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"Affordable" Care Act vent


Moxie
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You think I somehow should have had a magic mirror in which I could see I would have a non-lifestyle acquired life threatening chronic disease in 20 years time, and planned to meet my lifetime costs through taking out some prohibitively expensive cover-the-whole-damn-lot insurance while still a young adult ?

 

 

Well interestingly, this is what the ACA is intending to force people to do.  So obviously it must be the right thing.

 

Personally I have always had health insurance even as a young adult.  There might have been a short gap when I was 25 and still in grad school (I don't remember whether I purchased the university plan after my parents' insurance quit covering me; I remember thinking I had nothing to lose at that point anyway).  But generally, for an employed young adult to buy comprehensive insurance has historically been very reasonable.  The cost was not ridiculous, so it was obvious that the risk of going without insurance was unjustified.  For those unemployed or whose employers didn't offer comprehensive insurance, you could buy stop-loss insurance for pretty cheap (though many people were not aware of this).

 

The rise in costs has been pretty strange.  I really don't see how it is justifiable in the big picture.  $24k per year is a ridiculous amount of money just for routine health care and normal-risk insurance.  It's unsustainable.  Something's gotta give.

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I swore I wasn't going to post on this other than my list of some of the ways the ACA is increasing the cost of health care, but I can't resist this one--SKL is absolutely correct that the income redistributive effects of the ACA should not be ignored.  There has been at least one significant study on this that is mentioned here, though there are many articles floating around that address the same study.  

 

But, that's what insurance is. It ALWAYS is about redistributing income. I pay in, and don't get sick. You pay in and do get sick. You get the money. It has been redistributed. If you only got out what you put in, that would be a savings plan, not insurance.

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But, that's what insurance is. It ALWAYS is about redistributing income. I pay in, and don't get sick. You pay in and do get sick. You get the money. It has been redistributed. If you only got out what you put in, that would be a savings plan, not insurance.

 

No.  Insurance is not about redistributing wealth.  It's about spreading the risk over time and, to some extent, over populations.

 

Nobody "gets the money" if they get sick.  They just escape being bankrupted by their unexpected medical crisis.

 

Redistributing wealth happens when middle class people have to pay the premiums for low-income people.  Even more so when those premiums cover routine care, which is not a matter of risk and therefore not an appropriate subject for insurance in the first place.

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The corporate world seems to be embracing these high deductible plans--I don't think that can be blamed on ACA.

 

 

My major complaint #2.  You are not your insurance company's customer, your employer is.....so you have no real say in the decisions being made there.

 

Stefanie

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We had babies in 2006, 08, 10, and 12, as well as an inpatient stay in 09.  All of those were covered by employer sponsored health insurance, not ACA.  The difference in the six years was LARGE.  In 2006, our total cost for prenatal/delivery/postnatal/hospital....$100.  Premiums were something like $50/month.

 

In 2012, premiums had risen to $400/month (still affordable, but 8x as much), and our out of pocket cost was $10,000.

 

This coming year, premiums are $500, deductible is $5250, and our oop is $12,000.  We are not eligible for a HSA, because the federal government does not define our plan as a high deductible (high ded. is $12,500 for a family).  This is our only option as employer-sponsored.  We do not qualify for subsidies though ACA.  We're considering one of those health share programs, because of costs. 

 

Boy, I am sorry you have such poor options in your state!

 

However, I think you are misinformed about the gov't requirements for an HSA eligible plan. To be eligible, the deductible must be at least 1250 individual (2500 family) and the OOP Max must be NO GREATER THAN 6250 (12,500 family). 

 

There might be some OTHER problem with your plan for it to not be HSA eligible, but the problem is not that the OOP max is too low. 

 

 

For instance, we have an HSA eligible plan (and have since the ACA began a year ago). Our individual deductible is 1300; family is 2600. OOP Max is 2300 (4600 family) in-network and double that for out of network. (Our network is HUGE, and I have yet to find a doctor who was out of network.)

