What is the “sticker shock” for ACA reform?

There is a new NBER Working paper on that topic, by Mark Pauly, Scott Harrington, and Mark Leive, here is the abstract:

This paper provides estimates of the changes in premiums, average or expected out of pocket payments, and the sum of premiums and out of pocket payments (total expected price) for a sample of consumers who bought individual insurance in 2010 to 2012, comparing total expected prices before the Affordable Care Act with estimates of total expected prices if they were to purchase silver or bronze coverage after reform, before the effects of any premium subsidies. We provide comparisons for purchasers of self only coverage in California and in 23 states with minimal prior state premium regulation before the ACA now using federally managed exchanges. Using data from the Current Population Survey, we find that the average prices increased by 14 to 28 percent, with similar changes in California and the federal exchange states; we attribute the increase primarily to higher premiums in exchanges associated with insurer expectations of a higher risk population being enrolled. The increase in total expected price is similar for age-gender population subgroups except for a larger than average increases for older women. A welfare calculation of the change in risk premium associated with moving from coverage that prevailed before reform to bronze or silver coverage finds small changes.

You will find an ungated version here.  The general point is that you hear enormous amounts of talk, including from economists, about what a success ACA has been.  This talk does not in general consider trade-offs or welfare calculations, as could be illustrated by these results.

Comments

"The general point is that you hear enormous amounts of talk, including from economists, about what a success ACA has been."

I did?

where?

I heard a lot of talk about it being a failure. The difference now is that some on the right have finally started to shut up a bit about it because it isn't really helping them politically.

Really?! Wait til the election season heats up after Labor Day. Prediction -- Republicans will talk about it a lot. Democrats will avoid Obamacare like the plague.

It's really been toned down. And now that you have Republicans actually taking votes to improve provisions of the ACA, it's over. Now I'm sure some will rail against it during the election cycle but the Republicans know that doing that isn't going to really change anyone's mind on who they vote for, especially now that the law is basically doing exactly what it is supposed to.

That's a laugh. What has happened is that the failure of Obamacare has been supplanted by an ever expanding list of disasters brought to us by the SCOAMF. Hard to keep focused on one disaster when a new one seems to appear each week (or day).

Hard to focus when you use Fox News and related sources as your information source.

"Hard to focus when you use Fox News and related sources as your information source."

I related you comment to my wife and she remarked "that's what they all say."

**The general point is that you hear enormous amounts of talk, including from economists, about what a success ACA has been.**

This is one of those times when I see Tyler and I live in different countries, maybe even different planets. In my country, no one talks about the success of ACA. If the subject comes up, it is always negative like when I had my plan canceled. In the land where Tyler lives, the land where these laws are not applied, they spend their days holding "Celebrate ACA" parties.

... First, health reform is now a reality — and despite a shambolic start, it’s looking like a big success story. ...http://www.nytimes.com/2014/06/16/opinion/paul-krugman-health-care-and-climate-president-obamas-big-deals.html

Once again Krugman sticks his figurative foot in his mouth.

"Remember how people who signed up weren’t actually going to pay their premiums? The vast majority have."

Mr. Krugman should have read his own newspaper from the day before:

Reference: "June 15th, 2014 WASHINGTON — The Obama administration is contacting hundreds of thousands of people with subsidized health insurance to resolve questions about their eligibility, as consumer advocates express concern that many will be required to repay some or all of the subsidies."

http://www.nytimes.com/2014/06/16/us/thousands-to-be-questioned-on-eligibility-for-health-insurance-subsidies.html

I notice the micrscope for Obamacare fail seems to be getting more and more powerful. At first we were told it would trash the whole system. Then it was those using the website. Now it's hundreds of thousands being asked follow up questions about the applications (ohhh yes, before the ACA people who brought their own insurance had never had to do any paperwork!). What will it be tomorrow? Obamacare has failed because Ms Jenkins in Idaho had an appointment at 2PM but was made to wait until 2:15?

