Why Obamacare Won't Work: It Will Be Rational for People and Companies to Drop Insurance, Pay Fine
Martin Feldstein explains a fatal flaw of Obamacare in the Washington Post: It will be rational for individuals and companies to drop their current health insurance, pay the penalties, and wait to purchase insurance when they get sick:
A key feature of the House and Senate health bills would prevent insurance companies from denying coverage to anyone with preexisting conditions. The new coverage would start immediately, and the premium could not reflect the individual's health condition.
This well-intentioned feature would provide a strong incentive for someone who is healthy to drop his or her health insurance, saving the substantial premium costs. After all, if serious illness hit this person or a family member, he could immediately obtain coverage. As healthy individuals decline coverage in this way, insurance companies would come to have a sicker population. The higher cost of insuring that group would force insurers to raise their premiums. (Separate accident policies might develop to deal with the risk of high-cost care after accidents when there is insufficient time to buy insurance.)
In an attempt to prevent this, the draft legislation provides penalties for individuals who choose not to buy insurance and for employers that do not offer health insurance. But the levels of these fines are generally too low to cause a rational individual to insure.
Consider: 27 million people are covered by health insurance purchased directly, i.e. outside employer-based plans. The average cost of an insurance policy with family coverage in 2009 is $13,375. A married couple with a median family income of $75,000 who choose not to insure would be subject to a fine of 2.5 percent of that $75,000, or $1,875. So the family would save a net $11,500 by not insuring. If a serious illness occurs--a chronic condition or a condition that requires surgery--they could then buy insurance. Since fewer than one family in four has annual health-care costs that exceed $10,000, the decision to drop coverage looks like a good bet. For a lower-income family, the fine is smaller, and the incentive to be uninsured is even greater.
The story is similar for single people. The average cost of an individual policy is $4,800. An individual with earnings of $50,000 would face a fine of $1,250 and would therefore save $3,550 by not insuring.
In short, for those who are now privately insured through employers or by direct purchase, there would be substantial incentives to become uninsured until they become sick. The resulting rise in the cost to insurance companies as the insured population becomes sicker would raise the average premium, strengthening that incentive.
MP: What would make this choice to drop insurance and pay the penalty even more rational is the convenient, low-cost availability of basic health care from 1,200 retail clinics around the country, or through pre-paid plans like the No Insurance Club, or concierge medicine.
42 Comments:
Since I'm self employed, I'll be doing this math for sure. My HSA premiums run less than $2,100 per year but I hear that under the House bills it wouldn't meet the government criteria since it's high deductible.
If so, there's no way I'm going back to a $300/mo to $400/mo regular plan.
I'll just buy a cheap catastrohpic plan in case of car accidents and other incidents where signing up for insurance afterwards wouldn't work, and pay the fine.
I wouldn't call it a flaw but the intent of the bill. The federal government has shown nothing but disdain for the American people for years.
As Obama has said it will take 15 to 20 years to get the American people under a single payer government program. This bill does the job.
We don't know the details in the bill. Catastrophic plans could well be banned.
Michael nails it. This isn't a flaw. This is the goal. I figured out this would happen months ago...who would buy fire insurance, if you could buy it after the fire?!?! It will be much easier to pay the fine, or just sandbag somehow through some loophole etc. until you are actually sick.
Obamacare works by eliminating the competition. Private insurance will shrink and almost disappear over 20 years. Government will collect "premiums" by raising taxes on productive Americans and inflating the dollar. Middle income workers who now have employer covered insurance will find themselves in rationed public health clinics along with the poor before they can "change you can believe in."
The employer-based insurance system is failing. Fewer people are connected to companies, and companies can no longer afford the coverage.
I see some options to Obamacare, but for some reason few takers. Binding arbitration for all medical disputes by a pro-industry board, interstate competition, large deductibles and aggressive euthanasia in the case of terminally ill and aged.
Add in $100 billion a year in aid to emergency rooms, and we are done.
I would accept nationalized health care if they cap outlays to 12 percent of GDP, and be done with it. At least the medical-care monster wouldn't eat us out of house and home.