 

Combined with the HSA maximum contribution (6300 for the family), we are pretty much guaranteed to never have to use our entire HSA for regular covered medical care since our OOP max is so low, so we can use the spare to pay for braces or just to save for long-term-care insurance or even retirement. I'd been wanting a way to pay for braces pre-tax for EVER and was thrilled to have such a great plan for us. Our first year, 2014, we rolled over more than half our HSA towards this year or ultimately retirement (double tax benefited, as you contribute pre-tax and can withdraw tax free after retirement age). Our (unsubsidized) premiums are 1430/mo in 2015 for our family of 5. 

 

http://www.irs.gov/publications/p969/ar02.html#en_US_2013_publink1000204020

 

I hope your state offers you better plans in coming years!!

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However, I think you are misinformed about the gov't requirements for an HSA eligible plan. To be eligible, the deductible must be at least 1250 individual (2500 family) and the OOP Max must be NO GREATER THAN 6250 (12,500 family). 

 

There might be some OTHER problem with your plan for it to not be HSA eligible, but the problem is not that the OOP max is too low. 

 

 

I just read that IRS link differently.  The way I read it, it states that to be HSA eligible, the plan must have a deductible of $2500 or more, as well as a max OOP of $12,500 or more. 

 

It wouldn't make sense that they would cap a "high deductible plan" with a deductible of $2500.  Lots of people have higher deductibles than that.  Nor capping the OOP.  Lots of people have OOP maxes much higher than $12,5000.  And those are definitely high deductible plans.

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We had babies in 2006, 08, 10, and 12, as well as an inpatient stay in 09.  All of those were covered by employer sponsored health insurance, not ACA.  The difference in the six years was LARGE.  In 2006, our total cost for prenatal/delivery/postnatal/hospital....$100.  Premiums were something like $50/month.

 

In 2012, premiums had risen to $400/month (still affordable, but 8x as much), and our out of pocket cost was $10,000.

 

This coming year, premiums are $500, deductible is $5250, and our oop is $12,000.  We are not eligible for a HSA, because the federal government does not define our plan as a high deductible (high ded. is $12,500 for a family).  This is our only option as employer-sponsored.  We do not qualify for subsidies though ACA.  We're considering one of those health share programs, because of costs. 

 

We have an HSA and our deductible is $6400 for a family. So, maybe you could look into that again.

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I just read that IRS link differently.  The way I read it, it states that to be HSA eligible, the plan must have a deductible of $2500 or more, as well as a max OOP of $12,500 or more. 

 

It wouldn't make sense that they would cap a "high deductible plan" with a deductible of $2500.  Lots of people have higher deductibles than that.  Nor capping the OOP.  Lots of people have OOP maxes much higher than $12,5000.  And those are definitely high deductible plans.

 

You are right. Deductible must be a MINIMUM of 1250 (2500 family), but the OOP MAX has a MAXIMUM, not a minimum. 

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Oh well, I'm glad my 'something for nothing' is keeping me alive to mother my kids, without my parents having to sell their home in order to fund it. Lax irresponsible me.

 

 

Whether the government should subsidize healthcare for low-income people is - or should be - a separate question.

 

It's amazing how many ways our government manages to redistribute wealth without calling it that.  Like they think we aren't going to notice.  Let's just be up-front about it.  I think we should provide help to people who have chronic, expensive diseases.  That does not translate to "I should pay $24K per year for my health insurance."

 

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My family's experience with the ACA has been very positive. Our monthly premiums are significantly lower, and we've got better coverage. DH and I are both self-employed so no coverage through employers. I will say that the coverage is not nearly as good as the coverage we used to have through our employer many years ago.

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Because they are the ones giving a tax break?

Also a separate question. There is plenty of support out there for getting rid of the tax break for employers and employees who pay for insurance. Hell may freeze over first, but there is a case to be made for getting rid of the tax deduction and exemption. But for decades, the deduction and exemption have existed without the government's imposing substantive requirements on the coverage. The contents of that coverage were left to employers and employees.

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I'm not concerned about the tax break, I'm concerned about being able to avoid penalties for not having the plan the government says I should have - when that isn't what I want or need.

 

I don't think that the HSA has anything to do with avoiding penalties. An HSA is an account that you put money into, in addition to your health insurance, which enables you to get tax breaks. So it makes sense that the government has control over tax breaks.

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I don't think that the HSA has anything to do with avoiding penalties. An HSA is an account that you put money into, in addition to your health insurance, which enables you to get tax breaks. So it makes sense that the government has control over tax breaks.

