"Affordable" Care Act vent

[Momof3littles]

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?

 

When there was a proposal to cover end of life planning visits, people were up in arms that it was part of a death panel, weren't they?

[SKL]

When the decision was made to cover end of life planning visits, people were up in arms that it was part of a death panel, weren't they?

 

Making it mandatory to talk about "it's time to become Soilent Green" (sp) is not what I'm talking about.

 

I'm talking about kids having a fever etc.

[Momof3littles]

Making it mandatory to talk about "it's time to become Soilent Green" (sp) is not what I'm talking about.

 

I'm talking about kids having a fever etc.

 

Right, but end of life care is one of the greatest health burdens we face.  Addressing that became controversial.

 

edited to add: MDs could address when it is an emergency requiring ER treatment, etc. better during well visits, and often don't.  We have moved several times, so my kids have been with several different MDs and peds over the years.  ONE practice, affiliated with a nationally known children's hospital, gave a handout regarding "fever phobia" with accurate info regarding fevers not causing brain damage, when to call your practitioner, when to head right to the ER, what symptoms are deemed concerning along with fever, etc.  I have never received the info in print form from another practice, and we've been with 4 since my oldest was born a decade ago.  I have talked with our MDs in the past about riding a fever out, etc. because we feel comfortable assessing our kids' overall well being.  Our MDs have been supportive.  But these discussions have happened only because we've brought it up.

[ChocolateReignRemix]

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?

 

Considering that many countries which have more equitable access to healthcare (ie universal insurance or single payer) spend less per capita healthcare and have better healthcare outcomes for the population, I don't believe that there is a lot of evidence that making it more difficult to access care leads to a healthier population and lower costs.

[SKL]

Right, but end of life care is one of the greatest health burdens we face.  Addressing that became controversial.

 

This has no connection to what I was talking about.

 

But yes, it is controversial whenever the government gets into individual people's business.

 

I was talking about education and I'm not sure exactly what form it would take.  But I was not thinking "mandatory" anything.  However, let's say it became mandatory to advise parents during an ER visit for a non-life threatening event that they could do xyz to address the problem at home if it happens again.  (Seems like we shouldn't have to have a law to make that happen, but....)  That's a lot different from requiring a discussion like "we could save your kid, but we should probably just let him die and reduce the surplus population."

[TranquilMind]

$40 is a co-pay....not the cost of the visit.  If you wanted to pay the full price for that visit, it would be far greater than $40.

 

Same for drugs...do you have any idea what the real cost for prescriptions are?  

 

Disagree...but I hope you never need to find out how good it is to actually have real health insurance.  You have no idea what is coming down the lane. Perfectly healthy people have unexpected health crises all the time.  Or a loved one can be dx with a chronic condition...that will impact you long-term, and pre-ACA would have prevented you from getting any insurance.  

What, $100?  I've paid that to see a doctor I wanted.  Better than paying $5000 for some test that is not covered anymore. 

 

I am well aware of the ephemeral nature of life which is precisely why I said what I said.   Insurance used to cover EVERYTHING, and you used it as sparingly as possible, but when you did, it covered you.  I've been insured on my own (and now with husband) since the 70's, when premiums were low, deductibles very reasonable (like $200, not $3500 per person) and everything imaginable was covered. 

 

Today, you pay through the nose in premiums and again in deductibles, and still the important expensive things are not covered but by golly, that birth control pill, or yearly well visit for $100 is covered.  It's all backwards. 

[Pawz4me]

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.

 

Not really, since most people get their insurance through their employer(s).

 

[SKL]

edited to add: MDs could address when it is an emergency requiring ER treatment, etc. better during well visits, and often don't.  We have moved several times, so my kids have been with several different MDs and peds over the years.  ONE practice, affiliated with a nationally known children's hospital, gave a handout regarding "fever phobia" with accurate info regarding fevers not causing brain damage, when to call your practitioner, when to head right to the ER, what symptoms are deemed concerning along with fever, etc.  I have never received the info in print form from another practice, and we've been with 4 since my oldest was born a decade ago.  I have talked with our MDs in the past about riding a fever out, etc. because we feel comfortable assessing our kids' overall well being.  Our MDs have been supportive.  But these discussions have happened only because we've brought it up.

 

Or they could have a nurse or nurse practitioner on staff in the ER whose job it is to give exit interviews and educate people on home care for next time.  If the MDs do it, that would cost a ton (you'd have to have more MDs on staff in the ER).

 

[goldberry]

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.

 

People can't vote with their pocketbooks if they need a procedure or they are going to die. (or continue being sick, or possibly become more sick...)  Who is going to vote with their pocketbooks in those situations?  And what about if ALL the companies to choose from are, in fact, mostly the same?  So your only choice then is to pick one or do without.  You are way overestimating the amount of control or choice people have in those situations.