Then we could turn our guns to the parasitic military and Department of Agriculture, where some whopping cuts are in order.
As it is, we spend more on medical care, as a fraction of GDP, than any other advanced nation, with so-so results. We spend way more than any other nation on our military, and get back ossified lard, patronage and we can't prevail in Afghanistan after eight years.
I say pare it all back.
i fear he misses the twisted genius of this bill.
this "fear" is precisely the design of the whole thing. it's what they want.
consider: the fines go to the government. it's a vast cash windfall to prop up an aggressive social agenda. and best, it costs them nothing at all.
the cost is borne by insurance companies that not only will need to deal with having fewer, sicker customers, but also pick up the costs of those who get insurance after becoming sick.
this will, predictably, drive premiums wild and insurance companies out of business. this combination will then be trumpeted by the architects of this mess as a "failure of capitalism" and a clear indication of predatory and evil insurance companies.
even more insidious is the heavy tax planned for "Cadillac plans". the current threshold is set at about $8000, a number that will be easily reached in a few years once costs spiral out of control.
this bill is a work of dazzlingly Machiavellian perfidy. at a stroke it creates not only a cliff over which to push private health insurance and the irresistible force to do the pushing, but also manages to make a clear failure of governance out to be a failure of capitalism enhancing the perceived need for big government while simultaneously generating a huge cash windfall for these statist profligates.
in the sense that one may admire the cunning, stealth, and lethal grace of a tiger even as it leaps upon him, one can see the beauty and elegance of the plan, but like one being leapt upon by a tiger, it does little to improve the experience...
Well its hardly a suprise that pseudo Benny has a clue...
"aggressive euthanasia in the case of terminally ill and aged"...
Yeah, let's try that on you first since you're obviously suffering from some sort of dementia...
From the Heritage Foundation's blog site: $2.6 Trillion! A Closer Look at the Full 10 Years of Spending in the House Health Bill...
From the CBO, an updated letter to Dingell regarding the costs and more... (24 pages)
From the WSJ: What the Pelosi Health-Care Bill Really Says...
Note this: On Nov. 2, the Congressional Budget Office estimated what the plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income...
To opt out of paying for healthcare misses the point. Americans need to unite to help themselves AND one another. There is always a cost to be paid for living in society. Last I checked America was a country, and its citizens therefore, are subject to both the rights AND the responsibilities of living together, Unless it's the DIS-United States of America, of course.
The real problem is the insurance paradigm. As long as people expect to have every little hang nail covered, there will be no pressure to bring down costs.
Portable catastrophic plans that expose the public to some of the medical expense will bring down prices.
The government has chosen the other route and will ration care based on a persons value to the political class.
Yeah, let's try that on you first since you're obviously suffering from some sort of dementia
Juandos,
Play nicely.
An average of $13,375 per year for self-purchased family coverage? That doesn't sound right. At least in Maryland, that's the very high end of the options offered, and my insurance is less than $5,000/year which is perhaps a little under the average. I know rates vary by state, but $13k as the average? No way.
I just saw a clip of Pelosi saying there's a cap on what you pay in, but no cap on what you receive.
They should really start running a laugh track during floor speeches or people might think she's serious.
This is by design. Obama and the Democrats are looking to design a system that will create a crisis that will eventually force Congress to adopt a single payer system.
If an economists wanted to design a plan that would destroy the private sector health system, he or she would design this exact bill.
Hey, euthanasia may have ugly connotations, but the fact remains that huge amounts of medical care--and money-- are expended on individuals who are both terminally ill and aged.
Keeping Terri Shiavo alive costs a lot of money. Imagine keeping millions of Terri Schiavos alive, except they are aged. Now you have a picture of the Us system.
Someone has to pay. You want to volunteer? You are imposing your religious beliefs on us libertarians and true Constitutionalists.
Some medical outfits already terminate--Kaiser Permanente, for example, and not surprisingly, they have the most affordable plans in California.
With an aging population, anyone who thinks US companies can pay for medical insurance, support millions of elderly and terminally ill, and compete on world markets is just not thinking or being realistic.
