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Affordable Care Act -- NOT Affordable


yinne
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Our citizens will never get genuine healthcare until people wake up and realize that the majority of the poor and the sick do work and contribute to society and are not stupid or mooches looking for sugar daddies.

 

Thank you for saying that!

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http://health.usnews.com/health-news/health-insurance/articles/2013/08/28/aca-obamacare-bronze-tier-vs-catastrophic-health-insurance

 

The bronze plans are different from the catastrophic plans.   The link above shows you the difference.   You CANNOT get tax credits to help pay for catastrophic plans and you are not eligible for a catastrophic plan unless the government says you are.

 

Yvonne in NE

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If it's an ACA plan this is not true.  All ACA plans are required to cover preventive care before deductible without charging copays or coinsurance.

 

https://www.healthcare.gov/what-are-my-preventive-care-benefits/

This is true as long as they are the government required services and they are obtained in network.  I edited my earlier post to clarify that.

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Or they decide to not get treatment. It's not really talked about. I guess bc it's not .. Idk.. Just makes people uncomfortable.

 

My dad has decided to not have his aortic valve replaced. And he stopped taking the insanely expensive meds to help extend his time. He will suddenly drop when it finally ruptures. But he has decided he would rather leave his estate to his son than accrue a ton of debt (even after insurance/Medicaid) and leave nothing to his son. (Yeah the rest of us get absolutely nothing. Except I'll probably take care of him in his final days. And frankly, that's fine by me. Really.)

 

And my dad lamented if he knew now what he knew then, much as he loved my mother, he would have told her not to bother under going all the cancer treatments. She died within 6 months of the diagnosis. And the treatment was at least as miserable as the cancer and he lost almost everything afterwards to pay the medical debts. (Again, after insurance.)

 

And I've told my dh I would likely turn down medical treatment if I felt it would ruin our children's financial futures unless I had at least a 70% chance of success. Poverty sucks. I don't want that for them. Even if it means I'm not around to see them enjoying a better life than I started with. Seriously. Folks can talk all they want about how unimportant money is, but that's bull. Money isn't why I'd do it. But it's a major reason why I'd feel the need to do it for my kids and dh. Money doesn't buy happiness but it sure as heck buys a whole lot of things that make it easier to live a decent life.

 

Again. I think the root of healthcare evil IS insurance. So, as far as I'm concerned, any supposed national mandate plan that includes insurance as it's core is flawed and doomed from the start.

 

Sigh... I wish we could move. I'm so disenfranchised with our government that I'd seriously have zero qualms giving up my citizenship or at least taking on dual citizenship elsewhere. The irony is I can't afford a trip out if town much less out of the country. How the blazed did my dirt poor scavenging for potatoes and onions ancestors manage to leave their countries AND settle in here?

 

Oh yes... It's that time of year again... Maybe a new thread is called for...

 

In those cases, I kind of understand what you mean. But this stuff happens to young people too. My ex was only in his twenties when he got cardiomyopathy, and had a 3 year old son. Not treating it, and drowning in his own blood basically, in front of his family, wasn't really a fair option, you know? Sigh. 

 

But really, you and I both, although settling for different bad options, agree on the actual REAL solution, which is universal healthcare. We can both pray for it together, or move somewhere better and be neighbors :)

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In those cases, I kind of understand what you mean. But this stuff happens to young people too. My ex was only in his twenties when he got cardiomyopathy, and had a 3 year old son. Not treating it, and drowning in his own blood basically, in front of his family, wasn't really a fair option, you know? Sigh.

I don't think it's a fair option for anyone. And many a parent has had to accept they aren't rich enough to give their kid health they think is fair.

 

 

ETA: and I'm not sure how old you think I am, but I just turned 40. My dh and I have both chosen to do without care because of finances causing family hardship. Neither of us particularly had a death wish, but neither of us particularly wanted to deprive our children of dinner either.

 

But really, you and I both, although settling for different bad options, agree on the actual REAL solution, which is universal healthcare. We can both pray for it together, or move somewhere better and be neighbors :)

Yes. Exactly.
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Latest I've read is a high proportion of applications made on the exchanges are incomplete due to lack of certain pieces of info. They have no practical way yet of letting people know that. So they are going to eventually contact people by phone, but have not yet hired anyone to do so. Sigh.

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http://health.usnews.com/health-news/health-insurance/articles/2013/08/28/aca-obamacare-bronze-tier-vs-catastrophic-health-insurance

 

The bronze plans are different from the catastrophic plans.   The link above shows you the difference.   You CANNOT get tax credits to help pay for catastrophic plans and you are not eligible for a catastrophic plan unless the government says you are.

 

Yvonne in NE

Thank you for the link! It was really helpful!

 

Yes, I'm aware that the catastrophic plan is totally different.  It isn't even offered as an option for my family.  I was simply trying to say that the bronze plan I was able to view (for $200), didn't seem much better than the catastrophic insurance we had just recently gotten rid of.  I'm praying I simply misunderstood though.

 

For anyone that knows more than me...Am I to understand that the bronze plan will cover 60% of all medical costs even before my deductible is met?  If yes, that is great!  The wording on the plan I was viewing seemed to indicate the deductible had to be met before any insurance kicked in (aside from specific preventative care).  I could not click on the "details" link then, as it didn't work at all.

 

However! The good news is, I was able to briefly get on a few moments ago before it froze and booted me off again (...and it did not display our premium with the applied tax credit as the total this time - which was really stressful for me!). Anyway --  THIS is the plan I am thinking about for my family. It is from the "details" link that actually worked this time.  Where I live, we have a nice healthcare facility for day to day issues (so I like the option of being able to see what is cheapest -- our insurance or opting to use the health clinic).