 

And as far as government requiring insurance covering things, it is my understanding that it has only been things that affect "public interest".  IE, it is in the public interest for maternity/childbirth to be covered.  The only way that can afford to be covered is if everybody shares the cost, not just the person who happens to plan on getting pregnant. So, you may not want coverage for childbirth, but if you want to live in a country where childbirth is covered, you have to chip in.  (Hmmm, kind of like public school taxes...)  

[Momof3littles]

Or they could have a nurse or nurse practitioner on staff in the ER whose job it is to give exit interviews and educate people on home care for next time.  If the MDs do it, that would cost a ton (you'd have to have more MDs on staff in the ER).

 

 

You capture more people if you do it as part of a routine well visit.  No harm in providing exit advice to parents, but it needs to be addressed at routine well visits for sure. 

[SKL]

Considering that many countries which have more equitable access to healthcare (ie universal insurance or single payer) spend less per capita healthcare and have better healthcare outcomes for the population, I don't believe that there is a lot of evidence that making it more difficult to access care leads to a healthier population and lower costs.

 

First, as I've said before, the US is not the same as other governments.  Other governments also have better outcomes per dollar from educational spending than ours does.  Doesn't make me want to put our government in charge of even more important things.

 

Second, it is my understanding that where there are single-payer systems, the doctors are less likely to prescribe unnecessary meds and treatments.  So in that respect we could learn from them.  More isn't always better.

 

Third, I am not advocating making healthcare difficult to access.  I'm pointing out that sometimes medical intervention is unnecessary and does more harm than good.

 

[SKL]

You capture more people if you do it as part of a routine well visit.  No harm in providing exit advice to parents, but it needs to be addressed at routine well visits for sure. 

 

Has this happened for any readers here?  I have never had a doc at a routine visit recommend anything other than vaxes and screenings.  The standard printouts recommend eating fruits & veggies and exercising.  Never any suggestions for at-home care of illness / injuries.

 

Besides, the folks who go to the ER for these things are not necessarily the folks who take their kids to routine appointments.

[TranquilMind]

Our family does not qualify for subsidies, and premiums are too high for us to afford health insurance for 5. We only insure our kids. I seldom go to the Dr. I wish health care was more affordable. 

You and your husband will start paying fines this year for that.  Nice, huh?

[SKL]

Not really, since most people get their insurance through their employer(s).

 

 

RIght, but competition and consumers are still important.  Employee relations are important.  Positive change happens in the employer context.

 

[Momof3littles]

This has no connection to what I was talking about.

 

But yes, it is controversial whenever the government gets into individual people's business.

 

I was talking about education and I'm not sure exactly what form it would take.  But I was not thinking "mandatory" anything.  However, let's say it became mandatory to advise parents during an ER visit for a non-life threatening event that they could do xyz to address the problem at home if it happens again.  (Seems like we shouldn't have to have a law to make that happen, but....)  That's a lot different from requiring a discussion like "we could save your kid, but we should probably just let him die and reduce the surplus population."

 

What did I say was mandatory?  The proposal was to reimburse MDs for the time spent in helping a patient navigate end of life decisions.  It was never going to be mandatory; if you have a source that says otherwise, I'd be curious to see it.  To my knowledge, it was proposed as, "voluntary advanced care planning." http://www.nytimes.com/2010/12/26/us/politics/26death.html?pagewanted=all&_r=0

 

You are worried about the time and cost involved in an MD providing advice during a well visit about routine reasons that do not necessitate an ER visit.  The proposal to cover end of life planning was to make sure MDs were paid for their time when they address this with a patient, otherwise it may never be covered during a person's routine visit due to time constraints and MD not being reimbursed for the additional time. 

[SKL]

 

And as far as government requiring insurance covering things, it is my understanding that it has only been things that affect "public interest".  IE, it is in the public interest for maternity/childbirth to be covered.  The only way that can afford to be covered is if everybody shares the cost, not just the person who happens to plan on getting pregnant. So, you may not want coverage for childbirth, but if you want to live in a country where childbirth is covered, you have to chip in.  (Hmmm, kind of like public school taxes...)  

 

You're right, it's exactly like a tax.  Actually, it is a tax.  Yet another sneakily disguised "redistribution of wealth."

 

So yes, the government has been playing around with health insurance for a long time, which was my point.

[Momof3littles]

Has this happened for any readers here?  I have never had a doc at a routine visit recommend anything other than vaxes and screenings.  The standard printouts recommend eating fruits & veggies and exercising.  Never any suggestions for at-home care of illness / injuries.

 

Besides, the folks who go to the ER for these things are not necessarily the folks who take their kids to routine appointments.