There has to be hard cutbacks, to keep US industries competition, and that means lower tax rates. less medical, a cut back on the parasitic military ($700 billion annually), and a wipe-out of agriculture subsidies ($60 billion annually).
The USA can be Number 1 again, or at least Number 2, but it going to take some real sacrifices.
Even someone who posts with an Internet avatar of a toy gun ought to know that!
Terri Schiavo had a private trust to cover her care. Medicare paid some costs because government regulations prohibit opting out.
The easy solution to the problem is to give the people back their SS and Medicare taxes and let them chose end of life care rather than government panels.
From personal experience here in Canada, there are 3 levels of coverage. There is the public health care system of wait times and rationing; there is the U.S. for anyone in need of TIMELY care; and there is the third option...namely who you'all know...leveraging your contacts so that you receive better care.
My husband was put on an emergency bypass list by a doctor who he recommended for membership at the Royal Cdn Yacht Club 20 years previously. Without that intervention, my husband would likely be dead.
The level of healthcare that you are able to attain is what you fight for; there is no free lunch which you realize when your shoulder goes inoperable because you had to wait 6 months for an MRI you could have gotten in Buffalo or you are placed on a list for 1 1/2 years to see a back specialist. Waiting beyond medically safe period to receive cancer treatment is unconscionable.
Benny,
Who decides? Imagine a patient with a treatable illness ie. cancer. Intervention could allow that patient to see her grandchildren and live for an addl 10 years.
Under rationing, she would likely just be seen as a cost-benefit equation. In the U.K. for example, one hospital turned the bedsheets over between patients. It is also routine to prescribe a book rather than provide counselling or medication to patients diagnosed with depression...if you commit suicide, sorry, we didn't realize that your problem was that serious.
Ethanasia is the ultimate form of totalitarian socialism. The state becomes the ultimate arbitor of who is worthy of living and who is not. One thinks at these moments of Ronald Reagan who quipped when he was shot and about to go into surgery "I hope you're all Republicans".
QT is making the perfect point. Either the individual can choose their care, or the political class and their friends choose your care.
If you like the American housing situation, your going to love government health care.
Unspoken here is the increased cost to be borne by the millions of families who have member(s) living with disease and/or physical ailments. There can be no opting out of insurance to be purchased later "after the fact." These conditions are ongoing and ominous.
As juandos points out, Big Government health insurance will not be a bargain when the premium takes 17% of gross wages before FICA and income tax withholding.
Blenderking makes a good point that current health insurance premiums only average about $6,500 or so nationwide but NY and MA rates are above $13K. I think the point is that projected rates under the government plan is $13.5k.
I read there was jail time attached to intentionally not buying a policy.
http://republicans.waysandmeans.house.gov/News/DocumentSingle.aspx?DocumentID=153583
I sure am happy with my HSA account and high deductible policy. It will be a shame if I can't keep doing that.
I don't know why everyone gripes so much. This HSA thing is insanely well designed. I love it. There, I said it. I love my health insurance as it stands. I'm not rich. I'm not employed (i work for myself). I hate spending money but the HSA thing is perfect. It will be a damned shame if we can't keep it.
QT-
I guess I am just not concerned about the last year of life of a very aged person, or keeping Terri Schiavos alive for decades.
If I am 86, and the plug gets pulled--well, if I haven't squeezed out of life what I need to by 82, then.............
BTW, I am sure we all have stories, but I have seen terrible living and hospital conditions for the elderly. There is no point in sustaining "life" after some point.
I do not believe there is an obligation to keep people alive as long as technically possible.
Yes, I do believe in euthanasia. In fact, everybody does, they just don't want to admit it. They want the benefits of euthanasia, but then pretend they are not involved.
We will bankrupt ourselves in we try to take heroic care of all the elderly. It is time for common sense.
Canada is a democratic nation, in some ways more so than the US. Why do Canadians support a system that is so fundamentally flawed? I suspect it also has fundamental strengths.
I hope this bill doesn't pass the Senate ever. I wrote my senator in Ohio (both of them) and he supports any bill with a public option. I will vote for any Republican that runs against him. The debt added is not reasonable for a bill that has no positives.