 

So. What I really need to understand is what is covered BEFORE the deductible of $12,500 is met. Is 60% covered & my maximum out of pocket for our share of the 40% is $12,500?

 

I hope my confusion makes sense. I need clarity!

 

TIA!

Amy 

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Thank you for the link! It was really helpful!

 

Yes, I'm aware that the catastrophic plan is totally different.  It isn't even offered as an option for my family.  I was simply trying to say that the bronze plan I was able to view (for $200), didn't seem much better than the catastrophic insurance we had just recently gotten rid of.  I'm praying I simply misunderstood though.

 

For anyone that knows more than me...Am I to understand that the bronze plan will cover 60% of all medical costs even before my deductible is met?  If yes, that is great!  The wording on the plan I was viewing seemed to indicate the deductible had to be met before any insurance kicked in (aside from specific preventative care).  I could not click on the "details" link then, as it didn't work at all.

 

However! The good news is, I was able to briefly get on a few moments ago before it froze and booted me off again (...and it did not display our premium with the applied tax credit as the total this time - which was really stressful for me!). Anyway --  THIS is the plan I am thinking about for my family. It is from the "details" link that actually worked this time.  Where I live, we have a nice healthcare facility for day to day issues (so I like the option of being able to see what is cheapest -- our insurance or opting to use the health clinic).

 

So. What I really need to understand is what is covered BEFORE the deductible of $12,500 is met. Is 60% covered & my maximum out of pocket for our share of the 40% is $12,500?

 

I hope my confusion makes sense. I need clarity!

 

TIA!

Amy 

 

Is it saying your total out of pocket is $12,500 or your actual deductible. Everything I looked at gave a total out of pocket that included both the deductible and the co-insurance but the deductible itself wasn't that high (but this was on a basic calculator not an actually exchange site). One friend (in TN, so on the federal exchange) was looking at a bronze plan with a $6,000 deductible and a total out of pocket of $12,500. Normally, deductibles have to be met before anything is covered so I'd guess you'd need to meet the deductible first, with the exception of the preventive care that is covered at 100%. On a side note, even though we're in TN, we have Florida Blue and LOVE it. Their customer service has been great whenever we've had an issue.

 

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Thank you. That is how I interpreted it too :(

 

That really just means we need to continue to budget for day-to-day healthcare and additionally come up with $2,400 annually to pay for insurance that is no better than what we just cancelled.

 

I was so hoping we could get better coverage for a better price. Bummer.

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In the link Yvonne shared it seems to indicate that the bronze should cover 60%?? If not, it seems like the catastrophic plan is actually better -- it at least offers preventative care and 3 doctor visits before meeting the deductible.

 

This is really confusing for me & I normally can at least grasp insurance policies enough to know what I'm buying. Maybe when the website works I can use the chat mode.

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In the link Yvonne shared it seems to indicate that the bronze should cover 60%?? If not, it seems like the catastrophic plan is actually better -- it at least offers preventative care and 3 doctor visits before meeting the deductible.

 

This is really confusing for me & I normally can at least grasp insurance policies enough to know what I'm buying. Maybe when the website works I can use the chat mode.

 

If your deductible is $6000, you have to pay $6,000 before the insurance will pay anything (except the preventive stuff that is covered by paying your premium).   The 60%/40% coinsurance comes into play after your deductible is met.    If your total out of pocket is 12,700 the deductible took care of $6000 of it and you will pay 40% of the rest of your medical bills (the insurance picks up the other 60%) for a given calendar year until you reach the 12,700, after that you are covered 100%.      

 

Yes, I too would agree that this sounds like a catastrophic plan, but the government calls it a bronze plan.    The catastrophic plan is as explained in the previous post, but remember that the catastrophic plans under ACA are not available to everyone.  

 

Yvonne in NE

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I can't even grasp these high prices.  With the military insurance(Tricare), as long as you are active duty, your maximum yearly cost is $1000.  We reach that in about three months of using it and then we don't pay anything except the slightly higher cost of non participating physicians (like my dd's psychiatrist, she charges 100 a visit, and tricare pays us back 87 dollars and we just end up paying the rest- that isn't part of the 1K maximum).  Even when my dh retires next year, we will have a maximum of 3000 and we do not pay 100% before that.  We just have such high medical expenses that we end up paying the 700 in co-pays really, really quickly (it will be more once he retires).

 

 

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Well the healthcare act for my family is not anymore helpful than what our options were before. Insurance has changed so drastically. We have always had stellar insurance up until the last five years. My husband's employer doesn't offer it & finding actual insurance beyond catastrophic benefits is impossible (at least with a budget friendly price tag). Oh well. It could be worse for sure.

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Quote from Martha's last post:

 

"To people saying, oh if they can't afford insurance then they will qualify for Medicaid.

 

You need to know that is NOT a good thing. Medicaid is awful. Better than nothing? Sometimes it is. Sometimes it turns out to be nothing.

 

Case in point..

 

My son had a really awful planters wart on his foot. A fairly common non emergency thing to be sure. Until it went untreated for months because I could not get him in to a dermatologist to get it treated. But that point it was oozing green puss and was excruciatingly painful to walk on. Walking is very much a requirement of his daily life and his job.

 

I was in a waitlist for 3 MONTHS to get into either of the two drs in network on state insurance for kids. Finally I felt we just couldn't wait any longer. For crying out loud the kid needed pain killers in order to walk!

 

I called TWELVE doctors and not one of them were taking Medicaid or new patients and ALL of them said they'd have to waitlist us until February. I finally found one that would let us pay cash up front and could get us in the next day. $240 flat for the visit, the freeze treatment, and what I refer to as "The melon baller cut" to scoop the planter and infected tissue out (no injected painkiller, no local anesthetic) and follow up appointment.

