Health Care Architect Jonathan Gruber's Major Errors
Great post by Matt Palumbo at the Future of Freedom Foundation on the "the myriad fallacies, half-truths, and myths propounded throughout" Gruber's new book, Health Care Reform: What It Is, Why It's Necessary, How It Works. An excerpt from Palumbo's post:
Error 1: The mandate forcing individuals to buy health insurance is just like forcing people to buy car insurance, which nobody questions.This is a disanalogy -- and an important one. A person has to purchase car insurance only if he or she gets a car. The individual health insurance mandate forces one to purchase health insurance no matter what. Moreover, what all states but three require for cars is liability insurance, which covers accidents that cause property damage and/or bodily injury.
Technically speaking, you're only required to have insurance to cover damages you might impose on others. If an accident is my fault, liability insurance covers the other individual's expenses, not my own, and vice versa.
By contrast, if the other driver and I each had collision insurance, we would both be covered for vehicle damage regardless of who was at fault. If collision insurance were mandated, the comparison to health insurance might be apt, because, as with health insurance, collision covers damage to oneself. But no states require collision insurance.
Gruber wants to compare health insurance to car insurance primarily because (1) he wants you to find the mandate unobjectionable, and (2) he wants you to think of the young uninsured (those out of the risk pool) as being sort of like uninsured drivers -- people who impose costs on others due to accidents.
But not only is the comparison inapt, Gruber's real goal is to transfer resources from those least likely to need care (younger, poorer people) to those most likely to need care (poorer, richer people). The only way mandating health insurance could be like mandating liability car insurance is in preventing the uninsured from shifting the costs of emergent care thanks to federal law.
Stealing from the young and poor to pay for the old -- and the old and rich. Cool!
More:
Error 4: 20,000 people die each year because they don't have the insurance to pay for treatment.If the study this estimate was based on were a person, it could legally buy a beer at a bar. Twenty-one years ago, the American Medical Association released a study estimating the mortality rate of the uninsured to be 25 percent higher than that of the insured. Thus, calculating how many die each year due to a lack of insurance is determined by the number of insured and extrapolating from there how many would die in a given year with the knowledge that they're 25 percent more likely to die than an insured person.
Even assuming that the 25 percent statistic holds true today, not all insurance is equal. As Gruber notes on page 74 of his book, the ACA is the biggest expansion of public insurance since the creation of Medicare and Medicaid in 1965, as 11 million Americans will be added to Medicaid because of the ACA. So how does the health of the uninsured compare with those on Medicaid? Quite similarly. As indicated by the results from a two-year study in Oregon that looked at the health outcomes of previously uninsured individuals who gained access to Medicaid, Medicaid "generated no significant improvement in measured physical health outcomes." Medicaid is more of a financial cushion than anything else.
This one affects me deeply. So, with my huge new deductible, I still have insurance; I just can't afford to use it.
I'm not trying to make light of your problem; I realize you do have
a serious problem, and I'm sorry for your troubles.
However, I do seem to remember you previously commenting that
medical insurance as-was wasn't really insurance. Real insurance
covers you against serious monetary liability, not your routine
expenses. It looks like what you've got is Major Medical, which
does exactly this.
Ron at February 18, 2015 7:16 AM
Re: "Error 4: 20,000 people die each year because they don't have the insurance to pay for treatment."
Best estimates for death by hospital mistake are somewhere between 200,000 and 400,000 annually (NPR/Marshall Allen, ProPublica 9/20/2013).
So, it's 10 times more dangerous to go to the hospital than it is not to have health insurance?
Canvasback at February 18, 2015 7:45 AM
Amy Alkon
http://www.advicegoddess.com/archives/2015/02/18/health_care_arc.html#comment-5857160">comment from RonI didn't want "Major Medical" or I would have had it. I wanted what I had before Obama and a bunch of legislators overturned our health care system without reading what they were passing.
What that was was not Cadillac care but adequate care at a very reasonable rate without a deductible. I paid into the system since my 20s and used it very little. Now I have pediatric dental care for children I will never have and I'm funding all the people who didn't get in in their 20s and risked (back then) having costly rates when they were older.
I did the responsible thing and I'm screwed.
Don't tell me I have Medical Medical as if that's something good. My healthcare didn't need to get fucked with.
Also, because I pay my assistant a good bit (and need her because of my ADHD), I effectively make only a tiny bit of money a year (gross adjusted income). So, I fall below the lowest subsidy and though I said, "Well, what if I wanted to take the subsidy at the bottom, even though I qualified for more?" No go. I would be forced to take a greater subsidy, forced onto Medi-Cal, where you lose your care for (they say) 45 days but maybe more, while they're deciding your eligibility every year. (My favorite story is the guy who applied in January, died in April and got approved in June.) Also, this means I would have lesser care -- if care at all, since you can't get appointments very well or at all on Medi-Cal. I need to keep my psychiatrist, above all else. I need to stay on Kaiser. Now, thanks to Obama, I am paying a big amount every month that I can't afford and getting effectively very little for it (and not the care I need).
