Aetna Slowly Bailing out of ACA Public Health Insurance Exchange

[MaeFlowers]

Doubtful. A single payer would have streamlined processing and guaranteed reimbursement.

I can see that. But I can also see a huge mess especially if it is setup anything like the current Medicaid system. I also could many doctors choosing to take cash because reimbursements are too low.

[Murphy101]

Doubtful. A single payer would have streamlined processing and guaranteed reimbursement.

That's another exceedingly optimistic presumption.

[Mergath]

Why is it not also unethical to say they will only treat people who can afford premiums and deductibles and copays?

 

Either way, it's saying they won't treat people who can't pay.

 

I don't see how a person pays would be the point of why it might be unethical.

 

And also, most of the Drs who are going to no insurance are doing so bc it allows them to serve more people for a more reasonable price. All of the Drs we use that no longer take insurance are cheaper than copays and deductibles and premiums.

I don't know what it's like where you live, but here any doctor who refused insurance would essentially be refusing to treat the working poor, period. We have state insurance for low income people, but only the upper middle class or above can afford to pay for all their care in cash up front. Without doctors who accepted their state insurance, the poor would have no access to health care.

 

And if the biggest savings for the cash-only doctors comes from no longer having to hire people to deal with insurance companies, a single payer system would have the same effect.

[Arcadia]

And if the biggest savings for the cash-only doctors comes from no longer having to hire people to deal with insurance companies, a single payer system would have the same effect.

I see cash only doctors or dentists as similar in concept to cash discount offered by gas stations. The gas station owners rather give a discount upfront than deal with credit card companies.

 

The IRS had lost part of my tax return twice even though we went to the local IRS office to file. Even efiling has hiccups like IRS had their computers breached. So I am not optimistic about single payer system reimbursing smoothly.

[MaeFlowers]

I don't know what it's like where you live, but here any doctor who refused insurance would essentially be refusing to treat the working poor, period. We have state insurance for low income people, but only the upper middle class or above can afford to pay for all their care in cash up front. Without doctors who accepted their state insurance, the poor would have no access to health care.

 

And if the biggest savings for the cash-only doctors comes from no longer having to hire people to deal with insurance companies, a single payer system would have the same effect.

I think it depends. Here, many cash drs work on a sliding scale.

 

I've had Medicaid and insurance but for most of the past ten years, I have gone without any coverage. I don't have coverage now. I have found that cash is king. Most are willing to work with you and I have never been denied service.

 

I'm not completely against a single payer service, I just don't know how well it would work in our country. I have little faith in my state or federal government and their ability to handle it efficiently or effectively.

 

I never expected our current system to work. It's imploding pretty quickly and if premium hikes are really as much as 50% next year, it will fail even faster than I originally thought. It will be interesting to see where we go from here.

[redsquirrel]

Cash only? Who could reasonably do that and maintain a medical practice.  I had to pay 'cash only' because my doctor wouldn't take our insurance.  I had to pay for everything out of pocket and get reimbursed.  That means I had to pay for vaccinations out of pocket.  Do you know how much those cost? They cost about 400$ a piece.  I've had to write checks for 800$ and hope I got reimbursed a portion.  I had to pay 300$ for a pap, not counting the 125$ for the office visit.  I never got a mammogram when we had that (non) insurance, but I can't even imagine how we could pay for it

 

I doubt many doctors who went to cash only would get much business.  Most people can't afford it.  A single pediatric well visit could easily run over a thousand dollars.  It's just not sustainable.

[ChocolateReignRemix]

Why is it not also unethical to say they will only treat people who can afford premiums and deductibles and copays?

 

Either way, it's saying they won't treat people who can't pay.

 

I don't see how a person pays would be the point of why it might be unethical.

 

And also, most of the Drs who are going to no insurance are doing so bc it allows them to serve more people for a more reasonable price. All of the Drs we use that no longer take insurance are cheaper than copays and deductibles and premiums.

Based on what I have read doctors going to the concierge/cash payments serve fewer patients.

[ChocolateReignRemix]

That's another exceedingly optimistic presumption.

Not really. There will be a much larger number of patients using single payer than who will pay cash.

[redsquirrel]

Here is an article on the cost of vaccines. I can't imagine many people are ready to pay cash on the barrel for them

 

http://www.nytimes.com/2014/07/03/health/Vaccine-Costs-Soaring-Paying-Till-It-Hurts.html

[ChocolateReignRemix]

I can see that. But I can also see a huge mess especially if it is setup anything like the current Medicaid system. I also could many doctors choosing to take cash because reimbursements are too low.

 

Medicare is a better comparison as Medicaid is state controlled and varies greatly across the country.  In recent years the number of doctors who accept Medicare has been increasing so I am not sure there is strong evidence doctors would flee single payer.

 

Even with the angst over Obamacare (which is nothing like a single payer system) there has been only a small uptick in concierge/cash doctors.