 

I'm talking about a handout I was provided with what symptoms are concerning when accompanied by a fever, what myths there are about not treating a fever, when a fever combined with other symptoms needs to be addressed immediately, etc.  Yes, our pediatrician who was affiliated with one of the best children's hospitals in the nation did provide such a handout as part of well visits in infancy.  I'm not talking about how to DIY healthcare at home, just a sheet that debunked myths about fevers causing brain damage, what symptoms are in fact concerning, fever in very young infants always needing medical attention from a professional, etc.

[skimomma]

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 go to a chiropractor once a month (out of pocket as it does not count towards our deductible).  While he is great about a lot of things, he cannot treat the two issues I am having.  He is the one that has suggested I see a MD about them and also the one that told me it would likely require a referral to a specialist and could escalate quickly in cost.  His family has the same insurance so he knows exactly what the issue is and also understands why I am reluctant to go down that path.

[goldberry]

You're right, it's exactly like a tax.  Actually, it is a tax.  Yet another sneakily disguised "redistribution of wealth."

 

So yes, the government has been playing around with health insurance for a long time, which was my point.

 

So you don't believe that certain healthcare issues come under the category of public interest?  You can call it redistribution of wealth.  Or, you can say that we all pay, for example, to live in society where our elderly don't have to live in the street, and that a car accident victim isn't left at the scene because they don't have money to pay for an ambulance.  We pay a price to live in a society like that.  If no one wanted to pay that price, society would be drastically different.

[ktgrok]

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.

 

 

Wait, what? Most people have health insurance through their employer. They don't get to vote with their pocketbook. 

 

By the way....that vote word...you can do THAT with government, no pocketbook required. 

[ktgrok]

Making it mandatory to talk about "it's time to become Soilent Green" (sp) is not what I'm talking about.

 

I'm talking about kids having a fever etc.

 

the problem with healthcare in America isn't too many people in the ER with the sniffles. There are actually sick people out that, that need care, that are dying because they can't afford it. THAT is the problem. 

[ktgrok]

I'm talking about a handout I was provided with what symptoms are concerning when accompanied by a fever, what myths there are about not treating a fever, when a fever combined with other symptoms needs to be addressed immediately, etc.  Yes, our pediatrician who was affiliated with one of the best children's hospitals in the nation did provide such a handout as part of well visits in infancy.  I'm not talking about how to DIY healthcare at home, just a sheet that debunked myths about fevers causing brain damage, what symptoms are in fact concerning, fever in very young infants always needing medical attention from a professional, etc.

 

My pediatrician does give out handouts on what to do with a fever. Specifically, not to treat unless the child is uncomfortable, to call if the fever is over such and such, and they will advise you, etc. 

[StephanieZ]

Why should the government get to decide what the maximum OOP is going to be for an individual HSA?  Ridiculous.

 

HSAs are tax-preferred mechanisms. Anyone can save for whatever they want however they want. HSAs are unique in that they require some extra record keeping and they are eligible for tax breaks. I think the reason for the rules is to encourage consumers to choose GOOD insurance options. A high deductible is the rationale for the HSA in the first place (need to save up for it) and the relatively modest OOP Max is there so that insured people don't actually go bankrupt from medical bills.

FWIW, these laws have worked beautifully for us in that our insurer (Highmark BC/BS designed a policy just for HSA users . . . The legally lowest deductible and a very modest max OOP along with very generous benefits, even on prescriptions . . .  It is clear that this policy was written just to maximize benefit for the insured. It is perfect for us. 

[Momof3littles]

My pediatrician does give out handouts on what to do with a fever. Specifically, not to treat unless the child is uncomfortable, to call if the fever is over such and such, and they will advise you, etc. 

 

Peds who do this definitely exist, but IME it is not a widespread discussion yet in many practices.  I was just saying that instead of blaming people for taking their kids to the ER for a fever, PPs should consider whether the healthcare system has done its job in educating parents about fever, etc. in the first place.  My point is that I don't fault the parent, I fault the system for not handling the messaging better on things like childhood fevers, which would keep quite a few people out of the ER in the first place.  I dislike seeing concerned parents blamed; I'd rather see it as the fault of our system in communicating what is a true emergency with regard to childhood fevers.

[Sdel]

You absolutely can shop around for an open heart surgeon, its just a very limited shop due to insurance.  Most open heart surgeries are not emergent and are in fact "preventative" in nature. There is also very differing ideologies in preventative cardiology that affect the necessity of needing open heart surgery later.  Open heart surgery would also be catastrophic.  I am not talking about paying catastrophic or chronic costs OOP.  I'm talking about *routine* care.  Basic check ups, medical and dental, basic vaccinations, basic, short term use medications, lab work, diagnostic xrays.  Those most certainly could be shopped around but most times aren't because of insurance.  And I can't for the life of me see why any of those services should be so cost prohibitive as to essentially require a 3rd party payer in order to be able to afford to utilize them.   I also can't for the life of me see why I should have to shell out thousands of dollars a year, either in ins. premiums or taxes, for those services either.  The only reason I can see why they do cost so much today is the horrid mass of regulations, write offs, gov't subsidies, etc. that have evolved around health care (and a few OT social problems too) in the decades since health insurance was dreamed up. 

