost-control measures make it affordable? We can get 100% of everyone on health insurance coverage, but if they’re priced out of the plans or they’re able to get a prescription but unable to afford the medicine, then where does that leave them?
    As it stands, with the tax de-bate (opposite of a rebate?) as an incentive for everyone to be insured, there’s – as far as I’ve gathered – almost no actual cost-control for prices of procedures or medication.

    With that said, I would love to see Bayer or Johnson & Johnson’s lobbying dollars compared to how much higher they price their products in the U.S. versus the rest of the world.

  111. NCMan says:

    You know for a fact that I am talking about the young idiots who think they are immortal and would prefer to spend their money on beer and the latest Apple gadget. Or, anyone, young or not, who just decides they would rather game the system and take their chances than pay for insurance. I’ve said, those who can afford to purchase insurance but choose not to. Yet, you insist on claiming that I am talking about someone who if they are actually in the dire financial situation you describe, should qualify for a full subsidy. So, back off…..

  112. nicho says:

    Nope. Still putting words in my mouth — just to make your own point.

  113. lambert says:

    No. The next step is to replace ObamaCare entirely with a system that guarantees health care coverage to all, as a right. Single payer Medicare for All.

  114. Ford Prefect says:

    People aged 50-64. Maybe that’s not “old” in your book, but based on what I’ve (and countless millions of others) been facing vis a vis “insurance” since I turned 50 (they gave me a 60% increase to wish me a happy 50th!), it feels pretty damn old when I dive into the paperwork.

    Here in Cali, the “Platinum” plan pays 90% and only wealthy people can afford it. The “Silver” plan pays 80% and one needs to be upper-middle class or thereabouts. The “Bronze” plan, which is where most people are intended to end up, only pays about 60%. One car accident and you’re done financially. So it’s largely the same as it is now, with a few minor improvements.

    I’m barely middle class at this point and will end up in Bronze, most likely. Having to pay 40% means virtually all the routine stuff will be out of pocket, in addition to monthly rates. I’m not a citizen anymore, I’m just a revenue stream to policy-makers. And that’s what passes for “reform” in this country.

  115. lambert says:

    It’s also a testimony to the sterling efforts of Democrats and ObamaCare apologists, who must prevent the examination of health care pricing at all costs, in order to maintain the profit margins of their contributors in the health insurance industry. Well done, all.

  116. NCMan says:

    Health care should be a right. We should have Medicare for all covered by taxes. BUT WE DON’T. So, no one who can afford insurance should be able to get away with not buying it and then expect to receive free medical treatment paid for by the rest of us.

  117. lambert says:

    Why do you believe your sister should be forced to pay for health care via the insurance system instead of via taxes?

    To put this another way, why are YOU forcing ME to pay for health insurance company profits, CEO salaries, bonuses, and a socially useless and parasitical system of rental extraction?

  118. NCMan says:

    the banksters shouldn’t have been bailed out.

  119. lambert says:

    You’re confusing health care with health insurance, and you’re assuming that all health care insurance available under ObamaCare will be good insurance at a good rate.

    Health CARE should be available to all, not health INSURANCE, if for no other reason than to have a boatload of money. Again, if the Democrats had passed single payer Medicare for All in 2009-2010, we would already have saved a trillion dollars.

  120. BeccaM says:

    I don’t disagree, and now we’re getting into the real meat of the discussion: Is the coverage any good and/or a decent value.

    I would argue (and likely agree with you) that the coverage isn’t good enough, that it could be much better and less expensive if we went single-payer, and most of all that profit shouldn’t be involved at all. Hell, in many places, utility rates are better regulated than health insurance premiums.

  121. NCMan says:

    here you are admitting that you don’t know whether the insurance is good or not while folks such as Monoceros Forth have already declared that they know for a fact that the insurance is rubbish and shitty. Apparently Monoceros has access to information that you don’t have.

  122. Jon Green says:

    That’s not what he’s saying. He’s saying that having zero insurance is worse than having any insurance. Especially since, unlike fire or flood insurance, you’re almost definitely going to use health insurance at some point down the line.

  123. lambert says:

    Speaking of those of us between the age of 50 and 65, interesting fact:

    ObamaCare “literature” consistently describes Medicaid as something that one is eligible for. In fact, the Exchanges FORCE you into Medicaid at a certain income level; there is no choice in the matter.