[ChocolateReignRemix]

Cash only? Who could reasonably do that and maintain a medical practice.  I had to pay 'cash only' because my doctor wouldn't take our insurance.  I had to pay for everything out of pocket and get reimbursed.  That means I had to pay for vaccinations out of pocket.  Do you know how much those cost? They cost about 400$ a piece.  I've had to write checks for 800$ and hope I got reimbursed a portion.  I had to pay 300$ for a pap, not counting the 125$ for the office visit.  I never got a mammogram when we had that (non) insurance, but I can't even imagine how we could pay for it

 

I doubt many doctors who went to cash only would get much business.  Most people can't afford it.  A single pediatric well visit could easily run over a thousand dollars.  It's just not sustainable.

 

What many miss is that PCP may be cash only/concierge, but patients that use him may use insurance for tests/procedures/specialists. 

[ChocolateReignRemix]

I think it depends. Here, many cash drs work on a sliding scale.

 

I've had Medicaid and insurance but for most of the past ten years, I have gone without any coverage. I don't have coverage now. I have found that cash is king. Most are willing to work with you and I have never been denied service.

 

I'm not completely against a single payer service, I just don't know how well it would work in our country. I have little faith in my state or federal government and their ability to handle it efficiently or effectively.

 

I never expected our current system to work. It's imploding pretty quickly and if premium hikes are really as much as 50% next year, it will fail even faster than I originally thought. It will be interesting to see where we go from here.

 

Where are you getting the 50% from?  The latest projections (from healthcare surveys) I saw were in the range of 5% (average) for employer provided plans.  The ACA plans vary, but I think the silver plan increase was still around 10% (average).

[Murphy101]

Cash only? Who could reasonably do that and maintain a medical practice. I had to pay 'cash only' because my doctor wouldn't take our insurance. I had to pay for everything out of pocket and get reimbursed. That means I had to pay for vaccinations out of pocket. Do you know how much those cost? They cost about 400$ a piece. I've had to write checks for 800$ and hope I got reimbursed a portion. I had to pay 300$ for a pap, not counting the 125$ for the office visit. I never got a mammogram when we had that (non) insurance, but I can't even imagine how we could pay for it

 

I doubt many doctors who went to cash only would get much business. Most people can't afford it. A single pediatric well visit could easily run over a thousand dollars. It's just not sustainable.

Good grief. Yeah if it went like that I suppose so. But I'm not paying that much for anything at our cash pay Drs.

 

Geez. All my OB appts and anything done at my appts (including pap and some other stuff) for the 9 months and her doing a cesarean is going to cost me a grand total of $3200

 

My chiropractor was $200 to be establishes as his patient, which included a 2 hour appt where he went over all my medical issues, evaluated me, requested an X-ray, and my first adjustment. After that, all future appts are $60 each.

 

Yes, obviously if people can't or won't pay, cash/patient pay only wouldn't work for a dr. But in my limited experience, the costs are FAR less than with insurance and I get a lot more for my dollars.

[redsquirrel]

What many miss is that PCP may be cash only/concierge, but patients that use him may use insurance for tests/procedures/specialists. 

 

and many insurance companies won't pay if tests aren't ordered by a doc in their system. And they often need the tests run at a lab that they approve. And many insurance companies need a referral from a primary doctor in their system and will only cover specialists in their same network.

 

Sort of makes me LOL when people talk about how government shouldn't get between doctors and patients. The insurance companies have been there a very, very long time. They control who you can see, how often and what can be done.

 

Again, cash only practices are not really sustainable except for a very small number in the larger cities.

[Murphy101]

I don't know what it's like where you live, but here any doctor who refused insurance would essentially be refusing to treat the working poor, period. We have state insurance for low income people, but only the upper middle class or above can afford to pay for all their care in cash up front. Without doctors who accepted their state insurance, the poor would have no access to health care.

 

And if the biggest savings for the cash-only doctors comes from no longer having to hire people to deal with insurance companies, a single payer system would have the same effect.

Here the working poor are fill up the supposedly nonprofit hospitals. Because though they might have state medical (many toe the line of not quite qualifying and most in my state do not have it if they are adults) it's a PITA to get into a dr that will accept it. And many of the working poor have the worst jobs to navigate dr appts around. Even if they have the dr and the medical coverage, they can't get in to be seen between 9-5 M-F. So regardless of coverage, many working poor can't use regular dr offices.

 

ETA: and again, why do you accept its okay to refuse some of the working poor due to payment method and not others? There's a lot of working poor who can't pay either way.

Edited August 17, 2016 by Murphy101

[ChocolateReignRemix]

and many insurance companies won't pay if tests aren't ordered by a doc in their system. And they often need the tests run at a lab that they approve. And many insurance companies need a referral from a primary doctor in their system and will only cover specialists in their same network.

 

Sort of makes me LOL when people talk about how government shouldn't get between doctors and patients. The insurance companies have been there a very, very long time. They control who you can see, how often and what can be done.

 

Again, cash only practices are not really sustainable except for a very small number in the larger cities.

 

Some plans are more flexible when the referral is to someone in network.

 

And yes, looking into the numbers the concierge services are not sustainable for a larger population. 