 

Even if tax breaks were my concern, the government has ways of limiting these without telling me what to do.  Believe me, I see it every day.

 

The point is that I have to buy into some government-approved plan or I get a penalty for not having the right kind of insurance.

 

HSA or not, if I want to buy stop-loss insurance with a max family OOP of $25,000, and nothing else, I should be able to do that.

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I had this same problem last year but someone at the marketplace told me how to apply to get around that. It worked.

 

Could you expand on this please, we are in the same situation and while my son and husband are now insured, I am not but would very much like to be.

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You are reading in too much.  Its just very well known that generally across the board, people don't take as good care of the things don't have financial stakes in.  Health care is no exception.  When you remove the individual from the costs of their health care....the vast majority get lax.  It doesn't have anything to do with being able to look into a crystal ball and seeing what your health is going to look like in 20 year.   It is about making better choices on the whole.  Some may make better choices about their lifestyles, but I really mean more responsible, non-lifestyle, choices as a whole, across the board. 

 

To go fall back on the extreme stereotype (which is actually fairly common), the person on "gov't insurance" who waited 8 hours in the ER because they wanted the "free healthcare" to give their kid the Tylenol so they didn't have to go buy it.  You really have to ask yourself, if there had been some cost to the the person for the ER visit, would they have just gone and gotten the Tylenol from the store?  Some, no, many more others, yes.  Yes, extreme example, but I see this behavior and type of thinking to some extent infiltrating everywhere.  I just think it cultivates a "something for nothing" attitude; with the lovely bonus of skyrocketing costs.

 

Stefanie

 

Hogwash. They just would have gone without the tylenol, and the kid would have suffered.

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Hogwash. They just would have gone without the tylenol, and the kid would have suffered.

 

Well, then they would fall into the "some, no" category wouldn't they and you could still argue that behavior is a symptom of "something for nothing".  But there are many points along the way in health care where people don't question or examine their options when they don't have to pay out-of-pocket for it. 

 

Stefanie

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Could you expand on this please, we are in the same situation and while my son and husband are now insured, I am not but would very much like to be.

They had me apply alone. I still had to declare my Dh's income, but he wasn't applying for coverage on the application...just I was. Somehow it made a difference and I was allowed to show the cost of insurance for ME through my dhs employerer which was very expensive.

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Before ACA our health insurance was going up and up and up every single year, while coverage went down.

 

After ACA it went from $1000/month for 2 ppl with really crappy coverage, to $160/month for 2 ppl with very good coverage, to $0/month with pretty decent coverage.

Just curious: How did it become $0/month? I'd love to have that.

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Well, then they would fall into the "some, no" category wouldn't they and you could still argue that behavior is a symptom of "something for nothing".  But there are many points along the way in health care where people don't question or examine their options when they don't have to pay out-of-pocket for it. 

 

Stefanie

 

I really don't think we have a culture of too many people getting healthcare just for shits and grins. In fact, we have a culture of too many people NOT getting the care they need.

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Can we all agree that it would be much easier for everyone to use their money wisely if hospitals and doctors had to post their prices up front? I heard a story once of a guy whose wife stepped in a hole and broke her ankle. They didn't have insurance so he called several urgent care and hospitals. Place after place couldn't even give him a ballpark cost. He even asked what the general cost was to x-ray and cast the simplest type of broken ankle, recognizing that a more complex one would cost more. I think he had to call about ten or more places before someone finally gave him a minimum estimate.

 

Can you imagine if people had to have their houses or cars repaired without having any idea what the cost would be? I understand things can go wrong, but patients shouldn't be stuck going in blind for so many things. If places posted their prices, people could comparison shop. Don't tell me it's completely impossible because there is now at least one surgical center, doctor owned (in Oklahoma, I think) where the all-inclusive prives are clearly posted on the website. Obviously they don't handle emergency surgery, but if you know you need something done ahead of time, you can see how much they charge and not worry about them nickle and diming you for every tylenol or bandage.

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Can we all agree that it would be much easier for everyone to use their money wisely if hospitals and doctors had to post their prices up front? I heard a story once of a guy whose wife stepped in a hole and broke her ankle. They didn't have insurance so he called several urgent care and hospitals. Place after place couldn't even give him a ballpark cost. He even asked what the general cost was to x-ray and cast the simplest type of broken ankle, recognizing that a more complex one would cost more. I think he had to call about ten or more places before someone finally gave him a minimum estimate.

