Obama Damages Dems

[GandD 5,966]

fix a family doctor. ?? Is he broken ?

I went back and fixxored with my super ultra mod abilities

Too bad I can't change the quoted post. Alas, only the great penguina has that ability.

[Boiler 46,338]

So you are a numbers guy...what are the numbers that show it will fail?

Will it probably fail or definitely fail?

Will is not fail ( succeed) with a minor course correction as opposed to a restructure?

The folks with a leftward lean have always ( even before the act was enabled) dismissed the ACA as not being a plan for single payer universal health. They viewed the ACA as a rehash of the a Market based reforms advocated by the Heritage foundation ( not a left org)

The situation is very similar to compound interest.

Now this graph is putting a positive slant assuming 6% real rate of return which seems to be what OCare costs are going up by.

As an aside Colorado last I heard was using 8% as a real rate of return.

How many years will it take at 6% to consume the entire US GDP which is effectively static?

So something has to give, GDP has to go up significantly or medical costs contained. The former seems unlikely and Obama did nothing of consequence on the latter.

[TBoneTX 46,356]

I suspect that "medical tourism" will burgeon.

[Rob L 3,811]

A few issues with data and a few issues with the suppositions

Boiler: The situation is very similar to compound interest.

I agree the issue of medical services inflation is similar to the concept of compound interest. I think your retirement example demonstrates the inverse: The longer you wait to save for retirement, the harder you have to work because you don't have the miracle of compound interest working for you

Boiler Now this graph is putting a positive slant assuming 6% real rate of return which seems to be what OCare costs are going up by.

According to Y Charts

"US Health Care Inflation Rate is at 2.45%, compared to 2.47% last month and 2.00% last year. This is lower than the long term average of 5.43%. Category: Consumer Prices."

So not good based on the current inflation rate of 1.58%...but much better than recent historic norms.

Again inflation is not a rate of return, but it does compound.

How many years will it take at 6% to consume the entire US GDP which is effectively static?

First issue with this statement:

US GDP is not effectively static but grows at an annual rate of > 2.2% in recent years. When you have a GDB of 17 trillion dollars, it is simply not possible for the US to maintain a growth rate of 8 % like Tajikastan unless you have Douglas Adams writing the narrative. I started my career at Microsoft when our projected stock value was on track to exceed the Asset base of Germany. The smart money knew that would not sustain itself...they were right and my options went underwater. At least I did not borrow against the options

Second issue:

How many years will it take at 6 % to consume the entire US GDP?

Well because the the value of of the revenue that goes through the health care is apart of the GDP measurement..never. But I think you are not looking for a smart ### mathematical answer but the answer to the question: "At what point does the percentage of health care of GDP becomes unsustainable"

The US government studies maintain that at the current projections in 2024 1 in 5 dollars spent in the US will be spent on health care. http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2015.0600

This is due to several factors including the greying of America( good thing the ACA has that secret death panel clause) , extending longevity (damn medical advances extended our life) and the expansion of new technologies and therapies to make our lives longer, better, more fulfilling and ...healthier. This also includes that Justin Bieber Grill work I have been saving up for. Inflation is the biggest part of expansion , but even negative inflation will have our % of GDP grow

The situation is very similar to compound interest.

Now this graph is putting a positive slant assuming 6% real rate of return which seems to be what OCare costs are going up by.

As an aside Colorado last I heard was using 8% as a real rate of return.

How many years will it take at 6% to consume the entire US GDP which is effectively static?

So something has to give, GDP has to go up significantly or medical costs contained. The former seems unlikely and Obama did nothing of consequence on the latter.

Edited November 6, 2015 by Rob L

[Boiler 46,338]

Funny you should mention Douglas, we went to the same School. He was ahead of me if you were wondering.

Including Healthcare in GDP was something that always struck me as slightly odd but it is what it is so of course you are right.

Last figure I saw for US Healthcare spending was 17 ish percent so I assume it has gone up a small bit so 20% seems not very far away and of course it will keep on going.

Chicago Tribune

Last week, the Centers for Medicare and Medicaid Services released the 2016 premium data for the "benchmark" plans in the states using federal exchanges. Those are the second-lowest-cost Silver plans in each area, a benchmark chosen by health care experts using arcane methods involving chicken entrails and a pound of dry rhinoceros horn.