[Murphy101]

and many insurance companies won't pay if tests aren't ordered by a doc in their system. And they often need the tests run at a lab that they approve. And many insurance companies need a referral from a primary doctor in their system and will only cover specialists in their same network.

 

Sort of makes me LOL when people talk about how government shouldn't get between doctors and patients. The insurance companies have been there a very, very long time. They control who you can see, how often and what can be done.

 

Again, cash only practices are not really sustainable except for a very small number in the larger cities.

I don't live in a really large city. Nothing like Houston or Dallas.

 

But also, those insurance requirements are nutty.

 

So my friend is pregnant and needs an ultrasound. Her insurance says she has to use this one place for it to be covered. But if she uses that one place, her portion will be nearly $900. I was shocked bc I paid $500 for a level 2 anatomy scan. So I tell her, use this other place I used bc a basic ultrasound is about $200. If they cover it she pays $900. If they don't she pays $200-500. Same thing happened with her blood work. Her portion after insurance was nearly $200. I paid $85. The real annoying thing about the blood work is though we went to different places for our blood draws, they sent it to the SAME lab to be tested. Can anyone please explain how any of that makes any sense at all?

Edited August 17, 2016 by Murphy101

[Murphy101]

I think concierge is fine for most things and could keep cost realistic.

 

I think maybe, at least as a transition starting point, a universal program for major medical would be good. Eventually maybe that could cover everything and people would have some reasons to hink it might actually work out. Because I have to admit my faith in the govt handling it well is nil at this point.

 

I can buy my husband's insulin from out of the country for pennies compared to here with or without insurance.

But insurance wouldn't make me feel one bit more secure. Most people who filed bankruptcy for medical reasons had insurance. Why we keep pushing that insurance is the answer to getting medical care is beyond my understanding at this point.

[redsquirrel]

Good grief. Yeah if it went like that I suppose so. But I'm not paying that much for anything at our cash pay Drs.

 

Geez. All my OB appts and anything done at my appts (including pap and some other stuff) for the 9 months and her doing a cesarean is going to cost me a grand total of $3200

 

My chiropractor was $200 to be establishes as his patient, which included a 2 hour appt where he went over all my medical issues, evaluated me, requested an X-ray, and my first adjustment. After that, all future appts are $60 each.

 

Yes, obviously if people can't or won't pay, cash/patient pay only wouldn't work for a dr. But in my limited experience, the costs are FAR less than with insurance and I get a lot more for my dollars.

 

I am curious about how this works and where it is.  For example, my homebirth midwife, who is legal in my state but is not covered by any insurance network charged more for for my homebirth almost 12 years ago than what you pay now. I believe I had to pay 4,000 for all nine months of care and the birth. It could have been 5,000, but I don't think so.

 

A friend's son did not have insurance. His wife (also no insurance) had to have a C-section in California and it was 10,000 just for the section, not the care or the hospital stay. I have no idea how much that was, but I would not be surprised if they owed 20,000$ in total. It was about 5-6 years ago

 

I can see a chiro here, but my insurance does not cover it. Technically, it is covered by my insurance, but there are no chiros they allow into their network. So I have to pay cash. It costs me about 50$ a visit, but no establishing fee and no x-rays are done at this practice.  But I don't consider chiro care to be comparable to seeing a GP, and my chiro is quick to point out what she is and is not allowed to treat or diagnose.

 

Are you getting a cash discount, IOW, are these providers providing you care for cash but seeing other people in their practice, or another practice,  with insurance, or are these practices 100% cash for everyone?  Are they carrying malpractice insurance? That is what drives up the cost with many OB practices. It it only your OB who is 100% cash? Do you have a pediatrician for the kids who is also 100% cash? How are things like vaccinations covered?

[redsquirrel]

I don't live in a really large city. Nothing like Houston or Dallas.

 

But also, those insurance requirements are nutty.

 

So my friend is pregnant and needs an ultrasound. Her insurance says she has to use this one place for it to be covered. But if she uses that one place, her portion will be nearly $900. I was shocked bc I paid $500 for a level 2 anatomy scan. So I tell her, use this other place I used bc a basic ultrasound is about $200. If they cover it she pays $900. If they don't she pays $200-500. Same thing happened with her blood work. Her portion after insurance was nearly $200. I paid $85. The real annoying thing about the blood work is though we went to different places for our blood draws, they sent it to the SAME lab to be tested. Can anyone please explain how any of that makes any sense at all?

 

You live in a bigger city than I do.  We have one hospital. To get to the next hospital is drive an hour north or drive an hour south, and you will certainly be 'out of network' and insurance won't cover it. That is on two lane rural high ways and hope it's not in the middle of winter.  You will have driven several counties away from home, so it's not really practical. Plus, no local doctors work with those hospitals. We have one lab...at the hospital.  Some OBs will do their own u/s or you get sent to the one imagining center which is owned an operated by....the hospital.

 

I don't think this is an unusual situation for many people. I live in a small city, a college town that qualifies as a city. I could live in one of the more rural areas and have to drive an hour just to get to any medical care.