Or we can report on what it has well. Much quicker reading.

Time will tell, Boonton.

No, it is following the script detailed by Henry Riecken, and Stanley Schachter fifty years ago.

yes, democrats, you do have to pay for the tax you you vote for lol

I am guessing they didn't calculate in the cost paid by people who actually got seriously ill when had the old plans that didn't actually cover anything. Yes , real insurance cost a bit more than fake insurance.

Yep, all those dudes and geezers who didn't know that they could get pregnant.

Ironic, too, what some people consider "real insurance".

By the standards of some people, "real insurance" for their cars would cover oil changes and worn parts. Actually, that is NOT "real insurance".

But it comes a bit closer to the idea of health insurance practiced in essentially all other industrial nations, resulting in a cost savings of a third or more compared to American health costs.

1. No it doesn't.
2. Those other countries will be changing soon enough.

Cars are a bit more simple. Accidents tend to be very discrete events with measurable costs. But warranties are a better example and a type of insurance as well. There you get a clear relationship of the complications at play. On one hand a warranty covers repairs, on the other hand repairs are influenced by consumer behavior (such as being tardy on oil changes). So warranties often use a carrot and stick approach to try to avoid bad consumer behavior from inflating costs.

Some health costs are discrete, somewhat predictable costs (like planning to have a baby). Many are not.

So let me see how you think health insurance works.

Say you have a company that writes a lot of policies for old geezers...say it just happens that way...perhaps your best sales guy hangs out near a country club with lots of chaps in their upper 50's and early 60's.

So you think if the gov't says you must cover pregnancy this will cause you to increase your premiums because 'pregnancies cost money'...even though you'll never have to worry about such a claim from those in your pool.

And you're not just an engineer but 'The Engineer'. Very impressive.

That's really not the point, is it? We're talking about individual policies, aren't we? And we're talking about the lack of choice in what these policies cover and do not cover.

Not to mention that pregnancy is not an insurable even when you have a real definition of "real insurance". In "real insurance", routine pregnancies would be out of pocket expenses paid for with SAVINGS.

No, what you guys are calling "real insurance" is nothing more than a prepaid health care scheme to use pre-tax money to cover health related expenses, with a small "real insurance" component tacked on.

If you pick and choose what is covered you create a 'cost death spiral' where consumers try to buy coverage only for diseases they think they will get or have and insurance companies try to sell them only coverage for things they won't.

No, what you guys are calling “real insurance” is nothing more than a prepaid health care scheme ...

There's no law of physics that says insurance cannot be combined with a system of prepaying something. In fact life insurance, the original insurance, is very much like that.

And it is the point, at least in reply to your comment about old geezers getting prenant. For any insurance system the cost is tied only to the incident. If no one gets pregnant, then 'covering' pregnancy costs nothing. I could very easily write you a billion dollar policy against being eaten by zombies, I'll charge you $0.05 per year and at that it would be over priced. That's a point that is unrelated to a philosophical discussion of whether you think pregnancy should be covered via insurance or via some type of savings system.

I dunno, 20B:1 against zombies might be quite a value. I'd pay 400x that and spend some time trying to tweak the definition of "eaten" "by" "zombies" to get my $1B payday. Although I'd be pretty concerned about counterparty risk on that one - I get eaten by zombies and you skip town? I'm out $20. And... I've been eaten by zombies.

All they all impotent or infertile?

Or do you think that they should have no liability for the costs associated with a pregnancy that they are responsible for?

This is a lie that you either a victim of or a perpetrator.

A welfare calculation of the change in risk premium associated with moving from coverage that prevailed before reform to bronze or silver coverage finds small changes

Seems like a pretty serious problem with this paper. If you compare self-pay plans before the ACA to self-pay plans after you can't just look at price but also at what the plan covers. The sentence above, if I'm reading it correctly, seems to be saying if you opted for a cheaper ACA plan you're paying about what you paid before the ACA. That would imply those who are paying more are doing so because they want to have a more comprehensive plan that covers more and are willing to pay for it (otherwise why not just go for the bronze or silver plan and pay about the same?)

