The Affordable Care Act

[4-2-7]

Originally Posted by finnbow

A true free market isn't possible in health care. It doesn't exist anywhere in the developed world because it can't exist. A true free market requires a consumer with full information on the product he's buying from cost to alternatives to relative effectiveness, etc ....

Unless you know and understand all the details of every possible disease, medical procedure, drug, hospital performance, and rehab option to include their costs and relative effectiveness, an informed decision is impossible. So, how exactly are you going to evaluate all these things for an unexpected heart attack, stroke, broken leg, car accident or acute illness? Anybody that tells you that a free market in health care is possible doesn't understand both health care and free markets.

One of the very few items in the entire health care arena where a free market exists is eyeglasses. I've listened to Rand Paul say that the health care system should be designed like an optical shop where you can browse eyeglasses and compare fit, looks and price. This isn't a good analog for treating cancer, heart disease, diabetes or a broken leg, however. He's an ophthalmologist and his analysis brings to mind a saying "To a carpenter, every problem looks like a nail."

OTOH, free market choices can be made between insurance plans if the plans from all companies are designed identically (or very similarly). With this, you can compare apples to apples and select on price alone. This is exactly what Obamacare does in its 4 levels of plans (bronze, silver, gold, platinum).

ACA is not changing the medical care procedure side.

It's Insurance that we need open to competition.

We could definitely have an open market on picking and choosing who we want to hire as our insurance provider.

[finnbow]

Originally Posted by 4-2-7

ACA is not changing the medical care procedure side.

It's Insurance that we need open to competition.

We could definitely have an open market on picking and choosing who we want to hire as our insurance provider.

Most folks do. I have close to 40 to chose from. From the get-go, you have 11 providers to choose from in the California exchange.
https://www.coveredca.com/hbex/insurance-companies/

[4-2-7]

Originally Posted by d-ray657

Unfortunately, a true free market is the last thing that American Capitalists want.

As far as things that the government gets involved in costing more, take a guess at what percentage of Medicare dollars are spend on administrative costs.

Regards,

D-Ray

I would say on a percentage standpoint in government involvement would be low as Boxer want to point out. As do the left wing media mouths to show how cheap and money saving this bill is.

Governments impose many rules and guidelines that have to be followed down the chain.

If a doctor was doing there prior workload spending 80% of their time doing care the other 20% paperwork.

Then now has 60% of their time caring and 40% doing paperwork. there is definitely a higher cost per customer.

I would say a true free market is the last thing our government wants.

[4-2-7]

Originally Posted by finnbow

Most folks do. I have close to 40 to chose from. From the get-go, you have 11 providers to choose from in the California exchange.
https://www.coveredca.com/hbex/insurance-companies/

lol

Im talking about prior to the bill.

Insurance providers were only aloud to operate in designated states.

Providing a monopoly and shooting fish in a bowl.

[4-2-7]

Originally Posted by d-ray657

I'm not an accountant, and I don't play one on TV, but my recollection is that what we pay in medical insurance premiums is considered a medical expense. Your medical expenses have to reach a threshold of 7.5% of your adjusted gross income before everything over that amount becomes deductible.

I job I had years ago had a cafeteria plan that allowed you to make pre-tax payroll deductions that you would use for medical expenses. Don't know if that is possible any more.

Regards,

D-Ray

I would agree with this thought.
Thats a good point to collecting non cash benefits at work. You get taxed on your income but not your healthcare benefits or 401k.

Now if you're not going to get benefits at work and chose to be compensated in cash that would be taxed.

There is supposed to be some subsidies and that might balance it out. But who knows when the dust settles.

[finnbow]

Originally Posted by 4-2-7

lol

Im talking about prior to the bill.

Insurance providers were only aloud to operate in designated states.

Providing a monopoly and shooting fish in a bowl.

Not exactly. Traditionally, insurance of all types (auto, homeowners, health...) have been regulated by the states. This was codified by Congress in 1945. However, that doesn't mean that there aren't enough insurers in any state to preclude free and open competition. As noted in a previous post, I have nearly 40 choices here in Maryland and that was already the case before Obamacare.

In that states have long had a state regulatory structure for insurance (i.e., a state insurance commission), they're disinclined to give this authority up to the Federal government. It's kinda odd that the GOP frequently says it wants insurance to cross state lines (i.e., to be regulated by the Federal government under the Commerce Clause), while at the same time they say that the best government is state and local because it's closer to the people. I doubt that it would really have any material difference in pricing. You can get all the competition with several dozen companies operating in each state. The only meaningful difference in state pricing was that some states required different minimum policies and others didn't. This is now moot with Obamacare.

That said, the more companies you have, the more differenet paperwork your doctor has to process with an increased staff (and increased cost). Don't buy into the GOP panancea of buying insurance across state lines. The only real difference it will make is that it will drive your doctor's front office staff crazy.

[d-ray657]

Originally Posted by 4-2-7

I would say on a percentage standpoint in government involvement would be low as Boxer want to point out. As do the left wing media mouths to show how cheap and money saving this bill is.