 

Now, we aren't made of money. $240 came out of our grocery budget.

 

But that was a marble sized wound in my son's foot causing him daily pain. I shudder to think how bad it would have been if I waited until *maybe* a schedule opening in February.

 

I could list many other examples of Medicaid/Medicare not meeting the needs of those who need it.

 

So when I hear people say, "oh they will qualify for Medicaid/Medicare" or claim either is an example of limited universal healthcare - it leaves me really wondering how much they have to deal it personally. Because I don't know anyone that does who has such an optimist perspective of it. Maybe it's just awesome applesauce better in other states, but then again, I have family in other states who claim to wish they had it as good as Oklahoma. Which scares the bejezus out of me for them.

 

Dermatogists here have a 3-6 month wait for people with any kind of insurance, or cash-payers.  I have BCBS and had to wait that long.  So I wouldn't blame that on Medicaid.  But I do wonder why you didn't have a GP or nurse practitioner take care of this rather than waiting to get in to see a specialist?

 

And, for future reference since it might come back, plantar warts can be easily treated at home with apple cider vinegar.  Cut off the end of a q-tip, soak it in ACV, apply it to the wart and cover with a bandaid.  Repeat twice a day until it's gone.  I used it on one on my son's foot and it worked like a charm.  And it never came back (I've read that sometimes they do return with freezing/cutting).

 

I hope it doesn't feel like I'm calling you out by responding like this, and maybe you tried home remedies before going into the dr.  It just drives me nuts that a lot of people don't know about these types of easy, inexpensive alternatives.  We also use white vinegar or peroxide to fix swimmers ear without antibiotics, and d-mannose to get rid of UTIs.  I'd rather save the doctor visits for things we can't handle at home.

 

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This is the "only buy healthcare when you need it" idea.  It's unworkable from an economic standpoint.  If everyone had the choice to wait until they were ill, or high risk, or had a pre-existing condition to buy insurance, then very very few of us could afford it.  And since most of us at some point will become ill, high risk, or get a per-existing condition -- or have a parent or family member who will -- it is in all of our best interest to have healthcare that is affordable when that time comes. 

 

No, catastrophic health insurance is true insurance - like buying homeowner insurance in case your house goes down in flames.  It covers high cost/impact, low probability events. The previous poster you were replying to didn't say anything about buying catastrophic insurance after getting sick (which would be like buying homeowner insurance after the house burned down).

 

Healthcare is more like house maintenance and repairs, which responsible homeowners budget for and pay as they go, choosing what will work best for them without being told by the government what they are allowed and aren't allowed to do, what they are required and not required to do.

 

I have no interest in paying for the repairs on other peoples' homes.  And I don't want to pay for their abortions, birth control, their over-use of antibiotics and unnecessary ED visits.  I don't consider that appropriate use of my family's healthcare dollars.  I would like for most people to be able to afford to pay for their own ongoing healthcare and their own catastrophic insurance plans.  Which before government got involved with healthcare, was possible on a lower middle class income.  Along with paying for decent, fresh, wholesome food.  And I would also like for there to be a welfare/medicaid safety net for the very small portion of the population who truly can't work to support themselves, but I think it should be provided at the state level, not federal. 

 

Healthcare would be much more affordable if the government would get out of it altogether (including employer's deductions for employee health care).  I simply don't see any area where the government taking over what should be individual responsibilities makes things more effective or less expensive.  The corruption and incompetency is just so incredibly rampant.

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I just had a brilliant-middle-of-the-night-inspiration!  If the problem with the website is just server capacity (I know it's not but let's pretend), maybe they can have the NSA guys who've been spying on American citizens' phone calls and emails guys go on furlough.  Then use that server capacity for the ACA info and enrollment process?

 

And now I must get some sleep! 

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I was flipping through a Blue Cross brochure and read this:

 

• Federal law requires dependents under 
age 19 to have dental insurance with 
their medical insurance. Blue Cross 
of Idaho offers dental products that 
provide the coverage you need and meet 
all ACA requirements. 
 
I must have missed this, too.  My current grandfathered plan (took it out prior to 2010) hasn't added this to my coverage, but there seems to be quite a few things that grandfathered plans are exempt from.
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Dermatogists here have a 3-6 month wait for people with any kind of insurance, or cash-payers.  I have BCBS and had to wait that long.  So I wouldn't blame that on Medicaid.  But I do wonder why you didn't have a GP or nurse practitioner take care of this rather than waiting to get in to see a specialist?

Bc many GP's these days are useless for more than writing antibiotic scripts or referring to other drs. Oh and immunization shots. It's stupid, I agree, but it is what it is. 20 years ago when I'd go to the GP, his nurse would do the blood draws and he could do just about anything short of needing anesthetic. Now because of liability and insurance, they won't do anything in office. They don't have their own sets of scalpels, freezing machine thingy (ha. Sorry I haven't had coffee yet and can't remember the name of it), insurance won't pay for labs not pulled at certain facilities, and their liability won't cover them for procedures done in office. It's nuts and a ridiculous PITA for clients bc it adds a heck of a lot of costs and time to getting basic care. But it's the norm in many areas. (And yet another reason I'm pro universal healthcare. There's no reason other than insurance crud to make it this complicated.)

 

And, for future reference since it might come back, plantar warts can be easily treated at home with apple cider vinegar.  Cut off the end of a q-tip, soak it in ACV, apply it to the wart and cover with a bandaid.  Repeat twice a day until it's gone.  I used it on one on my son's foot and it worked like a charm.  And it never came back (I've read that sometimes they do return with freezing/cutting).

Did you think I just let him hobble about and did nothing to try to treat it at home? I did that. I used the OTC freeze treatments multiple times too. None of it worked. Again, poor and or being without insurance doesn't equal stupid or lazy. Most people try to self treat and I'm no exception. Especially when it is faster and cheaper and less painful than having a portion of their foot removed with a melon ball like scalpel.

