为什么ACA的个人强制要求ACA中最痛苦的部分,而ACA在没有ACA的情况下无法获得资助呢?

Sidney 08/21/2017. 12 answers, 4.732 views
united-states affordable-care-act

首先 - 请问,如果对问题的框架有挑战,那就走这条路。 我不知道我在这里说什么 - 所以我会尽量不要纠正心。

“平价医疗法案”(ACA)是一项具有多个组成部分的分裂和复杂的立法。 在关于废除的讨论中,政治家们承诺保留其中的一部分并消除其他部分。 有一些受到广泛赞誉的做法(让孩子们长期继续保留父母的保险,强制保留原有条件),少数人接受(最低保障标准,限制老人可以被迫支付的费用)和少数几乎所有ACA的反对者都会嘲笑,比如个人的授权。

我的问题是,我一直觉得,如果没有个人的授权,一般来说健康的人不会购买保险,而是像以前的保险一样,让孩子留在父母的保险更长久couldn't be realistically funded 。 没有摆脱其他一些规定,摆脱个人的任务就没有加起来。

政治家们如何承诺保持沉默和沮丧?

2 Comments
22 Mason Wheeler 07/29/2017
一个充满愤世嫉俗的观察者可能会指出你的问题的题目已经包含了自己的答案......
1 SoylentGray 08/01/2017
我想指出的是,有许多方法可以为ACA提供资金支持......它们在政治上更加痛苦。

12 Answers


Brythan 07/28/2017.

你正在反思这一点。

个人的任务是不受欢迎的,因为它惩罚那些想要花钱在健康保险之外的人。 更糟的是,这是一种累退税,因为没有保险的人主要是低收入。 高收入人群几乎总是有雇主提供的健康保险。

在2007年和2008年,民主党候选人的总统反对个人的任务。 正如大西洋月刊所说:

奥巴马在整个竞选过程中担任这一职位 他说,当选希拉里,政府将迫使你购买健康保险。 选我吧,我给你降低成本,让你保持自由。

除此之外,个人授权还不足以实际迫使人们购买保险。 每年约700美元的开支(收入的2.5%), 平均保险费用每年约3700美元,不需要补贴。 最便宜的保险费用为每年1800美元。

例如, 纽约客说:

然而,出于政治原因,蔑视这种“个人授权”的惩罚被设定在一个非常低的初始水平,这应该会逐渐增加。

很难捍卫一个耗费相对贫困人口的金钱的计划,因为它没有收取enough金钱而无法工作。 简单的事实是,政治家们不鼓励采取强硬立场并为其辩护。 他们宁愿谈论的是好东西而不是成本。 所以民主党人讨论好吃的东西

  1. 覆盖率增加(覆盖的人数)。
  2. 增加保险范围(程序类型)。
  3. 覆盖先前存在的条件。

共和党人讨论费用

  1. 预算影响。
  2. 增加税收。
  3. 保费增加。

应该很明显,好东西和成本一起。 但政治并不适合细微的论点。 或许涵盖先前存在的条件和更多程序,保费收入增加20%。 但民主党人(比如巴拉克奥巴马)声称保险费将会down ,而不是做出这种论调。 每个人都喜欢降低保费。

选民习惯于被告知他们可以拥有自己的蛋糕并且也可以吃。 不幸的是,这不是现实的工作原理。

你说

一直以来,我的印象都是没有个别任务的健康人士,他们不会购买保险,因为像以前的保险,让孩子留在父母身上的保险更难以得到现实的资助。

请注意,这有点误导。 个人授权提供了微不足道的收入,每年约为15亿美元 。 每年用于医疗保险补贴的开支为6,600亿美元

一般的观点是,如果没有授权,预先存在的条件覆盖将变得更加昂贵。 这是因为人们可能会等到生病(先前存在的状况),然后再购买保险。 但这个授权并不是政府的资助机制。 避免任务处罚的人增加了保险公司的资金。 当然,除了授权之外,没有真正的衡量有多少人不会购买保险。

该任务不应影响留在父母保险费用上的儿童。 事实上,情况正好相反。 父母保险的孩子是避免支付任务处罚的另一种方式。 这使得不太可能存在保险失误,并保持原有条件下降。

