Health Care’s Bipartisan Problem: The Sick Are Expensive and Someone Has to Pay

The Wall Street Journal ^ | January 12, 2017 | Anna Wilde Mathews and Louise Radnofsky

[JeepersFreepers]

The 2010 health law, also known as Obamacare, forced insurers to sell coverage to anyone, at the same price, regardless of their risk of incurring big claims. That provision was popular. Not so were rules requiring nearly everyone to have insurance, and higher premiums for healthy people to subsidize the costs of the sick.

If policyholders don’t pick up the tab, who will? Letting insurers refuse to sell to individuals with what the industry calls a “pre-existing condition”—in essence, forcing some of the sick to pay for themselves—is something both parties appear to have ruled out. Insurers could charge those patients more or taxpayers could pick up the extra costs, two ideas that are politically fraught.

Most U.S. health-care spending is for a small number of very expensive patients:

• -Most expensive 1% of patients = 21% of health care spending.
• -Most expensive 5% = 49%
• -Most expensive 10% = 65%
• -Most expensive 15% = 75%
• -Most expensive 20% = 82%
• -Most expensive 50% = 97%

[JeepersFreepers]

The table above is shocking! Almost half of health care spending is consumed by 5% of patients. The healthiest half of the population consumes only 3% of health care costs. It is difficult to see how the Republicans can cut off funding now that Obamacare is in place with the healthy subsidizing the sick through excessive insurance premiums and high deductibles. The only alternative would appear to be taxpayer subsidies. It is next to impossible, politically, to take away freebees once in place. Income redistribution continues to increase.

To get past the WSJ paywall, simply google the name of the article instead of using the link.

[Opinionated Blowhard]

Someone has to pay

Says who? And don't give me any BS about a "compassionate society." I'm at my compassion limit with all the Welfare and other transfer payments that I support.

[knarf]

That's what premiums are for.

If my premiums don't cover me, I'll change insurance companies.

[Drango]

To get past the WSJ paywall, simply google the name of the article instead of using the link.

I still get the paywall....hmmmmm.

[G Larry]

The overhead in Obamacare is nuts...and non-value added.

[Pollster1]

As usual, democrats are conflating several issues.

Yes, catastrophic coverage is expensive when something goes wrong. I’d love to have insurance covering just that situation, but they banned it. Catastrophic illness is rare, and the cost of that coverage is not insanely high.

What costs far more is elective medical care. When we say that some service is “free”, there is no incentive not to use that service, even if it’s not needed. I remember noticing that it was cheaper to take my kids to the doctor for the sniffles and get a prescription than it was to pay for over the counter medicines. There is something wrong with that. If we get rid of the “free” items, unnecessary utilization will go down, costs will drop, and we won’t need the unreasonable deductibles and copayments on real services.

[Neidermeyer]

I think the healthcare companies that pushed ACA on us should be forced to subsidize those patients for lets say the next 5 years regardless of profit or loss to the company. Let them crash and burn ,, the infrastructure will still be around ,, it’ll just be bought cheaply by someone else and run under a new name.

[Navin Johnson]

Totally correct. Nobody is entitled to health care, no matter what these libs think

[Buckeye McFrog]

The political reality is that you will never get enough public support to allow insurance companies to go back to denying coverage for pre-existing conditions.

We have to live in a world of political realities and not an “ideal plane”. And the political realities are that this is DOA with voting public.

[Secret Agent Man]

Who says someone has to pay? We are told by socialists its all free!

Just crank up the presses and issue more fiat money. You know the stuff backed up by good feelings and unicorn farts.

[BenLurkin]

Agreed.

The left always tries to conflate society with the government.

Government is not so society

[Mr. Douglas]

Someone has to pay
Says who? And don’t give me any BS about a “compassionate society.” I’m at my compassion limit with all the Welfare and other transfer payments that I support.

---

Exactly. We now have “gofundme” type stuff.

It’s interesting that when we were a “christain” nation, people were not afraid to die. Well, there is that, but also, how expensive IS morphene, anyway?

I’m 63 with no insurance. I trust the Lord to provide until the day I die. He has been an EXCELLENT health provider!

[pfflier]

The not sick, but mandated coverage types are expensive too.

The addicted, those seeking a disability of "convenience" and those selecting nonessential but very expensive procedures like sexual reassignment surgery are all in the top 5% category.

[Secret Agent Man]

Welfare to the receiver == gimme freeshqt i am entitled to

Welfare to the supplier == forced government confiscation of money you earned/invested

Government takes when you earn, they dont give you any back when you lose. But they still take from you, even then.

[Jim Robinson]

Well, gee. How in the world were we able to survive as a people for centuries before government, er, taxpayer paid health insurance?

[Tzimisce]

I was warning everyone about this.

And I was laughed at, mocked, made fun of and called a racist and worse.

The people I warned sat there with big smirks on their faces and voted for this anyway.

So now they’re discovering (to their horror) that I was right.

All I can say now is F**K YOU!

[Secret Agent Man]

I pay for everyone else. I dont go to doctors. I pay for all my supplements and vitamins and exercise gear. I get zero for the money that goes out the door for insurance every year.

[9YearLurker]

I think I see the infamous 80-20 rule in effect.

(Okay, 82-20, to be precise.)

[Oldeconomybuyer]

pre-existing condition”—in essence, forcing some of the sick to pay for themselves...

Wrong. Let the free market handle health insurance. Pre-existing conditions can be managed by waiting periods as policies did pre-Obama. The actuaries can figure out the math, companies can sell attractive policies anywhere in America, and Obamacare will forever be the emblem for big government failure.

[grania]

The most appalling way to look at that is 50% of the population only uses 3% of the expense of health care! When everyone is insured for everything, that 50% will gradually give up being responsible for their medical decisions, and they'll increase their expenses, too. That's an unaffordable spiral, We're already seeing some of that with the numbers of seniors who get hips and knees replaced, rather than live with limitations. Another aspect we're seeing is the heroin epidemic caused to a great degree by getting hooked on prescription meds.

Back in a college Philosophy class in the 1960s, one of our classes was an ethical discussion about this. What happens when there are expensive cures for diseases, but not the means to provide them for everyone? If I remember, the conclusion was that for every high-priced medical solution, there had to be a low cost option available.

What I would favor is a policy that covered catastrophic situations and diseases....nothing else. For those who chose that option and nothing else (or not even that), there should be first-aid/self-healing clinics for those who choose that. I don't see how else the problem can be solved.