 

I hope it doesn't feel like I'm calling you out by responding like this, and maybe you tried home remedies before going into the dr.  It just drives me nuts that a lot of people don't know about these types of easy, inexpensive alternatives.  We also use white vinegar or peroxide to fix swimmers ear without antibiotics, and d-mannose to get rid of UTIs.  I'd rather save the doctor visits for things we can't handle at home.

 

It does feel like it. I don't know any mentally stable person sitting around feeling like poo about whatever ailment thinking, "I can't wait to run into the dr bc it's just too much hassle to bother with this myself." It's rather insulting. I propose anyone that foolish probably shouldn't be self treating either.

 

I wouldn't presume to know better than the person about what is normal for their own care. I've never had a UTI or yeast infection in my life, so if I had something like that going on, I'd probably seek medical care too. Because it is not at all the norm for me.

 

And sometimes it really pays to see a specialist instead of a GP. In theory, any GP should be able to handle my dh's type 1 diabetes. But over the years we have learned the endocrinologist catches little stuff months and months faster and treats it better. We are willing to pay for the better and most up to date knowledge of his condition bc our experience has taught us it is very much worth every penny.

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Bc many GP's these days are useless for more than writing antibiotic scripts or referring to other drs. Oh and immunization shots. It's stupid, I agree, but it is what it is. 20 years ago when I'd go to the GP, his nurse would do the blood draws and he could do just about anything short of needing anesthetic. Now because of liability and insurance, they won't do anything in office. They don't have their own sets of scalpels, freezing machine thingy (ha. Sorry I haven't had coffee yet and can't remember the name of it), insurance won't pay for labs not pulled at certain facilities, and their liability won't cover them for procedures done in office. It's nuts and a ridiculous PITA for clients bc it adds a heck of a lot of costs and time to getting basic care. But it's the norm in many areas. (And yet another reason I'm pro universal healthcare. There's no reason other than insurance crud to make it this complicated.)

 

 

Did you think I just let him hobble about and did nothing to try to treat it at home? I did that. I used the OTC freeze treatments multiple times too. None of it worked. Again, poor and or being without insurance doesn't equal stupid or lazy. Most people try to self treat and I'm no exception. Especially when it is faster and cheaper and less painful than having a portion of their foot removed with a melon ball like scalpel..

My ds and I both had warts that were resistant to home remedies. NOTHING worked. I think it took ten trips to the dermatologist to get rid of one I had. I had no insurance either.

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We have, I believe, three insurance carriers providing insurance for the state exchange.  I've been able to get a quote for BCBS for their cheapest Bronze plan.  It would be $446. more than I am paying now for high ded. plan I have.  Plus, with the requirement for dental insurance (which I'm still confused about) that would add another $73. to the monthly bill.  Oh, and I didn't see my doctor's name on the list of providers for this Bronze plan.  She was on the list for another Bronze plan, but that was $72. more.  Do I laugh or cry?

 

I don't qualify for a subsidy because dh's employer offers ins., and his premium is not in excess of 9.5% of his salary.

 

I will be keeping my current grandfathered policy.  It has a $5,000. ded,, I can't remember the family total (thinking around $12-15,000), and now allows up to $500. for preventative care not subject to deductible.  There is no coverage for office visits, lab work, immunizations (unless that falls under the $500 for preventative care).  My mammogram this past summer was covered but subject to the $5,000. ded.  Why didn't that come under preventative care I wonder?  They did have to remove lifetime benefit limits and the annual maximum limit, though.

 

I was so hoping that I might be able to get an affordable policy that at least had co-pays for a few office visits, covered shots and preventative care ($500 doesn't go far) and such.  There are still a couple other carriers I need to check with, but in the past, BCBS has always had the best price when I was checking.

 

Right now I'm thankful I've got a grandfathered policy that I can keep.  However, I'm concerned about what kind of premium increase I'm going to see on that when it renews next June.  Dh's open enrollment is in Feb., and he's got the same concerns.  His company is not apt to increase their contribution, and it's already tight.

 

Done venting for now.

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Bc many GP's these days are useless for more than writing antibiotic scripts or referring to other drs. Oh and immunization shots. It's stupid, I agree, but it is what it is. 20 years ago when I'd go to the GP, his nurse would do the blood draws and he could do just about anything short of needing anesthetic. Now because of liability and insurance, they won't do anything in office. They don't have their own sets of scalpels, freezing machine thingy (ha. Sorry I haven't had coffee yet and can't remember the name of it), insurance won't pay for labs not pulled at certain facilities, and their liability won't cover them for procedures done in office. It's nuts and a ridiculous PITA for clients bc it adds a heck of a lot of costs and time to getting basic care. But it's the norm in many areas. (And yet another reason I'm pro universal healthcare. There's no reason other than insurance crud to make it this complicated.)

 

 

Did you think I just let him hobble about and did nothing to try to treat it at home? I did that. I used the OTC freeze treatments multiple times too. None of it worked. Again, poor and or being without insurance doesn't equal stupid or lazy. Most people try to self treat and I'm no exception. Especially when it is faster and cheaper and less painful than having a portion of their foot removed with a melon ball like scalpel.

 

 

It does feel like it. I don't know any mentally stable person sitting around feeling like poo about whatever ailment thinking, "I can't wait to run into the dr bc it's just too much hassle to bother with this myself." It's rather insulting. I propose anyone that foolish probably shouldn't be self treating either.

 

I wouldn't presume to know better than the person about what is normal for their own care. I've never had a UTI or yeast infection in my life, so if I had something like that going on, I'd probably seek medical care too. Because it is not at all the norm for me.

