Vote for those representatives who will not fund it. Problem solved until 2010, when we can elect those who promise to repeal it.

There are no benefits, only costs, until 2014. How popular do you think that is, in the midst of a recession/jobless recovery? Your take depends on whether you are a realist, or an optimist.

Preview is my friend. I meant to write 2012.

They have a plan.
Step 1: totally frak the private medical system.
Step 2: claim private medicine doesn't work and nationalize the whole thing in the name of "efficiency" and "free" health care.
Step 3: choose the next industry to consume.

Wait until the doctors start bailing. This is a common problem with those of the liberal persuasion. They imagine we can make any Utopian change, and the relevant key people will continue to act the same.

The feminists imagined they could change marriage and divorce laws any way they wanted, with no concern for the feelings and opinions of men. Now, marriage is going away, and in increasing numbers so are men.

In the 70's, probably very early in the lives of some here, we had a very small shortage of gasoline, which almost brought this nation to its fee. I don't remember any more, maybe 5%?

A recent survey showed that 1/3 of doctors said they will cease practice if the law is passed. That is presumed to be partly hot air, but if only 10% of doctors cease practice, which is probable, we are going to have a horrid mess. In many areas, it already takes several days to get in to see your doctor.

I say 'we' rather loosely, because I am not there. Enjoy.

Received this link from a friend yesterday.

http://mjperry.blogspot.com/2009/11/why-obamacare-wont-work-it-will-be.html

There are no benefits, only costs, until 2014.

Not true. These take effect immediately:

*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.

*Insurers will be barred from excluding children for coverage because of pre-existing conditions.

*Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.

*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.

*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.

*Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.

*A tax credit becomes available for some small businesses to help provide coverage for workers.

*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1. (Boehner especially hates this provision)

http://www.reuters.com/article/idUSN1914020220100319

Sp tanning salons will go out of business. That's always a positive. What about parents who don't want to keep paying for their children (26!--good grief!) are we stuck with them?

d00d - these by you are BENEFITS? So much for my $155/mo high-deductible catastrophic plan. Since they have to get rid of the lifetime limits, that's gonna at least double when it renews.

Thanks so much, 52%!

@KateC: RTFP: "Young adults will be able to stay on their parents' health plans until the age of 26."

Nobody's obliged to be stuck with them. But given that lots of young people are finishing school and having a hard time finding work (or work with benefits), offering them additional years of coverage under parents' insurance will help avoid unnecessary financial burdens on them or their parents.

Yes Brian, for lots of people, ending lifetime limits is a benefit. Insurance will cost somewhat more, but it means that they don't go bankrupt when they get cancer because their insurance calls it quits halfway through chemo because they hit their limit.

Just asking: Is anyone seriously making the argument that the bill just passed will lower costs? I mean, somebody who actually expects to be believed?

SOMEWHAT MORE?????

Do you actually know anything about insurance? Let me tell you what the statutory elimination of lifetime limits does.

It makes it completely impossible to price risk. The insurance company can no longer state a maximum payout number, and therefore is legally insolvent. In case you didn't know, insurance companies are required to keep a certain percentage of their total exposure in assets.

Guess what - THEIR TOTAL EXPOSURE IS NOW INFINITE.

Congratulations - the entire insurance industry is now done.

@ORD - Although it might just be coincidence, the price of burgers at the local Wendy's went up 30% yesterday.

The menu board on the drive thru says $6.39 (as of 10 minutes ago) for a triple baconator. The register says 7.99 (which the menu board probably says right now).

The only thing that's changed significantly that would effect the price of a burger is employment costs. If the requirement to provide insurance to part timers just kicked in, then the price of everything is going through the roof.

Say hello to my double dip.

Brian, I've seen this somewhere else today, and I thought it was an apt description: Insurance companies are now, in effect, government contractors. The government will decide who they can employ, what fees they can charge, and how much profit they will be allowed to make. And if/when that all goes wonky -- hey, there's always bailouts! (Or in this case, more likely, the ultimate "excuse" for implementing single payer.) In other words: it's not a bug, it's a feature.

"Where were you when the Republic died?"

Watching the Supreme Court decide the election for Bush. Where was everyone else, and do they have fun vacation photos from Iraq for us?

Watching the Supreme Court decide the election for Bush.

Right. Because making Florida uphold their own laws is so horrible.

Would you have preferred that the Florida Supreme Court be allowed to set aside both the law of Florida (without actually ruling on the law) and allow Gore to steal the election by dubious recounts?

Or was the Republic fucked in either case in your opinion?

It makes it completely impossible to price risk.

Not so good with stats and probability theory, huh? There's tons of data on how much treatment costs, the probability that someone will need such treatment, what percentage of people choose what kind of treatments, how long someone might remain their insured, and so on. From those data, one can build a model predicting the likely total payout for a policy and price accordingly.

