Can we finally put the Obamacare fight to rest?

[stollcpa]

Okay, I thought it was 50. I also thought the non compliance daily penalty excluded the first 50, as well. From some more brief research, looks like I was wrong.

I did most of my research on this 2-3 years ago, when people were still figuring it out.

I've been opposed to the employer provisions of the ACA since day 1, even when I thought our restaurant wouldn't be affected. I simply think health care should be divorced from employment altogether.

The problem is we can research one day and the next day there's a new interpretation. Many CPAs struggled mightily in December 2014 and January 2015 as new information seemed to come out weekly. The penalties were affecting our small clients with under 50 employees. Most of us initially just assumed we didn't have an issue with employers having less than 50 employees. We couldn't have been more wrong.

Also during tax season almost every person that came in who had went on the exchange and obtained insurance and a subsidy got surprises on their return. Almost every one of them had underestimated their income. Therefore when we prepared their returns they owed part of the subsidy back. Nothing worse than telling a young single mom working as waitress and attending college she owes the IRS money when she's used to large refunds because of earned income credit. This was most stressful tax season I've had in 30 years. I looked so bad after tax season my golf buddies didn't even give me a hard time when I got on the course after the 15th.

No doubt our health care system needs fixed. I just don't think the ACA fixed it.

BTW Goat I love your posts regarding religion. Would love to have you come down and argue with some of the AMISH/Mennonite bishops I grew up with.

 

[twenty02]

Wyden/ Bennett was a much better, bipartisan approach to health care reform. However it was deemed too ' radical ' an approach by this administration. It would have gone a long way to really fixing our system by beginning to sever the cord between employers and health insurance.

It's the biggest reason I oppose the aca. If you go back and look, Wyden attempted to ammend the ACA to put in elements of Wyden Bennett. He was shot down by Max Baucus in the finance committee hearings, literally in the middle of the night....at the behest of the administration. Wouldn't even allow it to be voted on.

 

[Rockfish1]

Wyden/ Bennett was a much better, bipartisan approach to health care reform. However it was deemed too ' radical ' an approach by this administration. It would have gone a long way to really fixing our system by beginning to sever the cord between employers and health insurance.

It's the biggest reason I oppose the aca. If you go back and look, Wyden attempted to ammend the ACA to put in elements of Wyden Bennett. He was shot down by Max Baucus in the finance committee hearings, literally in the middle of the night....at the behest of the administration. Wouldn't even allow it to be voted on.

Wyden's approach wasn't too radical for Obama, but it was too radical to pass. If you'll recall, an extraordinary effort was required to barely pass the less ambitious Affordable Care Act.

I liked Wyden/Bennett better than the ACA. I liked single-payer better than both. But it's politically naive to allow the perfect to become the enemy of the good-as-you're-going-to-get. That's why, in the end, I supported the ACA, even though it was far less than I wanted. The alternative wasn't Wyden/Bennett or single payer. The alternative was nothing.

 

[davegolf]

The government has issues with every program they manage from military overspending, to Welfare Fraud, Veterans Care, to Social Security set to go broke ad nauseam. Why does anyone think the Government can manage a single payer health care system with estimated spending in the trillions. How could we expect the same quality of care? Think about it - they can't manage the Veterans Hospital Care System which is small scale compared to what you are recommending. I don't understand anyone who thinks this is even feasible.

 

[Marvin the Martian]

The government has issues with every program they manage from military overspending, to Welfare Fraud, Veterans Care, to Social Security set to go broke ad nauseam. Why does anyone think the Government can manage a single payer health care system with estimated spending in the trillions. How could we expect the same quality of care? Think about it - they can't manage the Veterans Hospital Care System which is small scale compared to what you are recommending. I don't understand anyone who thinks this is even feasible.

The VA isn't the model that people are looking at. In the VA, the hospitals are physically run by the government, the workers are government employees. The system people tend to want is more akin to Medicare for all. The government basically takes over for Anthem or Wellpoint or whomever. We might argue about Medicare's reimbursement rates, but the system appears to work with amazing efficiency.

 

[CO. Hoosier]

The VA isn't the model that people are looking at. In the VA, the hospitals are physically run by the government, the workers are government employees. The system people tend to want is more akin to Medicare for all. The government basically takes over for Anthem or Wellpoint or whomever. We might argue about Medicare's reimbursement rates, but the system appears to work with amazing efficiency.