 

[ChocolateReignRemix]

I think concierge is fine for most things and could keep cost realistic.

 

I think maybe, at least as a transition starting point, a universal program for major medical would be good. Eventually maybe that could cover everything and people would have some reasons to hink it might actually work out. Because I have to admit my faith in the govt handling it well is nil at this point.

 

I can buy my husband's insulin from out of the country for pennies compared to here with or without insurance.

But insurance wouldn't make me feel one bit more secure. Most people who filed bankruptcy for medical reasons had insurance. Why we keep pushing that insurance is the answer to getting medical care is beyond my understanding at this point.

 

The bolded has nothing to do with health insurance.

 

The second bolded, there has to be some kind of insurance model (single payer, private insurance model like in some EU countries, etc) to allow for risk sharing to cover costly medical treatments.  There will not be any concierge services offering chemo to the masses any time soon (likely ever).

[Murphy101]

The bolded has nothing to do with health insurance.

 

The second bolded, there has to be some kind of insurance model (single payer, private insurance model like in some EU countries, etc) to allow for risk sharing to cover costly medical treatments. There will not be any concierge services offering chemo to the masses any time soon (likely ever).

To be clear, I'm pro universal healthcare. I also think one expanded Medicaid insurance model is not a good idea. Because again, to me, insurance in and of itself it the problem. A universal program that wasn't based on an insurance model would be my ideal.

 

And of course, I'm not sure what would solve lack of confidence in govt. Probably the govt proving it doesn't suck at something would be a good start.

[Murphy101]

You live in a bigger city than I do. We have one hospital. To get to the next hospital is drive an hour north or drive an hour south, and you will certainly be 'out of network' and insurance won't cover it. That is on two lane rural high ways and hope it's not in the middle of winter. You will have driven several counties away from home, so it's not really practical. Plus, no local doctors work with those hospitals. We have one lab...at the hospital. Some OBs will do their own u/s or you get sent to the one imagining center which is owned an operated by....the hospital.

 

I don't think this is an unusual situation for many people. I live in a small city, a college town that qualifies as a city. I could live in one of the more rural areas and have to drive an hour just to get to any medical care.

 

I know this is common too. But I'm not sure how expanded Medicaid/care would help with it. My dad is very rural and on Medicare. He drives nearly 3 hours to his heart dr and it takes months to get an appt. We have to send a relative with him to drag him in and make him stay bc in his old man mind he had an appt and if the dr is more than 20 minutes late seeing him, he wants to get up and leave bc "I ain't getting no younger and I'm not gonna die in this damned waiting room." But apparently all the appts are just for the day at some point maybe bc he often waits hours. I have a cousin near him who has to drive pretty far for Ob care too.

[GoodGrief]

In a single payer system, certainly many providers would go cash only in the short term. The long term impact would be a change in the sorts of students who go to medical school. Why take on the risks and burdens of a health care career when you can do something more lucrative?

 

I've had government health care my entire life, and have worked in a mini-version of a single payer system, the Indian Health Service. It's not medical Nirvana.

 

I just read a post in a (non-political) Facebook group in which I participate about a young man who has been denied a specific life-saving treatment in his country, a developed nation with a single payer system. Heartbreaking, but rationing is the reality of that sort of system. Neither our system nor the single payer systems are treating everybody for every condition. It's simply not possible. Supply and demand, and no matter how you are paying for it, there are going to be limits.

[ChocolateReignRemix]

To be clear, I'm pro universal healthcare. I also think one expanded Medicaid insurance model is not a good idea. Because again, to me, insurance in and of itself it the problem. A universal program that wasn't based on an insurance model would be my ideal.

 

And of course, I'm not sure what would solve lack of confidence in govt. Probably the govt proving it doesn't suck at something would be a good start.

Social security and Medicare are both successful programs. Our interstate highway system is pretty solid. National parks are managed well, as our many resources on federal lands. The CDC and related agencies are successful in their overall missions. I can easily go on.

[SemiSweet]

I'm curious about this. Really? You think the VA system works well? I have so many friends with opposite experiences I'm just wondering why so many would say the system is broken.

I didn't say it works well, I said I've had good experiences. I think there are two major issues at play here.

 

The first is that military people live in a medical bubble, some/many joined the military at 18 and haven't ever dealt with medical insurance. Their doctor and Tricare, especially as active duty members, handle everything for them , and in many places getting care is fairly quick and painless. So they get out of the military and surprise! You get to deal with all the waiting and red tape that pretty much the rest of the US population has always had to deal with.

 

The second issue is that you always hear the bad. Nobody hears about my good experience because the bad ones are more interesting/fit the rhetoric/make the government look incompetent, etc.

[MSNative]

Adjust for health care inflation and number of veterans served after our Middle East misadventures. A budget can grow in nominal funding but decease in real funding.

What I found doesn't show that.