    This matters to over 55s because after that age, Medicaid costs will be clawed back from your estate.

    So if you want to pass on your house to your kids, and you’re “on the bubble” between the bottom income to get you into the Exchange or be forced onto Medicaid, the choice is: (1) go into Medicaid and tell the kids to forget about the estate, or (2) do everything possible to manipulate your declarted income so that you stay in ObamaCare. Not exactly a Sophie’s choice, but still an ethical issue. Bonus ethical issue: Should “navigators” et cetera recommend to 55+ people that they falsely state their income “just a little bit high?” Bonus legal issue: ObamaCare income declarations are made under penalty of perjury. Does stating your income “just a little bit high” qualify?

    Just another example of ObamaCare’s Rube Goldberg-eque complexity in action….

  124. Ford Prefect says:

    Okay, so we’re supposed to tailor public policy because of your wayward sister? I get that you don’t approve of her choices. Maybe I wouldn’t either in the same situation. But I’m not going to criminalize an entire population of people based on one personal anecdote… which is what you (and “Obamacare”) are doing. ACA does not provide one lick of “healthcare.” It only mandates an insurance policy which may very well to turn out to be crap.

    Lastly, to be accurate, the government isn’t forcing your sister to “buy healthcare.” It’s forcing her to pay rapacious rates on insurance, which is obviously not the same thing. She may very well not receive much of any healthcare at all when she needs it. But she’ll have insurance she may very not be able to afford!

    In any case, how do you justify lumping in tens of millions of people into your sister’s “category?” Because that’s what you’re doing and that’s the only reason I object to your “reasoning.” You seem to resent your sister’s penchant for travel and “having fun.” That’s your right. I just don’t understand where you get off judging millions of complete strangers on that basis. We are talking about public policy here, not one individual who likes to have fun and is in need of coercion to stop all that vacationing.

  125. Monoceros Forth says:

    What the fuck do you know about how people are choosing to spend their money? Do you know whom I have in mind, in all this talk about punishing people who won’t buy shitty health insurance? Not myself. Not some young idiot who thinks he’s immortal but rather an old friend, self-employed, barely holding his head above water, who now has to choose between buying a garbage health insurance policy or paying the penalty for not doing so. He’s probably just going to pay the penalty; the way he looks at it, if some really serious health problem comes up, he’s ruined anyway, whether he’s got a joke policy or not, and it’s marginally more affordable for him not to buy coverage that will cover nothing.

    But, oh, no, according to you, because he’s not going to buy some worthless “insurance” he must be spending his money on “non-essential things”! You self-satisfied twit. You want to feel superior to someone? Find another target.

  126. lambert says:

    Exposing, once again, the whimsical and capricious nature of the Rube Goldberg device that is ObamaCare’s eligibility determination system.

  127. lambert says:

    That’s exactly what you’re saying. Your assumption is that all fire insurance is worth buying. I reworded your comment to highlight the assumption (and, I might add, remove the deception).

  128. “Young people won’t be “glad” they have this insurance if they get sick
    and the discover they have to pay $10,000 in out-of-pocket costs after
    thinking they were insured.”

    They will if they think they bought catastrophic insurance, which is exactly what they CHOSE. If they want better coverage, they can pay a higher monthly premium like everyone else.

    $10,000 out-of-pocket beats $60,000 out-of-pocket which can easily be the bill for an emergency visit these days.

    Young people are not too dumb to get the idea behind catastrophic insurance.

  129. Ford Prefect says:

    Um, no it doesn’t. The cost of putting out a housefire is vastly in excess of what an individual pays in taxes. The only way to individualize that would be to submit an invoice for the cost of firefighting afterwards to the person whose home was just gutted. Fire brigades were originally made “public services” by Benjamin Franklin in Philly for just this reason: common resources act, in this case, as a benefit for all. It’s also much cheaper for the individual.

    Making public policy decisions on the basis of that kind of individualization is a sham of an “argument.”

  130. lambert says:

    Health care is a right. There should be no question of rolling the dice, any more than there’s a question of rolling the dice when you go out and drink from a public water supply. (I suppose, in that case, drinking bottled water would be considered morally superior…)

    NOTE This comment is, however, important, since it points out another consequence of ObamaCare, which will be hospitals gutting their ERs,