Oh no, Marv

Medicare and Medicaid fraud and abuse is killing us. Why? Because of fee for service. Providers invent more schemes for scamming the system with phony services, phony patients and phony needs for real patients, than we can keep up with. A publicly funded fee for service model is absolutely the worst we can do. People who want single payer as the answer to the health care mess don't know what they are talking about. Even if we could manage to eliminate all of the burdensome fraud, Medicare still doesn't cut it. In hospitals where they try and do a good job and hold fraud to nil, the reimbursement rates are such that a quality hospital will not be able to sustain itself.

But the answer is available in two ways. Full bore capitation plans like Medicare Part C will at least remove the incentive for phony billing. But patient care would feel the brunt because there is no incremental reimbursement for costly patients. Another is to go full bore VA model. This makes the most sense from a cost efficiency standpoint, but once again patient care and service would suffer.

So long as we have public participation of any flavor in the delivery of medical care, there will ALWAYS be a tension between cost and service--ALWAYS. It is unavoidable. Private pay with private insurance contracts removes most of these tensions, but then access suffers. We have figured out how to feed people with no means. We have figured out how to provide a legal defense to defendants with no means. We have figured out how to provide housing to people with little means. Medical care is not that complicated. But it is very complicated when we have too much politics, too much political power, too much vested interests, not to mention an insatiable government appetite for "comprehensive" large programs, to satisfy.

 

[Marvin the Martian]

I am sure Fraud is a problem, but I have a theory it is against Anthem and Wellpoint as well. They aren't subject to the same disclosure laws, so who knows exactly how much. But the California insurance commissioner seems to think it is the billions of dollars per year. Some of it is doubtless medicare/medicaid but not all. I haven't see any percentages. Somehow Europe pulls off single payer (as does Australia and Japan). I'm not willing to admit they are smarter than us.

 

[Rockfish1]

I am sure Fraud is a problem, but I have a theory it is against Anthem and Wellpoint as well. They aren't subject to the same disclosure laws, so who knows exactly how much. But the California insurance commissioner seems to think it is the billions of dollars per year. Some of it is doubtless medicare/medicaid but not all. I haven't see any percentages. Somehow Europe pulls off single payer (as does Australia and Japan). I'm not willing to admit they are smarter than us.

Exactly. Every other developed country does precisely what Republicans mulishly insist is impossible.

 

[Rockfish1]

Oh no, Marv

Medicare and Medicaid fraud and abuse is killing us. Why? Because of fee for service. Providers invent more schemes for scamming the system with phony services, phony patients and phony needs for real patients, than we can keep up with. A publicly funded fee for service model is absolutely the worst we can do. People who want single payer as the answer to the health care mess don't know what they are talking about. Even if we could manage to eliminate all of the burdensome fraud, Medicare still doesn't cut it. In hospitals where they try and do a good job and hold fraud to nil, the reimbursement rates are such that a quality hospital will not be able to sustain itself.

But the answer is available in two ways. Full bore capitation plans like Medicare Part C will at least remove the incentive for phony billing. But patient care would feel the brunt because there is no incremental reimbursement for costly patients. Another is to go full bore VA model. This makes the most sense from a cost efficiency standpoint, but once again patient care and service would suffer.

So long as we have public participation of any flavor in the delivery of medical care, there will ALWAYS be a tension between cost and service--ALWAYS. It is unavoidable. Private pay with private insurance contracts removes most of these tensions, but then access suffers. We have figured out how to feed people with no means. We have figured out how to provide a legal defense to defendants with no means. We have figured out how to provide housing to people with little means. Medical care is not that complicated. But it is very complicated when we have too much politics, too much political power, too much vested interests, not to mention an insatiable government appetite for "comprehensive" large programs, to satisfy.

In addition to MtM's points, you persist in being wrong about Obamacare, which encourages providers to move away from fee-for-service. Meanwhile, "The Obama administration will push Medicare payment rapidly away from fee-for-service medicine within four years, outlining a plan to have half of all Medicare dollars paid by to doctors and hospitals via “alternative” reimbursement models by the end of 2018."

Having said so, it's not nearly so clear as you claim that the root of our cost control problem is fee-for-service. France relies heavily on fee-for-service, yet still pays much less than we do (for coverage that we would regard as very generous). The real difference is that our government is much less involved in setting the prices that providers are allowed to charge.

