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Just a couple of years after Obamacare was enacted, a big part of the problem was elucidated by several doctors working in an Oklahoma surgery center. From Reason TV:
(And very few of our political "leaders" have done a damn thing in the way of making a coherent effort to properly address the issues since then. The progressives' most commonly suggested "solution" has been to pour more and more money down the drain while not lifting a finger in any effort to promote market-based reforms or anything remotely resembling pricing transparency.)
Of course, to some progressives, a healthcare-related fiscal blowout is a feature, not a bug. In their view, outrage over exploding costs may germinate louder and louder clamoring for a single-payer system such as "Medicare-for-all."
Supporters envision this as an inexorable transition from the middlegame to the endgame.
The first patient that was getting her hand operated on got her health insurance policy from her employer. It did not come from HealthCARE.gov. This video is dealing with the healthcare system in general. This does not deal with the unique problems that the ACA (Obamacare) has.
The first patient that was getting her hand operated on got her health insurance policy from her employer. It did not come from HealthCARE.gov. This video is dealing with the healthcare system in general. This does not deal with the unique problems that the ACA (Obamacare) has. Yes, it does (or at least it would if key decision-makers allowed it to do so).
Notice that the title of the YouTube video I posted is "Oklahoma Doctors vs. Obamacare."
In any third-party-payer healthcare system, whether the bill-payer is an employer, an insurance company, or a governmental entity (such as Obamacare with its large subsidies), the key problem is perverse incentives enabled by pricing opacity. The narrative in the video points the way toward real reform.
Notwithstanding all the discussion of "risk corridors," etc., we are never going to get costs reduced to significantly less burdensome levels without real price transparency.
Insurers operating within the Obamacare structure should avail themselves of price-competitive care options, just as employers should.
Absent that, our incompetently implemented and horrifically expensive healthcare financing system is simply going to continue to act as a painful de facto tax on the American middle class and working class, who ultimately pay the price -- either directly or by way of receiving less in salary or wages than would otherwise be the case.
Notice that the title of the YouTube video I posted is "Oklahoma Doctors vs. Obamacare."
In any third-party-payer healthcare system, whether the bill-payer is an employer, an insurance company, or a governmental entity (such as Obamacare with its large subsidies), the key problem is perverse incentives enabled by pricing opacity. The narrative in the video points the way toward real reform.
The title of the video did not match the narrative. The woman that got her hand operated on did not have an Obamacare policy. She had a group insurance policy from her employer. A person with an Obamacare policy could have seen the same doctor and paid the same price for the hand operation "$2,000" unless that doctor for some reason took himself out of the network of doctors that the Obamacare policy had.
The reason Obamacare has large subsidies now in comparison to ten years ago is that most of the Obamacare policyholders are already sick. The risk pools are not balanced. The pieces of the ACA legislation that tried to induce a balanced risk pool were removed by Republican legislators. Unbalanced risk pools are the root cause for the high Obamacare subsidies not the lack of price transparancy.
Price transparancy is not a partisan issue. Neither party is trying to implement this. The removal of the risk corridor program and the individual mandate was strictly partisan. Had these two concepts not been removed, the large Obamacare subsidies that we see today would not be needed.
The party of Federal Government mandates for everything is the party of destruction.
The party of no was really only saying that history showed the only ideas the other side were presenting were the ideas of failure.
does the Federal Government mandate the payment of federal income taxes? God forbid it should ever come to that..
Obamacare baked in our fucked up healthcare system. without the mandate, Obamacare is basically a risk pool now. that's why the premiums are insane. at my age, a decent plan runs about 1k a month. and when i had it, BC/BS denied everything. it was a fucking joke, so without the mandate, you can guess what i did..
now my only "coverage" is EMTALA.
Medicare, as is, isn't sustainable. we need a patient-centered program. Medicare is now a provider-centered program. there is no brain behind Medicare, asking the question, "What is in the best interest of this patient? What is the best use of public funds?" Providers are committing battery every day on captive patients for totally unnecessary procedures.
What's a better use of taxpayer funds, 1 million vaccines for children to prevent a dangerous disease, or 1 complex brain surgery for a patient with a month to live? Medicare says the brain surgery.
(I'm not interested in a rebuttal that Medicare doesn't cover kids; I'm a health lawyer lol. Point is intelligent allocation of scarce resources. We have the best medicine in the world, but we still rank behind Costa Rica in World Health rankings.)
The title of the video did not match the narrative. (Seriously?) The woman that got her hand operated on did not have an Obamacare policy. She had a group insurance policy from her employer. A person with an Obamacare policy could have seen the same doctor and paid the same price for the hand operation "$2,000" unless that doctor for some reason took himself out of the network of doctors that the Obamacare policy had.