Governments impose many rules and guidelines that have to be followed down the chain.

If a doctor was doing there prior workload spending 80% of their time doing care the other 20% paperwork.

Then now has 60% of their time caring and 40% doing paperwork. there is definitely a higher cost per customer.

I would say a true free market is the last thing our government wants.

Who are these "left wing media mouths" of whom you speak? And what studies have provided the numbers that you have posited about the time spent by doctors doing paperwork?

And a true free market is a figment of someone's imagination. It does not exist and it is not possible.

And finally, I have pointed this out with other posters. Seeing improper word usage strikes me about the same as fingernails on a chalk board so:

"Their" is a possessive pronoun, used to indicate possession of an item or attribute, i.e., "Their gun did them no good."

"There" indicates location. "I can't go in there."

"They're" is a contraction for "they are." "They're going over there to get their stuff."

Regards,

D-Ray

[4-2-7]

Originally Posted by bobabode

Back on topic - http://www.washingtonpost.com/nation...y.html?hpid=z2

Looks like the CBOs assertions are correct and the rightwing echo chambers' are off the mark by a country mile. The PPACA is not going to kill 2.5 million jobs as Rush Limpballs and the screaming me-mes' at Faux Noise have been screeching all of last week.

So does that mean you take the wording and spin on the CBO report over the CBO report itself?

How Much Will the ACA Reduce
Employment in the Longer Term?

The ACA’s largest impact on labor markets will probably occur after 2016, once its major provisions have taken full effect and overall economic output nears its maxi- mum sustainable level. CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive. Because the largest declines in labor supply will probably occur among lower-wage workers, the reduction in aggregate compensation (wages, salaries, and fringe benefits) and the impact on the overall econ- omy will be proportionally smaller than the reduction in hours worked. Specifically, CBO estimates that the ACA will cause a reduction of roughly 1 percent in aggregate labor compensation over the 2017–2024 period, com- pared with what it would have been otherwise. Although such effects are likely to continue after 2024 (the end of the current 10-year budget window), CBO has not esti- mated their magnitude or duration over a longer period.
The reduction in CBO’s projections of hours worked represents a decline in the number of full-time-equivalent workers of about 2.0 million in 2017, rising to about
2.5 million in 2024. Although CBO projects that total employment (and compensation) will increase over the coming decade, that increase will be smaller than it would have been in the absence of the ACA. The decline in full- time-equivalent employment stemming from the ACA will consist of some people not being employed at all and other people working fewer hours; however, CBO has not tried to quantify those two components of the overall effect. The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in busi- nesses’ demand for labor, so it will appear almost entirely as a reduction in labor force participation and in hours worked relative to what would have occurred otherwise rather than as an increase in unemployment (that is, more workers seeking but not finding jobs) or underemploy- ment (such as part-time workers who would prefer to work more hours per week).
CBO’s estimate that the ACA will reduce employment reflects some of the inherent trade-offs involved in designing such legislation. Subsidies that help lower- income people purchase an expensive product like health insurance must be relatively large to encourage a significant proportion of eligible people to enroll. If those subsidies are phased out with rising income in order to limit their total costs, the phaseout effectively raises peo- ple’s marginal tax rates (the tax rates applying to their last dollar of income), thus discouraging work. In addi- tion, if the subsidies are financed at least in part by higher taxes, those taxes will further discourage work or create other economic distortions, depending on how the taxes are designed. Alternatively, if subsidies are not phased out or eliminated with rising income, then the increase in taxes required to finance the subsidies would be much larger.
CBO’s estimate of the ACA’s impact on labor markets is subject to substantial uncertainty, which arises in part because many of the ACA’s provisions have never been implemented on such a broad scale and in part because available estimates of many key responses vary consider- ably. CBO seeks to provide estimates that lie in the middle of the distribution of potential outcomes, but the actual effects could differ notably from those esti- mates. For example, if fewer people obtain subsidized insurance coverage through exchanges than CBO expects, then the effects of the ACA on employment would be smaller than CBO estimates in this report. Alternatively, if more people obtain subsidized coverage through exchanges, then the impact on the labor market would be larger.



The long and short of this is the government is providing an incentive not to work.

[4-2-7]

Originally Posted by 4-2-7

I don't know what some of you are reading, lots of comments stating thing that others are saying.

What the CBO report & news I have see is referenced to.

2.5 milion FULL TIME job loss by 2024.

Thats true as far as the report states.

The other point In the report is that 6-7 million that have healthcare at work as part of their benefits will be canceled. It's cheaper for the employer to not provide the health benefits and get a fine for worker that exceed a 30 hour week.

Read the CBO report and not your spin news.
http://www.cbo.gov/sites/default/fil...utlook2014.pdf

Effects of the Employer Penalty on Labor Supply
Under the ACA, employers with 50 or more full-time- equivalent employees will face a penalty if they do not offer insurance (or if the insurance they offer does
not meet certain criteria) and if at least one of their full- time workers receives a subsidy through an exchange. Originally scheduled to take effect in 2014, that penalty is now scheduled to be enforced beginning in 2015.