 

Can you imagine if people had to have their houses or cars repaired without having any idea what the cost would be? I understand things can go wrong, but patients shouldn't be stuck going in blind for so many things. If places posted their prices, people could comparison shop. Don't tell me it's completely impossible because there is now at least one surgical center, doctor owned (in Oklahoma, I think) where the all-inclusive prives are clearly posted on the website. Obviously they don't handle emergency surgery, but if you know you need something done ahead of time, you can see how much they charge and not worry about them nickle and diming you for every tylenol or bandage.

 

Oh I totally agree.  And with these high deductible plans it matters even more to know the cost upfront because realistically we (at least with the plan DH's employer offers us) will be stuck bearing the full cost of it.  We have deductibles of a a few thousand before but there was always a per person limit.  Now that has been removed and the insurance doesn't kick in until the 12,500 has been met but it doesn't matter if one person needs that much care or if it's spread across the whole family, nothing get paid until that cap is met.

 

I have some tests I need to have done.  I have some money left in my flex spending but not enough to cover the set.  I've spent the last month calling around trying to find out how much the stupid tests will cost so that I know how many I can do this year and how many I will put off till next year.  I can't even get a straight answer on whether the labs will be billed as in network or out of network forget the cost of the labs, the insurance "discount" amount etc  It's absolutely frustrating.  Everyone I have dealt with is very apologetic that they can't answer my questions but someone somewhere has to have this information I just haven't been able to figure out who.

 

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Can we all agree that it would be much easier for everyone to use their money wisely if hospitals and doctors had to post their prices up front? I heard a story once of a guy whose wife stepped in a hole and broke her ankle. They didn't have insurance so he called several urgent care and hospitals. Place after place couldn't even give him a ballpark cost. He even asked what the general cost was to x-ray and cast the simplest type of broken ankle, recognizing that a more complex one would cost more. I think he had to call about ten or more places before someone finally gave him a minimum estimate.

 

Can you imagine if people had to have their houses or cars repaired without having any idea what the cost would be? I understand things can go wrong, but patients shouldn't be stuck going in blind for so many things. If places posted their prices, people could comparison shop. Don't tell me it's completely impossible because there is now at least one surgical center, doctor owned (in Oklahoma, I think) where the all-inclusive prives are clearly posted on the website. Obviously they don't handle emergency surgery, but if you know you need something done ahead of time, you can see how much they charge and not worry about them nickle and diming you for every tylenol or bandage.

Great post.

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Absolutely agree on knowing the costs up front. When DS got his tonsils out, the dr told me he would go ahead and cauterize his nasal passages while he was under anesthesia (DS gets bloody noses all the time). I said sure. If I would have known it was $800 I wouldn't have done it. $800 isn't a lot for a medical procedure, but it is a lot of money for something that didn't really need done (and only lasted about 6 mos).

 

I have also had the experience of calling around urgent cares to find out how much a routine visit for a child with an ear infection is and not one would give me an estimate. It is ridiculous.

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About personal responsibility and individuals making "wise choices".....

 

We get our insurance through dh's employer.  It used to be the best insurance around.  But due to the skyrocketing prices, dh's employer started taking more and more away and charging more and more.  Now, our only option is a high-deductible plan with HSA.  Our monthly premiums are about $350/month for a family of three.  Our deductible for the family is $12,500 before anything kicks in.  So....roughly $1000/mo would have to be saved in order for us to be prepared to make that deductible.  That would be about 1/3 of our take-home pay, not even counting the $350 monthly premium.

 

We have been very lucky in that we have had no major medical expenses since the switch.

 

However, we are currently "wisely choosing" to not see a doctor unless almost-dead.  I currently have two medical issues that really need to be investigated.  Both cause discomfort (are significantly lowering my quality of life) and both could cause bigger and more-expensive problems if untreated.  We have the cash to go see a doctor.  But both issues will require tests and specialists.  Because I do not know how much those will cost, no one will tell me how much they will cost before appointments/referrals are made, and all could snowball into spending our entire deductible, I have decided to NOT have them addressed.  We don't have that kind of money.  And even if I was willing to go into debt to come up with the money, I feel like I have to "save" that option for a true emergency where someone in my family MUST be treated.

