I am sure ACA is working out for some - but not for me. A personal story
  • What about OB-GYN check ups - 1 per year? What about pregnancy & child birth.....covered? Sprained ligament (not requiring surgery) covered? Physical therapy for a sore back (preventing me from working) covered?
  • chronic diseases like diabetes?
  • Why are mammos and colonoscopies preventative? They are screening/diagnostic. Lung cancer kills more people than breast or colon - so yearly lung xray?
  • Chest X-ray does not pick up lung cancer soon enough to make a dent in mortality.

    Eta: some studies show a benefit from yearly CT scan, but some do not.

    Screening for lung cancer is a big problem.
    Post edited by gibberellin at 2014-01-30 16:36:28
  • I also fear that would drastically decrease the number of visits to the doctor, which can be both good and bad. It might reduce unnecessary visits, but it also might prevent people from getting something checked out that they really should. It's one thing to do it for $40, it's another for $200.

    My point is that the cost would come down if consumers really had to pay out of pocket.

  • Or you can do what other countries do and not RX a cat scan or huge procedre for every ache and pain. I went to the GI doc last week and ended up with $4000 procedure that I'm sure will result in me continuing to take Prilosec ie status quo.
  • GWebb said:

    What about OB-GYN check ups - 1 per year? What about pregnancy & child birth.....covered? Sprained ligament (not requiring surgery) covered? Physical therapy for a sore back (preventing me from working) covered?

    Yes, Ob/Gyn. I meant preventive care, actually, rather than PCP.

    chronic diseases like diabetes?



    eliz said:

    Why are mammos and colonoscopies preventative? They are screening/diagnostic. Lung cancer kills more people than breast or colon - so yearly lung xray?


    Glad you're all deferring to me, the insurance creator :-)

    This is just a general outline. But you get the idea. Medical insurance is not for everyday medical visits. I'd like a monthly premium of $150 for a family of four and a $3,000 per year per-person deductible. Preventive care is free.
  • ZZ, I hear you. It sucks. No argument from me, especially since I know you support the same model I do.

    shoshannah, I agree. We want too much from medical insurance. We want to get out more than what we put in, basically. The fact that we expect it to cover normal expenses such as sickness shows that we see it as more than insurance.

    On the other hand, places like Canada do fairly well by covering all medical needs. I guess it would work better if we only had their system, but as it is, we have an insurance system. Maybe ACA version 1.1 should deny sick visits and the like?

    PrincessKate, my experience with many insurance companies is that they seem to see themselves as in the business of claim denial. Their basic model is: 1. collect as much in premiums as the law will allow; 2. deny as many claims as the law will allow; 3. pay the remainder of the claims. Since that middle step makes a huge difference to the bottom line, it's in their interest to get really good at denying claims. So they have. My experience has been pretty much the same with all the companies. Aetna seemed a tad better, and not surprisingly, they are more expensive.
  • I still think as I have said before that since insurance company profits are capped as a percentage of revenue under ACA the rational behavioral model is the pay out as much as possible to providers, either through higher payments or more procedures thus being able to raise premiums and make more in dollar terms out of their allowed percentage of profit but thus driving high health care inflation. But it is the government that has made such a model the most profitable, just as the government drove the issuance of sub-prime mortgages by pressuring lenders to help "underserved populations".
    Post edited by zombie_zoinks at 2014-01-30 19:23:08
  • As a libertarian, shouldn't you want to pay as much on your own rather than be in a communal pool?
  • I have never heard that libertarians have problems with insurance pools.
  • The problem is the "noise" - trying to cap costs is going to take away some things that some people take for granted and cause more ridiculous "death panel" discussions and no one has the political will to stand up or come together to make real change.