(Just kidding! They don't use rhinoceros horn, which would be illegal. They use the ground-up bones of an ox slaughtered at midnight on the summer solstice.)

These data, which showed premiums rising an average of 7.5 percent, are useful. But they are limited. We'd like to think that this tells us "how much premiums went up," but it's not that simple.

First of all, while the subsidies are pegged to the benchmark plan, not everyone buys that plan. Some people buy the cheapest Silver plan. Some people buy a more expensive one. Some people buy an even cheaper Bronze plan, and some people spring for Gold or Platinum coverage. Knowing how the price of the benchmark has changed tells us a great deal about how the subsidies will be calculated in 2016, but not nearly as much as we'd like to know about what people are experiencing in the marketplace.

Moreover, the change in the benchmark rate doesn't even tell us about the cost of any particular plan. Last year's second cheapest policy could be this year's most expensive, if the insurer decides that it got the pricing wrong, while some other insurer slides into the benchmark spot.

Does that matter, you may ask? This tells us what price people can buy insurance at.

But insurance is not an undifferentiated good, like pork bellies or concentrated frozen orange juice. People don't want to "be insured" so much as they want to "get health care" — from providers they like, with the drugs and services they want in the benefit list. If the same package you got last year cost more, you probably aren't comforted to know that a different package you didn't want is still very affordable.

Obama administration defends troubled health care co-ops
Obama administration defends troubled health care co-ops
Besides, most people don't actively shop for health insurance every year; well under half of people who bought a policy in 2014 returned to the exchange to look for a new one in 2015. If their policy went up by more than the benchmark rate, then they will be paying the difference out of pocket.

And that matters a lot, because subsidies are probably the biggest thing keeping the markets from sliding into the dreaded adverse-selection "death spiral," in which sick people are more likely to buy insurance, so the pool is sicker and more costly, so prices go up, so the healthiest folks decide the insurance isn't worth it, so the pool gets sicker and more costly ...

Contrary to expectations, the mandate doesn't seem to really be doing much to get people to buy insurance, at least yet (the penalty is set to go up again this year, and that may get people to pay attention). The subsidies, on the other hand, clearly have a large effect, which is why the customer base for the exchanges is so disproportionately composed of folks who are getting large amounts of taxpayer assistance to buy insurance. Anything that increases the gap between the cost of the insurance and the subsidy they are getting is therefore worrisome, if you want the exchanges to get and stay healthy.

The doctor is ... out? Here's why Obamacare isn't thriving
The doctor is ... out? Here's why Obamacare isn't thriving
It is possible to find out what different rates are being charged by insurers in many states; I have a giant spreadsheet of the 2016 rate increases for those states that make them available, and boy does that make me popular at cocktail parties. Unfortunately, we still don't know what rate increases people are facing, because we don't know what individuals had in 2015, or what they'll buy in 2016.

This is frustrating. But a consulting company, Avalere Health, has provided at least slightly more data than we had before, supplementing the administration's release of the information on benchmark plans by looking at the cost of the cheapest Bronze and Silver policies. It's still far more limited than one would like, but looking at those rates does give us additional information.

The biggest thing they tell us is that, as I suspected when I wrote about the CMS release, the whole bottom of the market is undergoing a fairly massive repricing. In most states, the cost of the cheapest Silver plan, relative to the cheapest one last year, rose even more than the benchmark rate. And in most states, the cost of the cheapest Bronze plan went up by more than the cost of the cheapest Silver plan. (The average increase was 13 percent, but it looks as if it's unweighted, while the government used a weighted average. As I noted last week, the weighted average is usually the most meaningful national metric, but the unweighted can be revealing as well.)

That still doesn't tell us what happened at the top of the market, with the carriage trade splurging on policies that cover nearly everything. But I think there's one thing we can say for certain: Insurers significantly underestimated how much people would spend on health care, even if they chose stripped-down plans that have narrow provider networks and require consumers to cover a significant portion of their own costs.