 

And sometimes it really pays to see a specialist instead of a GP. In theory, any GP should be able to handle my dh's type 1 diabetes. But over the years we have learned the endocrinologist catches little stuff months and months faster and treats it better. We are willing to pay for the better and most up to date knowledge of his condition bc our experience has taught us it is very much worth every penny.

 

I missed the original post that led to your response, but in the past (15 yrs) dh's gp removed a couple moles for him and sent them to the lab.  Real easy.  Last time he asked the gp to do it, she wouldn't and referred him to a dermatologist.  My dd has a couple on her neck that need to come off, but I don't have the money right now.  It was much cheaper when the gp would do it.

 

Also, I've had several UTIs, and believe me, I try everything before I go to a doctor since I pay out of pocket for all of it.  A couple of times it's required a trip to the dr and antibiotics to get it cleared up.  For most things, going to the doctor is the last option unless it's some sort of emergency.

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No, catastrophic health insurance is true insurance - like buying homeowner insurance in case your house goes down in flames.  It covers high cost/impact, low probability events. The previous poster you were replying to didn't say anything about buying catastrophic insurance after getting sick (which would be like buying homeowner insurance after the house burned down).

 

Healthcare is more like house maintenance and repairs, which responsible homeowners budget for and pay as they go, choosing what will work best for them without being told by the government what they are allowed and aren't allowed to do, what they are required and not required to do.

 

I have no interest in paying for the repairs on other peoples' homes.  And I don't want to pay for their abortions, birth control, their over-use of antibiotics and unnecessary ED visits.  I don't consider that appropriate use of my family's healthcare dollars.  I would like for most people to be able to afford to pay for their own ongoing healthcare and their own catastrophic insurance plans.  Which before government got involved with healthcare, was possible on a lower middle class income.  Along with paying for decent, fresh, wholesome food.  And I would also like for there to be a welfare/medicaid safety net for the very small portion of the population who truly can't work to support themselves, but I think it should be provided at the state level, not federal. 

 

Healthcare would be much more affordable if the government would get out of it altogether (including employer's deductions for employee health care).  I simply don't see any area where the government taking over what should be individual responsibilities makes things more effective or less expensive.  The corruption and incompetency is just so incredibly rampant.

 

Healthcare was affordable before the government got involved for lower middle class people who were lucky enough to have no major health issues. That was the system where serious illness led to bankruptcy, and where people with pre-existing conditions could not get insurance. Many of us were not thrilled with that system.  

 

If there was some magical 'catastrophic' insurance plan that covered ongoing care for kids born with serious disabilities, or many years of treatments for chronic illnesses, or the astronomical payments for terminal illnesses, I am unaware of it.  That is what our new system is designed to provide.  And, no, it does not pay for abortions. 

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Latest I've read is a high proportion of applications made on the exchanges are incomplete due to lack of certain pieces of info. They have no practical way yet of letting people know that. So they are going to eventually contact people by phone, but have not yet hired anyone to do so. Sigh.

 

How would they hire people to do it? There is a shutdown. If the system truly is as terrible as it's made out to be, the Tea Party really shot itself in the foot by making themselves part of the failure of this system.

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No, catastrophic health insurance is true insurance - like buying homeowner insurance in case your house goes down in flames.  It covers high cost/impact, low probability events. The previous poster you were replying to didn't say anything about buying catastrophic insurance after getting sick (which would be like buying homeowner insurance after the house burned down).

 

Healthcare is more like house maintenance and repairs, which responsible homeowners budget for and pay as they go, choosing what will work best for them without being told by the government what they are allowed and aren't allowed to do, what they are required and not required to do.

 

I have no interest in paying for the repairs on other peoples' homes.  And I don't want to pay for their abortions, birth control, their over-use of antibiotics and unnecessary ED visits.  I don't consider that appropriate use of my family's healthcare dollars.  I would like for most people to be able to afford to pay for their own ongoing healthcare and their own catastrophic insurance plans.  Which before government got involved with healthcare, was possible on a lower middle class income.  Along with paying for decent, fresh, wholesome food.  And I would also like for there to be a welfare/medicaid safety net for the very small portion of the population who truly can't work to support themselves, but I think it should be provided at the state level, not federal. 

 

Healthcare would be much more affordable if the government would get out of it altogether (including employer's deductions for employee health care).  I simply don't see any area where the government taking over what should be individual responsibilities makes things more effective or less expensive.  The corruption and incompetency is just so incredibly rampant.

 

Do you have some numbers to back up the first bolded statement?  And do they factor in that before "government got involved" that treatment options for many conditions were limited/did not exist?  Do they take into account the difference in technology, and the impact technology has had on outcomes?

It is easy to make such broad statements but it is much more difficult to back them up with something other than broad generalizations and wishful thinking about the good old days when Doc Baker would treat the whole family and get paid with a chicken.

 

Regarding the second statement I bolded, if you do not see how government getting involved could lower expenses, I suggest you 1.) compare per capita spending in countries with heavy government involvement to per capita healthcare spending in the U.S., and 2.) spend a little bit of time studying the concept of economies of scale and how that applies to healthcare services.

 

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I don't have data, but my dad paid cash for the hospital births of two of my older siblings by setting aside $2 bills (ha! Those are getting hard to come by these days!) every 2 weeks. That was a ton of money to them back in the early 60s, but doable. Few people had insurance and if you couldn't pay cash, you often did without. But simple dr appointments and births were usually very doable to hear my parents and grandparents tell it. And they were very very poor. Govt involvement has not made basic care cheaper as far as I can tell.

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I think each state would have significant bargaining power as well. And it allows competition among states instead of a federal monopoly. It also allows more say by local people, both in who is bargaining for them and what is being bargained for. At least in theory.