I couldn't disagree more, as the title of the video squares perfectly well with the overall narrative. See (1) below.
The reason Obamacare has large subsidies now in comparison to ten years ago is that most of the Obamacare policyholders are already sick. The risk pools are not balanced. The pieces of the ACA legislation that tried to induce a balanced risk pool were removed by Republican legislators. Unbalanced risk pools are the root cause for the high Obamacare subsidies not the lack of price transparancy.
Incorrect. See (2) below.
Price transparancy is not a partisan issue. Neither party is trying to implement this. The removal of the risk corridor program and the individual mandate was strictly partisan. Had these two concepts not been removed, the large Obamacare subsidies that we see today would not be needed.
The last sentence indicates an attempt to ignore or deflect attention from the crux of the problem. See following explanation from Perplexity.
Once again, the removal of the penalty for mandate noncompliance and the risk corridor issue are not the main drivers of spiraling healthcare costs.
1. As I pointed out in my previous post, it's irrelevant whether the woman in question received her coverage through her employer's plan or by way of Obamacare, as the problem with either third-party-payer structure is the same. That is, in either case, costs have ballooned out of control for the same reasons. Once again, notice that the title of the video has the word "Obamacare" in it; thus it cuts to the heart of the challenges facing those who still want to defend the ACA and offer no "solution" other than to throw staggering sums of fresh cash into it, no matter the costs.
2. The lack of any measure of price transparency is a far larger driver of increasing costs than the presence of "unbalanced risk pools."
You don't have to take my word for it. One of my "trusty research assistants" (An AI LLM) came up with this neat little explainer in only a couple of seconds! If you want to gain a better understanding of the issue, it includes plenty of informative links.
From Perplexity:
Risk-corridor underfunding and weaker-than-intended mandate compliance both contributed to ACA cost and premium problems, but they are only part of the story and not the dominant drivers.
## Risk corridors and premium spikes
The ACA’s temporary “risk corridor” program was designed to share unusually high early losses or gains among insurers in 2014–2016, to stabilize premiums while carriers learned the new market. Insurers that did well were to pay into a pool, and those with big losses were to be paid out of it. Because losses far exceeded gains, Congress later limited federal payments so HHS could only pay out about 12.6% of what was owed, leaving over 12 billion dollars in promised payments unpaid until years of litigation forced the government to honor them. This shortfall pushed some co‑ops and smaller insurers into insolvency and drove others out of the exchanges, which reduced competition and contributed to premium increases in many markets.[1][2][3][4][5][6][7][8]
## Mandate strength and noncompliance
The individual mandate was meant to bring healthier people into the risk pool; modeling and later evidence show that without a credible mandate, adverse selection raises nongroup premiums. Studies simulating or observing mandate weakening estimate that dropping the penalty increases exchange premiums on the order of roughly 3–13%, with millions fewer people insured. That is meaningful, but still a modest slice of overall premium growth, which is also driven by underlying medical cost trends and pricing.[9][10][11][12]
## Other major ACA cost drivers
Analyses of marketplace rate hikes in the mid‑2010s and later point to several large factors beyond risk corridors and mandate behavior:
- Underlying growth in medical and drug costs (“medical trend”).[13][14]
- Early underpricing by insurers that then “caught up” with large corrections in 2017 and later.[14][15]
- The end of the separate transitional reinsurance program and the weakened risk‑corridor backstop, which removed subsidies that had been holding premiums down.[4][7][13]
- Market uncertainty around other ACA payments (like cost‑sharing reductions) that led insurers to build political and legal risk into premiums.[16][17]
So, the failed funding of risk corridors and an individual mandate that proved weaker than intended did raise premiums and destabilize some insurers, but most of the ACA’s cost pressure comes from the same forces pushing up U.S. health costs generally: high provider and drug prices, underlying medical trend, and market concentration, layered on top of those policy missteps.[15][13][16]
Hey TC, your "trusty research assistant" is impressively fast and thorough! Not sure if I have time to peruse all 20 of his/her "informative links" lol.
So your assistant told us the real driver of exploding health-care costs is "the lack of any measure of price transparency". I seem to recall that was also a conclusion reached by Stephen Brill when he published his ground-breaking Time Magazine article "Bitter Pill: Why Medical Bills Are Killing Us" way back in 2013.
The Brill article introduced me to an unfamiliar term - hospital "chargemaster". At first I thought it referred to an actual live person, who toils in a hidden back room at every hospital and sets absurd rip-off prices for the thousands of items, services and procedures delivered each day by doctors, nurses and staff.