5 comments
16 Segfault 07/28/2017
15亿美元是针对个人授权收取的税收处罚金额。 它并没有衡量有多少收入来自卫生保健提供者的健康个人谁没有得到充分利用的计划。
3 Andy 07/28/2017
@Segfault“OP在询问如何让”让孩子留在父母的保险上“可以得到资助,这是由保险公司承担的成本,而不是联邦政府的成本。” 它不是保险公司出生的成本; 它不能自由地遵守政策,你仍然必须支付家庭保险费率,以保持你的孩子。
1 Segfault 07/28/2017
@Andy这是一个离题,但让我反驳这一点:如果它不是比买他自己的计划便宜,它不会存在。 它降低了保险公司的利润率。
1 Segfault 07/28/2017
@Andy这个离题越来越长,哈哈。 我不想就此进行大讨论,因为这是我原来的评论中的一个小切点。 让我问一下,如果保险公司向5个成年人的团队出售家庭计划而不是5个个人计划,那么他们为什么不为那些30岁或以上的孩子做这件事? 请回答这个问题,这不是修辞!
1 Andy 07/28/2017
@Segfault因为他们不仅仅向一组五个成人出售一个家庭计划,他们还出售了80个家庭计划,每个计划3-5人。 团体保险计划中的家庭计划(通过您的雇主)与您可以在交易所(个人市场)获得的家庭计划相比,保费较低。 通过这80个家庭计划,你有20个单人或保险+配偶计划,所有计划都有单点联系。 这就是我的小公司,有100名员工。 想象一下保险公司刚刚从GE那里得到多少计划。

PoloHoleSet 07/28/2017.

个人授权要求人们采取负责任的行动,而不惜牺牲钱包/预算。 一个普遍的主题是不负责任的自私自利 - 在一个人们可以选择符合他们原有观点的新闻/信息的时代,越来越多的自由受到影响。

所以,人们会看到很短的一段话:“我现在没有生病,为什么还要为健康保险付钱?”

大多数批评是基于对基本误解的反应,或者对以下几点有误解 -

  1. 整个社会的代价更高,对于受到医疗保健需求打击的个人而言更具灾难性,并试图在没有保险的情况下处理这些情况,从而导致个人破产,并将成本转嫁给其他人。

  2. “我为什么要为别人付钱”的“我”观点? 方便地忽略了这样的事实,即如果发生什么事情,决定不被保险意味着其他人将不得不为你支付(拖欠所有债务,除了学生贷款,不仅仅是医疗,破产时提交,成本转嫁到他人点# 1)

  3. 虽然健康保险涵盖正常的,预期的和预防性的费用,但其目的是为了保障付款人免受意外和更高的possibilities

  4. 没有人选择生病或绝症。 每个人最终死亡。 这意味着每个人都会违背自己的意愿,在他们的生活中需要医疗保健,除非他们完全健康并因某种瞬间事件而死亡。 这使得“选择”医疗保健的想法成为某种消费者选择的谬误。

  5. 通用保险不是一个短期命题。 你一辈子都在买东西。 当你年轻/健康时,你可能比你付出的钱多。 当你年纪大了或者生病多了,你就会得到比现在更多的钱。这个想法是平衡的,再加上你为这种灾难性保护付出了代价。

  6. 那些把它看作“我目前不使用x,y,z”或“我可能不会使用x,y或z”的人不理解保险的概念,这是集中的风险/使用。

  7. 大部分的反对意见都是因为奥巴马提出的,而且是反思性的。 个人授权是医疗保健检修的必要组成部分,是由保守的遗产研究所在回应克林顿90年代失败的建议时提出的,并在共和党总统候选人米特罗姆尼成为马萨诸塞州州长时成功实施。 显然,个人授权与GOP或保守价值观根本相冲突,没有任何一个概念是一个概念。 除了基本的无知之外,反对派的很大一部分是“拍摄信使”的心态。

5 comments
3 Tim 07/30/2017
The idea is that it balances...它不可能平衡。 根据定义,保险通常不值得; 平均而言,你会付出比你多的钱,否则保险公司不会获利。 这是NHS的另一个优势。 虽然很多人付出的钱比他们使用的多,但NHS平均不赚钱 - 目前他们亏本。
2 David Schwartz 07/30/2017
@Tim没有任何关于保险的概念要求它由公司发行或者这些公司获利。 您可以拥有保险公司发生的保险。 您可以购买支付超过其从客户收入但由政府补贴的公司发放的保险。 (这在美国实际上很常见于健康保险。)
1 Maciej Piechotka 07/31/2017
答案似乎更能解释为什么他们不应该抱怨,而不是为什么他们抱怨。 当我越来越欣赏ACA时,由于删除了先前存在的条件,它使医疗保健远离保险。 因此,没有个人授权,健康就会被挤出系统(保险公司将有“柠檬市场”并相应地设定价格)。 随着医疗保健得到了中上阶层税收制度的补贴,它迫使较贫穷的年轻人有额外的支出
5 Wes Sayeed 07/31/2017
“这是一个普遍的主题,即不负责任的自私自利 - 自由遭到挫折......”-1,这是我见过的最具有争议性的答案。 问题是人们为什么不喜欢个人的任务,你的回答基本归结为“因为人们很愚蠢,这就是原因。” 这不是一个答案,那是一种自以为是的咆哮。
1 PoloHoleSet 07/31/2017
@MaciejPiechotka--是的,但如果我把它放在“他们的反对意见是基于误解和/或无知”,我会被问到我在说什么误解,所以我继续支持它。 对立部分真的很简单。 误解和无知的数量涵盖了一个非常广泛的区域或区域,这就是为什么答案如此结束的原因。

Cort Ammon 07/31/2017.