 

Stefanie

[ELaurie]

Dh owns his own small business. No employees. It is our sole support. Our health insurance premiums were going to double for the same high deductible coverage. We were priced out of the health insurance market. We are now with Samaritan Ministries, a health share organization.

We are in a similar situation. I would love to hear more about your experiences with Samaritan so far. Feel free to PM me.

[Sdel]

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? 

 

I think it would generally lead to more interest in actually evaluating treatment options and increased education, not just the public, but by the docs as well.  And many people absolutely get more than they need and are never educated otherwise.  Here is an example:

 

Basic oxygen monitoring is a pulse oximeter.  When DD was an infant she was on oxygen.  It would have cost $500 to rent a pulse ox.  The hospital wanted to force us to get an apnea monitor, didn't even mention the pulse ox, which would have cost at least $1,000.  We managed to negotiate a pulse ox because DH is a nurse.  The difference....one would alarm after she'd  'stopped breathing' long enough to drop her oxygen saturation and one would show how oxygenated her blood was at a glance at any time AND alarm at less than 92%.  If we hadn't worked in health care and hadn't known better, we wouldn't have even been given the option to evaluate what was best for us and what risks we were comfortable to take.  It didn't matter what the cost actually was to us as insurance was paying 100% by then, but we felt the apnea monitor was more risk than the pulse ox.  It also shows the basic lack of regard for the costs of things when third party payers are involved, who cares how much it costs....its what the doc wants even if there is a better, least costly alternative. 

 

Stefanie

[Joker]

I just finished open enrollment through dh's work and found out mental health care on our new plan is covered 100%! Care for my oldest, who is dealing with anxiety and depression, has cost us so much these past few months. We're switching to an HMO that will raise our premiums to $250/month (from $95) and the mental health coverage makes it completely worth it. We don't need referrals and her current doctors/therapists accept the HMO. I know many are complaining about the routine care that's included thinking it has raised the costs too much, but I think covering mental health care at 100% is a good move. I hate to think where dd might be right now if we didn't have the means to cover her costs these past months and it takes a great weight off knowing in January I won't have to stress about the money part of it.

[Sdel]

Has this happened for any readers here?  I have never had a doc at a routine visit recommend anything other than vaxes and screenings.  The standard printouts recommend eating fruits & veggies and exercising.  Never any suggestions for at-home care of illness / injuries.

 

Besides, the folks who go to the ER for these things are not necessarily the folks who take their kids to routine appointments.

 

Both of the pedi's I have used have fever/antibiotic flyers on bulletin boards their patient rooms.  They don't call attention to them, but they are there.  However, both of these pediatricians have been intrinsically linked with a hospital system and are not more or less "free standing".  The nature of the relationships between doctors and hospitals has also been drastically changing and is another significant factor in where this mess is heading; and I'm not sure, may also be another factor drastically different from the universal systems as well.

 

Stefanie

[Serenade]

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.

Exactly

[NoPlaceLikeHome]

Making it mandatory to talk about "it's time to become Soilent Green" (sp) is not what I'm talking about.

 

I'm talking about kids having a fever etc.

They only wanted to provide coverage for those who wanted to consult their doctor about end of life care and the patient's wishes regarding the same. What is wrong with that? Seems like a good thing to me since I took care of tons of people whose bodies were desperately trying to die but we kept them temporarily alive by hooking them up to all sorts of unpleasant machines and tubes because no one had discussed end of life care with the family:( My grandmothers has the good fortune to die at home in the comfort of their own beds. 

[Guest]

I just finished open enrollment through dh's work and found out mental health care on our new plan is covered 100%! Care for my oldest, who is dealing with anxiety and depression, has cost us so much these past few months. We're switching to an HMO that will raise our premiums to $250/month (from $95) and the mental health coverage makes it completely worth it. We don't need referrals and her current doctors/therapists accept the HMO. I know many are complaining about the routine care that's included thinking it has raised the costs too much, but I think covering mental health care at 100% is a good move. I hate to think where dd might be right now if we didn't have the means to cover her costs these past months and it takes a great weight off knowing in January I won't have to stress about the money part of it.

I'm happy for you. But, I don't think mental health coverage is mandated by the ACA?? And, you realize that the $250 isn't the actual insurance cost, right??

[NoPlaceLikeHome]

So you don't believe that certain healthcare issues come under the category of public interest?  You can call it redistribution of wealth.  Or, you can say that we all pay, for example, to live in society where our elderly don't have to live in the street, and that a car accident victim isn't left at the scene because they don't have money to pay for an ambulance.  We pay a price to live in a society like that.  If no one wanted to pay that price, society would be drastically different.