 

[CO. Hoosier]

I am sure Fraud is a problem, but I have a theory it is against Anthem and Wellpoint as well. They aren't subject to the same disclosure laws, so who knows exactly how much. But the California insurance commissioner seems to think it is the billions of dollars per year. Some of it is doubtless medicare/medicaid but not all. I haven't see any percentages. Somehow Europe pulls off single payer (as does Australia and Japan). I'm not willing to admit they are smarter than us.

That's a legitimate point

The other fee for service places heavily regulate the charges. I have also from time to time suggested that we treat health care as a regulated monopoly and heavily regulate the rates much like we have done with utilities. The down side is that R&D would suffer because it is difficult to build that into the rate structure and review. This is one of the reasons for the AT&T break-up. If AT&T still ran all of telecom, would we have the variety and advances we have seen in the last several decades? There is a reason why the US dominates in the Nobel prizes for medicine.

 

[mike41703]

Why would an employer-provided plan raise plan costs because of ACA?

Because Obamacare taxes the employer a large sum(something liberals love to brush under the rug). I don't need to but I will continue to spell it out. The large tax leaves less money for the employer to spend on employees which in turn either winds up in layoffs or stagnant pay further leaving the middle class in a pinch. F that.

 

[TheOriginalHappyGoat]

Because Obamacare taxes the employer a large sum(something liberals love to brush under the rug). I don't need to but I will continue to spell it out. The large tax leaves less money for the employer to spend on employees which in turn either winds up in layoffs or stagnant pay further leaving the middle class in a pinch. F that.

While I don't disagree with that entirely, you didn't even answer his question. It wasn't about why the employer provisions suck, it was how in the world they will raise plan costs.

 

[mike41703]

While I don't disagree with that entirely, you didn't even answer his question. It wasn't about why the employer provisions suck, it was how in the world they will raise plan costs.

Because that "Obamacare tax" was made possible by the law. The only way premiums stay the same in that scenario is if my employer picks up the tab.

 

[TheOriginalHappyGoat]

Because that "Obamacare tax" was made possible by the law. The only way premiums stay the same in that scenario is if my employer picks up the tab.

I still think you misunderstood Buzz's question, because that doesn't follow.

I really don't want to get in a fight about this, because I am guessing we agree on most substantive points re: the employer provisions of the ACA. It just seems like you're not actually addressing the particular point buzz asked about, and instead just piling on with a Gish gallop style criticism.

 

[mike41703]

I still think you misunderstood Buzz's question, because that doesn't follow.

I really don't want to get in a fight about this, because I am guessing we agree on most substantive points re: the employer provisions of the ACA. It just seems like you're not actually addressing the particular point buzz asked about, and instead just piling on with a Gish gallop style criticism.

I don't see how but apparently you're convinced I'm lost.

Also while we're on the topic of misunderstanding, I don't have an effing clue what gish gallop is.

 

[Marvin the Martian]

I don't see how but apparently you're convinced I'm lost.

Also while we're on the topic of misunderstanding, I don't have an effing clue what gish gallop is.

I believe the question is, how does an employer mandate raise the price of healthcare coverage? We can debate what impact it has on jobs or wages, but how does it make healthcare more expensive.

 

[mike41703]

I believe the question is, how does an employer mandate raise the price of healthcare coverage? We can debate what impact it has on jobs or wages, but how does it make healthcare more expensive.

I didn't read it like that. What I quoted was how does an employer's provided plan go up bc of OC. Your question...I wasn't addressing that.

 

[Marvin the Martian]

But an emploer's plan should not go up. Most major corps already provided coverage. More people had coverage through their work than any other way. So if Lilly was already covering a worker, what in ACA causes Lilly to pay more?

Keeping children covered longer I get, that would have an impact. Of course ages 21-25 is pretty much the definition of the invincibles. So their cost, while real, isn't nearly as much to the plan as their parents.

 

[hootch1]

There is a fee to support the Patient-Centered Outcomes Research Institute included in ACA. The initial fee was set at $1/covered employee increasing to $2/employee and adjusted for medical inflation after that. Self insured companies, pretty much any large company, have to pay the fee. The fee is set to expire with the start of the 2020 federal fiscal year.

A second way the cost can go up for a company is the cadillac plan tax. Officers often have additional coverage that could push them above the thresholds.