It isn't just a fine:
Democrats’ health care bill has mandates and penalties
By DAVE HELLING
The Kansas City Star
Nov. 07, 2009
"People who don’t get insurance and don’t pay the penalty face fines and possibly jail time."
"Why do Canadians support a system that is so fundamentally flawed?"
"Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlin for the 4-3 Court last week. Canadians wait an average of 17.9 weeks for surgery and other therapeutic treatments, according the Vancouver-based Fraser Institute. The waits would be even longer if Canadians didn't have access to the U.S. as a medical-care safety valve. Or, in the case of fortunate elites such as Prime Minister Paul Martin, if they didn't have access to a small private market in some non-core medical services. Mr. Martin's use of a private clinic for his annual checkup set off a political firestorm last year.
Canadians continue to sue their government over health care. Ditto France and England.
Americans complain about insurance, people of other countries complain and die over the care they get.
Benny, you would have been one the Nazis biggest supports.
Anonymous said...
I read there was jail time attached to intentionally not buying a policy.
That seems to be if you don't get coverage AND don't pay the fine. Unless they require people to submit proof of insurance along with tax returns, how will they know except for an audit? Or spookily if they match insurer lists against IRS records.
The first person arrested for this should challenge the Constitutionality.
benny-
your argument about a democratic canada keeping its system meaning that it must have good aspects is naive.
the problem with single payer is once you have it, there's not getting rid of it. the taxes go out, the service is in place, the years long wait lists are in place. there are not enough doctors to meet demand.
so what do you do? how do you get out of the mess? even if there were enough after tax dollars left for people to buy private insurance, what would they do with it? to what doctor would they go?
if doctors were allowed to drop their public wait lists and just treat private insurance patients, imagine what would happen to the already lengthy wait lists. further, all the best doctors would likely go. both would demolish the public system.
and if you think just whipping up an infrastructure of insurers and doctors that know how to bill them and a system to settle the transactions is easy, you've never seen a medical billing system.
they are now stuck with a deteriorating system and nothing much they can do about it except to nip down to the US if they really need something urgently.
it's a great system if you break your arm or need strep throat treated, but get an endocrine disorder or anything complicated and difficult to diagnose, and you are in deep, deep trouble.
further, your notions about not wanting to pay for shiavo etc are valid, but you come to the wrong conclusion from them. the point is not that the government should decide not to keep such people alive, it's that the government should not be involved in such decisions at all. these are personal decisions and should be made by the individuals involved based on their own notions of cost and benefit. these decisions are far too personal to be made by a bureaucracy.
however, such a bureaucracy is the inevitable result of involving the government in dispensing healthcare. the answer is not more rationing, it's less government.
isn't it interesting that there is always enough food around and we can all decide what we want to eat? even those who receive government assistance do so. yet food is plentiful and cheap. why? because we pay cash. imagine how absurd a government welfare program would be if it gave each person assisted a credit card with no limit and told them to buy whatever food they wanted. such a program is obviously absurd. but isn't that exactly how medicaid and medicare are set up?
only one thing can return our medical system to sanity and stop the insane cost inflation: moving to cash pay. everyone gets an HSA. make hospitals compete on price. it's a technology based business. costs should be increasing less than CPI, not 2.5 times its rate.
compare welfare to medicare. welfare's costs have not gone out of control because it's not a buffet, as medicare is. welfare doesn't need all the insane bureaucracy and outrageous price controls of medicaid because it has a market to do it for food and rent and clothing.
this same market that keeps the price of bread and sneakers reasonable could work for most of healthcare as well. but a system where the consumer of a service is not the one who pays for it is just never going to work.
it's not that healthcare is a special case and needs to be treated differently from rent or food, it's that we have treated it specially, broken the market mechanism, and now have a dysfunctional situation as a result. more attempts at top down management will only make it worse.
Is it clear yet how HRA plans fare under the bill? Under current law these are considered insurance, even though no actual insurance company may be involved, and are required to have annual benefit caps (which the bill apparently requires real insurance company plans not to have).
