I am an expert on the PPACA debate me....

Thus, the insurance companies will not lose money. Bingo.

 

That's an interesting interpretation since "plan bears loss" appears several times in that graphic.

 

Along with government reimburses.

 

The CBO projected the premium impact of the then-pending legislation back in 2009. Their estimates turned out to be significantly too high, as insurers and providers alike have been more aggressive about containing costs than expected. The promise on health care cost growth was that it would be slowed--the cost curve would be bent. That has happened, and more than was projected back when the ACA passed.

For instance, here's the CBO back in 2013 (their point is even more true now than it was then):

Premiums and health care cost growth are overperforming the predictions, not underperforming.

Of course they knew those benefits would be included, they're set by the statute (42 U.S. Code § 18022 - Essential health benefits requirements). Everyone paying attention knew that.

The ACA identified the 10 categories of essential health benefits. HHS deferred to the states in lieu of developing a more detailed definition of what those 10 coverage categories entailed.

Risk mitigation in the early years of the marketplaces was always part of the package--you can't stand an insurance market up from scratch without it, there's no feasible way to do that. I don't know who exactly didn't tell you but it was very much part of the public record. And obvious to anyone familiar with this topic that such mechanisms would be required at the outset.

Again, everyone knew this. Obama said as much during a primetime address to a joint session of Congress in September 2009 (and was shouted down--"you lie!"--by some yokel Congressman from South Carolina who mistakenly thought illegals are covered).

See previous point about essential health benefits.

Not quite. Summary of Benefits & Coverage & Uniform Glossary

There have been four large surveys of consumer satisfaction with marketplace plans that I'm aware of: one by Gallup, one by J.D. Power and Associates, one by The Commonwealth Fund, one by the Kaiser Family Foundation.

All have found that same thing: people buying plans in the marketplaces like them. Including on the dimensions you've identified.

 

I'm not clear why you think insurers must match premiums to their underlying costs if it's impossible for them to lose money.

The answer, of course, is that it's not impossible for them to lose money on exchange business and they do, as you pointed out in the first post, need to charge actuarially sound premiums. Even with the temporary premium stabilization mechanisms.

 

Yes and no. What this can lead to is self diagnosis which is both expensive and dangerous. Many symptoms can mask themselves as something else. A rash for example could be the symptom of a more serious underlying problem other than a skin condition. . The most important thing is to engage a GP you can trust.

I'll use the Australian example. If you have a problem go see your local GP under Medicare. If he/she recommends a specialist that will also be covered under Medicare, or part of it. If you engage a specialist off the street, Medicare might not cover the consultation.

 

So you believe a dermatologist wouldn't be able to determine the possible causes of a skin rash? Less able to do so than a Primary Care Physician? And that a family practitioner would be more qualified to do so? No way. The "GP", gate keeper is 99% of the time going to refer the patient to a Dermatologist and if he thinks it is Cancer would likely refer the patient to an Oncologist.

Perhaps I give to much credit to the intelligence of patients. Because if I have acne, and any other problem with my skin, I am going to first see a dermatologist. It isn't self diagnosis. As self diagnosis would mean you believe your skin rash is due to an insect bite, allergy and so on.

In the mean time, back to the issue. Do you know that when an insurance policy requires your "primary care physician/gate keeper" they, the primary care doctor are paid more if they "don't refer you to a specialist" there by saving the insurance company money? Probably another thing most people don't understand. The gate keeper is there to save the insurance company money. Period. They get monetary incentives to do so.

 

Wrong, the "Exchange Policies" more often requiring a primary care physician must refer you to a specialist. And, now the governments attempt to increase the number of primary care physicians is for the purpose of saving money, paying these doctors more if they don't refer patients to specialists and refusing to reimburse specialists if the patient doesn't have a referral. However, I still have trust that the primary care physician would refer the patient to a specialist when needed. And, you should be able to seek treatment from a doctor you trust. That is one flaw in the PPACA and exchange insurance policies. You can't keep your doctor you trust as the President and the Dems promised.

But you don't seem to have a problem with their lies. So good luck. You will get the treatment your insurance companies says you can get and it will be provided by a doctor they choose.