首先,您的实际问题的答案很简单。 你问:“如果一个政治家对ACA至关重要,他们怎么能够个人授权呢?” 显而易见的答案是,一般来说,不同意个人授权的政治家也不同意ACA的整体。 这就像问你如果反对战争,你如何反对杀人。 更有趣的问题是有人反对杀害,如果他们是战争。 这就是有趣的论点所在。

政治家承诺保持高涨并消除波动,因为这是政治家的行为。 他们做出这样的承诺。 这就是政治机器的工作原理。

至于个别任务的具体情况,有预算论据。 事实是,只需增加保费就可以在没有个人授权的情况下为ACA almost所有的项目提供资金。 这就是保险的作用。 但是,关于造成问题的原有条件存在一个具体问题。 有一种愿望(主要来自民主人士,虽然我不排除共和党人)有保险覆盖预先存在的条件。 但是,如果你研究保险的实际运作情况,保险公司将被迫集中这些风险。 如果他们将他们汇集到一个“高风险组合”(这是一个已被抛出的术语),那么保费将无用支付。 如果你know在未来5年内你需要30万美元的治疗,那甚至不是一个风险:这是一个已知的因素。 在正常的市场条件下,一家保险公司在未来5年内保证30万美元的费用,自然会收取至少30万美元的保费!

这被许多人认为是不可接受的。 逻辑是棘手的,但合理。 如果你有一个高价的产品,并且以市场价格收费是不可接受的,那么ACA需要人为压制这些价格。 这意味着其他人将不得不为此支付 - 其他人在池中。 但是谁会选择在数学上比您预期的医疗成本更昂贵的水池中,以便覆盖别人已知的问题? 那个游泳池里的人会逃跑,寻求其他解决方案。 这会提高价格,导致更多的逃离。

ACA对此的解决方案是个人授权。 它剥夺了您的“自由”来决定是否支付健康保险,而是要求您必须将自己置于其中一个池中。 无论保险公司认为您应该为医疗保健支付多少价格,您都需要为此付费。

ACA的很多部分都可以在没有个人授权的情况下进行调整和资助,但是原有的条件覆盖有一个自然的滚雪球效应,如果没有它,会破坏稳定。

那么,一个政客通过攻击个人的任务来做什么呢? 他们正在攻击ACA的绝大多数支持者不完全理解的一条腿(实际上,绝大多数公民并不了解......)这意味着这些支持者不会像他们一样拼命地集结攻击ACA负责人。 一旦这条腿不稳定,他们会说:“看,整个系统都不稳定,让我们重新谈判。” 然后他们会试着把注意力集中在他们想看的部分上,让他们不想看到的部分掉下来。 这就是政治。 今天,共和党人正在这样做,但放心,这一进程绝对不是党派。 每个政治家都已经做到了。

5 comments
MSalters 07/28/2017
“一家保险公司在未来5年内保证花费30万美元” - 这种情况并不罕见, 人寿保险就是这样工作的。 也许有点高,但不是保险公司会担心的。 而30万美元的待遇则不太确定 - 明天你可能会被汽车撞到。 它不会花费30万美元的保费。
3 Cort Ammon 07/28/2017
@MSalters就人寿保险而言,未知数是你付出多少钱(死前),所以还有一个有意义的未知数。 我可以调整措词以便与之交谈,但我认为这可能会稀释信息而不是帮助。 但是,根据您在未来5年内被汽车撞击的统计概率,保险代理机构可以为您提供保费的轻微折扣是正确的。
jamesqf 07/30/2017
@ MSalters:这不是人寿保险的工作方式。 在任何时期,死亡的概率都是已知的,这取决于年龄和健康等因素,因此保险公司可以相应调整其利率。 因此,25岁健康的人每年的保费要比80岁的癌症患者低得多。 这也是为什么通常排除自杀和战争死亡的原因。 OTOH对你的家属有利,如果你死了,应该超过你的成本 - 这就是为什么对没有家属的人毫无意义。 但是ACA根本就不能这样工作。
Izkata 07/31/2017
“这就像是问如果你反对战争,你如何反对杀人,更有趣的问题是有人争论说如果他们是为了战争而杀人。” - 这些都不矛盾,看起来至少有一个词是错的/缺失
Cort Ammon 07/31/2017
@Izkata好的间谍,第二个应该是“反对杀人”。 我会编辑

Deolater 07/28/2017.

很简单,个人授权是法律的一部分,要求普通人做某些事情,所以这是普通人最容易看到的法律的一部分。

尽管ACA的一些批评者反对它对保险公司提出的各种要求,但这对大多数普通美国人来说,这在很大程度上是学术的,而他们本身并不是保险公司。 对于这些普通人中的一些人,其余的法律对他们来说无关紧要。 至少,一些大公司的成本是否上涨并不是一个特别私人的问题。

至于你的最后一个问题:

政治家们如何承诺保持沉默和沮丧?