I agree that quality of previous health coverage needs to be considered when doing a comparison. Simply saying something cost more can be pretty uninformative. My car price went up! But now I have a new Ford Fusion instead of a broken-down Escort.

What units are used to quantify coverage? Potential payout? Actuarial risk shifted? And isn't the expected value of the lifetime payout of insurance equal to the sum of the cash flows of the payments, plus a few $$ for administration/profit?

This talk does not in general consider trade-offs or welfare calculations

which the above doesn't talk about either. If group A pays more in premiums because the risk pool is expected to have more sick people in it, the other side of that coin is where were those sick people before and who was paying for them?

Tyler's statement makes sense if you think that he regards Ezra Klein and Matt Yglesias as economists, and spends a lot of time reading them.

".....average prices increased by 14 to 28 percent"

That's huge.

Is there some way of translating that into a CPI increase? If healthcare is 16% of the economy, can I say that there will be a one-time increase in CPI of 28% X 16% = 4.48%?
That seems high, but there's got to be a real jump in inflation with price hikes like these.

1. Something like 90%+ of the population either gets health coverage through their employer or a gov't program like Medicare/Medicaid/VA. So you're talking about a very small group of the population that actually buys health insurance the way you buy auto insurance....by going to different companies or using a broker and then writing a check to pay for it.

2. You can see this from your figure. If healthcare was 16% of the economy, a 20% increase would make it now closer to 20%. A shift of 4 points of GDP into a sector in a year or two would be a massive shift in the economy. Yet even though the health care sector has plenty of spending in it, there's no evidence of such massive expansion in such a short period of time. In fact it appears to actually be somewhat flat or slightly negative recently.

There's research and data to support effort point of view on every subject. So much for scholarship. The sad thing is that much of the scholarship is being conducted at colleges and universities, or what I refer to as the higher education industry.

"There’s research and data to support effort point of view on every subject."

No, not really.

Those opposed to ACA have not done a good job of pointing out how the trade-offs could have been improved.

"First, do no harm"...

Do you honestly think the existing, pre-ACA system was "doing no harm"? Or was it just working fine for you, and you generalized that to everyone else?

Straw man. You must be an adherent of the Obama school of rhetoric. Pre-Ocare was not perfect, but now we have seen that we can do worse.

"Those opposed to ACA have not done a good job of pointing out how the trade-offs could have been improved. "

LOL, have you missed the news for the last year? There are plenty of people reporting on the large premium increases versus the premium drops that were widely touted by Obamacare proponents. Everyone currently paying a higher fee realizes that from their point of view the trade-offs would have been better without Obamacare.

"There are plenty of people reporting ..."

Which is why Repubicans can't seem to find a single example of such a real person for their commercials and instead have to use actors.

Your post seems to imply that the premium increases aren't real, but anecdotally my 20%+ increase this year was very real. And more objectively, the source story indicates that on average people are paying higher rates this year:

"Using data from the Current Population Survey, we find that the average prices increased by 14 to 28 percent,"

I'm kind of pondering whether you a) didn't read the actual post or if b) you just don't care what the facts are?

See my comment below on 14-28% increases. If there's been a 20% increase in health care spending over the last year that would represent 4+ points of GDP moving which would be a massive shift in the economy. No such health care boom has happened.

You paid +20% for exactly the same coverage?

Average price point can go up at the same time value goes up.

If everyone gets a price increase of 20% then suppliers of health care also see 20% more income (either because they charge more or they get more patients). For the entire economy that would represent about a 5 point increase in GDP spent on health care. For that type of move to happen in a single year would be massive and we'd see a lot of evidence of it.

Now a tiny piece of a segment of the economy can increase a lot in price but it have no impact on overall spending.