  • just as the government drove the issuance of sub-prime mortgages by pressuring lenders to help "underserved populations".



    sigh
    zombie lies never die
    pun intended

  • I have just managed to survive a horrific year to have my healthcare cancelled due to the ACA. I know have it renewed a new plan(hopefully), but the stress and inconvenience whole I am recovering from a major health issue was almost taking me to my grave. The ACA stinks in my opinion. I am low income, have always paid my way, had major health problems and do not have assurance that I can keep the same doctors.
  • Shoshanna - That's the way it used to be several decades ago. But then the employer-provided, comprehensive health insurance system ramped up and, along with that, the fees paid to providers ramped up. It was great (at least for awhile) if you had good insurance or were independently wealthy but sucked for those who did not. Unfortunately, you can't just stop covering those things because the whole system has evolved based on that kind of insurance being in place. So now we are trying to make that kind of insurance available to everyone and creating more unintended consequences. It's a mess.
  • I still think as I have said before that since insurance company profits are capped as a percentage of revenue under ACA the rational behavioral model is the pay out as much as possible to providers, either through higher payments or more procedures thus being able to raise premiums and make more in dollar terms out of their allowed percentage of profit but thus driving high health care inflation. But it is the government that has made such a model the most profitable, [...]



    I won't address your assertion about banking.

    I agree the danger you cite is very real. This is how the Bell System became so big. They had an incentive to increase costs.
  • eliz said:

    Why are mammos and colonoscopies preventative? They are screening/diagnostic. Lung cancer kills more people than breast or colon - so yearly lung xray?

    You're right, they're not. Preventative would be paying for docs to help people to quit/not start smoking, lose weight, etc.

  • Suzie2 said:

    eliz said:

    Why are mammos and colonoscopies preventative? They are screening/diagnostic. Lung cancer kills more people than breast or colon - so yearly lung xray?

    You're right, they're not. Preventative would be paying for docs to help people to quit/not start smoking, lose weight, etc.

    They prevent late-stage diagnosis.
  • be careful what news stories you post about the ACA. There are people who follow up and find out the real deal behind them.

    lol. what we have is absolute jerk employers who ideologically cost their employees cash.

    http://www.dailykos.com/story/2014/01/31/1273912/-LIVE-Pa-co-wrongly-thinks-it-s-health-ins-woes-are-ACA-related
  • Even if what the dailykos says is true and these people can go to the exchange to get cheaper coverage, how do you know that this is because of the jerk employers ideology? How do you know that this guy who runs a business w/ 6 employees understands how to navigate that stuff.

    HR departments give bad advice ALL THE TIME! When I worked for a small company that went public in the 90's we were advised to exercise/buy/hold our stock options. That was horrible advice. There was no political motivations involved. It was made out of ignorance(and perhaps hubris).

  • You're correct, its not the employer, they were just incompetent and trusted their insurance broker. Its the insurance broker who was corrupt.

    Why do you think the news was there at the time their new premiums were announced at this particular small company? The newscast was a set up.


    It appears that the insurance broker shown in your video, Charles E. Moore, has a strong ideological hatred of the Affordable Care Act. Here is a link to some of his published writings:

    http://www.americanthinker.com/...

    I hope you agree with me that there is something seriously wrong with this situation and, at the very least, this company’s employees deserve to know that they may not be getting the best – and most affordable – health insurance available to them.





    http://www.americanthinker.com/charles_e_moore/


  • I'm sure it was set up because they knew it was going to be bad. I would agree that it would be best for the employees to know all their options. And while, their insurance broker may have nefarious motives, why does this stuff need to be so complex? Inherent in the problem is that these bureaucracies become very complex.

    In the case where my HR department(and the bank handling the IPO) came and told people to buy and hold, you had people with AMT tax bills higher than their salary. This became somewhat difficult for these people to manage when the stock fell about 98%. I don't think there were political motivations. People are given bad advice for all sorts of reasons. If you think this is some isolated event, I think you are mistaken.
  • as the author of the dailykos post says, I'd have my ACA-dar working. Most people are trusting and wont look into their options when they get their premiums back from the unscrupulous.

    I'd guess you'd say caveat emptor, I say its unethical and a side effect of the propaganda pushed hard from the right-wing (R) side of the aisle in accordance with their own media accomplices at FOX that people do not know exactly where to look for insurance, find help in aquiring it, and know approximately how much it will cost them, and what the cost would be without the ACA.
  • Not caveat emptor really. I do think that people need to take responsibility for themselves. I do think that there is a tendency for these programs to become very complex. This coupled with the problematic rollout makes it difficult for people who work for a living to navigate it all.

    To say that this is a side effect of Fox propaganda is frankly pretty hilarious. I'm not defending Fox news, as its pretty bad. But to blame this kind of thing on them is pretty childish.
  • So, how is that tied to people not being able to effectively navigate the bureaucracy? Is Fox also responsible for small business owners and individuals not being able to effectively plan for the complexities of the tax code as well?