这正是政客(和不诚实的销售人员)所做的。 在ACA的特殊情况下,共和党是社会保守派,财政保守派,民粹主义者和(越来越)民粹主义者的联盟。 一些共和党选民真的很喜欢ACA的“好”部分,其他人真的想要废除任务(特别是个人任务)。 承诺两个,你会得到两个选票。


Michael Richardson 07/28/2017.

反对这一任务的一个常见论点就是这样的:

在ACA之前,保险非常昂贵,我负担不起。

有了ACA,保险非常昂贵,我负担不起,因为没有保险而被罚款。

有人认为ACA不能成功。 该系统的成本增加很大程度上将由18岁至30岁之间现在需要购买保险的所有年轻健康人士支付。 然而,与此同时,他们增加了人们可以留在父母的保险上的年龄。

虽然能够继续照顾家庭的计划是有限度的,但ACA依靠支付成本的很大一部分人并没有被要求这样做。

1 comments
Sam I am♦ 08/02/2017
评论不适用于长时间的讨论; 这个谈话已经转移到聊天

coteyr 07/29/2017.

这显然是一个热点问题,但我会尽力解释我能做到的最好。

ACA的许多部分通常被认为是“好”的。 可见的是“没有预先存在的条件”,“孩子停留更长时间”以及HIPAA的变化/调整。

个人的任务通常是被挑选为不好的,因为它有一些或多或少的缺陷被包含进去。 确实,ACA如果没有它,至少在理论上是行不通的,这就是为什么它往往是前锋和中锋的原因。 摆脱个人的任务,整个事情就会消失。

反对个别任务的一些论点包括:

  • 健康保险不起作用。 你得到较低的护理标准和较少的选择。 保险公司决定你的护理,而你的医生不会。 这是非常真实的。 许多医生会根据他们的经验和智力开处方,并根据规定的计划为保险公司支付费用。 这导致个人护理质量较低,但理论上使护理质量更好。
  • 健康保险太贵了。 我发现这也是真实的。 今年我的家庭医疗保险费用约为9,000美元。 我们的医疗保健总成本只有2,300美元左右。 支付2,300美元,然后再支付9000美元,对我们来说更具经济意义。 事实上,通过这种成本差异,我们可以(并且确实)每年为储蓄账户节省约5,000美元的医疗需求。 我们实际上是在紧急情况下被覆盖的。
  • 个人的任务减少了个人选择。 我们很高兴能够为急诊室,手术等提供“紧急”保险,我们不希望“全面覆盖”不幸的是,这些飞机已经停产。 因此,现在不是我们的首选设置:“我们将支付我们通常所有的医疗费用,并获得保险以涵盖紧急事件”。我们必须“全面覆盖”,费用太高,并且给我们的护理质量较低。
  • ACA /个人的授权实际上会让医生变得更加昂贵。 有时令人无法接受。 例如,我的妻子看到一位专家。 专家访问,自己支付350美元。 通过保险的共同支付约为60美元。 60美元似乎较小,但为了符合这种共付的资格,她不得不频繁下注,并且每月支付750美元。
  • 将个人授权卸给雇主会产生巨大的经济影响。 由于您不能选择不提供保险,所以没有业务成本上涨。 有些人需要付钱。 相反,薪酬冻结,工资降低或产品成本增加,某个地方需要弥补差异。
  • 许多美国人首先不希望它。 事实是,很多很多美国人首先不想要ACA或个人任务。 他们觉得它要么做得不够,要么完全无效,要么实际上是有害的。
  • 它没有解决健康保险的问题。 我听到的一个共同主题是,单个任务并没有解决问题,它只是迫使每个人都有同样的问题,使问题更容易接受和更难解决。 健康保险不能解决健康问题。

tj1000 07/29/2017.

个人的任务......购买医疗保险的要求......是奥巴马医疗的关键,这将使该系统价格合理。 这是医疗保健的一种社会保障 - 在你年轻的时候付钱,年纪大的时候也会受益。

正是约翰罗伯茨所裁定的是税收,因此没有发现奥巴马的违宪。

真正的问题不在于购买保险的责任 - 如果您拥有车辆,您必须购买保险,在没有保险证明的情况下无法获得车牌。 这是如何obamacare的地方。

奥巴马医改是一项重大变革,对很多人都有重大财务影响。 几乎有一半的国家在放弃这一点时被忽视,那些基本上被禁止讨论该法案的共和党人所代表的那些人,一些非常强烈的感觉出现了,足够强大,使茶党能够站起来,让人民当选为国会在2010年的“停止奥巴马”平台上。无论好坏,这就是他们所做的,我们因此陷入了六年的僵局。

还应该指出的是,这些重新编辑现在正在重复这个同样的错误 - 他们在制作替代品时忽略了这个问题。 结果将同样令人沮丧。 遗憾的是,跨党派沟通和妥协的美术已被遗忘。

将保险关系置于其他要求之下,从而降低罚金:涵盖任何先前存在的条件。 这本身就是一个很好的要求,只要你不生病就没有办法退出。 个人授权的可怜小处罚远远低于实际的政策,是以相对无风险的方式选择退出的方式 - 如果您真的生病,您只需购买一项政策。