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Healthcare was very cheap.  When all they could do was send you home to die.  When there were almost no available medications.  When we were a more active society with a much lower rate of obesity and chronic illness.  When there were no MRI/CAT machines.  When surgery was a 20% of death from infection.  Yeah, healthcare was cheap before the government got involved.

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I never heard my parents complain about health insurance costs, but my dad was a postal employee and had good insurance.  However, for the last 6-7 years, we have been stretched and stretched to afford even catastrophic coverage, and I consider us lower middle class.  Although we could pay the premium for catastrophic health insurance, that didn't mean we always had the money available to pay the doctor's visit or the lab fees for blood work.  It's been quite some time since I feel we've had affordable health insurance.  So while health insurance was affordable for the average middle class family in the past, it's been moving beyond the financial means of many middle class families for some years now.

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I don't have data, but my dad paid cash for the hospital births of two of my older siblings by setting aside $2 bills (ha! Those are getting hard to come by these days!) every 2 weeks. That was a ton of money to them back in the early 60s, but doable. Few people had insurance and if you couldn't pay cash, you often did without. But simple dr appointments and births were usually very doable to hear my parents and grandparents tell it. And they were very very poor. Govt involvement has not made basic care cheaper as far as I can tell.

 

If you are doing without the service because you cannot pay for it, then it is not affordable.  I am not sure why that is a difficult concept. 

 

To be fair, the average middle class wage earner can still pay for basic doctors appointments out of pocket.

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I think each state would have significant bargaining power as well. And it allows competition among states instead of a federal monopoly. It also allows more say by local people, both in who is bargaining for them and what is being bargained for. At least in theory.

 

 

How would the states be competing among themselves?  Increasing the number of customers does not generate bargaining power, and in fact, the opposite is true.

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I never heard my parents complain about health insurance costs, but my dad was a postal employee and had good insurance.  However, for the last 6-7 years, we have been stretched and stretched to afford even catastrophic coverage, and I consider us lower middle class.  Although we could pay the premium for catastrophic health insurance, that didn't mean we always had the money available to pay the doctor's visit or the lab fees for blood work.  It's been quite some time since I feel we've had affordable health insurance.  So while health insurance was affordable for the average middle class family in the past, it's been moving beyond the financial means of many middle class families for some years now.

 

And I believe everyone with a clue agrees, but the key will be figuring out a solution.

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I never heard my parents complain about health insurance costs, but my dad was a postal employee and had good insurance. However, for the last 6-7 years, we have been stretched and stretched to afford even catastrophic coverage, and I consider us lower middle class. Although we could pay the premium for catastrophic health insurance, that didn't mean we always had the money available to pay the doctor's visit or the lab fees for blood work. It's been quite some time since I feel we've had affordable health insurance. So while health insurance was affordable for the average middle class family in the past, it's been moving beyond the financial means of many middle class families for some years now.

This is how I feel. We've always had really great insurance! My kids are only 12 & 9 and my daughter's total maternity care and birth was $115. My son was $15-- total!! This was through united healthcare offered by my husbands employer then. It didn't eat up his check to afford it, and we had lots of other benefits too. And it wasn't just for pregnancies, it was great insurance for any issue!! Now he doesn't even have the option of health insurance where he works. We have to pay out of pocket & we can only afford catastrophic coverage. The problem is, that money serves us better in a savings account where we can access it for our actual healthcare issues that require doctor visits, prescriptions, etc. We make too much money to receive assistance at all and we make too little money to afford anything worthwhile. It just feels frustrating. It's not that the bronze plan price is unreasonable -- it's a great price! The issue is it doesn't hold any real benefit in truly meeting affordable healthcare. We now need to pay not only the premium but also our day-to-day healthcare costs (which aren't cheap!). It is simply catastrophic insurance -- not at all what I had hoped for. The plans that would count as "good insurance" for my family through the marketplace are more than our budget can handle right now. It's a bummer!

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I just had to share this here if for no other reason than to vent a bit.

 

Dh had to go to the ER last month during the middle of the night. I just received the bill and it is astronomical - and we have insurance. It will take us quite a while to pay it off (and that's if nothing else happens during that time).

 

One part of the bill was $600. That $600 was just for the doctor gluing dh's head back together. Someone else cleaned it up and it took the doctor a whopping two minutes to glue it. That wasn't the only bill that was from the specific doctor either. This part stated specifically for gluing the wound. I won't even go into what the other bills are for and total as I still have to wade through all the different people/companies/labs and charges. I feel ill and in two weeks we have to make our new elections for open enrollment.

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For most of our marriage we had good insurance.  Dh's employer paid his and contributed a portion towards the family.  Thankfully we were on that during all my pregnancies and my youngest's multiple surgeries.  Our portion of the premium started increasing but was still affordable, but since 2006, with three lay offs, a 35% decrease in salary, steadily increasing premiums with decreasing coverage, and rapidly increasing medical costs it is just darn near not affordable.  The quotes I got today for a bronze policy for the girls and me is not affordable for us.

 

My dd had a visit to the dr's office where they drew blood and did an EKG.  $530.  Lab work for the blood test about $400.  Haven't seen the bill from the cardiologist yet, and none of it applies towards our deductible since office visits and lab work isn't a covered expense.

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I'm not sure I get the difference between then and now some days.

 

Then they didn't have the treatments available.

 

Now they don't have he treatments available to millions because of cost.

 

Insurance does not make it affordable. Millions of people with insurance can't afford care.

 

It seems the biggest difference is most are sent to nursing homes or hospitals to die and really rack up a high bill. At least if they were sent home to die, it's be cheaper for most of them. (No judgement on either. Just saying it's not like people aren't being left to die now too. We just do it more politely and less obviously.)