    I already agreed that Fox news is not a great news source. That hardly makes them unique. Even the NY Times runs hit pieces regularly. This is what is done in the press.
  • I think we agree that in general our - meaning American - media do not do a very good job informing the public.

    However my point is that the Fox new source and their subsidiary tentacles are not news sources, they are purely propaganda arms and as such are meant to misinform.
  • Not sure about the difficulty in "navigating the bureaucracy" here. Doesn't that just entail going onto the exchange website? Or calling the phone number? Doesn't seem to be much of a wall to climb.

    As regards to Fox news - don't dismiss them too handily. All they do is put out poison about Obamacare - a lot of people are going to come to the conclusion that to even consider going on the exchange is ridiculous. Bette of Spokane, who's healthcare story got twisted around in the GOP SOTU response, said "I wouldn't go on that Obama website at all,” , proud of her ignorance and ability to hurt herself by not availing herself of her best option. Did she get that from Fox? Maybe, maybe not. But she got it from somewhere like Fox.
  • Not sure about the difficulty in "navigating the bureaucracy" here. Doesn't that just entail going onto the exchange website? Or calling the phone number? Doesn't seem to be much of a wall to climb.

    As regards to Fox news - don't dismiss them too handily. All they do is put out poison about Obamacare - a lot of people are going to come to the conclusion that to even consider going on the exchange is ridiculous. Bette of Spokane, who's healthcare story got twisted around in the GOP SOTU response, said "I wouldn't go on that Obama website at all,” , proud of her ignorance and ability to hurt herself by not availing herself of her best option. Did she get that from Fox? Maybe, maybe not. But she got it from somewhere like Fox.



    Agree.

    I also think small business employers should stop offering health insurance and give employees the money towards insurance, which they can get in the exchange. I can't wait for insurance to be separated from employment more than it is now. This is a positive movement and I can't wait for it to gain speed.


  • hoops said:

    I think we agree that in general our - meaning American - media do not do a very good job informing the public.

    However my point is that the Fox new source and their subsidiary tentacles are not news sources, they are purely propaganda arms and as such are meant to misinform.



    There is tons of propaganda out there. Judith Miller's reporting in the NY Times purpose was exactly what you describe. This goes on all over the place. Fox, may be a particularly strong example. They are hardly alone.

    Not sure about the difficulty in "navigating the bureaucracy" here. Doesn't that just entail going onto the exchange website? Or calling the phone number? Doesn't seem to be much of a wall to climb.

    As regards to Fox news - don't dismiss them too handily. All they do is put out poison about Obamacare - a lot of people are going to come to the conclusion that to even consider going on the exchange is ridiculous. Bette of Spokane, who's healthcare story got twisted around in the GOP SOTU response, said "I wouldn't go on that Obama website at all,” , proud of her ignorance and ability to hurt herself by not availing herself of her best option. Did she get that from Fox? Maybe, maybe not. But she got it from somewhere like Fox.



    I have coverage through my wife's job. We never went to the site to check. I think its one thing if you don't have it through your employer. But if you are working, and that is typically what you do, it may not be obvious to you. There are always those who are not going to reason very well. Even I, who think the program is going to be a total disaster, would go to the site if I needed healthcare.
  • lisat, part of me agrees with you. I would eventually like a single payer system even, although you didn't say that. My concern is how complicated separating insurance from employers can become. I am a freelance union member with excellent insurance. To maintain it we have chosen to forgo any meaningful raises for years and years. If my insurance coverage is markedly decreased I'll never get those raises back. I'm not quite sure what the solution is.
  • just saying.... try figuring out, car insurance options.

    it may not be quite as complicated as healthcare insurance, but its pretty insane (at least here in NJ, maybe elsewhere, too).

    ACA is making this bubble up.... but its true about insurance in general
  • I'm confused. If you get your insurance through FU, how does that impact raises? If you're a freelancer, isn't your rate determined by negotiations with your client?
  • And in theory if the company doesn't have to pay for healthcare, they can pass that to employees so that they can pay for insurance.
  • FilmCarp, there must be more to your story than you're telling, because foregoing raises sounds nutty.
  • FilmCarp, there must be more to your story than you're telling, because foregoing raises sounds nutty.