 

Not cool.  And in the end, I feel forced to make LESS responsible choices that could end up costing far more.

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Going without Tylenol might have been better.  I rarely gave it to my kids, not because of the cost.

 

Agreed, fevers have a biological purpose, so unless it is getting dangerously high I usually let them run its course without intervention.  And in my example, presumably the people are going to the ER because they DO want treatment, they just don't want to be personally responsible for it.  Otherwise, why bother sitting through the ER wait at all, wouldn't it just be easier to ignore the fever? 

 

Stefanie

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Agreed, fevers have a biological purpose, so unless it is getting dangerously high I usually let them run its course without intervention.  And in my example, presumably the people are going to the ER because they DO want treatment, they just don't want to be personally responsible for it.  Otherwise, why bother sitting through the ER wait at all, wouldn't it just be easier to ignore the fever? 

 

Stefanie

 Or maybe it IS dangerously high, and they don't have the money for the medication. If you have a negative balance in your bank account, and no cash, sitting in the ER to get your kid treatment seems more responsible than letting them continue to get hotter. 

 

That anyone thinks people are getting healthcare for fun, blows my mind. No one WANTS to hang out at the ER all day long. 

 

The idea that people are going around using healthcare they don't need, just as a game, is crazy. If a regular doctor's visit was free, they would go there if the kid was sick. 

 

And if you personally know people that sat in an ER for 8 hours to avoid paying the money for tylenol, I would hope you would donate some tylenol, to make the kid feel better. 

 

The way our society sits around judging "the least of these" is mind boggling. 

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Not cool.  And in the end, I feel forced to make LESS responsible choices that could end up costing far more.

 

That is because costs are insanely out of control at this time.  If costs were reasonable a much greater segment of the population could afford most routine/preventative care.  Go back and look at the kind of bills that people had back in the 50s.

 

For those interested......here are some breakdowns from some of our itemized hospital bills from this year.  The vet charges are from a bill from 2012. 

 

1000mL of normal saline - charge $113 per bag.   Cost to obtain....about $2.50.

plastic urinal - charge $31

12 hours oxygen - charge $480

plastic bulb syringe 2 oz- charge $33

Complete blood count - hospital charge $132, my vet's charge $37

Basic metabolic panel - hospital charge $591, my vet's charge $65

 

Why is there *such* a discrepancy?  Why can I pay $2,500 total for an OOP Lasix procedure and three follow up eye exams; and yet a simple blood test from a hospital costs 1/5th of that?  Why are the same tests, using the same machines that much cheaper at a vet than a doc?  Is it because I would have to pay for it myself?

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A lot of the cost is malpractice insurance etc.  However, I don't believe that explains all of it.

 

Tort reform is badly needed.  So is better education for docs etc.  I go to the doc and they follow all these protocols, but still give me bad advice or otherwise screw up half of the time.  PS no discounts or returns ....

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We let most fevers run their course.  There are still many MDs and nurses (let alone parents) who have unsubstantiated fever phobia themselves who will advise treating a fever over X number of degrees, even if it wouldn't be dangerous to let it run its course (not a young infant, no other concerning symptoms, not heat related illness, etc.)

 

http://www.nytimes.com/2011/01/11/health/11klass.html?_r=0

http://www.ncbi.nlm.nih.gov/pubmed?term=2001%20crocetti%20fever

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165093/

 

MDs need to be more proactive about explaining this.  I don't think it is fair to assess this situation as parents trying to get something for nothing (going to the ER for Tylenol).  There has genuinely been a lack of parent education on this topic, some MDs and nurses still go by dated or inaccurate info themselves, and medical staff haven't done enough to work with various groups who still hold strong to their fever phobia.  This isn't the fault of parents; they care, that's why they are there for 8 hrs in the ER.  They  haven't had the right info conveyed strongly enough, often enough, or accurately, or perhaps it hasn't been communicated clearly to them in their primary language if they aren't native English speakers.  They are concerned their child will get brain damage, have seizures, etc. from an untreated high fever.  Let's get our medical personnel up to speed on clearly conveying this info to parents, regularly and often, in easily understood language, putting the info into the parent's native language, etc. rather than criticizing the parent(s) for trying to get their children care.