"I hope I don't get cancer" now replaces the breast MRIs a breast surgeon said I needed every two years (due to large, dense breasts and family history). Yay, Obama! Thank goodness that same surgeon sent me for a BRCA test (negative!) before Obama fucked with our health care.
Amy Alkon at February 18, 2015 8:30 AM
@Ron: Yes, but major medical had cheap premiums. That was the point of it. The ACA plans have PPO price tags but major medical benefits.
ahw at February 18, 2015 8:33 AM
Thanks, ahw.
Amy Alkon at February 18, 2015 9:10 AM
It is a very lopsided and complicated system Ron.
I am in my 30s with a family. I am also financially savy with good income and savings. I only want major medical coverage and I am willing to pay most costs out of pocket. Unfortunately major medical is not legally available. So my premium costs have jumped from $125/mo to $635/mo, my deductible has jumped from $3k/year to $13k/year. There is also the complication of finding doctors that accept the insurance. I purchased a plan through Humana last year and found that any hospital would take it, I just couldn't use any doctors. And I mean that entirely literally. My wife got pregnant. We called over 40 ObGyn offices listed on the Humana website as providers and none of them would take the insurance. This year before buying a plan we went to all of the doctors we planned to use this year and asked them what insurances they took. Thankfully there was an option they all would accept. But doing this took almost 2 days of work. Not something most people can do.
On the flip side, I have a coworker who is older (50s I think) married with no children. She makes a good income but not what I make and has few savings. Prior to O-care she did not have insurance because it would have cost her ~$1k/mo. Now she does have insurance. She is paying ~$75/mo with no deductible.
Now for the kicker, we live in Texas which has a federal exchange. PPACA is quite clear that subsidies are not available to consumers who use a federal exchange. Obama has provided those subsidies anyways. This is now in front of the supreme court and should be ruled on this year. I can't predict what will happen but I expect a 5-4 ruling. I just don't know which will be 5 and which will be 4. If the law is followed my coworker will drop her insurance like a hot potato. There is no way she can afford it without the subsidies.
Ben at February 18, 2015 9:44 AM
Ben - thank you, yours is the exact situation me and my family have been forced into as well - we live in Minnesota. It is maddening. In doing the legwork myself in order to find coverage for me and my two young daughters, the health insurance representatives I spoke to noted that there are many families in the same boat. That is, the family premiums for any employer-offered coverage have skyrocketed, as well as the premiums for major medical only. And the increase in annual deductible is absurd. Yes, the care part of the equation is missing after the Act was passed. Now we do the same as Amy, and just hope that we won't have to visit the doctor outside of well-child checks, vaccinations, and annual physicals. It literally appears as though this was designed to drive out the middle class. And forcing people to pay the government should they opt-out of health insurance? Government overreach is right.
Jess at February 18, 2015 9:53 AM
Let's be honest. There were two, and only two, motivations for the ACA: (1) to buy votes by creating a new entitlement class, and (2) to lay the groundwork for a socialist system. All other explanations are either rationalizations or outright lies. Obama said he was going to fundementally transform America, and he's doing it.
Cousin Dave at February 18, 2015 10:43 AM
Exactly what I've been saying for years... The Obamafans LOVE this, no matter the reality, which is: Unaffordable. They chose a title for it to try and fool the idiots, "Affordable Care?" There's nothing affordable or, case in point, usable about it. Just like anything the government touches, they break it, overcomplicate it, screw it up - and then it becomes more inefficient and fucked up than without them. But hey, "They are doing good" except that none of these fucking represenatives, legislators or elected officials have to actually participate in what they passed but didn't read. So - FUCK THEM? Nope... FUCK US.
Lee Ladisky at February 18, 2015 10:49 AM
Let me clarify, we can afford the single employee premium (still outrageous but the company contribution offsets it agreeably) for my husband alone, but the family rate for the employee- offered coverage costs nearly as much as the monthly mortgage payment for our modest home. If I were a single mother though, I would qualify for state-funded coverage. Minnesota has a wonderful social safety net, which can be appreciated - but not when suddenly it would make sense for parents to divorce each other just so they could afford government-mandated health insurance coverage.
Jess at February 18, 2015 11:55 AM
My family would be in the same situation as Jess and Ben if I didn't have my (pretty awesome) employer coverage. We don't qualify for subsidies. We'd have to spend nearly $8k just on premiums. So if even one of us got sick we'd be in at least $13,000.