为了回到汽车模型,这与仅购买汽车保险(而不是拒绝车牌)的小惩罚大致相同,同时还要求汽车保险公司覆盖任何预先存在的事故。 在这种情况下,我们大多数人只会在我们遇到沉船事故后才会选择退出和购买,而汽车保险单的价格将通过屋顶......因为obamacare政策的成本最近已经完成。

如果这是与汽车合法的话,那么任何半路智慧的人都会问 - 什么骨头立法者提出了这个问题? 当然这是行不通的。 杜只是不说。

这几乎是奥巴马医疗的预先存在的条件部分的个别任务和强制性覆盖读取。 他们并不认为这一点很好......佩洛西的'我们必须通过它来发现它里面的内容'的评论回来困扰着我们所有人。

这是一个把主要经济模式固定在绝望乐观的概念上的案例:当“覆盖现有条件”条款时,人们会自愿地每年额外支付数千美元(对于家庭来说,则为数万美元)而荒谬的低点'惩罚'意味着他们不必这样做。

截至今天,唯一真正可行的解决方案是将Medicare系统扩展到所有公民。 工资扣除,所以它是基于收入的支付规模的缩水比例,每个有能力支付进入系统的人都会付钱,没有办法退出。

要么是这样,要么对个人的任务进行惩罚,等于医疗保健政策会让人付出的代价。 也可以继续前进,并将其作为工资扣除额并与之一并完成。

2009年为什么没有这样做是超越我的。 为什么今天的repubs不这样做是超越我的。

与保险公司倾销奥巴马护理有关的深化危机并不像预算赤字那样糟糕,但对选民来说却不是直接可见的。 人们因为无法获得医疗保健而死去,这一点非常明显。

5 comments
3 jamesqf 07/29/2017
如果我选择不开车,我不必保险。 如果我有良好的驾驶记录,没有事故,交通票,DWI的定罪&c,那么我会比那些有这些事情的人付出更少的代价。 正如大多数其他类型的保险将个人风险纳入成本一样。 但奥巴马护照的授权几乎使所有这些都成为非法行为,迫使低风险人士拿起高风险人士的费用。 正如罗伯茨大法官所说,这是一种税收。
2 blip 07/29/2017
@ jamesqf如果你可以选择不拥有一个身体,那反驳论点可能是有道理的。 :)但是,是的,保险的作用方式是每个人都投入 - 甚至不太可能最终使用它。
1 jamesqf 07/30/2017
@blip:这不重要。 我可以选择不使用传统的医疗系统(比如说我是基督教科学家); 我可以(的确如此)选择过一种健康的生活方式,这可以减少我需要医疗护理的几率。 然而,在ACA的支付下,我的付款方式和我的邻居完全一样,他们的运动想法是坐在电视机前重复做12盎司卷曲。
1 tj1000 07/30/2017
@blip:也不是那么简单。 如果你按照这个例子得出合乎逻辑的结论,那么医疗保健费用将决定你的生活。 你的所有活动都将根据他们的成本来判断。 告别攀岩,泛舟,在酒吧度过一个愉快的夜晚,快速的汽车,骑马,足球......所有有趣的事情都会让生活值得生活。 我们都会变得无聊,沉闷,毫无生气的自动贩卖机,过着我们的医疗保健成本的生活。 你确定你要走这个方向吗?
2 Magisch 07/31/2017
@jamesqf医疗保健是一个俘虏市场,历史先例和逻辑说,资本主义对俘虏市场的做法是行不通的。 这就是为什么全民医疗保健是only真正可行的解决方案,以及为什么绝大多数发达国家拥有这种或那种形式。

Segfault 07/31/2017.

右翼的立场是,提供全民医疗保健不是联邦政府的责任。 如果个人的任务被取消,健康的人离开医疗保险体系,那么必须传递给病人的医疗保健费用将会增加。 成本增加可能意味着需要医疗保健的低年级病人可能无法接受,而右翼政治家愿意接受这一点。 他们的立场是,为了获得更好的医疗保健,个人需要工作或独立富有。