SOme MDS will want to cover themselves and may send a family in to the ER if it is after hours, even for "just" a fever.  I doubt most parents want to spend 8 hrs in the ER.  It isn't fair to blame the families here IMO.

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I suggest that those of you who are not able to afford to see the doctor consider a chiropractor.  They can help with a lot of things and it is a lot more affordable.  And they will tell you how much they charge up-front.  :)

 

I have used a chiro in select circumstances and would disagree with this advice as a primary care type of option.

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I don't know why, but somebody has to fix it. Our health care premiums alone TRIPLED last year for far worse coverage with a high deductible. We are self-employed, get no subsidies, and will pay somewhere between 15-20K this year alone on health care for our average health family. That is completely unsustainable for us. It has to STOP!!

 

 

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My coverage price went down. The only people I know whose rates went up, were those young and healthy who were hoping not to pay in until they got old and sick.

 

I hate to break it to you all, but getting them to spread the cost of their health care over the parts of their lives when they can actually pay was part of the whole idea. Before, people weren't paying until they got sick. And then they were like, "Holy cow, medicine is expensive! I need help!" But you know what? If you'd have paid in before, it would be easier to help you. But you didn't. You wanted to say, "I'm low risk now, I'm never going to get sick, therefore, I should not pay in. Until I get sick. Which is, totally coincidentally, the time at which my income will plummet because I won't be able to work. So then I'll take medicare."

 

It is not one party or the other that caused this. It is Americans' total unwillingness to take personal responsibility, to put in the tax money and the contributions, the political investment, that people from real civilized countries put in. They want a free ride.

 

Well guess what. It's not going to happen.

 

 

And honestly, the government doesn't handle its current responsibilites very efficiently, so I wouldn't expect that to change.

 

As opposed to the private sector, which is ripping us all a new one extremely efficiently! Yay! How efficiently Starbucks is selling coffee--that must be totally like helping a human person develop from infancy into a contributing member of society. Not at all different!

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SOme MDS will want to cover themselves and may send a family in to the ER if it is after hours, even for "just" a fever.  I doubt most parents want to spend 8 hrs in the ER.  It isn't fair to blame the families here IMO.

 

Agreed, it was a bad, example and one I was hesitant initially to use.  I just couldn't think of a better one at the time.  Lovinmyboys post about the tonsils is really more what I was trying to get at.  If someone was paying OOP in a similar situation, would they have been a bit more diligent in examining their options before agreeing to a medical procedure? 

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Everyone pays for their own *routine* care and then if the gov't would get out of the way some, the market can be quite inventive for a wide variety of plans.  

 

How was the government "in the way" before the ACA when costs were still out of control?

 

As for how gov't/insurance driving up costs....it's because neither actually pays the full costs.  Medicare/Medicaid pay by schedules.  The way medicare pays hospitals is by admitting diagnosis.  So, if you go in for pneumonia and Medicare has decided that pneumonia is a 4 day stay, they will pay for 4 days, and ONLY 4 days.  If you leave after 3, great the hospital made money on you.  If for some reason you don't respond well to treatment and you stay 5 or 6 days....well, too bad, hospital lost out on money and they'll have to eat the cost of your extra days stay.  Very much a simplified example, but what generally happens.  It is generally well understood that businesses "pay taxes"....they pass them on to the customer via price.  Same thing. The hospital doesn't just eat it, they try to get it back by increasing the costs of care. 

 

When you say "full costs", the thing is, nobody really knows what those are any more.  This is not the *sole* fault of the government/insurance, but a result of the whole interdependent twisted system.

 

Same thing happens with insurance.  The contracts the doctors have with the different insurance carriers have agreements to "write off' portions of the bills, once again leaving those costs uncovered and to be made up elsewhere. 

 

So how would that change if the government was "out of the way"?  That is what has been going on for years.  And the portion "written off" for insurance companies pales in proportion to the amount "written off" for the completely uninsured.  Yet no one wants to "force" people to have insurance because that's un-American.  Well, ok then, how do you address that?