Buying a catastrophic plan under an HRA then becomes the purchase of reinsurance, not primary insurance, with the HRA covering deductibles and co-pays.
Benny,
I believe in non-resuscitation for elderly and terminally ill patients. That however, is not euthanasia but allowing a human being to die once rather than multiple times.
One cannot take Terri Schiavo as representative. The case was a very difficult one because it was difficult to determine whether brain death had occurred. Terri's case did highlight how difficult it becomes when a patient does not fit into neat definitions of quality of life or brain activity levels.
I have used the U.S. system where my husband was able to see the foremost orthopaedic surgeon in N.A. within 2 weeks vs. watching my husband become permanently disabled thanks to criminally incompetent care resulting in permanent disability. Unfortunatley, the orthopaedic surgeon in Canada gave my husband weight lifting exercises for a torn rotator cuff causing the rotator cuff to complete snap (radical tear) then he had to wait over 8 months to get an MRI at which point his shoulder had become inoperable.
At present, due to gross medical incompetence, my husband cannot lift his arm above 90 degrees or push forward (ie. using a drill).
In Canada, we had politicians making decisions on levels of care and funding with the result that access to care has been compromised. We have long waiting lines for specialty care, cancer treatment and diagnostic imagery. Canada currently ranks at the bottom of the OECD in terms of MRIs per capita...ranking lower than South Korea.
The U.S. currently has expensive care however it has very good care. You get what you pay for. If you think good health care is free, I can tell you that's an illusion.
Oh geez, you can't make this stuff up. From a WSJ article:
"Sec. 59b (pp. 297-299) says that when you file your taxes, you must include proof that you are in a qualified plan. If not, you will be fined thousands of dollars. Illegal immigrants are exempt from this requirement."
People are also exempt if they reside outside the US, even including possessions of the US. So moving to the Virgin Islands or Puerto Rico is an option, or Canada.
And there's a religious conscience exemption. That might be a big loophole. Can't find the section where it says what kind of objection you have to have. If Scientology qualifies, I wouldn't be shocked.
The big question is in the fine print of the tax form. If the fine is part of the tax form then you have to file. If the fine is separate of the tax form, then you can't be forced to file a tax return. The court hasn't gotten to the point of requiring people to file their crimes with the government each year.
Since I manage medical insurance claims daily for a physician office, it seems only fair that the insurance plans (Wellpoint, UHC, Aetna, Cigna, ad nauseum) get screwed out of their mega bonuses and obscene profits (Anthem CEO 2005 bonus >> $24,000,000), so what's the problem with sick people paying for their own care and healthy folks not carrying the burden?
I see inscos abusing the "pre-existing condition" clause as an excuse not to pay claims daily) The biggest fraud/scam yet to be uncovered in health care in this country is families with 2 health care plans (both working, both with company plans, both paying FULL PREMIUMS), but the plans only payout 1 claim, and keep the rest as profit/bonus... it's called co-ordination of benefits and it is a fraud...
Beware... shame someone doesn't address this
OA,
You are exactly right. Catastrophic coverage for example, is not considered an acceptable form of medical insurance coverage.
The Pelosi plan will not even cover all of the uninsured. If this was the justification, it hasn't met the goal. If the justification is budget neutrality or reducing the overall cost of health care, the CBO has blown this subterfuge.
If neither of the stated goals are even achieved, the purpose would seem to be replacement of the current system with a mandatory public one...a la Canada or the UK. It costs just as much except that you have to wait 2 years to get hip replacement surgery, 18 months to get to a specialist, thousands of patients are without a primary care physician, diagnostic imaging equipment is largely early 20th century technology...i could go on but you get the picture.
There are a great many things that one can do to improve health:
1. a heart smart diet which also turns out to be a prostate friendly diet
2. maintaining your weight in the low range of BMI; better yet maintaining your hip to waist ratio which is a better predictor of health
3. moderate exercise (3 hrs a week is perfect)
The amazing part about the human DNA is that there are genes which can be turned off & on. Epi-genetics studies this phenominon and it appears that lifestyle choices are a lot more important that was previously believed. Nova Science Now did a very interesting program about this subject.