Some of this may reflect pent-up demand, if folks who had been putting off treatment for years went out and got all the services they'd been delaying. But the consensus seems to be that the pool is sicker than expected (and that includes unsubsidized folks who are buying insurance off of the exchanges but form a single actuarial risk pool for the purposes of pricing the insurance). It's also older; the administration was looking for about 40 percent of exchange enrollment to come from folks 18 to 35, and at the end of the last enrollment period, that number was stubbornly stuck around 28 percent.

This is not surprising, exactly, but it is perhaps somewhat disappointing. Subsidies or no, people who don't get a lot of value out of insurance don't seem to be buying it. As a result, the cost of the cheaper policies — the ones you'd expect the healthier folks to be buying, because they don't expect to use it much — is going to have to go up, because the average cost to cover the people who remain is higher than initially hoped.

Does this mean that Obamacare is in the early stages of a death spiral? We're certainly not in death spiral territory now, and it's too early to say whether we're headed there, because the program is still evolving. As I say, the mandate has so far proved surprisingly irrelevant. But this year it goes up to a pretty hefty sum — the higher of $695 per adult and $347.50 per child, or 2.5 percent of your annual income — and perhaps people will look at the higher fees, sigh, and finally decide that they might as well pay a little bit extra and get some insurance. More realistically, perhaps they will freak out in spring of 2017, when they see what the mandate penalty does to their 2016 tax refund, and head over to the exchanges when the next open enrollment period finally rolls around.

To be sure, 2016 is also the year that the risk adjustment programs end, which will tend to push prices up. This law has a lot of moving parts, and it's hard to assess it while they're in motion. All we can do is wait and see where they finally end up.

Bloomberg View

[Jacque67 7,328]

Funny you should mention Douglas, we went to the same School. He was ahead of me if you were wondering.

Including Healthcare in GDP was something that always struck me as slightly odd but it is what it is so of course you are right.

Last figure I saw for US Healthcare spending was 17 ish percent so I assume it has gone up a small bit so 20% seems not very far away and of course it will keep on going.

Chicago Tribune

Last week, the Centers for Medicare and Medicaid Services released the 2016 premium data for the "benchmark" plans in the states using federal exchanges. Those are the second-lowest-cost Silver plans in each area, a benchmark chosen by health care experts using arcane methods involving chicken entrails and a pound of dry rhinoceros horn.

(Just kidding! They don't use rhinoceros horn, which would be illegal. They use the ground-up bones of an ox slaughtered at midnight on the summer solstice.)

These data, which showed premiums rising an average of 7.5 percent, are useful. But they are limited. We'd like to think that this tells us "how much premiums went up," but it's not that simple.

First of all, while the subsidies are pegged to the benchmark plan, not everyone buys that plan. Some people buy the cheapest Silver plan. Some people buy a more expensive one. Some people buy an even cheaper Bronze plan, and some people spring for Gold or Platinum coverage. Knowing how the price of the benchmark has changed tells us a great deal about how the subsidies will be calculated in 2016, but not nearly as much as we'd like to know about what people are experiencing in the marketplace.

Moreover, the change in the benchmark rate doesn't even tell us about the cost of any particular plan. Last year's second cheapest policy could be this year's most expensive, if the insurer decides that it got the pricing wrong, while some other insurer slides into the benchmark spot.

Does that matter, you may ask? This tells us what price people can buy insurance at.

But insurance is not an undifferentiated good, like pork bellies or concentrated frozen orange juice. People don't want to "be insured" so much as they want to "get health care" from providers they like, with the drugs and services they want in the benefit list. If the same package you got last year cost more, you probably aren't comforted to know that a different package you didn't want is still very affordable.

Obama administration defends troubled health care co-ops

Obama administration defends troubled health care co-ops

Besides, most people don't actively shop for health insurance every year; well under half of people who bought a policy in 2014 returned to the exchange to look for a new one in 2015. If their policy went up by more than the benchmark rate, then they will be paying the difference out of pocket.

And that matters a lot, because subsidies are probably the biggest thing keeping the markets from sliding into the dreaded adverse-selection "death spiral," in which sick people are more likely to buy insurance, so the pool is sicker and more costly, so prices go up, so the healthiest folks decide the insurance isn't worth it, so the pool gets sicker and more costly ...