Exactly. Some high profile politicians in our country who are against the Affordable Healthcare Act or universal healthcare actually said that those without insurance who showed up at the ER should not even get care. :svengo:  Essentially let them die since we all know it must be there fault!!! :glare:

 

Then folks forget that emergency rooms do not treat chronic conditions such as cancer or asthma or diabetes nor do they pay for the meds which can be hundreds or even thousands of dollars a month.  Many folks did not have insurance. This is why our country needed some sort of healthcare reform. The Affordable Healthcare Act is a step in the right direction. I would like to see medicare for all.

[Joker]

I'm happy for you. But, I don't think mental health coverage is mandated by the ACA?? And, you realize that the $250 isn't the actual insurance cost, right??

 

Even with the company's portion it's under the $2000/month talked about here and I do know that's because it's through his employer and they are a very large one. I also know mental health isn't mandated (I think it should be) but I'm grateful dh's employer chose to offer the plan. I think they're able to offer better plans because the amount employees pay in is based on their positions and salaries. Those on the bottom of the position/salary ladder pay little to nothing but directors and officers pay 50-75% of the plan costs. Dh is in the middle and right now that's really working for us.

 

[TechWife]

I'm happy for you. But, I don't think mental health coverage is mandated by the ACA??

 

It most definitely is. It must be covered just like any other illness. It is known as "mental health parity and addiction equity." 

 

It's about time we made some progress in covering these illnesses. 

[JumpyTheFrog]

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.

  

 

Yes, all the different prices could drive a person crazy. Think of how many employees each office has to hire just to deal with insurance. No wonder some doctors and dentists either make you file it yourself or don't accept any.

 

When there was a proposal to cover end of life planning visits, people were up in arms that it was part of a death panel, weren't they?

  

 

I've read a bit about how so many people insist they or their families members get every possible treatment right before death. Often these are treatments the doctors themselves refuse because they know how lousy the outcomes are. For example, Reader's Digest had an article a few months ago about which treatments most doctors refuse. The ones that I remember were CPR (it said most patients that are revived go on to die soon after anyway or live with a terrible quality of life) and chemotherapy. The doctors are often reluctant to suggest to people to refuse these treatments, maybe because they get accused of only trying to "save money." Other times, the patients or decision makers won't listen.

 

I think this may be why people wanted to allow doctors to be paid for appointments talking these things out with their patients before they were in the hospital facing the decision. Instead, it sounds like people went nuts talking about "death panels," as if any attempt to educate patients about which procedures they'd probably want to avoid if they knew what they were really like is equivalent to trying to kill old people. It seems like we have a culture where people don't want to let go and think that anything short of trying the newest expensive (and often unproven) treatment is murder or something.

 

Are other cultures like this? Haven't I read that something like half our healthcare spending comes from trying to keep people alive one more week or month? At some point, some sort of rationing has to be done. It sounds heartless. But no government, group, or insurance company could ever afford to provide every available expensive drug or surgery to every nearly-dead patient.

 

We are in a similar situation. I would love to hear more about your experiences with Samaritan so far. Feel free to PM me.

  

 

We've been members for six years. If you'd like to start a spinoff thread, I can post there about what we like and dislike.

 

It also shows the basic lack of regard for the costs of things when third party payers are involved, who cares how much it costs....its what the doc wants even if there is a better, least costly alternative. 

Yes, doctors are often completely clueless about how much different drugs cost, for example. I am fortunate to have one that is somewhat aware of costs, maybe because she doesn't take insurance and charges $150 for a 45 minute appointment. I had a gut infection and she said I could either try the prescription antibiotic, which is expensive (I think about $1000 for a 14 day course?) or spend $50-100 on some herbal products that work about as well and were less likely to have side effects or cause a yeast overgrowth.

[Joker]

It most definitely is. It must be covered just like any other illness. It is known as "mental health parity and addiction equity." 

 

It's about time we made some progress in covering these illnesses. 

 

I didn't know it had to be covered. Under our old PPO we had to pay quite a bit out of pocket, so I was really, really happy to see the new plan cover it at 100%. I hope to see it happening more and it's going to be a huge help to us for the next while.

[SKL]

So you don't believe that certain healthcare issues come under the category of public interest?  You can call it redistribution of wealth.  Or, you can say that we all pay, for example, to live in society where our elderly don't have to live in the street, and that a car accident victim isn't left at the scene because they don't have money to pay for an ambulance.  We pay a price to live in a society like that.  If no one wanted to pay that price, society would be drastically different.

 

That is not what I said at all.

 

I'm saying that government meddling has made insurance not really pure insurance any more, but more a mixture of insurance + wealth redistribution + public policy.  I don't think health corporate or individual health insurance is the place to implement public policy / wealth redistribution.