5 comments
3 Andy 07/28/2017
鉴于与肥胖相关的疾病是最重要的医疗保健成本,人们的另一种选择是更健康和运动(即使只是散步)。
4 Segfault 07/28/2017
@是的,这是第三种选择,人们不应该生病或受伤。
4 WernerCD 07/29/2017
没有人对病人没有得到他们所需要的帮助“没有问题”......甚至不是“邪恶的”共和党人。 这只是解决方案的一部分(人们需要工作) - 顺便说一句,想要强大的经济会出现什么问题? - 其他部分包括竞争,知名度,减少繁文(节(你称为gov计划,不增加8层繁文 - 节 - 每一层花费金钱)......说“对方想让你生病”是一种旋转一半的事实 - 人们使用“假新闻”这样的词的原因
1 Segfault 07/29/2017
@WernerCD我的意思是说,正确的立场是医疗保健应该由私人资助,而且没有保险的人数可以接受。 你是对的,它有偏见,我会纠正这一点。
5 WernerCD 07/29/2017
事实上,这一点变得更加困难,因为在这方面有100种不同的意见......但“保守”观点认为,联邦政府在医疗保健方面没有发言权。 这不是授予美联储的枚举权 - 如果这是美联储的权利,那么在过去的200年里它在哪里? 这不是美联储的权利......保持它应该在的地方 - 在州一级。 美联储不推动汽车保险。 驾驶是不正确的。 其他一切(任务,直到26岁的孩子等)都是次要的“噪音”。 只是我的愚见。

user3753318 07/28/2017.

与Deolater的答案类似 - 根据授权,政府要求个人采取something ,而某些人不愿意这样做。 任务的反对者可能会说,如果人们想要保险,他们可以去购买。 如果不这样做,他们有可能在需要照顾时因无法保险而在脚下自杀。 因此,他们说政府没有业务告诉他们什么是最好的。 在美国构建任何“大哥哥”或“保姆式”是使其不具吸引力的常用方法。 (在我住的纽约,我们听到这个已经有12年了,而麦克布隆伯格是市长)。

当然,这一切都忽略了这样一个事实,即在任务授权之前,那些不富裕而且不符合团体健康保险资格的人(比如说,通过他们的父母或雇主或者通过像AARP或工会这样的亲和团体)常常无法承担保险保费。 或者他们所能承受的保险覆盖范围如此之小,或者共付/共同保险/免赔额如此之高,以至于使得这些保单实际上难以负担。

2 comments
2 Andy 07/29/2017
呃,你确实意识到,即使在授权后,你的第二段中的所有内容仍然是正确的?
1 blip 08/01/2017
@你需要解决'不断上涨的医疗保健费用'和'获得健康保险'的问题。 医疗保健费用一直在上涨,很可能会继续这样做。 ACA是关于确保人们有access健康保险。 随着时间的推移,ACA应该help控制成本(增加风险池),但本身并不会奇迹般地解决导致成本上涨的所有其他问题。

JimmyJames 07/31/2017.

重要的是要明白,个人的任务和预先存在的条件的覆盖面是紧密结合的。 预先存在的条件法本身将使销售健康保险成为一项亏损业务。 授权背后的想法是创造一个可以弥补这个问题的巨大投保人。

考虑通过雇主的团队计划。 These plans generally cover pre-existing conditions. The reason that this is possible is that the employer makes a deal with the insurance company that a certain percentage of employees will take and pay for the insurance and/or the company agrees to pay a certain amount. This means that even if there are a few really sick people (aka high utilizers) in the group, there will be a lot of healthy people paying for their care.

The idea of the mandate is to create a gigantic pool of insured people so that insurance companies are willing to sell insurance. It's not simply about costs. Its about whether the market can function. Prior to the ACA, there really wasn't a significant individual market. Relatively few (healthy) people could afford it and most of them were already getting insurance through their employer. For this reason I find all the news about rising premiums to be so misleading. Compared to what? Most people could not even buy insurance on the individual market if they wanted to and it was unaffordable for many people who could get it.

The mandate is not something that was cooked up as part of Obamacare. For example Milton Friedman (the highly influential conservative economist) "advocated replacing Medicare and Medicaid "with a requirement that every US family unit have a major medical insurance policy." . The individual mandate is a core component of Romneycare .

While it's true that some conservatives have long opposed the individual mandate because it means the government must choose what insurance is acceptable (essential benefits), I think it's pretty obvious that when the ACA was passed, the Republicans latched onto this as the most unpopular piece of the law. Then, when they were not in power, they talked about the mandate as much as possible because it played well in the polls.

The problem now is that, despite the rhetoric, the ACA and the exchanges have been successful. There are a few places where the market is not doing well but these are also places where the state and local governments are politically antagonistic to the ACA. In addition, there ways that the current congress is damaging the current exchange system without a full repeal. The ACA is essentially a three-legged stool where the three legs are pre-existing conditions, subsidies, and the individual mandate. To remove the mandate, you need to replace that leg and those proposed so far are too short.

Everyone is congress knows this. There's an army of lobbyists representing the insurance companies telling them that if they remove the mandate without addressing the adverse selection issue the insurance companies will exit the market place and the individual market will basically vanish. That's why the Senate won't pass the 'repeal' without a realist replacement.

PS It's kind of orthogonal to the specific question at hand but one of the big misconceptions I see repeatedly is that people think that the rising cost of insurance (the rate of growth of which has actually slowed since the ACA) is caused by the 'insurance companies'. This is patently false. The 'skim' that health insurance companies take from what they get from premiums and what they pay for care and drugs has not changed. What costs more is care and drugs. For example, a course of treatment for Hep-C is about $90,000. This is something that didn't exist a few years ago. Every time a new test and a new treatment comes out, the rates need to increase to pay for the increase in costs.

