Obamacare

GasBandit

Staff member
I agree. I guess I expected better out of you and hadn't realized you were being sarcastic with DA. God love the big lug, but DA is basically GB on the other side of the coin.
Politically, perhaps. But I don't think we're of similar temperment. I'm much more sarcastic and objective, whereas DA is very earnest and forthright but subjective and emotional about everything and takes almost everything personally.
 
Politically, perhaps. But I don't think we're of similar temperment. I'm much more sarcastic and objective, whereas DA is very earnest and forthright but subjective and emotional about everything and takes almost everything personally.
My financial situation is the result of messes of my own making. I have to live with that. And yes, I do take it personally when you keep dropping that afford line. Because it says to me that no matter how much I bust my ass at my job or taking care of my family, I'm not worthy of decent health care because I'm one of "teh poor".

I was supposed to have a cardiologist visit in June. The visit went like this:

Me: "How much is this going to cost?"
Them: "Do you have insurance?"
Me: "No."
Them: "$160."
Me: "Goodbye."

By the GasBandit standard, that's just too bad for me. Or, if thanks to a new government program I can now afford that visit without as much pain to the wallet, I'm now considered a thief? Damn right I take it personally.
 
My wife has become expert in working with medical billing. They are pretty good about letting us set up a payment plan with no interest that fits our ability to pay.

Of course that's only helpful because while we can't pay immediately, we will be able to pay later. Doesn't help where one cannot pay now or later.
 
go ahead and stop paying your taxes and see what happens.
I have no problem paying taxes so long as I receive value for doing so. Money is essentially work in tangible form, so ideologically I have no problem allocating some of my work for the greater good of society. I enjoy helping others, I find it personally very rewarding and see it as my duty to contribute to the health/success of my functioning society. Taxes are merely a formalized way of ensuring that all members of a society contribute to that society. What I do not enjoy is when people pervert/game this arrangement to their own ends, such as embezzlement ("There's so much. A little off the top for me won't hurt"), pork ("We cheat the other guy and pass the savings on to you"), leeches ("I'll have some of yours, but you can't have any of mine"), etc. They're all forms of theft, really. If nobody is seeding, then nobody can download, right? And if there are too few seeders, then they become overtaxed and no doubt bitter about having to hold up the entire cloud. That's hardly a community attitude, and it's why (ideally) everyone has to seed/tithe/pay taxes...otherwise it doesn't work. It also follows that the people with the fattest pipes will end up contributing the most packets to the flood, and have no legitimate standing to be outraged by this due to the Stan Lee/Voltaire principle. You gotta keep your ratio nice and high, otherwise you are cheating, plain and simple.

And if you don't believe me, go ahead and throttle your uploads and see what happens. ;)
Doesn't help where one cannot pay now or later.
There's that break-even point beyond which you have to decide whether working hard enough to earn enough money to repay the debt will kill you anyway, and whether you would just be happier/better off by forgoing care. I don't know if it's a supply/demand thing, but that whole idea of "the sweet release of Death" is abhorrent to me. I never want to find myself in any sort of situation where the idea of just going ahead and dying fills me with more hope and joy than it would if I were to continue to live.

--Patrick
 
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The current system is broken. You may feel the new system is better. It may be better, for you. Is it better for everyone? No. It's certainly not. I have friends losing good healthcare and having to trade down to a worse plan on obamacare, and paying more for it.
How is this the case when if you have insurance, you're complying with the law? The only way someone would have to trade down is if their employer took away their insurance as a result of the new law, as far as I know.
 

GasBandit

Staff member
How is this the case when if you have insurance, you're complying with the law? The only way someone would have to trade down is if their employer took away their insurance as a result of the new law, as far as I know.
Which is happening to an alarming degree. The cost of obamacare compliance has raised premiums in many places, and a lot of businesses have dropped either coverage entirely, or shrunk to only providing individual coverage but not spouse/dependent coverage.
 