 

"Between 2000 and 2012, the VA’s budget nearly tripled, rising to $124 billion from $45 billion. Even after adjusting for medical inflation, which has grown much faster than normal consumer price inflation, the VA budget increased by 72 percent between 2000 and 2012. Over that same time, the total number of VA patients increased by 69 percent, from 3.3 million in 2000 to nearly 5.6 million in 2012. According to figures contained in the departmental appendices accompanying annual Office of Management and Budget proposals, the number of acute inpatients treated by the VA increased by only 49 percent.

 

http://thefederalist.com/2014/05/30/this-chart-shows-why-the-vas-problems-have-nothing-to-do-with-funding/

 

This NPR article gives a look at just a sliver of what our veterans are having to deal with. My father is a disabled vet. He's been dealing with the VA for decades and it has only gotten worse. Hours and hours wait to even get someone on the phone, months long waits to get appointments, numerous appt reschedules because the VA failed to send in appropriate authorizations.

 

http://www.npr.org/sections/health-shots/2016/05/16/477814218/attempted-fix-for-va-health-delays-creates-new-bureaucracy

[Guest]

I think it's unethical to be a healthcare provider and say "I'll only treat people who can afford to pay out-of-pocket."

Many people have such high deductibles that they are paying out of pocket. As Lanny noted, it would be more cost effective for them to be self-insured. Investing the very high premiums they and their employers pay until needed for something catastrophic in midlife would work out for them.

[ktgrok]

Maybe. Maybe not. My dentist has gone to cash only because he's sick of dealing with insurance. I wonder if MD would follow suit?

 

I think a huge number of people don't have dental insurance, so that makes sense financially. If EVERYONE had medicare, it would not make sense, financially, for all the doctors to stop taking medicare. Only so many people would be willing to pay out of pocket. 

 

I mean, EVERY other major country has some form of universal healthcare, and I haven't heard of an issue where most of the doctors refused to take said healthcare. It just isn't feasible. Right now, there are enough people that can't afford insurance to make cash pay a viable business option. But if everyone had universal coverage,that would no longer be the case. 

[Bluegoat]

I'm not sure where this worry that in single payer systems, doctors won't accept patients unless they pay cash.

 

It's pretty simple - in single payer systems that isn't an option for insured services.

 

THe business about care being slower, or less good, is pretty much BS too.  There are plenty of universal insurance programs in many different countries, and the care in these countries is usally as quick or even faster than the US, and the health outcomes are better too.  Even in a lot of countries that we would consider less developed.

 

The only think I wonder about is why, when people talk about universal insurance in the US, they talk about it being run nationally.  Most countries that big don't do that, it's broken down into somewhat smaller units for the purposes of running the insurance program.

 

The idea that somehow the US is so different that it could never work there is crazy.  It's a matter of political will, and people who get something out of the system in place convincing people that somehow it is impossible.

[ktgrok]

I am curious about how this works and where it is.  For example, my homebirth midwife, who is legal in my state but is not covered by any insurance network charged more for for my homebirth almost 12 years ago than what you pay now. I believe I had to pay 4,000 for all nine months of care and the birth. It could have been 5,000, but I don't think so.

 

 

Exactly. I cannot imagine how 9 months of care plus a surgical birth, anesthesia, hospital stay, etc is 3K, when my homebirth midwife charges 5K for 9 months of care and a vaginal birth. And that is her discount cash price. 

 

Also, it should be noted the reason things are cheaper for cash pay is that the doctor doesn't have to pay a full time employee (or department of employees) to fight with the insurance company. And he can predict exactly what he will get paid. The SAME thing that happens in single payer. That's one of the reasons countries with single payer have such reduced medical costs. 

[ktgrok]

Many people have such high deductibles that they are paying out of pocket. As Lanny noted, it would be more cost effective for them to be self-insured. Investing the very high premiums they and their employers pay until needed for something catastrophic in midlife would work out for them.

 

Unless that catastrophic thing happens earlier. My ex, when we were married, caught a routine virus, never noticed it, until it infected his heart and put him into heart failure. He developed cardiomyopathy and was sent to a teaching hospital to be evaluated for a transplant. Oh, and he also had a kidney disease, totally random, that has caused him to have one kidney transplant already, and he will need another soon. He's 42, these problems started in his 20s. 

 

Or the guy I know that tripped on a curb and need total reconstruction of his knee, then almost died from blood clots, 

 

Or the woman who had a stroke while pregnant in her 30s and was in the ICU for weeks before dying. 

 

Or the young woman who had a premature baby that needed open heart surgery. 

 

Any one of these things is well beyond what even a very frugal saver could plan for. 

[Haiku]

Many people have such high deductibles that they are paying out of pocket. As Lanny noted, it would be more cost effective for them to be self-insured. Investing the very high premiums they and their employers pay until needed for something catastrophic in midlife would work out for them.

 

To be clear, I think the insurance system is crap and that we should have universal healthcare.

 

That said, we don't have universal healthcare. We have an insurance system. Our family has to have insurance because our kids, collectively, require $4000+ in life-saving medication every month. Dumping insurance would not make that more affordable for us. So, we have this insurance, and then when I go to the doctor, it's inconvenient for him to accept my insurance, so now I have to pay $100+ to see him or take my kids? Instead of a small copay or free preventive care? No, thanks.