I decided to ask my own trusty research assistant for a definition of "chargemaster". After a 3-second pause for reflection, I was told the following:
A hospital chargemaster (or Charge Description Master, CDM) is a comprehensive, internal database listing every billable item, service, supply, drug, or procedure a hospital offers, each with a unique code and a high "sticker price," acting like an MSRP for healthcare services. It's crucial for billing (UB-04 forms) to insurance and uninsured patients but often bears little resemblance to actual costs, leading to inflated prices that fuel healthcare spending and complicate price transparency.
Something tells me if we ever decide to get serious about rolling back the corrupt, uncontrolled, incessant upward spiral of health-care costs, the place to start would be with the hospital chargemasters. My research assistant said these cost lists should be loosely regarded as "sticker prices" or MSRPs for each item. Does that mean purchasing health-care is like buying an automobile, which you suggested earlier in this thread is a much more transparent exercise? I don't think so!
When's the last time anyone visiting an ER for emergency medical treatment asked to see an itemized bill estimate prior to admission? You can't shop around when you're desperate. You have to let the hospital rape you (or your insurer, or the government) with their monopoly pricing. At a car dealership, you can negotiate, and walk across the street if the price isn't affordable.
Anyway, here's a link to that Steve Brill article for anyone who is interested. It's beyond discouraging that 12 years later (and 15 years since the enactment of the egregiously misnamed Affordable Care Act), the problem has only grown a lot worse!
Next, Let's Rebrand Obamacare As the WFA (Waste, Fraud and Abuse) Act!
ObamaCare Is a Mecca for Fraud
Federal auditors at the Government Accountability Office show how easy it is for the ineligible to sign up.
By The Editorial Board
Dec. 7, 2025 4:35 pm ET
The Minnesota Medicaid grift illustrates how open-ended government welfare can easily become an inducement for fraud. A new Government Accountability Office report finds the pandemic-era sweetened ObamaCare subsidies are also ripe for gaming.
The GAO last fall began an undercover test in which it submitted insurance applications for fictitious individuals to the federal ObamaCare exchange and insurance brokers. Nearly all of its invented people were able to enroll in subsidized plans despite submitting false or no records to verify their identities and incomes.
Of GAO’s 24 applications, 23 were approved. Eighteen enrollees were still covered as of September, suggesting that the exchange and insurers didn’t verify information even after enrollment. The subsidies paid to insurance companies for those 18 applicants totalled more than $10,000 per month, equivalent to a $6,700 annual subsidy for each enrollee.
GAO says in some cases “we were not prompted to provide documentation” to verify an applicant’s identity. No Social Security number? No problem. In another instance, the ObamaCare exchange “notified us that it had verified the applicant’s estimated income based on documentation we submitted. However, we did not submit documentation.”
In two cases, brokers called the ObamaCare help center because applicants had submitted invalid Social Security numbers. The center let brokers submit the fraudulent applications anyway. This suggests the Centers for Medicare and Medicaid Services, which runs the federal ObamaCare exchange, was ignoring fraud.
GAO also analyzed enrollment data in 2023 and 2024 for data anomalies. It found more than 29,000 Social Security numbers in 2023 and nearly 68,000 in 2024 that were used to receive more than one year’s worth of insurance coverage with subsidies in a single year—meaning the same Social Security number was used by more than one person.
In 2023 one Social Security number was used to apply for more than 125 policies. Perhaps this was identity theft, but it’s also possible brokers submitted fake Social Security numbers to enroll ineligible or phantom people in plans. Brokers earn more in commissions from insurers if they enroll more people in ObamaCare.
The Justice Department has charged numerous brokers with enrolling people in ObamaCare plans, or switching them to new plans, without their consent. GAO identified at least 30,000 applications in 2023 and 160,000 in 2024 that had “likely unauthorized changes by agents or brokers.”
GAO also found that incomes weren’t later verified for enrollees who received $21 billion in subsidies in 2023. That means they might have received bigger subsidies than they were eligible for. The Paragon Health Institute’s Brian Blase has warned that ObamaCare’s lax verification controls encourage people to understate income to get bigger subsidies.
Using Census Bureau data, Mr. Blase estimates that about 6.4 million people this year were improperly enrolled in subsidized ObamaCare plans, costing taxpayers $27 billion. He has also found that about 40% of enrollees in plans fully subsidized by the government filed no medical claims. GAO’s report suggests many may not be real people. Others may have employer coverage and been enrolled by brokers without their knowledge.
This year’s GOP tax bill included modest reforms to prevent ObamaCare fraud, such as requiring the exchange to verify Social Security numbers and income data before enrolling applicants in plans. It also requires people to repay the government if their incomes turn out to be higher than what they estimated on their applications. The Congressional Budget Office projected that the tax bill’s ObamaCare fraud controls could result in about one million more people going uninsured, but most aren’t eligible for subsidies—and some might not even exist.