This is a poor argument. Most normal people don't want to be political footballs, to be used and discarded by your "friends", and to have one's name and family's name dragged through the mud by enemies. I know several people whose premiums have gone up a lot but will only grumble to friends and family.
And lastly, trotting people out on camera will never combine the ACA defense force because they will always summer those are just rare exceptions.

Most people don't, but it's rare to piss off a lot of people and not being able to find one to complain publically. The idea that millions of people are chafing under horrible ACA plans but are afraid to go public because of peer pressure to support Obamacare is absurd...esp. since Red State politicians are tripping all over themselves trying to one-up each other on Obamahate.

I am sure there are many working class Red State Republicans who would like nothing more than to appear on Hannity and Sons (or whatever) and get all red-faced about how they're getting ripped off by the ACA, or perhaps even forced onto Medicare.

The fact that there are not is very telling. None can make it past even a cursory fact check.

I suppose these are only anecdotes, but just today there was a thread on my Facebook with approximately 10 people I knew from college (UC San Diego, Class of 1998) complaining about both the increased costs under the ACA and how impossible it was to get actual coverage under their new policies (seemingly due to the insurers dropping all of their old providers from coverage, or from insurers inability to figure out how to offer coverage and comply under the new rules).

The nitwits in the press don't understand the distinction between private GROUP insurance (90% of those covered by private insurance), which is largely unaffected; and private INDIVIDUAL insurance (10% of those covered by private insurance) which is regulated by ObamaCare. The number of people seeing rate increases is a share of that 10%, so a very small group. Esp. compared to the number of people now able to get coverage.

The small business I work for dumped their group insurance policy. Who knew 2016 was such a magic number when more changes come?

I hope this trend continues - it is absurd that so many people have their health insurance linked to their jobs, especially in an adaptive economy. Why should me going from one employer to another affect if my daughter can continue to see her pediatrician?

Sure it does. Not all networks are the same, especially with HMOs. If I go to a new employer, one of my decision factors has to be "what ideosyncratic decision did some HR functionary make five years ago regarding their health plan and network choice"?

That's just silly and has nothing to do with my interest or ability in the job.

The number of people "able to get coverage" is directly related (among other things) to the number of people seeing rate increases. This makes me doubt your relative numbers.

Something like between 1.7-10 million people are newly insured under Obamacare. Why do you think that number dwarfs the share of the 10% having their rates increase?

"What the exchanges appear to be doing is mainly helping people who were previously insured.... thanks to taxpayer-funded subsidies and higher premiums for young people."

http://www.forbes.com/sites/theapothecary/2014/05/10/new-mckinsey-survey-74-of-obamacare-sign-ups-were-previously-insured/

How exactly did that happen if Obamacare supposedly cancelled everyone's plan? Or as they estimated the plans covering about 2M people? If 8M signed up on the exchanges you have a 6M difference (and that doesn't include those who got covered under expanded Medicaid).

How did what happen?

I think your point seems to be that it didn't do much damage because it didn't do much good, either.

Let me do that again for you. The claim was made that 2M policies got cancelled due to the ACA. So if only 2M people signed up in the exchanges I would agree that would seem to just be an even swap....but 8M signed up so clearly there's a 6M+ difference there in private health plans alone before you toss in Medicaid expansion. When you do there's really no way around the fact that coverage has dramatically expanded in the US with no detectable impact on the 90%+ of people who were already covered before the ACA.

Chait is not an economist, but he has plenty of articles talking about ObamaCare successes. Here's a good example/rundown: http://nymag.com/daily/intelligencer/2014/06/todays-obamacare-non-train-wreck-news.html

ObamaCare opponents are frantically moving the goalposts. "Nobody will sign up!" 8 million signups. "Okay, but it will be only old sick people" 28% are 18-35, enough to prevent death spriral. "Well... nobody will pay their premiums" > 85% pay. "Erm, insurers won't participate" Participating insurers will increase in 2015, not decrease. Yes premiums on the individual markets rise, because they can no longer screen out anyone with health problems. That's a feature, not a bug. Z - care to mention the new plan you got?