[Bluegoat]

I think a huge number of people don't have dental insurance, so that makes sense financially. If EVERYONE had medicare, it would not make sense, financially, for all the doctors to stop taking medicare. Only so many people would be willing to pay out of pocket. 

 

I mean, EVERY other major country has some form of universal healthcare, and I haven't heard of an issue where most of the doctors refused to take said healthcare. It just isn't feasible. Right now, there are enough people that can't afford insurance to make cash pay a viable business option. But if everyone had universal coverage,that would no longer be the case. 

 

No, because they can't, it would be illegal.  They would just have to stop practicing.

 

If you look back to the beginning of universal insurance programs in various places, you will see that some doctors did say they would stop working, they would never get new doctors, and so on.  And perhaps some did, but it wasn't a huge deal, in the end, and lots of good people still become doctors even though they have to accept the rates that are mandated (though doctors have a part in setting these rates, it's generally negotiated.)

 

In most of the west, being a doctor is still a well paid and respected position, despite universal care/insurance.

[Bluegoat]

To be clear, I'm pro universal healthcare. I also think one expanded Medicaid insurance model is not a good idea. Because again, to me, insurance in and of itself it the problem. A universal program that wasn't based on an insurance model would be my ideal.

 

And of course, I'm not sure what would solve lack of confidence in govt. Probably the govt proving it doesn't suck at something would be a good start.

 

What else would you suggest?  A lot of similar types of government programs are also done on an insurance basis sucessfully - we have Employment Insurance for example, if you lose your job or for maternity leaves, and so on. 

 

Since not everyone needs the same kind of care or would cost the same, it would make no sense to allot a particular amount to each person.

 

I suppose you could set up all the clinics and such, and then have the gov pay for all the expenses, run the clinics, and put the doctors on salary.  I think though that would probably be a real administrative mire.  It happens here in some places where it is very isolated, but with universal insurance, most doctors work for themselves, so they can run their practices as they prefer - control is pushed down to the lowest level.

[TechWife]

I don't know. Probably not. My mom did what she wanted, and every time she followed her own judgment instead of what she was told to do, she got better.

But if Medicare covers all 325 million of us on single payer, then there are going to be some demands and hoops to jump through, I would think. I hope not though.

 

Lots of doctors are dropping Medicare now.

 

This was interesting (ack on perforating the colon!)

 

http://www.aarp.org/health/conditions-treatments/info-2014/choosing-wisely-medical-tests-to-avoid.html

 

Here is a very interesting article. You are forced into Medicare at age 65 if you want to get social security even if you don't want Medicare.

 

Why Am I Being Forced into Medicare at Age 65?

Every American aged 65 years old or older is eligible for Medicare. Once you hit 65, you become automatically eligible; it is unavoidable. Those who receive Social Security benefits are automatically enrolled in Medicare. There is no way to opt out of Medicare once you are 65 if you receive Social Security. Either you enroll in Medicare Part A, or you forfeit your Social Security benefits. Most individuals are unwilling to forfeit their Social Security benefits, and thus accept the enrollment into Medicare.

 

There is a great deal of speculation as to why the system is set up in this manner, but unfortunately, there is no clear or direct answer. Perhaps this policy was initially instituted to make it easier for seniors to enroll in Medicare once they reached they age of 65, but was never discontinued when private coverage became more commonplace.

I think you are concerned about something unnecessarily. My parents have had Medicare for over 20 years now. They have never been forced to do one single thing. Ever. They have never needed something and not had Medicare pay for it. Ever.

 

There is nothing preventing a person who is claiming their social security benefit from having private insurance. Nothing. With the disappearance of pensions and company sponsored retirement plans, the number of people who have access to private insurance after their retirement from the workforce is dwindling, contrary to what you are saying here. There is no premium for Medicare Part A - the part that covers hospitalizations and physician visits. I see no benefit to having the option to decline Medicare if you are no longer working.

 

I am unclear why you think people who are of retirement age and are no longer working should have the option to be uninsured. Have you ever seen a hospital bill for a broken hip and for the rehab that follows? For pneumonia? Cancer? Kidney failure?

 

What is the benefit of having someone unable to pay their hospital bills?

[TechWife]

I agree. Does your insurance now make it affordable? Some drugs are, especially if you have to buy them over and over. Anything I ever use is usually not much cheaper with insurance (like antibiotic, a valium before a recent dental surgery, etc). There is one pharmacy here that will give a person antibiotics free IF you can use that kind (I can only use one class, so it doesn't work for me). That helped out once.

 

My father has arthritis in every single joint in his body - no exaggeration. His pain medicine retails at over $500 per month. Medicare Part D lowered that to around $300 per month. Because of their income status, they qualified for "extra help" that is available through Obamacare. This resulted in their Part D premiums being lowered and a decrease in the cost of their medications. That pain med my dad takes now costs less than $10 per month. You will not find me complaining about medication coverage under Medicare or Obamacare.