Democrats want to boost enrollment in ObamaCare no matter the cost because they view the subsidized and regulated plans as a way-station to a single-payer system. Senate Minority Leader Chuck Schumer plans to tee up a vote this week to extend the pandemic-era subsidies, which have been an inducement for fraud.
Republicans would be wise to remind voters that Democrats sold ObamaCare on false pretenses - e.g., it would make healthcare “affordable.” Extending the subsidies would perpetuate that fraud.
1. As I pointed out in my previous post, it's irrelevant whether the woman in question received her coverage through her employer's plan or by way of Obamacare, as the problem with either third-party-payer structure is the same. That is, in either case, costs have ballooned out of control for the same reasons. Once again, notice that the title of the video has the word "Obamacare" in it; thus it cuts to the heart of the challenges facing those who still want to defend the ACA and offer no "solution" other than to throw staggering sums of fresh cash into it, no matter the costs.
2. The lack of any measure of price transparency is a far larger driver of increasing costs than the presence of "unbalanced risk pools."
You don't have to take my word for it. One of my "trusty research assistants" (An AI LLM) came up with this neat little explainer in only a couple of seconds! If you want to gain a better understanding of the issue, it includes plenty of informative links.
From Perplexity:
Risk-corridor underfunding and weaker-than-intended mandate compliance both contributed to ACA cost and premium problems, but they are only part of the story and not the dominant drivers.
## Risk corridors and premium spikes
The ACA’s temporary “risk corridor” program was designed to share unusually high early losses or gains among insurers in 2014–2016, to stabilize premiums while carriers learned the new market. Insurers that did well were to pay into a pool, and those with big losses were to be paid out of it. Because losses far exceeded gains, Congress later limited federal payments so HHS could only pay out about 12.6% of what was owed, leaving over 12 billion dollars in promised payments unpaid until years of litigation forced the government to honor them. This shortfall pushed some co‑ops and smaller insurers into insolvency and drove others out of the exchanges, which reduced competition and contributed to premium increases in many markets.[1][2][3][4][5][6][7][8]
## Mandate strength and noncompliance
The individual mandate was meant to bring healthier people into the risk pool; modeling and later evidence show that without a credible mandate, adverse selection raises nongroup premiums. Studies simulating or observing mandate weakening estimate that dropping the penalty increases exchange premiums on the order of roughly 3–13%, with millions fewer people insured. That is meaningful, but still a modest slice of overall premium growth, which is also driven by underlying medical cost trends and pricing.[9][10][11][12]
## Other major ACA cost drivers
Analyses of marketplace rate hikes in the mid‑2010s and later point to several large factors beyond risk corridors and mandate behavior:
- Underlying growth in medical and drug costs (“medical trend”).[13][14]
- Early underpricing by insurers that then “caught up” with large corrections in 2017 and later.[14][15]
- The end of the separate transitional reinsurance program and the weakened risk‑corridor backstop, which removed subsidies that had been holding premiums down.[4][7][13]
- Market uncertainty around other ACA payments (like cost‑sharing reductions) that led insurers to build political and legal risk into premiums.[16][17]
So, the failed funding of risk corridors and an individual mandate that proved weaker than intended did raise premiums and destabilize some insurers, but most of the ACA’s cost pressure comes from the same forces pushing up U.S. health costs generally: high provider and drug prices, underlying medical trend, and market concentration, layered on top of those policy missteps.[15][13][16]
The ACA’s temporary “risk corridor” program was designed to share unusually high early losses or gains among insurers in 2014–2016, to stabilize premiums while carriers learned the new market. Insurers that did well were to pay into a pool, and those with big losses were to be paid out of it. Because losses far exceeded gains, Congress later limited federal payments so HHS could only pay out about 12.6% of what was owed, leaving over 12 billion dollars in promised payments unpaid until years of litigation forced the government to honor them. This shortfall pushed some co‑ops and smaller insurers into insolvency and drove others out of the exchanges, which reduced competition and contributed to premium increases in many markets.[1][2][3][4][5][6][7][8]
What I wrote in post #75 & #78 say same the thing as above. Removal of risk corridor program led to premium increases. I did not use any AI tools to come to the same conclusion.
To implement price transparancy is a fix for the entire healthcare system in the USA. Yes, the ACA would benefit from that.
Until price transparancy becomes a reality I would argue that to reduce the need for the large subsidies in the ACA do one of two things
Bring back the risk corridor program or move individuals age 55 and above over to the Medicare system.
The Risk Corridor program is in the Medicare Part D legislation signed into law by Bush43. The difference is The Risk Corridor program is permanent in Medicare Part D. It should have been permanent in the ACA. Your AI tool tends to imply that. Like Lustylad, I don't have time to go thru all those links.