I used to be able to count on Tyler for a smart conservative perspective, but it looks like he's also fallen to ObamaCare Derangement Syndrome. Remember this gem from October? "6. The exchanges will be mostly working by March 2014, but by then the risk pool will be dysfunctional."

Remember, the abstract above mentions that bronze and silver plans see little change. So that sounds like the increase only happens if someone is selecting the more comprehensive plan...which to me sounds like people are choosing to pay for more coverage. What then is the problem with that?

Thanks Boonton, for making a very legitimate criticism here, instead of the typical lefties here like VTprof, who spout nonsense or who quote noted dishonest hacks like Jonathan Chait.
I'd like to hear someone address that point about bronze and silver plans.

Which of those facts where "nonsense", exactly? Can you refute them with facts?
http://acasignups.net/

That is the welfare calculation. I assume that is a net-net assessment.

I'm not clear how it can be.

If you told me before Mr. Smith was happy to spend $500 a month eating out rather than having coverage but this year he has a $500/month policy because he's been 'forced' too...you can do a welfare loss on that.

Mr. Smith was spending $6K eating out. Now he spends $6K on coverage. The mandate is, say, $90 so we can assume Mr. Smith values coverage at $5910 or more. If he valued coverage any less he'd opt to just pay the penalty. If he valued it much more he would have spent his $6K pre-ACA on coverage rather than other things. So his welfare loss is no more than $100.

BUT say Mr. Smith had coverage for $400 a month. He goes to Obamacare and sees plans for $400, $500 and $600 a month. He opts for the $600 plan because it covers more. How do you now calculate a wefare loss? if Mr. Smith wanted to stick with a lower coverage/lower price plan he could have choosen the $400 one. Instead he opted to get more. Is that a welfare loss and 'price increase' or a change in consumption choices?

"ObamaCare opponents are frantically moving the goalposts."

Well since you brought up moving the goalposts, how about these gems:

"'If you like your health care plan, you'll be able to keep your health care plan'" - Barack Obama

"The only change you’ll see are falling costs as our reforms take hold."" - Barack Obama

""If you like your current plan, you will be able to keep it. Let me repeat that: If you like your plan, you'll be able to keep it."" - Barack Obama

“In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year.” - Barack Obama

The Left has a habit of projecting their defects onto their critics, real and imagined. In fact, it is a defining trait of cults. When all of the promises of ObamaCare failed to materialize, the cult was crestfallen. But, they have rallied and are now pretending it was a great success. In order to avoid defending these absurd claims, they are pointing the finger, claiming you evil right wingers are "moving the goal posts."

So... what's your definition of "success" or "failure", exactly? By what criteria has ObamaCare "failed"? What would have to happen for you to say that it had succeeded?

Another good example of shifting the focus from your defects onto some other place. It is the default response from you guys.

"So… what’s your definition of “success” or “failure”, exactly? By what criteria has ObamaCare “failed”? "

I'll go by the President's own metrics.

Obama (Bristol, Va., June 5): "In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year. And we’ll do it by investing in disease prevention, not just disease management; by investing in a paperless health care system to reduce administrative costs; and by covering every single American and making sure that they can take their health care with them if they lose their job. … And we won’t do all this twenty years from now, or ten years from now. We’ll do it by the end of my first term as president of the United States."

You're not really talking about Obamacare but campaign promises Obama made before he was elected to his first term, many made before the financial collapse! I'm fine with that....just like I'm fine judging Bush a failure for his promise to eliminate the national debt.

I'm sorry JWatts, but we have to take you goal off the board. Boonton moved the goal posts so your point no longer hits the mark.

we aren't talking about goal post shifting. We are talking about what's a reasonable metric to measure Obamacare.

If you want to use pre-2008 campaign promises, fair enough. By that metric the US has never had a successful president or policy.