The only way someone would have to trade down is if their employer took away their insurance as a result of the new law, as far as I know.
a lot of businesses have dropped either coverage entirely, or shrunk to only providing individual coverage but not spouse/dependent coverage.
There are also companies like Trader Joe's, which eliminated health care for some employees simply because it would be cheaper for Trader Joe's to just cut some of them off entirely (thus making them exchange-eligible) and then give them a check to go buy insurance for themselves on the exchanges.

This makes sense when you realize TJ's is owned by the same people who run Aldi. They're all about "business done as cheaply as possible."

--Patrick
 
A question regarding something that was mentioned in the shutdown thread: Isn't the government cost of healthcare largely due to the cost of Medicare and Medicaid? And, if the TAHA can partially or completely replace it, shouldn't it actually lower the costs of healthcare or at least come even (i.e. 'pay for itself' indirectly)? If it doesn't replace Medicare and Medicaid, what the fuck does it solve?

In any case, it seems clear should be done about this system. FFS, you are number 1 in healthcare spending (http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita ), and as much as 45% is apparently from the public sector! ( http://data.worldbank.org/indicator/SH.XPD.PUBL?order=wbapi_data_value_2011 wbapi_data_value wbapi_data_value-last&sort=asc ). In one of these threads @GasBandit compared the TAHA to 'burning the house down', something so objectively bad that you don't need to present an alternative. But that ignores the fact that there is an underlying problem: the house is rotten, what is your solution to that?

EDITED: I wrote ACA and I meant TAHA, I guess
 
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TAHA doesn't replace Medicare or Medicaid, in fact it was designed specifically not to address those people already covered but those two programs.

It is an additional cost on top of all of that. A huge additional cost.
 

GasBandit

Staff member
A question regarding something that was mentioned in the shutdown thread: Isn't the government cost of healthcare largely due to the cost of Medicare and Medicaid? And, if the ACA can partially or completely replace it, shouldn't it actually lower the costs of healthcare or at least come even (i.e. 'pay for itself' indirectly)? If it doesn't replace Medicare and Medicaid, what the fuck does it solve?

In any case, it seems clear should be done about this system. FFS, you are number 1 in healthcare spending (http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita ), and as much as 45% is apparently from the public sector! ( http://data.worldbank.org/indicator/SH.XPD.PUBL?order=wbapi_data_value_2011 wbapi_data_value wbapi_data_value-last&sort=asc ). In one of these threads @GasBandit compared the ACA to 'burning the house down', something so objectively bad that you don't need to present an alternative. But that ignores the fact that there is an underlying problem: the house is rotten, what is your solution to that?
The rot in the house has been vastly overstated, but it is there. The problem is the high cost of healthcare. This stems from the fact that because the consumer has become divorced from the actual costs ("Here's my insurance, bring on the MRIs and designer drugs because I paid my premiums and it's time to cash in"). I posted a story in an earlier ObamaCare thread a few weeks ago about -

Man needs hernia surgery, schedules it and tries to use his medical insurance. Hospital wants $20,000 up front for his portion of the cost.

Man cancels surgery, goes to different hospital, claims "self paying/no insurance," Hospital charges him $3000.

Methinks I see a glimmer of a solution.
There's plenty of things we haven't tried that might bring the cost of medical care down. Reintroducing competition to the market will help. Some think allowing insurance to be sold across state lines would also help. Perhaps instead of high premium, low deductible health plans we should try out high deductible, low premium HSA plans with employer contributions - for example, the insurance company that provides insurance for where I work offers an HSA plan that has a 10k deductible, but the premiums are less than $100 a month and every month the employer deposits $50 into your HSA account. That means that you're covered in case of catastrophic injury or illness, such as getting hit by a bus or cancer, and you have $600 a year on a debit card to pay in cash for lesser medical services (which as illustrated above can be much cheaper if you tell them you're paying in cash up front). And unlike traditional insurance, that HSA money rolls over from year to year. You can even choose to contribute more to your HSA if you want, and your contributions are tax deductible. So if you start one when you're young and healthy, by the time you're in your 30s you could have a very comfortable medical padding indeed, while actually spending much less over that time period. We could also revisit drug patents (20 years currently) to see about making it faster to get cheaper generics on the market.