[Haiku]

My dad is on Medicare and has been for years (he's nearing 80). He's currently being treated for cancer, and there have been no issues with his coverage. If his doctor says he needs it, he gets it. I am handling a lot of his care, and I honestly cannot imagine the nightmare it would be if I had to deal with insurance. I have spent 12+ years navigating the insurance system with my kids who have chronic illnesses, and I tell people I could have gotten a PhD in all the time I have been on the phone with the insurance companies, trying to force them to pay for contractually obligated services. I've had to sue our insurance companies twice.

[TechWife]

Blue Cross Blue Shield of Arizona will not offer coverage on the Exchanges, for 2 counties in Arizona: Pinal and Maricopa. They are a non-profit and they are losing too much money on the Exchanges.

 

The only possible solution I see for this would be if somehow, healthy people would sign up on the Exchanges. There are too few healthy people doing that now, and too many people with expensive medical problems who are signing up.

 

http://www.foxnews.com/politics/2016/08/15/aetna-to-drop-some-affordable-care-act-markets.html

Let's be clear - this one suite of products, ACA policies, is what is losing money. On the whole, taking all of their products into consideration, insurance companies are still making healthy profits.

 

Many people who are signing up on the exchanges haven't had health insurance in yeas, if ever. This means that as a group, they have had less access to healthcare, especially preventative care. I would expect, and the insurance companies should have expected, for this population to be less healthy than the population who is continuing on private insurance policies. This means that they will initially, as a group, cost the insurance companies money. The health of people (again, as a group), utilizing AHA policies should improve over time with their improved access to health care. It will look different five, ten, fifteen, twenty years down the road because the overall health of the ACA policyholders will improve.

 

Insurance companies fought to have the ability to compete for business, but they don't want to pay the price in the short term to see long term profits. Managing for the long term health of a company is overall a better deal than managing for short term stockholder returns. Some companies are beginning to realize this and better manage stockholder expectations, but a transition back to this management philosophy will take quite a long time.

[Josh Blade]

Providers didn't take your health care because it literally didn't pay enough to cover expenses? You get booted from practices where you have been for years because they have stop taking your plan due to the low payment. The only providers who do take it are hours away or have years long waiting list?  that happened to us with Empire Plan.  It's not just Medicaid. 

 

And a single plan also requires that providers take that plan.  They can't turn you away because that is the way they get paid. Its a system and everyone is in it.

 

 

This happened to us this year. When I chose our insurance provider at the beginning of the year, I made sure our PCP, my wife's OB, and our kids' doctor was all in network. 

 

We're young and healthy, so we don't go to the doctor's often. The very first time my wife goes to see our PCP (about a month ago), she is told that they no longer accept our insurance because they had such difficulty getting paid all the time. We ended up paying out of pocket. My wife goes to see her OB for her annual check. She's excited to see her OB because he literally saved her life and our son's life last year after an emergency C section followed by an emergency hysterectomy. Same thing at the OB office. They stopped taking it because they can never get paid. Luckily, her doctor stepped out to talk with her for a minute anyways, but she didn't get her normal exam ($300 without insurance). 

 

So we're stuck with this insurance plan until the next open enrollment, but can't go to any of our doctors that were in network during open enrollment. 

[Mergath]

In a single payer system, certainly many providers would go cash only in the short term. The long term impact would be a change in the sorts of students who go to medical school. Why take on the risks and burdens of a health care career when you can do something more lucrative?

Fine by me. Someone going to medical school solely to get rich, and who would walk away the second they realized they weren't going to make as much money, would probably be a horrible doctor anyway. I'll gladly take the people who have a passion for medicine over the people who have a passion for money.

[Laura Corin]

No, because they can't, it would be illegal. They would just have to stop practicing.

 

If you look back to the beginning of universal insurance programs in various places, you will see that some doctors did say they would stop working, they would never get new doctors, and so on. And perhaps some did, but it wasn't a huge deal, in the end, and lots of good people still become doctors even though they have to accept the rates that are mandated (though doctors have a part in setting these rates, it's generally negotiated.)

 

In most of the west, being a doctor is still a well paid and respected position, despite universal care/insurance.

In the UK, doctors are free to work for cash outside of the NHS, or to top up their NHS salaries by taking some private patients. Most don't, however, as there isn't a big market for their services at the GP level.

[Josh Blade]

Where are you getting the 50% from?  The latest projections (from healthcare surveys) I saw were in the range of 5% (average) for employer provided plans.  The ACA plans vary, but I think the silver plan increase was still around 10% (average).

 

 

I'm not who you were quoting, but in GA, the Insurance companies are requesting an average 27% rate hike for next year.

 

In 2013 before the ACA fully kicked in, I was paying $42 per person per month in my family for a plan (individual plan bought privately rather than an employer plan). This year, I'm paying $127 month/person and with a ~25% increase next year, that means I will be paying roughly 4x for my premiums what I was paying 4 years prior with a much higher deductible and copayments. It's insane. We have 2 more providers dropping out this year as well after 2 or 3 dropped out last year. 