 

But bottom line, your generally 100% elective surgery options (Lasix/boob implants) are so much more affordable in the grand scheme of health care costs because they know they have to appeal directly to the consumer.

 

See, instead I think it is because those services are, in fact, elective.  An open heart surgery is not something you "shop around" for in most cases.  That is the flaw in trying to apply free-market philosophy to health care. 

 

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Agreed, it was a bad, example and one I was hesitant initially to use.  I just couldn't think of a better one at the time.  Lovinmyboys post about the tonsils is really more what I was trying to get at.  If someone was paying OOP in a similar situation, would they have been a bit more diligent in examining their options before agreeing to a medical procedure? 

 

Oh, I agree with you about encouraging a wise use of what's available to us as patients.  I worked in healthcare pre kids, still read journals, etc. and it frustrates me to see how many MDs are still recommending procedures for which there is poor evidence, for example.  My mom was recently talking to her MD about a friend who was going through heart issues and they wheel in an ECG at my mom's appt basically to "reassure her" nothing is wrong with her heart, despite the fact she had zero complaints, zero symptoms. My mom left feeling reassured, even though a routine ECG in a case like hers is pretty worthless based on the data. She was merely talking about what a friend's husband was going through with testing, etc. Were they trying to reassure her?  Was there a financial incentive in doing this procedure?  Was it explained to my mother than if she's asymptomatic, not about to have surgery, etc. it is was unlikely she needed this ECG?  No.

 

People don't want to hear that some of the common screenings may be very poor in terms of having any prognostic value, or any measurable improvement on health.  But if that's said by medical personnel, now they are "rationing" healthcare, which draws the ire of some in this country.  My MIL is approaching 70, and is still in that mode of thinking of many in her generation that more testing, more screening, more, more, more is better, and if she can't demand any test she wants, she's being shortchanged by having medicare+a supplemental policy.  Our citizens are so convinced that more testing, more intervention means better health and better outcomes, and sometimes MDs are happy to play along as it can be profitable, or they can cover their bases and avoid a lawsuit in the very rare chance they are wrong when they didn't send you for a CT for every single complaint. 

 

A lack of scientific literacy is partially to blame, IMO.  People simply don't understand in some cases that more is not always better.  But I don't fault parents for worrying about their kids, and I don't fault people for feeling certain tests, procedures, and screenings are more effective than they are, because that's the message that's everywhere.  I feel that the entire medical community has poorly communicated the messages about the risks of excessive testing and diagnostics, overuse of meds, risk of overtreatment, etc, and that falls squarely on them, not the patient, as far as I am concerned.  I think we are starting to hear more about it on occasion (like with respect to PSA testing in men, or annual screenings for things like cervical cancer in women who haven't ever had an abnormal PAP, no HPV, etc.).  But IMO, the general public is just not there yet.  They are convinced some of these screenings and tests work better than they do to preserve their health, not realizing that excessive diagnosis and over treatment comes with significant risks that may exceed any benefit.

 

And to be clear, I'm all for appropriate screening, reducing risk factors, preventative care, etc. when backed by science.  And I think we should err on the side of caution on some of the screenings we aren't sure about yet in terms of how effective they are long term, or ones we have mixed data on. But when we have years and years of data on certain procedures and tests not being effective or carrying risks greater than the risk of disease, we need to be more judicious.  And that's not going to happen until we get more scientific literacy and get medical staff to communicate these issues to the public more clearly.  eta: But I disagree with blaming the patient for overuse of procedures, testing, etc.   I think this falls to the medical community to convey more clearly (for ex: overuse of CT scans) to patients.  It will take time, but I don't think we should blame patients for this.

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The differences in the medical systems go far beyond the payment mechanism.  I do not think moving to a single-payer, universal health care system in the US would result int he same outcome as European countries without some other major changes.  When doctors go to medical school almost for free, when doctors and hospitals are not concerned about expensive lawsuits, when doctors do not have to pay astronomical malpractice insurance, when there is a bias toward less invasive treatments and less use of expensive diagnostic and testing, etc. the outcome is much different.

 

This is an excellent point.  And really leaves even less hope that our healthcare problems in the US will ever be resolved.