I hope the bastards that voted for Obama are really enjoying that hopie-changie: the president asked: "Does anybody think that the teabag, anti-government people are going to support them if they bring down health care? All it will do is confuse and dispirit" Democratic voters "it will encourage the extremists"...
Juandos,
The links you provide are spot on. The ego of Obama is truly awsome. How does he imagine that he will get re-elected by people he scorns/disrespects?
Glen Beck made an interesting observation that the left has 3 approaches to dissent on just about any issue, namely to claim that your opponent is:
1. Wrong headed (ie. you just don't get it)
2. Scary/dangerous
3. Motivated by greed
There seldom seems to be any attempt to actually address the issues raised (ie. Americans at the tea parties or attending the health care townhalls) or to present a logical counter argument.
Sorry that Benny is a bone of contention. I wish he would drop the subsidies, subsidies, subsidies..but it seems that is unlikely...like expecting Nancy Pelosi to forge a bi-partisan bill.
Hey QT, what drives me up a wall is the fact that for at least a decade Obama didn't make it a secret of what he is...
Obama's community organizing days should've been a tip off along with his rantings on local public radio that should've informed voters a long time ago especially now in the age of the internet...
Sheesh!
The answer to the Schiavo case is clear, have the discussion about what you want done in that sort of case now. Put the wishes in writing, and fill out a health care power of attorney (Guess what this was called a death panel). With the power of attorney it would be clear who makes the decisions in your case, thereby eliminating the issue that came to court, whose wishes the spouse or the parents prevailed. Its more important the older you get to have this taken care of.
Is that so bad. If guaranteed-payment healthcare ceases to be tied directly to employment because everyone drops their insurance, then we level the playing field although through a rough forced restard.
Does it not follow that the ensuing reshuffle will tier the insurance industry to offer pricier consumer service while the government is forced to formally define the level of guaranteed aid it is willing to support.
It would be healthy to reunite consumers of health care with the costs of it, and also healthy to put out in the open the reality that government inevitably pays for an implicit guarantee of health. It would also force the issue of how much we guarantee either through politics or by market decisions where private insurers offer high end services and meet more consumer demands until the costs and user numbers max out in the new competitive market for individuals.
Seems fine to me, albeit a rocky route.
"Does it not follow that the ensuing reshuffle will tier the insurance industry to offer pricier consumer service while the government is forced to formally define the level of guaranteed aid it is willing to support...
Why should the federal government be involved in the first place?
Is that hidden away somewhere in the Constitution?
I'm sure that for those who think federal government interference there can yet be another bizzare reterpretation of the Commerce Clause...
This petition respectfully requests that President Obama keep true to his word and veto HR 3962 should it cross his desk. The president stated that he "will not sign a bill that raises the deficit". HR 3962 does, in fact, raise the deficit2. Signing this petition indicates strong opposition to HR 3962. Demand that the president keep his word. Sign here:
http://www.ipetitions.com/petition/vetoHR3962?e
Help get 5,000,000 signatures! Pass it on.
Your very USE of (or repetition of) the prejorative term "obamacare" indicates your lack of honest intellection about the subject!
Right. Part of the plan... and it is all good. See, the point is to get to universal "single payer" and we are all on the way there. The "plan" is to create a "plan" that brings it about faster.
You know all those times you trick your spouse by promising something just to get what you want for yourself? Well, that is what we are doing to you. And it is working and your protestations are meaningless.
Do you realize that my "everybody" includes far more people than your "everybody"? We will soon be like the rest of the industrialized world... no longer the exception. You and I are not exceptional. Don't be foolish.
The funny part is that you republican types will be taking credit for it when all is said and done. Typical.
Now, a good argument for you would be to scream from the rooftops that us liberals are trying to trick the country into single payer while we talk about a "public option". See, that would be a rational argument. Indeed that is what we are doing and it will work. But when you try to argue that we will just point out the inherent superiority of such a system and thus make you look doubly foolish. See, we are seizing the day. Sweet.
Now, there are better things for you to be concerned about so you may as well just move on. I'm trying to help you, take it or leave it.
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