This misunderstanding makes it seem like it should be no big deal for insurance to cover pre-existing conditions. They think the insurance comapnies have huge vaults of gold coins and cash like Scrooge McDuck or something. This misconception also leads people to be outraged by being forced to carry insurance. It feels like being forced to pay tribute to Croesus.

5 comments
JimmyJames 07/31/2017
I'd love a comment from the downvoter. This is actually something I know quite a bit more about than the average person. If anyone wants to dispute the documented facts here, please don't be a coward.
blip 07/31/2017
OK, I had to read this twice. It actually explains things quite well. Yes, the individual mandate and pre-existing coverage go hand in hand. The fact that Trump recently claimed you can buy health insurance for $12 a month shows that he really has no idea how the health insurance industry works. Sadly, a lot of supporters of his party's attempts at undoing the ACA seem to share that naiveté. +1 from me.
JimmyJames 07/31/2017
@blip I don't think is naivety. Nothing has passed because they know all this. You have the libertarian wing that doesn't care about this and the moderate wing that does. It's unfortunate because this is probably the only way that we don't end up with a single-payer system. If the ACA is repealed or allowed to fail (it needs some tweaks) 'Medicare for all' seems much more likely and that would be a little ironic.
blip 07/31/2017
Well, I was referring to the masses more than congress. I truly believe Trump doesn't have an understanding of Health Care. (Remember his infamous "who knew it would be this complicated?"). And I believe a lot of people that voted for him don't, either. Look at the polls showing the number of people that hate 'obamacare' but think 'the ACA' is good. All that said, yes, I think we're in complete agreement that, at the end of the day, a single payer system is the only real solution for both parties.
JimmyJames 07/31/2017
@blip You misunderstand. I am not a supporter of single-payer in the US. What I would like to see is a real market-based system where the customer (the insured) are choosing directly from the sellers (the insurance carriers). Having the employer involved really makes no sense. I don't get my home or auto insurance through my employer. They do offer life insurance as a perk but I am free to buy it on the open market. What we have now with self-funded, employer-based, federal medicare, state medicaid and all the rest is basically chaos. The mandate will allow for that market.

Peter Masiar 08/01/2017.

Mandate is not popular, because freeloaders are very vocal constituency , and mandate (or "no freeloaders") was a standard part of any conservative health care reform suggested by conservative think-tanks.

Using this very vocal constituency allows to politicians to attack ACA which they dislike for other reasons.

Mandate "refuseniks" are freeloaders because they want to pay (low low monthly fee) for insurance only during months they require (expensive) health services, paid by everyone else , gaming the system.

Even Mitt Romney, when he established individual mandate in Massachusetts in 2006, called such people "freeloaders".

It is made worse by the fact that hospitals are required to provide emergency services regardless of the ability to pay (so people are sure they can game the system , even if partially, and are used to be able to do it), even if hospital knows/suspects that person will not pay for provided services. This cost of emergency services is so high that (I read a research somewhere) for few homeless people it would be cheaper to provide them free housing (so they have less medical emergencies) than "free" emergency care they are getting now. Not all homeless, but few. But of course it would not work, because it would give such homeless perverse incentive to consume more emergency services to qualify for free housing.

If you don't want people without insurance dying on the street like in a 3rd world country, we need individual mandate.

2 comments
Sidney 08/01/2017
I feel this could almost be a good answer if it were reasonably well fresh out without epithets.
Peter Masiar 08/01/2017
@Sidney OK I removed the rant part, even if I think was quite valid

Joel Rees 07/29/2017.

This is a bit long, but we can't answer the question without getting the full context in front of us.

First, let's start by asking what people did before there was insurance:

(1) They didn't get sick or have accidents.

(2) When they got sick or had accidents, they just died immediately and saved society the burden of caring for them.

(3) If they didn't have enough resources (including, but not limited to, savings) people who were close to them -- people in church, sodalities and fraternities, etc., friends, neighbors, relatives, sometimes even strangers would help them until they got back on their feet. And life went on.

Correct answer? Drumroll, please ...

(E) All of the above.

If you don't understand that much, we can't talk meaningfully about this.

Second, let's ask what happened with insurance:

(1) Check. Lots of people were still not needing help. One point of difference, some of these people are voluntarily joining the strangers I mentioned above who help other people in need, by contributing to one of many independent companies that establish these pools that we talk about.

(2) Check. Lots of people were still getting sick or having accidents and dying. One point of difference is that some of those who died were covered by insurance and some weren't.

(3) Check. But with more insurance available, fewer neighbors and strangers feel the need to get involved, unless they get involved by buying insurance. And, with money going out in insurance premiums, there was less available for savings.

Overall result?