 

I am not saying it was rosy in the 60s. Not at all. Could not pay me to have a baby like my mother did.

 

But we do have a crazy amount of inflation for things compared to then that does not seem in proportion.

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I'm not sure I get the difference between then and now some days.

 

Then they didn't have the treatments available.

 

Now they don't have he treatments available to millions because of cost.

 

Insurance does not make it affordable. Millions of people with insurance can't afford care.

 

It seems the biggest difference is most are sent to nursing homes or hospitals to die and really rack up a high bill. At least if they were sent home to die, it's be cheaper for most of them. (No judgement on either. Just saying it's not like people aren't being left to die now too. We just do it more politely and less obviously.)

 

I am not saying it was rosy in the 60s. Not at all. Could not pay me to have a baby like my mother did.

 

But we do have a crazy amount of inflation for things compared to then that does not seem in proportion.

 

Insurance grew out an of an effort to make expensive medical procedures more affordable via risk sharing.  No, it has not made it affordable to all, and that is where we agree.  What you fail to realize is that without insurance, many procedures would be unaffordable except for a select few consumers.

What you propose (universal healthcare - which I agree with) is in reality a more extensive form of insurance.  You seem to get hung up on the "insurance" part of the discussion and miss the bigger picture.

 

Keep in mind when someone pays for a procedure now they are not only paying for what the receive, but also a portion of the fixed cost for what they might need later.

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How would the states be competing among themselves? Increasing the number of customers does not generate bargaining power, and in fact, the opposite is true.

One, I think each state would be able to negotiate for what their constituents want, which could be very different from state to state.

 

Two, just like states compete to attract employers and tourism, I think states would want to have great plans to encourage people to live there.

 

Three, we are all simply discussing things here. POV. Possibilities. Ideals. Thinking out loud. Sharing personal experiences. None of us are claiming to have all the answers. Okay, well maybe that's all just me.

 

I don't think any government should be negotiating a dang thing with insurance companies. Ever. I think there should be a single payer (um, well actually I guess 50 payers. ;) universal program.

 

I think insurance is the problem NOT the solution.

 

I think until we as a nation accept that as fact, costs won't get more affordable, they will just keep being renamed and reshuffled about and be just as astronomical and cause care to be difficult to attain for the average citizen.

 

I'm not sure what people mean by no government involvement in healthcare.

 

Remember that addendum I mentioned?

Ethical unbiased medical licensing is a proper use of government oversight.

If the FDA wasn't turning into a nearly complete farce, I'd be very much okay with it.

 

I'm not proposing abolishing the federal or state government. I'm not anti government, though I do think it best limited.

 

Neither am I looking to either to look out for my best interests or to be morally upright. I think a lack of trust and a hefty dose of skepticism wrt government in general is a prudent default. :)

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Insurance grew out an of an effort to make expensive medical procedures more affordable via risk sharing. No, it has not made it affordable to all, and that is where we agree. What you fail to realize is that without insurance, many procedures would be unaffordable except for a select few consumers.

What you propose (universal healthcare - which I agree with) is in reality a more extensive form of insurance. You seem to get hung up on the "insurance" part of the discussion and miss the bigger picture.

 

Keep in mind when someone pays for a procedure now they are not only paying for what the receive, but also a portion of the fixed cost for what they might need later.

 

Yes, I'm hung up on insurance because I think it is the root of the problem.

 

No, I don't think I'm missing the bigger picture. I'm just disagreeing with your POV on it.

 

Yes, I understand that when I pay for something medical, I'm not actually only paying for that medical situation, but all related to it. (Dr overhead, billing office, equipment lease or purchases, licensing, training... And so on.)

 

I think that was the theory of insurance when it started, but that is certainly not where it ended up.

 

Now, it isn't even really insurance. Insurance implies a rare and avoiding use.

 

For example, I didn't expect or plan to have my van hit a couple weeks ago, if I had, my insurance company probably wouldn't have given me a policy. Insurance is a gamble against being used.

 

Insurance companies are no longer insurance companies. They are a source of artificial price gouging and market games. I think making them mandated for everyone to be a nonsensical plan to make healthcare affordable and I fail to see any evidence that it will do so. It like saying the problem with gangs is so many people can't join a gang for protection, so now everyone will be required to pay for it and then everyone will be safe. If the problem with "insurance" companies IS the insurance industry, then I don't understand how making everyone give them business is a good idea. But I suppose time will tell whether I am right or wrong.

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Healthcare would be much more affordable if the government would get out of it altogether (including employer's deductions for employee health care).  I simply don't see any area where the government taking over what should be individual responsibilities makes things more effective or less expensive.  The corruption and incompetency is just so incredibly rampant.

This video, posted in the other healthcare thread, does an excellent job of explaining why countries with significant government involvement in healthcare pay far less for it than we in the US do.

 

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This is how I feel. We've always had really great insurance! My kids are only 12 & 9 and my daughter's total maternity care and birth was $115. My son was $15-- total!! This was through united healthcare offered by my husbands employer then. It didn't eat up his check to afford it, and we had lots of other benefits too. And it wasn't just for pregnancies, it was great insurance for any issue!! Now he doesn't even have the option of health insurance where he works. We have to pay out of pocket & we can only afford catastrophic coverage. The problem is, that money serves us better in a savings account where we can access it for our actual healthcare issues that require doctor visits, prescriptions, etc. We make too much money to receive assistance at all and we make too little money to afford anything worthwhile. It just feels frustrating. It's not that the bronze plan price is unreasonable -- it's a great price! The issue is it doesn't hold any real benefit in truly meeting affordable healthcare. We now need to pay not only the premium but also our day-to-day healthcare costs (which aren't cheap!). It is simply catastrophic insurance -- not at all what I had hoped for. The plans that would count as "good insurance" for my family through the marketplace are more than our budget can handle right now. It's a bummer!

