A Request, Finally, Fulfilled

Commenter Boonton requested a concise summary of the healthcare bill, sans notes or google lookups.

Liberal Congressmen last Spring and Summer dialed in range and windage of their Leupold scopes what they considered the most egregious faults of the current healthcare and “fixed” it with a bill they passed with no little chicanery and much cajoling this Summer. So, what were the primary features of this “great big bill” as one might explain to an outsider who was (blissfully) ignorant of the whole affair. Well, in short, as the Democrats saw it there were two big problems with healthcare that needed focus, the first being … that the current healthcare system had too many people falling into gaps and had no coverage and the second was that healthcare costs have been rising faster than just about any other sector in the economy. 

For the first part, that is the gaps, they have a few basic strategies to deal with that.

  • First, they made it illegal for insurers to refuse to coverage on the grounds of pre-existing conditions. 
  • Second, they’ve expanded various healthcare programs like Medicare/aid and so forth to cover not just the elderly but widened it more to cover those in financial trouble (this is not new … just expanded further).
  • Finally, insurance “exchanges” will be formed which hope to provide competitive markets for those who need to privately (not through their employer) to obtain health insurance. 

For the second part, how to control costs

  • They’ve capped the profits that insurance companies and other health care providers (like drug mfgs/developers) can earn.
  • They plan to limit government funding and sponsorship (Medicare assistance) more aggressively especially if returns are judged to be limited or the patients are elderly and to drop these requirements as part of their “minimum acceptable” healthcare insurance regulatory environment. 
  • And they’ve put strict limits on malpractice payments and restructured the medical community tort environment to prevent defensive medicine. Oh, wait … that’s not part of it. Never mind, malpractice can continue unabated. After all, it impacts healthcare costs and practices not at all.
  • And they’ve expanded the powers and scope of federal healthcare regulatory agencies and bureaucracies, after all, bureaucratic technocracy is the best way to control costs. No really this is their big plan for controlling costs. Regulators. 

Now some of these programs incur costs. How have they kept this off the federal budget? Well, the biggest hit is in vastly higher insurance premiums for everyone except those who can’t afford it at all. Most of it isn’t on budget at all. See, they expanded coverage to the needy … and have to assist (it remains to be seen if this is underfunded) insurers with the pre-existing condition folks, but they hope to balance that with cost containment of current other healthcare programs (elderly assistance) and by taxing the uninsured. Yes, you’ll be able to “keep” your insurance plan as it is … if you can still afford it. But the point is the majority of those increased costs don’t impact the <em>federal</em> budget … just yours. And this is the biggest part of the ACA/Obamacare deception. Keep everyone concentrating their eyes on the federal budget ball and ignoring the two factors which are bigger but remain unnoticed. The first being … this is going to make your healthcare much more expensive and second, because insurance is going to get a lot more expensive for your employer … and they’re pushing to make private insurance more palatable. The second part will move more and more people out of employer and into publicly regulated insurance markets which in turn make you far more dependent on the government. That in turn, was the plan all along. For the average person, one will find will make top notch healthcare more and more a feature of who you know not how much you earn, which in the Democrats view is (apparently) a better state of affairs. 

Oddly enough, one of the frequently mentioned (as in mentioned with an touching example or presence of an affected individual) features of the new bill, that pre-existing coverage part that was mentioned so often in the arguments for the bill. Well, it turns out that the program was unrolled already. And golly, in the first 9 months a whopping 4,000 people enrolled in the entire US … or about .001% of the population. So, here one of the primary talking points of the campaign for the bill vastly over-estimated the number of affected individuals. Now, as an unintended consequence, it remains to be seen if the “pre-existing condition” as a feature used to prevent people from only enrolling in an insurance plan in emergencies gets bigger use from those people who actually really need it … or if smart people figure out that the penalty set for not having insurance during healthy times and then enrolling when very ill ends up being an economically favorable strategy. 

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3 comments

  1. Boonton says:

    Will need to take some time to review. Minor quibble I don’t think there was any expansion in who is covered by Medicare (basically everyone over 65). There was an expansion in Medicare D’s drug benefit, mainly being abolishing the ‘donut hole’.

    Also I’d like to see you go into more detail on why you think ‘everyone’s’ premiums will rise dramatically.

  2. Mark says:

    Boonton,
    Why will premiums go up? Two reasons right off, as noted two (?) days ago in testimony by the ACA/Obamacare chief financial auditor he believed that one of the effects of the bill will be to accelerate the increase of healthcare costs. Second, you’re requiring expansion of coverage to pools that both cannot pay as much and are higher risk, which will increase costs for the whole pool.

  3. Boonton says:

    So basically you’re saying sick people who buy private coverage will drive up insurance costs. OK but then what exactly were those sick people doing before? Were they simply not getting any care? Or were they? If they were then someone somewhere had to be paying for it who is no longer paying for it now.