A more helpful and sensible measure, though, is to ask questions like "on balance is this a good policy? Does its pros outweigh its cons? Would the most efficient way to improve this policy be to tweak it as data comes in or scrap it entirely and put some other structure in its place" By that measure it's actually coming out not just good but surprisingly good.

"we aren’t talking about goal post shifting. ..."

First, you imply that somehow holding Obama to his very own statements is unreasonable. And then you precede to shift the goal posts to vague and hard to measure qualities. And then you declare a score through your freshly erected goal posts.

Your post is almost an example of Poe's Law. If I didn't have the other posts to go by, I'd suspect you were sarcastically pulling my leg.

95%+ have kept their plan and of those who didn't it's actually a challenge to find real examples of equilivant plans that cost more than for a given level of coverage (note, yet again, that the study above even asserts silver and bronze level plans saw little change).

I suppose if you want to play a stickler then strictly speaking 'everyone' out of the 300+M people in the US didn't get to 'keep the plan' they liked. But far more did than would have under any other plausible reform option and, of course, 'keeping you plan' was never an option before either as everyone is familiar with the yearly increases that plans feature, changing around what is covered and what isn't, which doctors are in and out etc.

I suspect you are conflating a lot of things.

http://www.cbsnews.com/news/how-obamacare-will-change-employer-provided-insurance/

"If you're one of the 80 percent of Americans who is insured or covered through an employer plan or through Medicare or Medicaid, or the Veterans' Administration, there is no change for you except for an increase in benefits that everyone receives as a result of the Affordable Care Act," White House spokesman Jay Carney said Tuesday

That "increase in benefits"...

Medicare did in fact eliminate the drug coverage 'donut hole'.

Uhhh, medicare created the drug coverage loophole.

Anyway, the point is, more than just the exchanges are affected. And you can't really claim that the negative effects are small unless you also acknowledge out that the positives are also small.

If the program is small, that is one thing. If it has only started to kick in, that's another. But you can't compare long term benefits to short-term costs.

Not following this. It was asserted that Obama's statement that those on gov't insurance would not see their benefits cut, if anything increased. Fact is Medicare is by far the largest gov't medical program and it existed before Obamacare and by closing up the hole Obamacare increased Medicare. That's not a partisan statement, it's a statement of fact.

"But the previously uninsured who will receive minimal subsidies, who constitute a sizeable fraction of the uninsured population, are estimated to experience a very large increase in financial responsibility. Not only will they have to pay significant premiums but, because of increases in total utilization because of moral hazard or greater willingness of providers to supply care, their responsibility for out of pocket payment will also increase."

And what did these people do before? Get hit hard with unexpected expenses and utilize publicly subsidized care, or go bankrupt because they did not plan ahead and cannot afford the care. Also, there is a lot of pent up demand for services for people who did not previously have insurance. This is not surprise. If they have neglected their health care needs for years, they will use services. The concept of moral hazard is particularly interesting in health care. What one wants and what one _needs_ in terms of care is a tricky question.

"Also, there is a lot of pent up demand for services for people who did not previously have insurance."
Great point. Like how I didn't have home insurance for a few years, then, once I got it, four trees hit my roof simultaneously. Because I had pent-up demand for it.

I think you have no idea how health insurance works in country. It's not purely catastrophic coverage.

On the other hand, you could be mocking all folks who insist we can treat health care like other market good.

What I'm mocking is the idea that health insurance is insurance at all. It's obviously not, because insurance doesn't create a "pent-up" demand. If I buy comprehensive car insurance it's not because I have some burning desire to have a car wreck but just haven't been able to afford it. It's more like a prepaid medical service, and the only thing we're really arguing about is the proportion of the fees that should be paid by the user vs. Uncle Sam.

You are correct that health insurance serves dual purposes -- it is like a prepaid medical plan, but it is also true insurance for catastrophic events.