    Fox News strikes again!
  • Colonoscopies are preventative because those small polyps that are removed and are benign do not have an opportunity to grow into cancerous lesions. It cuts the cancer rate significantly.
  • Even the "mainstream media" contributes to the propoganda. The front page of the Star Ledger said "Obamacare takes effect" or something along those lines. Um, it is NOT called Obamacare. If you consider yourself a legit media source, at least use the actual, accurate name!!
  • It's not a big deal, but it should be said that while it is complicated, it is still being fleshed out and maybe there will be improvements that we can all pick through.
  • I went back out on healthcare.gov again this afternoon to see if there was anything that would compete with the craptastic plan my employer changed to in anticipation of the ACA. Nada, zip, zilch. My new plan sucks a thousand times over yet nothing on healthcare.gov can compete with it. So lame. I guess I just have to accept that the days of actual high quality healthcare plans are a thing of the past.
    Post edited by wnb at 2014-02-03 21:37:00
  • wnb said:

    I went back out on healthcare.gov again this afternoon to see if there was anything that would compete with the craptastic plan my employer changed to in anticipation of the ACA. Nada, zip, zilch. My new plan sucks a thousand times over yet nothing on healthcare.gov can compete with it. So lame. I guess I just have to accept that the days of actual high quality healthcare plans are a thing of the past.



    ya see, that's what I'm afraid of when the employer mandate kicks in next year (?). Not sure if that's realistic or not, but you never know with a law as complex as this.

  • wnb said:

    I went back out on healthcare.gov again this afternoon to see if there was anything that would compete with the craptastic plan my employer changed to in anticipation of the ACA. Nada, zip, zilch. My new plan sucks a thousand times over yet nothing on healthcare.gov can compete with it. So lame. I guess I just have to accept that the days of actual high quality healthcare plans are a thing of the past.



    What was the best you could find? Your story strikes me as odd, because I got a good deal for myself. I'm paying $385/month for just myself, for a silver plan. Mind you, I'm in NY State, so things are different, but I wouldn't expect them to be drastically different. Maybe my plan is bad or expensive or both, but it's an improvement from what I had last year in both coverage and price. Maybe what you had last year was just super-fantastic?

  • Maybe what you had last year was just super-fantastic?



    Yes, I had a super-fantastic plan. But I think the days of super-fantastic plans are gone.
  • What do people consider high quality? I mean...what are the top positive and negative attributes you're considering when you evaluate a plan?
  • Deductible -- low
    Copays -- low
    No deductible for Rx meds
    Most impotant: low premium


  • RobB said:

    What do people consider high quality? I mean...what are the top positive and negative attributes you're considering when you evaluate a plan?




    Low deductible, predictable copays, good network. In that order.

    The absolute biggest negative in my current plan is that they did away with copays. Now instead we are responsible for a percentage of the cost of whatever service is received. Which, of course, is entirely unpredictable. You go to see a doctor you really have no idea what they're going to find, what tests they're going to order, let alone what each of those things is going to cost. We just get the bill 6-8 weeks later... And of course have to pay the whole thing, because now the damn deductible is so high. So those are some major negatives.

  • wnb said:



    RobB said:

    What do people consider high quality? I mean...what are the top positive and negative attributes you're considering when you evaluate a plan?




    Low deductible, predictable copays, good network. In that order.

    The absolute biggest negative in my current plan is that they did away with copays. Now instead we are responsible for a percentage of the cost of whatever service is received. Which, of course, is entirely unpredictable. You go to see a doctor you really have no idea what they're going to find, what tests they're going to order, let alone what each of those things is going to cost. We just get the bill 6-8 weeks later... And of course have to pay the whole thing, because now the damn deductible is so high. So those are some major negatives.



    I had a hard time adjusting to the HD plan after a copay plan but now I actually prefer it. Thankfully my employer funds my HSA to the full amount of my deductible but once I meet the deductible I don't pay anything.
  • @wnb, is there an out-of-pocket maximum?
  • @Tarheelsinnj, of course there is. And of course it, too, is astronomically higher than my old plan.

    ACA, in establishing minimum standards, also inadvertently, but predictably, established maximum standards as well.



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