 

I mean, everyone ought to eat vegetables.  We can all agree with that, right?  So maybe there should be a law prohibiting restaurants to serve patrons unless every plate contains a minimum amount of vegetables (as listed on the government's Approved Vegetables List).  Never mind the fact that some of the patrons probably had a fruit smoothie for breakfast and a vegetable smoothie for lunch and just want some meat and potatoes for dinner.

 

Or alternatively, we could agree to educate people about the benefits of vegetables, provide low-cost sources of vegetables (if access is an issue), and let people choose to eat them or not eat them.

[goldberry]

It most definitely is. It must be covered just like any other illness. It is known as "mental health parity and addiction equity." 

 

It's about time we made some progress in covering these illnesses. 

 

That's a great example of something that is in the public interest to be covered.  A large group of people say the mass shootings are not a gun problem they are a mental health problem.

 

But hey, I should be able to choose what I want to use, right?  No one should force me to buy something I don't want to use.  So.... I should be able to "opt out" because I don't need or utilize mental health services.  Because I want to opt out or my insurance company does, then more and more insurance companies are unable or unwilling to cover mental health care.  The next mass shooter with mental illness comes along, and everyone again says, it's not guns, it's mental illness, and what are we going to do about that....  

 

Funny, the same people saying that are the same ones who don't think insurance companies should be *required* to cover anything...

[goldberry]

Exactly. Some high profile politicians in our country who are against the Affordable Healthcare Act or universal healthcare actually said that those without insurance who showed up at the ER should not even get care. :svengo:  

 

 

Well, that is where a true system of personal choice and accountability leads.  If a person has a choice to say, I am not going to pay for that, then really, why should they unless they have to live with the consequences of that choice? But that's where the societal impact comes in.  The rest of us don't want to watch and standby while individuals live with those consequences.  

 

Does anyone remember a story awhile back where there was a rural fire department...there was a certain area not within their district, but they could pay a relatively small fee to still be included in fire protection.  One family refused to pay.  Their house ended up burning down, and everyone faulted the fire department, saying they should have responded anyway.  

 

Well, that family made a choice.  They did not want to pay for something they thought they would not use.  (They were wrong. The same way people who think they will never need expensive healthcare are usually wrong.)  But the fire department was the villain! How horrible that they in fact honored that family's choice that they did not want to be included in the fire protection district!  We don't want to stand by and watch someone's house burn down because they didn't pay, anymore than we want to stand by and watch someone die who needs medical care.  

 

If we give someone a choice, they should have to stand by it.  If we are going to provide for them anyway (which we are) then they should have to contribute.  Very simple I think.

 

Anyway...bowing out.  I'm really cranky tonight so sorry if I seem argumentative....this is one of those subjects that I know I can do nothing about but which I feel very strongly about...leading to crankiness!  :glare:

[Sdel]

That's a great example of something that is in the public interest to be covered.  A large group of people say the mass shootings are not a gun problem they are a mental health problem.

 

But hey, I should be able to choose what I want to use, right?  No one should force me to buy something I don't want to use.  So.... I should be able to "opt out" because I don't need or utilize mental health services.  Because I want to opt out or my insurance company does, then more and more insurance companies are unable or unwilling to cover mental health care.  The next mass shooter with mental illness comes along, and everyone again says, it's not guns, it's mental illness, and what are we going to do about that....  

 

Funny, the same people saying that are the same ones who don't think insurance companies should be *required* to cover anything...

 

Theoretically, if the majority of policies were sought by individuals there could be affordable mental health (like vision or dental insurance) rider or bundled plans that individuals chose in addition to whatever level of catastrophic coverage they wanted.  I believe this is how those few self purchase plans work, they are just such a minority of purchasers they don't have good collective bargaining power over price.  This type of model works very well for every other type of insurance, why is it so unacceptable for health insurance?  What you are describing is one of the negatives to single payer and employer based health insurance where you are not the insurance company's primary consumer. 

 

Stefanie

[horsellian]

I'm saying that government meddling has made insurance not really pure insurance any more, but more a mixture of insurance + wealth redistribution + public policy.  I don't think health corporate or individual health insurance is the place to implement public policy / wealth redistribution.

 

But a 'pure' system of insurance would have to allow the insurance companies to reject anyone they like (say for a pre-existing condition?) and would leave you back in the place where lots of people can't afford insurance so get no access to healthcare, or cannot find an insurer willing to insure them.

 

The trouble with health insurance as a free market is that the people who most want insurance are those with a higher likelihood of needing to call on it, so these are the people the insurance companies would least like as customers!

[creekland]

I mean, everyone ought to eat vegetables.  We can all agree with that, right?  So maybe there should be a law prohibiting restaurants to serve patrons unless every plate contains a minimum amount of vegetables (as listed on the government's Approved Vegetables List).

 

Totally off topic, but this is the way school lunches work now.  Everyone buying the lunch MUST take the vegetable and fruit offered.  It's really, really sad seeing how much good food is being thrown out (untouched apples, etc).  It's sickening.