Would you have preferred that the Florida Supreme Court be allowed to set aside both the law of Florida (without actually ruling on the law) and allow Gore to steal the election by dubious recounts?

I would have preferred that Florida's Supreme Court be able to decide what the law of Florida.

"There's tons of data on how much treatment costs, the probability that someone will need such treatment, what percentage of people choose what kind of treatments, how long someone might remain their insured, and so on. From those data, one can build a model predicting the likely total payout for a policy and price accordingly."

But the whole damn purpose of this exercise is that the insurance companies won't be allowed to price accordingly! Everybody within a handful of broadly defined demographic groups will have to be charged the same. And once the courts rule that certain of those have Special Rights and hence should have to pay less regardless of all those pretty statistical models, anybody who's left having to pay a market price will say screw it and move to Belize.

Dave - I didn't have the heart to take the next swipe and mention that I've got a math degree. Thanks for smacking him first.

Everybody within a handful of broadly defined demographic groups will have to be charged the same.

Doesn't mean they still can't price things in, they just have to aggregate more broadly.

Brian, if you have a math degree, you should know how to address these sorts of problems. I'm not impressed.

Look, dumbshit, it's really simple. It's a limit problem more than anything else.

You can aggregate all you want. But when you are not allowed to deny coverage or service to anyone for any reason, you really don't have the ability to evaluate risk. Or more precisely your can evaluate it but you can't price to it.

Add to this the fact that the government will also be reviewing any premium increases and will deny or cap those and you've got a recipe for disaster.

Further adding to the problem is the fact that as copays remain low, and media hysteria about medical malady du jour increases, service utilization will increase.

Here's where the problem comes in:

The company has an upper limit of what it can pay out in claims: premiums - (overhead + expenses). That's the most basic formulation. There are other sources of income (investments, primarily) but we'll leave those out for now.

I'm sure the tables show that a certain percentage of patients will hit the lifetime cap. You can price that in to your risk assessment. Now that the cap is gone, you can't, because you no longer have an absolute maximum number that can be hit by any given patient.

You've also got the increased utilization to absorb. Which means even more payouts. So you price that in to your risk, and premiums increase. But the government just said that premium increases are bad. After all, some company was being lambasted for a 40% premium increase. Somehow I doubt that increase was so the executive suites could all be fitted with golden bidets.

This is exactly the problem California caused when it regulated retail pricing of electricity and deregulated wholesale pricing. Retail electric suppliers were forced to sell electricity below cost.

Now that the cap is gone, you can't, because you no longer have an absolute maximum number that can be hit by any given patient.

Brian, I get the sense that you haven't done much statistical or probabilistic modeling. Even lacking an absolute cap in payouts, it is possible to use actuarial data to compute the probability of paying more than X amount, Y amount, Z amount, etc., based upon age and gender of the person being covered (and whatever factors can be included) and use those to determine the rate which a customer must pay in order to cover those risks. It's a more complicated process that one with a cap, but in the tail of that probability distribution, you essentially get a zero asymptote (i.e., there is no real likelihood that the company will have to spend more than that) and can work from there, adding in a risk premium to provide a little cushion.

it is possible to use actuarial data to compute the probability of paying more than X amount, Y amount, Z amount, etc., based upon age and gender of the person being covered (and whatever factors can be included) and use those to determine the rate which a customer must pay in order to cover those risks.

What he's saying to you is that the government won't let them price policies where the actuarial tables say they should b/c they've got to keep premiums low. You're not addressing his point.

You're not addressing his point.

I'm very much addressing one point that Brian made: "It makes it completely impossible to price risk. "

That point is incorrect.

As far as premiums go, by using the mandate to push lots of low risk people who might otherwise be uninsured into coverage, insurers now have a bigger pot of money to work from, which may actually create an opportunity to lower premiums in general. I don't believe there is language in the bill setting premiums; if there is, that does greatly increase the likelihood of insurers being in financial trouble if they are set artificially low or insufficiently subsidized.

There was a "case study" a few years ago in Readers Digest about the "Million Dollar Patient". He came into the ER at a teaching hospital with conflicting symptons. By the time he expired -- less than 30 days later -- the surgeries, treatments, expiremental meds, etc. was over a $1 million -- the hospital had to absorb about $500K of that.

Does that really make sense?

There was a "case study" a few years ago in Readers Digest about the "Million Dollar Patient". He came into the ER at a teaching hospital with conflicting symptons. By the time he expired -- less than 30 days later -- the surgeries, treatments, expiremental meds, etc. was over a $1 million -- the hospital had to absorb about $500K of that.

Does that really make sense?

"Does that really make sense?"

Maybe people have a fear of dying. I think I'm more afraid of dying SLOWLY.