Contrary to expectations, the mandate doesn't seem to really be doing much to get people to buy insurance, at least yet (the penalty is set to go up again this year, and that may get people to pay attention). The subsidies, on the other hand, clearly have a large effect, which is why the customer base for the exchanges is so disproportionately composed of folks who are getting large amounts of taxpayer assistance to buy insurance. Anything that increases the gap between the cost of the insurance and the subsidy they are getting is therefore worrisome, if you want the exchanges to get and stay healthy.

The doctor is ... out? Here's why Obamacare isn't thriving

The doctor is ... out? Here's why Obamacare isn't thriving

It is possible to find out what different rates are being charged by insurers in many states; I have a giant spreadsheet of the 2016 rate increases for those states that make them available, and boy does that make me popular at cocktail parties. Unfortunately, we still don't know what rate increases people are facing, because we don't know what individuals had in 2015, or what they'll buy in 2016.

This is frustrating. But a consulting company, Avalere Health, has provided at least slightly more data than we had before, supplementing the administration's release of the information on benchmark plans by looking at the cost of the cheapest Bronze and Silver policies. It's still far more limited than one would like, but looking at those rates does give us additional information.

The biggest thing they tell us is that, as I suspected when I wrote about the CMS release, the whole bottom of the market is undergoing a fairly massive repricing. In most states, the cost of the cheapest Silver plan, relative to the cheapest one last year, rose even more than the benchmark rate. And in most states, the cost of the cheapest Bronze plan went up by more than the cost of the cheapest Silver plan. (The average increase was 13 percent, but it looks as if it's unweighted, while the government used a weighted average. As I noted last week, the weighted average is usually the most meaningful national metric, but the unweighted can be revealing as well.)

That still doesn't tell us what happened at the top of the market, with the carriage trade splurging on policies that cover nearly everything. But I think there's one thing we can say for certain: Insurers significantly underestimated how much people would spend on health care, even if they chose stripped-down plans that have narrow provider networks and require consumers to cover a significant portion of their own costs.

Some of this may reflect pent-up demand, if folks who had been putting off treatment for years went out and got all the services they'd been delaying. But the consensus seems to be that the pool is sicker than expected (and that includes unsubsidized folks who are buying insurance off of the exchanges but form a single actuarial risk pool for the purposes of pricing the insurance). It's also older; the administration was looking for about 40 percent of exchange enrollment to come from folks 18 to 35, and at the end of the last enrollment period, that number was stubbornly stuck around 28 percent.

This is not surprising, exactly, but it is perhaps somewhat disappointing. Subsidies or no, people who don't get a lot of value out of insurance don't seem to be buying it. As a result, the cost of the cheaper policies the ones you'd expect the healthier folks to be buying, because they don't expect to use it much is going to have to go up, because the average cost to cover the people who remain is higher than initially hoped.

Does this mean that Obamacare is in the early stages of a death spiral? We're certainly not in death spiral territory now, and it's too early to say whether we're headed there, because the program is still evolving. As I say, the mandate has so far proved surprisingly irrelevant. But this year it goes up to a pretty hefty sum the higher of $695 per adult and $347.50 per child, or 2.5 percent of your annual income and perhaps people will look at the higher fees, sigh, and finally decide that they might as well pay a little bit extra and get some insurance. More realistically, perhaps they will freak out in spring of 2017, when they see what the mandate penalty does to their 2016 tax refund, and head over to the exchanges when the next open enrollment period finally rolls around.

To be sure, 2016 is also the year that the risk adjustment programs end, which will tend to push prices up. This law has a lot of moving parts, and it's hard to assess it while they're in motion. All we can do is wait and see where they finally end up.

Bloomberg View

An Essex boy?? Gasp! Edited November 6, 2015 by Jacque67

[Boiler 46,338]

An Essex boy?? Gasp!

The skeleton in my closet.

I was 4 when we moved, does that help?

[Teddy B 17,252]

I once had a conversation with a lead trauma nurse in an emergency room in Canada. Before taxes, she made just over $150,000 USD equivalent. After all was said and done, she took home about $63,000.

So you tell me... is it worth it???