There was a new way of making a living called working for (or running) an insurance company. (I'm speaking loosely here, some of those weren't really companies in the legal sense. There were several legal categories besides company for insurers. I think some of those categories still exist.) This is not a strictly bad result -- has both pluses and minuses.

Also, it became easier for people without good neighbors, church or other abstract community, close relatives, etc. to get help. This contributes to alienation, but it also contributes to reintegration. Again, there are both pluses and minuses.

Unnoticed tertiary results?

Insurance companies start making rules that our government is Constitutionally forbidden from making. This is an essential bit of information here.

Third, let's ask what will happen with mandatory insurance.

(1) Will people stay healthy?

We should hope so. We aren't sure, however.

(2) Will people get seriously ill or have accidents and die?

How can we expect it to be otherwise?

(3) Will family, neighbors, friends, relatives, people in their abstract communities, and strangers still help?

哎哟。 Yes, but everyone is paying insurance, so it's harder for those who are not making a lot of money to help. And most people don't make a lot of money.

Wait, let's back up to (2). Insurance companies are motivated to reduce risks, so they will be making even more rules to try for force people to be healthy and safe.

They will also escalate the social narrative about " responsible behavior " as if conformance to any arbitrary set of rules could really be called such.

Does letting the insurance companies get their fingers in every little aspect of individual lives actually make anyone healthier, safer, or more responsible?

I hate to be rude, but use your common sense --

When was the last time society was benefited by someone, or by some group, asserting they should be allowed to play God?

You say the rules aren't that bad, but I'll point to some examples. Flu shots are considered a moral requirement in Japan, in no small part due to the social narrative from the insurance companies.

Do they work? For some people, they seem to work, but there is a growing percentage of people who have bad reactions and end up becoming seriously ill, permanently disabled, or dying. The insurance companies started backpeddling on this recently.

Surely things are not that bad in the US?

Vaccinations.

哦! Think of the CHILDREN!

I am thinking of the children. Most vaccinations were recommended not to be given before six months or so for very important biological and medical reasons. It was not that they were not recommended before six months, they were recommended against .

But the pharmaceuticals salescrew works on the insurance salescrew and the staffs at hospitals, and "Oh! Let's just get them done with and over before the parents forget!"

And the vaccinations don't work like they used to. They change children's biology, and the new generation is, no, not superhuman by some chemist's accident. The new generation is susceptible to a new class of diseases that are harder to deal with.

Vaccinations are not the only problems here.

And, finally we get to the question of mandatory premiums.

I've been sidelined from my original career path for more than fourteen years or so. I've been working entry-level/temporary jobs, just barely making a living. I haven't been making enough to send my kids to school, and that fact makes me something of a social pariah in Japan.

I just crossed an age line three years ago where it has become difficult both to renew the contract, and to get a different entry-level/temporary job. I paid about $150 yesterday for August's mandatory insurance premium when I don't have money for August's rent or next week's food.

Fortunately, because I live in Japan and not the US, I don't have to pay an additional mandatory premium to the fatherland. (Fortunately, somebody who wrote the law realized we expatriates would have good cause for class-action suit against the government if they tried to double-down on us.)

(JFTR, I'm writing this while I wait for a friend to give me permission to use her as a reference on a job application.)

There are a lot of people in any country who are physically healthy, who, for reasons they really don't control, are one step away from being in the sort of situation I am in.

Now do you understand why the question of mandatory insurance, and the ACA that underlies it, is considered "nuanced".

5 comments
blip 07/29/2017
"Insurance companies are motivated to reduce risks" = not necessarily. Most of the revenue from medical insurance companies comes from group plans. They price group plans as they need to to make a profit. Risks go up? 没什么大不了的。 They just raise their rates. As for the companies with the group plans...rates go up? No biggie, they just raise the employees contribution amount.
1 Philipp♦ 07/29/2017
Welcome to Politics.SE. Please note that we prefer it when answers illuminate a topic from a neutral point of view. The tone of this answer is very opinionated and polemic.
2 Stilez 07/30/2017
First part: add 4) They suffered inhumanely, often through no cause of their own, and ultimately often couldn't "get back on their feet" or needed long term help they couldn't afford. So their lives, the lives of others, the economic burden to society if one only respects money, all lost out, often by very great amounts. Someone who couldn't afford good treatment for an injury often couldn't work, and to support them others couldn't work as much. Not just "they died or got on their feet". (Cost to society of a larger-than-needed "have/have not" division, in all its impacts? Probably huge.)
1 GGMG 07/31/2017
This answer would read a lot better without the unwarranted and uncited tirade against vaccines.
1 Stilez 08/01/2017
@JoelRees not really the issue. Many kinds of suffering and rippling-out harm are much less likely if there is good medical access for the condition. Insurance creates have/have nots on that. My main point is that the list of 1 -3 is incomplete - it misses out a huge block of arguably the most important group for this Q - those who don't die, don't just "get up and carry on", whose medical matters affect them, others and society badly, and where access to high quality medical would make a big difference but is decided by financial abilities not medical needs. Can you add them to your post?

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