 

Suggest you google, Obama promises insurance companies that lose money on exchange plans a subsidy.

 

You can check this yourself. Go to the federal exchange site, apply for a quote stating you don't smoke and then apply saying you do smoke. Apply saying you have lymphoma and then apply not stating this. The PPACA only says you can't be denied insurance for a pre-existing condition, not that you can't be charged a higher premium is you have a pre-existing condition. If you apply and you friend with a pre-existing condition applies for the same policy, I guarantee your premium will be lower.

 

This all falls down in the Australian model due to single payer universal healthcare system. I was actually referring to the Australian model. Patients just can't rock up to most specialised medical professionals without a referral from a GP.

The process is quite simple actually.

1. Consult your GP and the bill is covered under Medicare (no money changes hands).

2. If there is a problem that is beyond GP's skill sets, he/she will direct you or recommend a specialist. If you want a second, third opinion, consultation with other doctors is also covered under Medicare (again no money changes hands).

3. Consult a specialist, also covered under Medicare or part of.

4. The specialist will recommend a course of action.

 

So are you actually claiming that before the ACA insurance companies didn't require you to have a referral to see a specialist?

 

Wrong. Your pathetic attempt to use smoking as a preexisting condition is amusing if nothing else. Read the law about preexisting conditions with a modicum of comprehension.

 

No the worse policies did. What I am saying is that why would I pay my out of pocket/copay to see my family doctor so he could refer me the specialist I already knew I should see? That costs me more.

And the only way it would save money is if my family doctor didn't refer me to the specialist I needed to see, he/my family doctor getting a kick back for not doing so and me probably needed another visit with my family doctor. The Family doctor being paid less than what a specialist would have charged if I saw him first.

 

Nope, you need to actually read the law. It is available online in case you would actually like to,know what you are talking about.

 

Go ahead and provide any evidence to support your claim.

 

ok, I went to family physician because I had psoriasis on my head and it cost me my co-payment only for him to tell me to see a Dermatologist. So I had to pay the family doctor a copay and my insurance paid the remainder of the office visit charge, if any. Then I had to pay my co-pay again when I went to a dermatologist and my insurance paid the remainder of his fee. Get it?

 

So I don't understand exactly what that proves. You would have had to do exactly the same system prior to Obamacare. That sequence is required by the insurance company not by the ACA.

Oh, and if your family physician can 't deal with psoriasis I would suggest you try to get a competent family physician. If he or she needs a specialist to diagnose Psoriasis there is a problem somewhere. Or maybe they they part of the same network and just milking the system. Or maybe practicing defensive medicine to avoid a lawsuit. Ha,ha.

 

For those of you who continue to think the US healthcare system is cheap or the best in the world here is some data from Forbes. Not exactly a left wing source to say the lest!

http://www.forbes.com/sites/danmunr...ked-dead-last-compared-to-10-other-countries/

Read it and the talk again about that old canard about the US having the most expensive system with close to the worst outcomes in he developed world.

 

One would think with all of America's wealth, technology and brain trusts, it would at least be in the top ten.

 

You are so wrong, prior to Obama care my policy didn't require that I see what they call a "gate keeper", a family practice physician that decides if I need to see a specialist. Many "exchange policies now have this requirement because the Government decided it "might" save "them" money and the insurance companies money. Screw the insured's that now have to make co-payments to two doctors.

You don't understand anything about how the health care system works. Or, how insurance coverage works.

 

http://www.theatlantic.com/business...health-care-so-ridiculously-expensive/274425/

This is a good article and helps to explain some of the reasons are healthcare system is so costly and also why we are the best when it comes to providing treatment for many diseases. Regardless what many studies report, we do have the best outcomes when it comes to many diseases. You have to look at the way they determine healthcare ranking among various Countries. IMO the 5 indicators that the WHO uses do not indicate the quality of care and outcomes of treatment. The are more administrative than clinical.

 

So exactly why did your policy change and when. Based on your past record of making things up it is hard to believe anything you say.

- - - Updated - - -

Life expectancy and infant mortality are very straight foreward.

 

So if you read the article we are absurdly expensive and lead only in cancer care, and wait times. A very poor return for the world's most expensive medical system.