 

One problem with ACA as it stands currently is that there are several pitfalls and traps buried in the legislation which make it unlikely that it will actually accomplish the ideals I would like to think inspired it.  Exactly why this was is debatable and most answers have some variant of political spin and bias.  In some cases it probably really is as simple as many who voted for (or against the legislation) were poorly informed on what they were voting for.  I'm sure this has been the case with other pieces of legislation but not to such a degree.  From a practical standpoint, I do worry that this will have the most significant adverse impact on families with children under certain income levels and this is a concern. 

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One problem with ACA as it stands currently is that there are several pitfalls and traps buried in the legislation which make it unlikely that it will actually accomplish the ideals I would like to think inspired it.  Exactly why this was is debatable and most answers have some variant of political spin and bias.  In some cases it probably really is as simple as many who voted for (or against the legislation) were poorly informed on what they were voting for.  I'm sure this has been the case with other pieces of legislation but not to such a degree.  From a practical standpoint, I do worry that this will have the most significant adverse impact on families with children under certain income levels and this is a concern.

Actually, the trouble wasn't so much about the legislation itself. The trouble is that states sued over the medicare expansion. SCOTUS said that states couldn't be required to accept it. Many states didn't accept it. There wasn't another mechanism in the law to cover lower income families. Some states accepted the Medicare expansion. Lower income families will be covered in those states as was the intention. Other states are trying to figure out a different sort of measure. I think so far Arkansas is the only state so far that's had something approved. But, the flaw wasn't in a lack of understanding.

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Actually, the trouble wasn't so much about the legislation itself. The trouble is that states sued over the medicare expansion. SCOTUS said that states couldn't be required to accept it. Many states didn't accept it. There wasn't another mechanism in the law to cover lower income families. Some states accepted the Medicare expansion. Lower income families will be covered in those states as was the intention. Other states are trying to figure out a different sort of measure. I think so far Arkansas is the only state so far that's had something approved. But, the flaw wasn't in a lack of understanding.

I think you mean Medicaid expansion.  You're correct that Arkansas is currently the only state who has received federal approval (so they will get some federal funds to assist with their efforts) for their alternative gap coverage solution.  There are four other states currently working on plans or with plans that are awaiting federal approval.  Unfortunately, there are other pitfalls with the legislation.  You may be correct that the flaw wasn't truly a lack of understanding and I've heard various political spins on that (whether those who passed it believing it wouldn't work did so hoping that failure would pave the way for universal health care or whether they did so hoping it would show that this won't work and send us back to the original free market system we started from---obviously perspective on these issues shapes much there).  Having said that I do think that many of our representatives did vote without good understanding of what exactly they were really voting for.  I and a few other physicians personally spoke with two senators (interestingly neither for my state) on a different health care legislation issue shortly after ACA had passed.  It came up in the course of the conversation and both senators seemed to have no idea and one joked that the physicians had a better understanding of the legislation than they did so perhaps we should have had a vote.  Both of these senators voted in favor of ACA (and, no, neither in question was Nancy Pelosi).

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I think you mean Medicaid expansion.

Sorry, yes, Medicaid.

 

 

You're correct that Arkansas is currently the only state who has received federal approval (so they will get some federal funds to assist with their efforts) for their alternative gap coverage solution.  There are four other states currently working on plans or with plans that are awaiting federal approval.  Unfortunately, there are other pitfalls with the legislation.

You're going to have to give specific examples, if you want to discuss them.

 

 

You may be correct that the flaw wasn't truly a lack of understanding and I've heard various political spins on that (whether those who passed it believing it wouldn't work did so hoping that failure would pave the way for universal health care or whether they did so hoping it would show that this won't work and send us back to the original free market system we started from---obviously perspective on these issues shapes much there).

Oh, I *definitely* think Democrats (at least) felt that *if* this didn't work, then it would help push the country toward Universal Health Care and that Republicans hoped for the opposite.

 

 

Having said that I do think that many of our representatives did vote without good understanding of what exactly they were really voting for.  I and a few other physicians personally spoke with two senators (interestingly neither for my state) on a different health care legislation issue shortly after ACA had passed.  It came up in the course of the conversation and both senators seemed to have no idea and one joked that the physicians had a better understanding of the legislation than they did so perhaps we should have had a vote.  Both of these senators voted in favor of ACA (and, no, neither in question was Nancy Pelosi).

I've had that sort of conversation with a lot of people in power over a lot of issues, sadly. This is hardly the only issue like that.

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This article is on the web today (11 OCT 2013). Nine (9) health insurers are exiting the Nebraska market.

 

http://www.foxnews.com/politics/2013/10/11/obamacare-effect-companies-exit-nebraskas-health-insurance-market/

Just refuse to offer any individual insurance plans and focus on group plans only. It does make sense as business strategy. Especially if insurance companies feel they can't make a worthy or reliable profit from individual policies. (Which I wouldn't be surprised by. In a tough economy and job uncertainty, I bet they get a lot of bounced premium checks every month.)

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Well, it seems we went from having the worst insurance this year to having it pretty good next year.

 

We'll only be paying $90/month for four people, our deductible is only $4000, and our max out of pocket is $8000.

 

I don't know why this year was so horrible but I'm happy with next year's policy.

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Well, it seems we went from having the worst insurance this year to having it pretty good next year.

 

We'll only be paying $90/month for four people, our deductible is only $4000, and our max out of pocket is $8000.

 

I don't know why this year was so horrible but I'm happy with next year's policy.

 

Is that with a subsidy?

 

If I could get anything close to that, I would be doing cartwheels!

 

I am happy that some people are finding affordable premiums, though.

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