 

Before the past couple of years the fruit/veggies were offered, but if a student didn't want them, they could just pass on it rather than taking it just to toss it in the garbage.

[creekland]

We are in a similar situation. I would love to hear more about your experiences with Samaritan so far. Feel free to PM me.

 

We've been with Samaritans for over 10 years (maybe 12) and have never had a bad experience (5 claims now).  It's saved us thousands of $$ and been a better (more personal) experience than when we had insurance.  There's no way I would go back to insurance even if it were the same cost at this point.

 

If you want any specific details about how it's worked, feel free to pm.

[Momof3littles]

  

 

I've read a bit about how so many people insist they or their families members get every possible treatment right before death. Often these are treatments the doctors themselves refuse because they know how lousy the outcomes are. For example, Reader's Digest had an article a few months ago about which treatments most doctors refuse. The ones that I remember were CPR (it said most patients that are revived go on to die soon after anyway or live with a terrible quality of life) and chemotherapy. The doctors are often reluctant to suggest to people to refuse these treatments, maybe because they get accused of only trying to "save money." Other times, the patients or decision makers won't listen.

 

I think this may be why people wanted to allow doctors to be paid for appointments talking these things out with their patients before they were in the hospital facing the decision. Instead, it sounds like people went nuts talking about "death panels," as if any attempt to educate patients about which procedures they'd probably want to avoid if they knew what they were really like is equivalent to trying to kill old people. It seems like we have a culture where people don't want to let go and think that anything short of trying the newest expensive (and often unproven) treatment is murder or something.

 

Are other cultures like this? Haven't I read that something like half our healthcare spending comes from trying to keep people alive one more week or month? At some point, some sort of rationing has to be done. It sounds heartless. But no government, group, or insurance company could ever afford to provide every available expensive drug or surgery to every nearly-dead patient.

 

  

 

The same is true of many nurses, physical therapists, physician assistants, etc. across the healthcare system.  I have articulated my desires in this realm to my DH, as having a proxy clear on your desires is IMO more important than a "living will" in most cases.  I agree regarding CPR, and am open to palliative care, hospice, etc. as I age.  If I am close to death, I do not want a feeding tube, for example.  I had the privilege of taking a course when I was in school co-taught by an oncologist and his wife, who served as a chaplain and hospice nurse for 35 years.  That really shaped my beliefs about end of life care and intervention, in combination with my own personal and professional experience.

 

It doesn't mean that everyone has to arrive at those decisions, but many, many people do not realize how poor the outcomes are with things like CPR under certain circumstances, do not realize that withholding feeding at the end of life can actually be more comfortable for the patient, etc.  I think it would be beneficial for people to be given this information, as I think that we still aren't there.  And doctors should be explaining to patients how to articulate their wishes to their family, how to select a proxy, etc so that individuals can have the best chance possible to have their desires honored. 

 

[SKL]

If we are going to provide for them anyway (which we are) then they should have to contribute.  Very simple I think.

 

Hmm ... so we hold some people accountable more than others.

 

But I'm still saying that if the community or government wants to help someone, they should use community or government resources to do it, not force the hand of "free enterprise."

 

I agree we need to do better with mental health care in this country.  I've said it many times.  What is wrong with having the government provide this across the board, and then if someone wants a more expensive option they can pay oop or via their insurance?  Also individuals / employers could demand good mental health coverage as they realize mental problems happen to working people too.  Just because it is a good thing to have does not mean the government needs to force insurance companies to provide it.

 

As for "reproductive health" (esp. contraception, VD, elective abortion) I think that should be a personal choice.  But again, if the majority vote is for subsidized contraception etc., then let the government provide it.  Let's be straightforward about the fact that it's a subsidy / transfer of wealth forced by the government.

 

I also don't see anything wrong with people going collective for health insurance as non-smokers, non-drinkers, vegans, or whatever, if they feel their personal choices are healthier and lead to lower health costs.  Forcing them to pay for the illnesses of people who knowingly make less healthy choices is a transfer of wealth.  If the majority vote does not want smokers to foot the entire bill of their habit, then let's directly give smokers money to pay higher insurance preimiums.  Let's call it what it is.  (I do realize the cigarette tax is in part an answer to this, and I am not a fan of the cigarette tax for other reasons.)

 

(Or an employer should be able to decide it is not going to fuss over who has better or worse habits etc and just include everyone and everything.  And individual employees should be able to opt in or find something that suits them better.)

[SKL]

The trouble with health insurance as a free market is that the people who most want insurance are those with a higher likelihood of needing to call on it, so these are the people the insurance companies would least like as customers!

 

No. The idea of insurance is that people pay in over the long term because they realize something might happen that would be prohibitively expensive.  Most Americans have been paying health insurance premium while not sick for most of their lives.  That is how it is supposed to work.  The wrinkle comes in when someone decides not to pay and then suddenly decides they want insurance after they get sick.  That is not playing fair.  Most people play fair in this respect.