In CBO’s judgment, the costs of the penalty eventually will be borne primarily by workers in the form of reductions in wages or other compensation—just as the costs of a payroll tax levied on employers will generally be passed along to employees.

12 Because the supply of labor is responsive to changes in compensation, the employer penalty will ultimately induce some workers to supply less labor.
In the next few years, however, when wages probably will not adjust fully, those penalties will tend to reduce the demand for labor more than the supply. In the longer run, some businesses also may decide to reduce their hiring or shift their demand toward part-time hiring— either to stay below the threshold of 50 full-time- equivalent workers or to limit the number of full-time workers that generate penalty payments. But such shifts might not reduce the overall use of labor, as discussed below.

Effects of the Employer Penalty on the
Demand for Labor
Beginning in 2015, employers of 50 or more full-time- equivalent workers that do not offer health insurance
(or that offer health insurance that does not meet certain criteria) will generally pay a penalty. That penalty will initially reduce employers’ demand for labor and thereby tend to lower employment. Over time, CBO expects, the penalty will be borne primarily by workers in the form of reduced wages or other compensation, at which point the penalty will have little effect on labor demand but will reduce labor supply and will lower employment slightly through that channel.
Businesses face two constraints, however, in seeking to shift the costs of the penalty to workers. First, there is considerable evidence that employers refrain from cutting their employees’ wages, even when unemployment is high (a phenomenon sometimes referred to as sticky wages).

19 For that reason, some employers might leave wages unchanged and instead employ a smaller workforce. That effect will probably dissipate entirely over several years for most workers because companies that face the penalty can restrain wage growth until workers have absorbed the cost of the penalty—thus gradually eliminating the negative effect on labor demand that comes from sticky wages.

A second and more durable constraint is that businesses generally cannot reduce workers’ wages below the statu- tory minimum wage.20 As a result, some employers will respond to the penalty by hiring fewer people at or just above the minimum wage—an effect that would be simi- lar to the impact of raising the minimum wage for those companies’ employees. Over time, as worker productivity rises and inflation erodes the value of the minimum wage, that effect is projected to decline because wages for fewer jobs will be constrained by the minimum wage.
The effect will not disappear completely over the next 10 years, however, because some wages are still projected to be constrained (that is, wages for some jobs will be at or just above the minimum wage).

Businesses also may respond to the employer penalty by seeking to reduce or limit their full-time staffing and to hire more part-time employees. Those responses might occur because the employer penalty will apply only to businesses with 50 or more full-time-equivalent employ- ees, and employers will be charged only for each full-time employee (not counting the first 30 employees). People are generally considered full time under the ACA if
they work 30 hours or more per week, on average, so offset the effects of changes in federal spending and taxes. Over time, however, those effects are expected to dissipate as overall economic output moves back toward its maximum sustainable level.

ME
Basically a part time work force will be imposed by employers giving no health care as benefits. Shorter hours means less income or two part time jobs.

The workers that are working 40 weeks will be dropped from work provided health care. The employer will pass the added cost in fines to the worker and workers will make less income as a result.

Net result is all workers/individuals will be providing their own healthcare and thats not "Free". Yes at first there will be some subsidy based on the workers income. So if they earn too much they will lose it. So this effect will stop people from working to much.

So now you have a workforce that will be earning less income do to the shorter work weeks. But yet have more bills to pay with the added expense of providing their own healthcare.

This will push more people onto more entitlement programs.

Did I mention the the government does not do anything to earn income, ie: sell goods and services. They only generate funds by taxing, as they spend more workers pay more taxes. So the next thing to happen to the socalled freebies is we all get taxed more to pay for it.

This kind of bull shit will even get me to stop working. Give me my freebies Im entitled too.

All this less income will have a negative effect on local, nation and global economies.

My post the other day

[4-2-7]

Originally Posted by finnbow

Not exactly. Traditionally, insurance of all types (auto, homeowners, health...) have been regulated by the states. This was codified by Congress in 1945. However, that doesn't mean that there aren't enough insurers in any state to preclude free and open competition. As noted in a previous post, I have nearly 40 choices here in Maryland and that was already the case before Obamacare.

In that states have long had a state regulatory structure for insurance (i.e., a state insurance commission), they're disinclined to give this authority up to the Federal government. It's kinda odd that the GOP frequently says it wants insurance to cross state lines (i.e., to be regulated by the Federal government under the Commerce Clause), while at the same time they say that the best government is state and local because it's closer to the people. I doubt that it would really have any material difference in pricing. You can get all the competition with several dozen companies operating in each state. The only meaningful difference in state pricing was that some states required different minimum policies and others didn't. This is now moot with Obamacare.

That said, the more companies you have, the more differenet paperwork your doctor has to process with an increased staff (and increased cost). Don't buy into the GOP panancea of buying insurance across state lines. The only real difference it will make is that it will drive your doctor's front office staff crazy.

You did make some very good points on this one.