Say, in case anyone knows, some guy on Ragbrai told me last year that "life" cycles on the planet Earth every seven years. So life leaves your body and becomes life in other things, and then the minerals your body is made out of become other things, and everything that is living right now passes its life on to other things every seven years. How would you possibly measure something like that?

It sounds a little too fung shui for me, but so what? The point is, your only alternative is not to live at all, so what's with all the complaining? I'm pretty sure a cycling tour is in order ...

I don't believe there is language in the bill setting premiums;

According to this article in Bloomberg, premiums are decided by the state:

"Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified."

http://www.bloomberg.com/apps/news?pid=20601087&sid=aa32kl.M09T4

So the answer is that no, the government won't set prices. Only that states will be permitted to exclude gougers from
the exchanges designed to allow individuals and small groups to pool risk. But they can charge whatever they want if they don't participate. Facism!

Well, "gougers" is a subjective term. The fact is that this does give the states lots of power in setting premiums, under the threat of banishment from the exchanges.

Yep, and because every company who wants that exposure will be participating in the exchanges, we should have something that comes close to a real market in insurance for once.

OK, now I know for a fact you're a moron, d00d.

Name one instance where government interference in markets has resulted in price transparency.

Has it occurred to you or any other leftist that government meddling (the HMO concept was created by Ted Kennedy) is the reason we're in the position we're in today?

The actual cost of care is hidden from anyone who doesn't pay cash. And now you're not only going to hide that, you're going to create a false cost of insurance that completely removes anything resembling a price signal from the entire industry.

Yep, and because every company who wants that exposure will be participating in the exchanges, we should have something that comes close to a real market in insurance for once.

To the contrary, we'll have a government controlled market, not a real one. As brian points out, that's what caused all the trouble to begin with. A real market would allow insurance companies to compete across state borders. Why doesn't this bill allow that if they're oh-so-concerned about keeping premiums down?

d00d, artificial-izing the market is the whole goddam point of the bill! What about that are you incapable of understanding?

Dave - he's a lib. He doesn't think, he feels.

Thinking's too much like work.

Anyone who thinks what we currently have in health care is anything approaching a market is delusional. The exchanges will help create a market and pool risk for individuals. In addition to this, the bill brings unprecedented transparency to costs in our our health care system.

Hospitals will have to post prices. Insurance products will be presented with standardized information, consumer ratings and quality measures. The payments physicians take from drug and device companies will be in a public database. There will be independent funding for research on the relative effectiveness of different treatments. Some of these changes are small and some are big, but put together, the system is going to become a lot more visible in the coming years.

http://voices.washingtonpost.com/ezra-klein/2010/03/transparency_and_the_health-ca.html

But all you fools can see is "ZOMG Obamussohitler has destroyed our freedoms."

He doesn't think, he feels.

Yeah, I don't think Brian. Never. For example, no thought went into my dismantling above of your claim that risk pricing is now impossible for insurance companies. Not a lick. LOL.

Did anyone here say we had a market? No, we all said that the problems were caused by government-sponsored DISTORTIONS TO THE MARKET. The "exchanges" will not create a lick of transparency because the end consumer will still not see the TRUE costs of health care. They will get a bill, for sure. Just like I do now. And all the prices on it ARE LIES. And they will continue to be such.

Since the hospitals and doctors are all going to be paid from a standardized scale, there IS NO COMPETITION. Do you not grok what price fixing does?

Regardless what the Washington Post says (when they take Obama's dick out of their mouth), no law increasing government control over service pricing can ever deliver transparency.

And you're right - no thought at all went into your feeble attack on my claim.

I'll try to state it again, perhaps I was unclear.

In order to price risk, you have to have the following things:

1) Ability to predict your total premiums collected.
2) Ability to predict your likely claim payments paid.
3) Ability to assign a cap to your potential maximum payouts in a catastrophe.

#1 is gone, because people can avoid buying insurance until they are sick, and the insurance companies can't refuse them. The mandate is a joke unless the fines exceed premiums, which they won't. In order to get #1 back, the government would need to impose a fine greater than average premiums, and back it up with prison time for anyone failing to keep continuous coverage.

#2 is gone, because the government is requiring them to pay everything without limit. When something is perceived as cheap or free, people will use more of it.

#3 is gone, because there are no lifetime limits.

Allow me to put it in terms of homeowner's insurance. Suppose the government no longer allowed companies to refuse homeowner's insurance to people who'd already suffered a loss, required them to pay any claim for damages with no deductible, and placed no upper limit on the number of claims to be paid.

What incentive does anyone have to keep the insurance current unless forced to? And even then, what incentive does anyone have to not use their insurance for maintenance by simply waiting until the roof fails rather than replacing it before it does?

And none of this gets into the financial viability of the insurance companies. Since the government will be setting maximum premiums, controlling premium increases, and setting them by geography and not demography, the insurance companies will never bring enough money in by insuring young, healthy people to cover the losses.