 

I think the insurance companies know that we all have a risk of having a catastrophe.  They just don't want us to wait until we have a catastrophe to "opt in."  That's the reason for the pre-existing condition clauses, and I understand that most of those restrictions are temporary, i.e., one year (and waived if you've been on other insurance up to that point).  If someone decides to play the lottery until they get sick, they have essentially chosen to depend on other sources of help - welfare, charity, bankruptcy - to deal with their risk.

 

Access to the "fair play" kind of insurance was greater when the government was meddling less, because it was a lot more affordable to the individuals.  Now thanks to government interference among other reasons, the cost is causing more people to opt out and there aren't good alternatives to enable them to manage their risk.

[Jane in NC]

No. The idea of insurance is that people pay in over the long term because they realize something might happen that would be prohibitively expensive.  Most Americans have been paying health insurance premium while not sick for most of their lives.  That is how it is supposed to work.  The wrinkle comes in when someone decides not to pay and then suddenly decides they want insurance after they get sick.  That is not playing fair.  Most people play fair in this respect.

 

I think the insurance companies know that we all have a risk of having a catastrophe.  They just don't want us to wait until we have a catastrophe to "opt in."  That's the reason for the pre-existing condition clauses, and I understand that most of those restrictions are temporary, i.e., one year (and waived if you've been on other insurance up to that point).  If someone decides to play the lottery until they get sick, they have essentially chosen to depend on other sources of help - welfare, charity, bankruptcy - to deal with their risk.

 

Access to the "fair play" kind of insurance was greater when the government was meddling less, because it was a lot more affordable to the individuals.  Now thanks to government interference among other reasons, the cost is causing more people to opt out and there aren't good alternatives to enable them to manage their risk.

 

The pre-existing condition restriction was temporary for situations that were temporary--but not necessarily for chronic conditions including congenital ones.  You may argue that the so called free market should be able to opt out of paying for sick children.  But what is a family to do if they cannot pay for their child's health care in an environment where states are reducing social safety nets?

 

On another note...

 

There really is not a free market in health insurance in my opinion.  As noted by others, employers choose our potential plans.  In our case, my husband can choose a plan for himself, himself or me, or himself and family.  The latter is the same if you are a single parent or married and wish to cover your children. The latter has the same fee whether you have a single child or eight children. 

 

We have in network doctors, in network drugs--most people do. Is this really a free market?

 

Further, insurance companies have had the upper hand in determining what is covered, who would be covered (prior to ACA) and how often it would be covered despite what a medical professional had to say on the issue.  Doctors have been butting heads with insurance companies for as long as I have known.  Free market?

 

[horsellian]

No. The idea of insurance is that people pay in over the long term because they realize something might happen that would be prohibitively expensive.  Most Americans have been paying health insurance premium while not sick for most of their lives.  That is how it is supposed to work.  The wrinkle comes in when someone decides not to pay and then suddenly decides they want insurance after they get sick.  That is not playing fair.  Most people play fair in this respect.

 

 

 

Yes, but if you want to have a free market, then you have to let people choose not to get insurance.  Also, what you describe is inherently redistributive, and reminds me of the way a single-payer system is redistributive.

[ktgrok]

No. The idea of insurance is that people pay in over the long term because they realize something might happen that would be prohibitively expensive.  Most Americans have been paying health insurance premium while not sick for most of their lives.  That is how it is supposed to work.  The wrinkle comes in when someone decides not to pay and then suddenly decides they want insurance after they get sick.  That is not playing fair.  Most people play fair in this respect.

 

I think the insurance companies know that we all have a risk of having a catastrophe.  They just don't want us to wait until we have a catastrophe to "opt in."  That's the reason for the pre-existing condition clauses, and I understand that most of those restrictions are temporary, i.e., one year (and waived if you've been on other insurance up to that point).  If someone decides to play the lottery until they get sick, they have essentially chosen to depend on other sources of help - welfare, charity, bankruptcy - to deal with their risk.

 

Access to the "fair play" kind of insurance was greater when the government was meddling less, because it was a lot more affordable to the individuals.  Now thanks to government interference among other reasons, the cost is causing more people to opt out and there aren't good alternatives to enable them to manage their risk.

 

You are missing the part where the insurance company would drop you, or not renew, after a catastrophic illness. Not to mention that since most people had insurance through their work, losing their job meant that they would very often havea gap in coverage (COBRA is expensive!) and then couldn't get insurance privately do to preexisting issues. My father lived in terror that he would lose his job, and not be able to get insurance again for my mom, because of her cancer diagnosis. They paid all their lives, and yet something out of his control, a lay off, could cause her to lose insurance, and possibly her life. 

 

Thankfully she is not old enough for medicare, and he no longer has that fear hanging over him.