Not sure what else the trauma nurse was having deducted from her pay, but based on the Canadian income tax table on the link below, she would have paid $32,637 or 22% in Federal taxes and depending on where she was from, approx. 13% in provincial taxes for another $19,500. She would have paid a total of $52,137 in taxes and taken home $97,863. That's with health insurance all paid for as well. Yes they pay a little more in Canada, but they got more back as well.

Canadian 2015 income tax rates: http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html

I'm married to a Canadian. Their system has its problems too. Wait times for one. You have to find a family doctor which isn't easy apparently.

My wife says about the same, but she likes the Canadian system far better over the US system overall. My wife still can't come to grips with having to dish out a copay and having to pay a percentage of her visit as well.

[JohnR! 5,495]

One of the red herrings about health care in Canada, or in other developed countries, surrounds the wait to see a doctor. While it is true that you may need to wait to see a specialist, it is also reasonable to expect that a lifetime of preventative health care will drastically augment the chances that a serious illness or chronic condition be caught in its early stages.

My wife says about the same, but she likes the Canadian system far better over the US system overall. My wife still can't come to grips with having to dish out a copay and having to pay a percentage of her visit as well.

[Boiler 46,338]

One of the red herrings about health care in Canada, or in other developed countries, surrounds the wait to see a doctor. While it is true that you may need to wait to see a specialist, it is also reasonable to expect that a lifetime of preventative health care will drastically augment the chances that a serious illness or chronic condition be caught in its early stages.

I remember when my Granny went to see the local GP, she must have been in her late 60's?, she said she had not been for some time, Doctor said it had been 30 years.

Now she was of a generation who grew up pre NHS, one of the problems the NHS now has is there is so much unneeded demand.

[Teddy B 17,252]

Not sure what else the trauma nurse was having deducted from her pay, but based on the Canadian income tax table on the link below, she would have paid $32,637 or 22% in Federal taxes and depending on where she was from, approx. 13% in provincial taxes for another $19,500. She would have paid a total of $52,137 in taxes and taken home $97,863. That's with health insurance all paid for as well. Yes they pay a little more in Canada, but they got more back as well.

Canadian 2015 income tax rates: http://www.cra-arc.gc.ca/tx/ndvdls/fq/txrts-eng.html

My wife says about the same, but she likes the Canadian system far better over the US system overall. My wife still can't come to grips with having to dish out a copay and having to pay a percentage of her visit as well.

The tax rate for $150,000 income in Canada listed above is a total of 35%. If it were in the US at the same $150,000 income, the federal tax rate would be 25% and if the person lived in Mass with a 6.25% state income tax rate, the grand total paid in taxes would be 31.25%, or $46,875 paid in taxes with no health insurance included. That's only a $5262.00 difference between the two. I know people who pay more than that in health insurance per year, I pay almost exactly that much. So there really isn't a whole lot of difference between the US and Canada when it comes to income tax rates. Perhaps Canada isn't as socialistic as some peeps make it out to be.

[GandD 5,966]

My wife says about the same, but she likes the Canadian system far better over the US system overall. My wife still can't come to grips with having to dish out a copay and having to pay a percentage of her visit as well.

We have pretty decent healthcare coverage where we work. The biggest obstacle for us, is the lack of real skill in our hometown. We (and others we know) usually travel an hour to Nashville to have anything done. There's hospitals here but they're just not the best. Especially for specialty doctors.

[decocker 7,198]

[Expat1 971]

The situation is very similar to compound interest.

Now this graph is putting a positive slant assuming 6% real rate of return which seems to be what OCare costs are going up by.

As an aside Colorado last I heard was using 8% as a real rate of return.

How many years will it take at 6% to consume the entire US GDP which is effectively static?

So something has to give, GDP has to go up significantly or medical costs contained. The former seems unlikely and Obama did nothing of consequence on the latter.

Good grief what's the assumed retirement age - 80?

[Expat1 971]

I once had a conversation with a lead trauma nurse in an emergency room in Canada. Before taxes, she made just over $150,000 USD equivalent. After all was said and done, she took home about $63,000.

So you tell me... is it worth it???

It is if it includes retirement, which the right never talks about.

They live longer than we do. Wonder why, with that terrible healthcare? Americans have the same average lifespan as Chile. I don't think you can drink the tap water in Chile yet so isn't it time to try something different?