You can look at this as a purely academic enterprise and come up with a model in which risk can be priced. But your model is bullshit because most of the variables in it are statutorily outside valid ranges to get a risk value that's insurable.

In other words, if your risk probability == 1, you don't have insurance, you have a bank, and one with dwindling reserves at that.

Brian, all of your claims assume that none of the elements of the bill works as expected. If that is the case, then yes, things break.

1. You assume most people won't get coverage until they are ill. Since most people are covered currently, and most of the rest won't dig the idea of paying the extra tax, I'm pretty sure that we get most people in coverage before serious illness. It is possible this is wrong, and if so, the mandated tax will need to be increased. It's fixable.

2. Ability to predict your likely payouts is not broken. Your failure to grasp this indicates you don't get probability theory. Even with no total cap on lifetime payouts, there is a clear distribution of likely payouts based upon known factors; people don't live forever no matter what. We can estimate the likelihood of maximal payouts and price accordingly.

3. See #2.

d00d - all of your claims assume that people's behavior does not change. You assume that everyone will irrationally maintain insurance when it is less expensive to do without. You also assume that companies will continue to offer insurance to employees in the face of massive premium increases.

Like I said, so long as the difference between the fine for not providing or purchasing insurance (separate fines for companies (percentage of payroll) and individuals (percentage of income)) and the insurance premium is in favor of going without insurance, enrollments are going to drop like a rock.

When my insurance company tells me in August that they cannot renew my policy because it does not meet mandatory minimum coverage requirements, but how about this nice policy that does for only $500 a month (I pay $150 now), I'll cancel. The fine is only 2.5% of my AGI, which I'm presently minimizing to get to a zero or low tax situation. I can live with a stagnant lifestyle until the socialists are finally rousted from power.

And ability to predict likely payouts IS broken when there is no ceiling -- unless you are ready to admit that there are so-called "death panels" that will authorize denial of costly end-of-life expenses in favor of hospice or euthanasia.

You cannot assume that policy does not impact behavior, especially when it is intended to. You also cannot assume that you will get the change you want. They tried raising the luxury tax to soak people who were buying yachts. Rather than collecting a fat payday, the government got less revenue because rich people just stopped buying yachts and put many yacht builders out of business in the process.

I'm an engineer. I'm trained to look for unintended consequences. Congress is made up of idiots who are intellectually incapable of admitting that such a thing even exists.

There exists no explanation for how this health care law will improve anything. Because it won't. Between intended destruction and unintended consequences, we're pretty much fucked.

Yep, I do assume most people will either keep their existing insurance, or be persuaded by the mandate (which for most is a non-trivial amount of money) to buy insurance. I expect your reactionary approach to be the exception, not the rule. It's possible these things are wrong. It's certain that aspects of this will need tweaking. We'll see who's right in a few years.

Since you're starting from invalid assumptions, all your conclusions are necessarily wrong. No wonder you think my statement about risk assessment was incorrect.

Let me lay it out for you. My insurance WILL NOT be renewed since it is not legally acceptable to the new regime. When I was looking at insurance, the cheapest comprehensive HMO policy available was over $350 a month. I'm certain I won't be offered anything that inexpensive that is compliant.

Assuming I gross $120,000 per year (AGI), the 2.5% penalty is only $250 a month. And since the insurance companies can't refuse me after I'm already in the hospital, why the fuck should I renew my policy?

If I'm an employer, I can tell you I'm not going to pay a doubled premium, I'll just pay the pissant little fine, bump my employees' wages by the difference between today's premium and the fine, and let them get their own insurance. I'm certainly not going to cut wages to pay the higher premiums, and in this economic environment a price increase is suicide.

You cannot start from your assumptions because they assume that everyone is stupid and not motivated by self interest.

It is not from the benevolence of the butcher, the brewer or the baker, that we expect our dinner, but from their regard to their own self interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages.

I suspect we'll know in less than six months who's right. Most companies have open enrollment at the end of a quarter or half. And a good number of large corporations run on a october or november fiscal calendar.

My insurance WILL NOT be renewed since it is not legally acceptable to the new regime.

No doubt it is a very high-deductible, catastrophic insurance plan. Here in NJ too, it's impossible to buy such a plan. This is an example of governmental meddling in insurance that has irritated me for years. Why should such plans not be made available? Isn't this what most healthy people want from insurance? Imagine the savings such plans could mean. Imagine the even greater savings they could mean if meaningful competition from insurance companies in other states was allowed. The fact that the new bill perpetuates these foolish bans strikes me as evidence that the objective here was not to improve people's situations vis-a-vis health care.

Kishke - completely correct. In fact, the plan I have wasn't available in this state not too long ago.

This "plan", such as it is, is merely a tax on youth and good health.

At least in the short term. In the long term, it's about the ability to control all the minutae of daily life.