There is no question that people forgo needed care because they can't afford the fees to pay for it when they don't have insurance. It is likely they can't afford insurance premiums in general either, which is why we have Medicaid for those folks, as well as the federal subsidies for low-income people on the exchanges. There is in fact pent up demand for treatments that people really should have received but put off because they weren't absolutely necessary at the time. Now that more of these people now have insurance they are of course going to be more likely to get that care.

This is not surprise. If they have neglected their health care needs for years, they will use services.

Is this supported, or just a spitball explanation?

I have had an individual health care policy in Washington state for six years. My premium and deductible did go up about 25%, but benefits were added. For example, I had no coverage for drugs, but I do now. My catastrophic plan, in other words, was discontinued for me. I can, if I desire, apply for an exemption that would allow me to buy a catastrophic plan once again on the grounds that the raise in my premium and deductible are unaffordable for me. It's very hard to know, as yet, how this shift or trade-offs will work out for me financially, so I'm accepting this new plan for now. I also, just to see how it would work out, applied for Washington Healthplanfinder. It was very easy to do, but I didn't accept the coverage offered for personal reasons.

I am a supporter of the ACA and Washington Healthplanfinder because I support some form of universal health care coverage. A number of people I know can now get healthcare free, which is what they need. The biggest problem among my friends who qualify has been qualms they have about the plan, most of which, but not all, are misinformation, so they were slow to sign up or didn't. Of course, they will get treatment if they really need it, via really expensive options.

Now, I assume, and have had from the beginning, that there will be changes to the ACA going forward. The main achievement of the ACA was to recognize a form of universal coverage. If people would offer improvements in good faith, I think we could alter the plan as needed, but I'm not seeing a lot of good faith. When I want to learn something about the ACA, I find the following site useful: https://www.healthcare.gov

Finally, this is the basis for what I would actually like to see in healthcare: Wow. I can't find it. It was an interview of Milton Friedman done in 2001. I'll try and dig it up. In any case, I would like to see changes to our current system.

The good faith arguments you seek are out there, and have been for a long time.
Separate health insurance from employment. Make health insurance into real insurance (allow catastrophic only plans) Subsidize such plans for those who really need it. Deregulate health insurance, and allow interstate insurance. (Note that before he choose to shill for the ACA, even a partisan like Krugman supported many of these recommendations).

These are basically the complete opposite of the ACA, so it's hard to make subtle improvements to a system that is headed 180° in the wrong direction.

Throw in a financing component and I am there.

No, good faith in this context means to "come to the bargaining table" where you can have anything you like as long as it is ACA, as long as you raise the status of ACA.

I was at the bargaining table. Nobody came.

Pardon me? What table? Plus, who are you?

Someone who wanted to keep the one type of insurance shown to reduce costs.

I realize you are new around here.

And I refer to the negotiating that democrats complained Obamacare wouldn't have sucked so bad had Republicans not offered even worse ideas.

The ACA has low end plans that swap higher consumer out of pocket spend in exchange for lower premiums. The exchanges do actually make it viable to have a market where people are not using their employers to buy health insurance. Even interstate insurance is allowed since there's really no reason why an insurance company wouldn't essentially have a single plan that's sold on multiple state exchanges. High end employer provided plans also lost some of their tax favorability (the so-called Cadillac plans).

People who talk a game like triclops often care more about making demands and don't bother to see when they actually win some of them.

That's funny, because they kept telling us we were naive to think interstate insurance was even possible.

Now you tell us they gave us what we want. That's interesting news.

Because, if it was so doable, it's odd they didn't just stop keeping it illegal sooner.