[ktgrok]

I'm not who you were quoting, but in GA, the Insurance companies are requesting an average 27% rate hike for next year.

 

In 2013 before the ACA fully kicked in, I was paying $42 per person per month in my family for a plan (individual plan bought privately rather than an employer plan). This year, I'm paying $127 month/person and with a ~25% increase next year, that means I will be paying roughly 4x for my premiums what I was paying 4 years prior with a much higher deductible and copayments. It's insane. We have 2 more providers dropping out this year as well after 2 or 3 dropped out last year. 

 

 

Rates started going up, across the board, before ACA, and have leveled out a bit post ACA. 

 

That said, wow, that's cheap!

 

We pay over 1,000 for our family a month. 

[ChocolateReignRemix]

I'm not who you were quoting, but in GA, the Insurance companies are requesting an average 27% rate hike for next year.

 

In 2013 before the ACA fully kicked in, I was paying $42 per person per month in my family for a plan (individual plan bought privately rather than an employer plan). This year, I'm paying $127 month/person and with a ~25% increase next year, that means I will be paying roughly 4x for my premiums what I was paying 4 years prior with a much higher deductible and copayments. It's insane. We have 2 more providers dropping out this year as well after 2 or 3 dropped out last year. 

 

Dig into those numbers a bit.  The article calculated the weighted average based on last year's market share, and those market shares do change year to year with the rates.  Two companies requested extremely high increases while everyone else was in the 6-15% range.  Georgia also /= the country.

[Josh Blade]

Rates started going up, across the board, before ACA, and have leveled out a bit post ACA. 

 

That said, wow, that's cheap!

 

We pay over 1,000 for our family a month. 

 

Insurance rates since I started working went up every year, but it was in the 5-10% range annually. Since the ACA, it's been >20% for me every year. I understand why. My family is young and healthy. Those are the people most disproportionately burdened by the ACA due to how health insurance works (the young/healthy subsidize the sick/old).

 

 

Our whole family is under 30 and we can get catastrophic plans (which are basically bronze level plans with lower premiums). My wife turns 30 this year and I will in early 2018. If we had the cheapest bronze level plans they would be just over $1000/month. Our cheapest employer plan is also $1100/month. 

[Haiku]

Our whole family is under 30 and we can get catastrophic plans (which are basically bronze level plans with lower premiums). My wife turns 30 this year and I will in early 2018. If we had the cheapest bronze level plans they would be just over $1000/month. Our cheapest employer plan is also $1100/month. 

 

Ten years ago, when I was in my 30s, we were paying >$1500 a month for our insurance. Now we pay $238 a month (family of 5). Insane premium prices are not the fault of the ACA, and the companies that tell you that are lying to you.

[Josh Blade]

Dig into those numbers a bit.  The article calculated the weighted average based on last year's market share, and those market shares do change year to year with the rates.  Two companies requested extremely high increases while everyone else was in the 6-15% range.  Georgia also /= the country.

 

So we should just disregard rate hike data because market share changes? Sure, since Aetna, is dropping out of exchanges their market share will most likely go down. That basically leaves those people moving to BCBS or Humana (as those three companies are currently ~90% of the marketshare). If they're lucky, they'll be able to go to BCBS which isn't going super crazy (roughly the same increase as Aetna). If they're unlucky, Humana is the other option in their area and they will see a gigantic increase. Most likely, average rate increase will actually be higher than that 27% weighted average in the article just because of how high the Humana rate increase is due to shifts from Aetna to other carriers. 

 

 

Also, no single state is going to be representative of the country. That doesn't mean you should marginalize the effects on the budgets of the hundreds of thousands of people in GA on private insurance. 

[ChocolateReignRemix]

Insurance rates since I started working went up every year, but it was in the 5-10% range annually. Since the ACA, it's been >20% for me every year. I understand why. My family is young and healthy. Those are the people most disproportionately burdened by the ACA due to how health insurance works (the young/healthy subsidize the sick/old).

 

Individual experiences are never a good indicator of trends in the health insurance market.  The linked article gives some insight into trends before the ACA, but this one quote gives you an idea of how much individual experiences can vary.

 

For example, looking at all premium filings collected in 2008, 10 percent of people enrolled in plans experienced no rate increase while, at the other extreme, 10 percent saw increases of 17.8 percent or more.

 

 

http://www.commonwealthfund.org/publications/press-releases/2014/jun/new-analysis-of-health-insurance-premium-trends

[Lady Florida.]

I've never heard of cash-only doctors. Well, not never. That's how it was when I was growing up. I should say I haven't heard of cash-only in my area in this century.

 

Admittedly I'm not looking for them. When I need to find a new doctor I look for one that takes our insurance. However, while there are some doctors who don't take our insurance, in my searches I haven't run across doctors who don't take ANY insurance. Yes, there are doctors who won't take ACA or Medicaid or Medicare, but they still aren't cash-only. Friends who don't have insurance have the problem that they can't find a doctor because no one will take them if they don't have insurance.