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Agreed, it was a bad, example and one I was hesitant initially to use.  I just couldn't think of a better one at the time.  Lovinmyboys post about the tonsils is really more what I was trying to get at.  If someone was paying OOP in a similar situation, would they have been a bit more diligent in examining their options before agreeing to a medical procedure? 

 

but, is that what we want? Do we think there are that many people getting healthcare they don't need, that is totally worthless, and they need to learn to pay for it themselves to curb their wasteful healthcare ways? Or would that actually just lead to a lot of people not getting care at all? 

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My coverage price went down. The only people I know whose rates went up, were those young and healthy who were hoping not to pay in until they got old and sick.

 

I hate to break it to you all, but getting them to spread the cost of their health care over the parts of their lives when they can actually pay was part of the whole idea. Before, people weren't paying until they got sick. And then they were like, "Holy cow, medicine is expensive! I need help!" But you know what? If you'd have paid in before, it would be easier to help you. But you didn't. You wanted to say, "I'm low risk now, I'm never going to get sick, therefore, I should not pay in. Until I get sick. Which is, totally coincidentally, the time at which my income will plummet because I won't be able to work. So then I'll take medicare."

 

It is not one party or the other that caused this. It is Americans' total unwillingness to take personal responsibility, to put in the tax money and the contributions, the political investment, that people from real civilized countries put in. They want a free ride.

 

Except that most Americans have been paying in all along.  And those of us who have been paying in all along are the ones getting bigger and bigger bills.

 

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How was the government "in the way" before the ACA when costs were still out of control?

 

The government has been forcing employers' and insurance companies' and doctors' hands for decades.  It has been creeping up quietly; it is certainly not new.

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. Don't tell me it's completely impossible because there is now at least one surgical center, doctor owned (in Oklahoma, I think) where the all-inclusive prives are clearly posted on the website. Obviously they don't handle emergency surgery, but if you know you need something done ahead of time, you can see how much they charge and not worry about them nickle and diming you for every tylenol or bandage.

 

 

I wish that could be the way things worked.  But I have to wonder if that is actually connected to the fact that they don't do emergency surgery, etc.  People in need of emergency surgery have to be treated, even if they are unable to pay.  So the facility tries to (really, HAS to) make that up elsewhere.

 

I also wonder if they deal with insurance or only self-pay. Because each insurance company has to think they are getting the best deal and discounts, and each one has their own pricing set up.  

 

Maybe that would be a decent starting point - everyone pays the same prices - insurance or self-pay.  (I don't mean nationwide, I mean per facility),   Because I think that is at the root why they can't tell you prices up front.  They charge everybody differently depending who they are and what insurance company they are with.

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but, is that what we want? Do we think there are that many people getting healthcare they don't need, that is totally worthless, and they need to learn to pay for it themselves to curb their wasteful healthcare ways? Or would that actually just lead to a lot of people not getting care at all? 

 

A lot of things are better treated with basic loving care at home, so yes, I think it would be better for people to get what you call "no care at all" in a lot of cases.

 

When you go to the ER (or the doctor for that matter), you expose your family and others to infections, make the sick person more uncomfortable, and often medicate something that is better unmedicated.  I consider it poisoning when a person is medicated unnecessarily.

 

It would be nice if parents could be better educated about taking care of sick family members at home.  How come the ACA doesn't have any budget for that?

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The government has been forcing employers' and insurance companies' and doctors' hands for decades.  It has been creeping up quietly; it is certainly not new.

 

Are you referring to things like FDA regulations, acceptable standards of care, things like that?  Or something else?  

 

And don't the insurance companies do that also, dictating how long people should stay in the hospital, what preferred meds doctors should use, what THEY consider standard care?

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Are you referring to things like FDA regulations, acceptable standards of care, things like that?  Or something else?  

 

And don't the insurance companies do that also, dictating how long people should stay in the hospital, what preferred meds doctors should use, what THEY consider standard care?

 

Yes, insurance companies negotiate all sorts of things, like any business.  People can vote with their pockebooks if they don't like what a business does.  Can't do that with the government.

 

The government has long been forcing certain situations to be included in healthcare insurance coverage.  Stuff many people do not want to buy / pay for.  This is one of the reasons some employers began to opt out instead of offering something workable for the employer.

 

And the government has been forcing doctors to make IT expenditures and report stuff etc. etc.  All of it costs money.

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