Good faith, triclops, would involve humility on your part, and some real specificity, not general statements. Without addressing the power of the Insurance Lobby, AMA, or Pharmaceutical industry, I can't even begin to take your good faith seriously. This is where I would start, but it's just the general direction I'm coming from: http://www.forbes.com/2009/06/18/milton-friedman-medical-insurance-opinions-columnists-health-care.html

Weird. The interview with Milton Friedman about health care reform that I find the best starting point for understanding health care reform is now a dead link:

http://www.hoover.org/publications/digest/3459466.html

The ACA doubled down on the broken employer-provided-insurance-pays-for-everything model. The single most problematic issue with our healthcare system is the purchasing structure. There is no way we would have ended up with a system that features one party purchasing the equivalent of a service plan and extended 3P warranty (note: not an insurance plan) on behalf of the one who would ultimately consume the services if it weren't for some historical distortions involving price controls, and then current tax structures. The consumer is two steps removed from caring about the ultimate price of the services, or having any power to really negotiate anything.

We really need to separate out medical care into 5 baskets (maybe the first two could be combined; same with the last two): 1) Real public goods, like vaccinations; 2) basic diagnostic and preventative care (if the government is picking up the tab, this essentially included in 1); 3) Basic medical care; 4) Catastrophic injury care and rehab; or 5) long-term deadly disease care.

In my mind, the government should pay for 1 for sure; I could be convinced that it should also pay for 2; people should pay for 3 themselves; and insurance should be purchased or a socialized risk pool created to cover 4 and 5. To the extent genetics advances to the point of eliminating uncertainty on diseases, this may need to be socialized, which would essentially mean that instead of insurance people would pay into a government-controlled pool that is set up like something akin to insurance.

Unfortunately, passing the ACA put us a lot further from getting something like that.

Did the ACA 'double down' on employer provided insurance? The exchanges provide a sensible way for people to buy insurance on their own. I can easily see them being used by a growing army of free lancers who mix and match multiple jobs during their careers and can't be easily tied down to a single job for insurance. Likewise the ACA reduced some tax benefits for the upper tier employer provided plans.

So actually the ACA took, if anything, a half step away from the 'your job = your insurance" model. I understand you want to burn that model to the ground but if the model is so bad then the rewards of taking the half step should demonstrate their merit over time.

My premium and deductible did go up about 25%, but benefits were added. For example, I had no coverage for drugs, but I do now.

To make a fair comparison then at a min. you should compute what you spent on drugs pre-ACA, subtract what you spend post-ACA now that you have some coverage for drug, and then subtract that from the increase and see what % you are left with.

That's why I said this:
"It’s very hard to know, as yet, how this shift or trade-offs will work out for me financially, so I’m accepting this new plan for now."

Well, Obama did publicly apologize for his clearly incorrect statement about people being able to keep their health care plans. I understand that will not buy you a cup of coffee, but he did indeed fess up that he messed up on that one, even if it took awhile for him to do so.

Regarding rising costs, I am not sure if this paper is about something happening in the future or something that has already happened. As it is, I just googled health care costs and got an April 1 USA Today story saying that indeed health care costs rose at an annual rate of 5.6% in the last quarter of 2013, the highest rate in 10 years. It attributed this increased rate of increase to higher spending on hospitals, although seemed to be unable to pin down exactly what lay behind that. In any case, it was not rising health insurance premia that was the cause. Somebody named Dales at Capital Economics was quoted as forecasting a 2.5% rate of health care cost inflation over the next 2 years, and he was hyperventilating that this would force the Fed to raise interest rates. Maybe, but he did not mention rising health insurance premiums as a factor, but maybe he is just stupid and the official data are all cooked, not taking account the wisdom of this study. In any case, maybe the premia are on average rising at the rates declared in this paper, but somehow they are only translating into a possible 2.5% overall rate of health care costs. Horrible.

He apologized? That's good stuff, Barkley.

Will he apologize for lying about everything he said about the NSA as he tells them to carry on, as they were?

Andrew', what's your point? Only President Obama lies? Plus, would it kill you to reference what you're claiming?

I wonder if John Roberts considers increased premiums just an outsourced tax.

The two families I know that were affected directly by this had their rates double, and one of them lost some preferred doctors in the bargain.

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