I just love how the president gave lip service to the middle class at the SOTU address. Take a third of our income before we even see it, require us to spend another 10% after that on "affordable" health insurance, then try to tax what little we're able to sock away for our kids' college education that was supposed to be in a tax-protected savings plan. I assume he's going after my retirement account next.
ahw at February 18, 2015 11:58 AM
You got that right ahw! I heard recently that there is a federal plan in the works that will require employers of more than 21 employees (or something like that) to offer a retirement savings plan. Sure, that would be great - except now we are placing additional costs (in time and money) on small businesses. They would have to hire someone to administer the plan, and there would be additional time and paperwork and tax duties (because I am assuming that although this would be another in a long list of federal requirements, the feds would not be providing those additional services and certainly not free of charge).
Jess at February 18, 2015 12:10 PM
Besides, I thought the government was already planning for my retirement by taking out Medicare and social security taxes so that they can take care of me in my twilight years. Oh, no?
Jess at February 18, 2015 12:13 PM
Silly rabbits.
Paul Krugman, Nobel Prize winning economist, says the higher premiums are because you are getting better coverage than that fig-leaf coverage you had before.
http://www.nytimes.com/2014/02/03/opinion/krugman-delusions-of-failure.html?_r=0
Conan the Grammarian at February 18, 2015 1:22 PM
The 12 states with no-fault auto insurance do indeed have what amounts to compulsory collision insurance.
@Cousin Dave: That's my read, too. Obama is quite faithfully following the instructions of his buddy Saul Alinsky.
@Lee Ladisky: You just have to appreciate the irony of the name of the law. Just like the "Bank Secrecy Act" which outlawed banking secrecy, the "Affordable Care Act" outlaws affordable care.
@Jess: Look up "Ponzi scheme."
jdgalt at February 18, 2015 3:38 PM
Affordable Care Act doesn't mean more affordable for us. It means more affordable for the government and the insurance companies and health care corporations that supported it.
Ken R at February 18, 2015 4:34 PM
Our insurance costs us far more than what we used to have now too. My husband wanted to try switching companies last year. I told him not to switch until I could find doctors that would accept us on the plans. There were a ton listed and despite calling every single one, not a one accepted new patients. I was also in the early stages of a very high risk pregnancy (pregnant with IUD in place and also my blood clotting disorder). It would have been next to impossible for me to be seen for the pregnancy. The insurance required establishing with primary care (of which none on the list were accepting new patients) and having the pregnancy confirmed so they could then put in a referral to OB. I was told it would take 6-8 weeks to get in to a primary care, assuming one was available, then 6-8 weeks after that visit to see an OB. I was looking at a 3-4 month wait to even be seen for my pregnancy and then it would be an additional 8-12 weeks to get in to see a perinatologist, which is absolutely necessary to manage my medications, blood clotting disorder, and the problem of having an IUD still in place in my uterus. And no, they would not prescribe my Lovenox injections until I saw perinatology and that med was not covered by insurance anyway. When all was said and done, it would have taken 7 months to see the doctor I needed to for my care, if I was even able to see primary care to start the beaurocratic nightmare, and I was 9 weeks pregnant at the time we would have started new insurance. I had my baby at 30 weeks, so I would have never gotten to the appropriate doctor before I had him and who knows what would have happened because I'd had some serious issues pop up even with close monitoring. So, if we had picked that plan I would have had no care and over $13,000 in hospital bills. I'm guessing it would have been much more because the olan said it only covered up to two weeks of hospitalization and my son spent 9 weeks in the NICU. After we discovered all the crap that would be involved with changing insurance we opted to stick with a Kaiser plan since we were already established patients and never had problems being seen in a timely manner for anything of a more urgent nature. This is a plus now because my son has some health issues from being so early that need a lot of close followup until he gets older.
BunnyGirl at February 19, 2015 3:05 PM
"The 12 states with no-fault auto insurance do indeed have what amounts to compulsory collision insurance."
I don't know if Florida still has this system, but when I lived there, their alleged "no fault" system was nothing of the sort. It didn't ban or restrict accident lawsuits in any way. What it did do was allow people who drove old paid-for beaters to carry only "personal injury protection", or PIP, insurance. PIP was basically major medical for accident injuries, with a lot of restrictions. Liability coverage wsa not required.
PIP was sold by a bunch of fly-by-night outfits who sold policies, collected payments, and then went bankrupt as soon as claims started rolling in. (But not before transferring all the company's assets to a new company, leaving the old one bankrupt with no assets, and creditors with no recourse). The end result was that uninsured-motorist coverage in Florida was outrageous, $2000 or more a year -- and this was back in 1985. The people who drove the old beaters, when they got into an accident, simply walked away abandoning the wrecked vehicle and bought another one. Most of the time the police didn't even bother collecting their info, assuming that they stuck around after the accident long enough for the police to get there.
Cousin Dave at February 20, 2015 9:25 AM
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