But we're not interested in really having that debate. Everything's a crisis, everything demands immediate action. Immediate action that puts more control and spending power in the hands of the federal government. As I've often said, TACA has little to do with health care and a whole lot to do with control.
 
TAHA doesn't replace Medicare or Medicaid, in fact it was designed specifically not to address those people already covered but those two programs.

It is an additional cost on top of all of that. A huge additional cost.
Um, follow up question then. Why doesn't it? Is it this way by design or is it by compromise? I mean, Obama wanted other models that he was obviously not able to pass, such as single payer or an option of a government run insurance. Would these have covered part of the cost problem? Wouldn't it have been just an extension of Medicare/Medicaid?

GB yes, I see. Now that I remember all this more clearly (a few years ago I followed with some attention the problems and nuances of you healthcare system, but since they don't affect me I just forgot), I wouldn't say that it's a matter of wanting more control (I tend to think the best of people) but perhaps an attempt to solve these problems under the restrictions of: 1 - Medical insurance and industry lobbiesm 2- A society and political system that won't accept solutions that Obama would have preferred.

Anyway, thanks for answering.
 
Well, was able to get a user name and password on Healthcare.gov, but clicking anywhere on the page ends up causing an error, logging me out and sending me back to the log in page.

Frustrating, but I guess it's progress. Maybe by November I'll be able to check out all the healthcare plans available to me.
 

Dave

Staff member
My biggest pet peeve is that to find out what the exchanges would do for me I have to jump through flaming hoops. I am already on my work insurance and want to see if it would be cheaper and better to be on an exchange, but to do so I have to first fill out all the information about myself, my family and my income (which I have), then I need to take something to my work and have them fill it out (which I have not). Only then can I compare and contrast plans. Which is just stupid.
 
Well, was able to get a user name and password on Healthcare.gov, but clicking anywhere on the page ends up causing an error, logging me out and sending me back to the log in page.

Frustrating, but I guess it's progress. Maybe by November I'll be able to check out all the healthcare plans available to me.
That's where I'm at, too.
 
I dunno what the heck he was applying for, but my private insurance has never taken me that long to fill out, nor has it asked me for all that stuff he got asked. Not even Blue Cross/Blue Shield.
It probably depends on the state. Private insurance in NJ had really painful application procedures when I was using it a few years ago.
 

GasBandit

Staff member
It probably depends on the state. Private insurance in NJ had really painful application procedures when I was using it a few years ago.
That could be it. Hell, in Texas, the form is only slightly more complicated than

"Dj'ya want some insurance? (Yep/Nah) ____"
 
Hm, going through the process now. Seems to be working so far...

Edit: Application finished. Still have to wait to be 'verified' as who i say I am. Hopefully that doesn't take too long.
 
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Hm, going through the process now. Seems to be working so far...

Edit: Application finished. Still have to wait to be 'verified' as who i say I am. Hopefully that doesn't take too long.
Some of the online questions were just vague enough that I used up all my chances to verify myself that way. Then like an idiot I continued the application process without writing down the Experian reference number when I called outside of their office hours. When I finally did get through, they didn't have any record of me.

Long story short, I waited through the weekend and tried again this evening to upload a scan of my drivers license. Success. Application is done, ID verification pending. All I can do now is wait. I already know who the provider will be (Highmark only WV participant), so the only unknowns are the level of coverage and cost.
 
I dunno why, but for some reason I'm dreading the results. It's not like I have an income which is above the poverty level, though (yet, damn waiting to finish school to have a nice, happy, full time job). I'm really hoping I can find something reasonable for my wife and I.
 
Well, I got through the application process. Everything seems to be working smoothly now.

Got to the plan section. I chose to look at gold plans, since they most closely match my current coverage (80% coverage w/dental). I don't qualify for any subsidies (though no surprise there--I'm at 7X the poverty level for my county).

The plan that most closely matches my current insurance is about $800/month. I'm currently paying $584/month. That seems about right, since my employer subsidizes a portion of my health insurance. I know that under COBRA, my current insurance would be much higher than $800/month. Copays and generic drugs are slightly less through the marketplace, but we're talking about the difference of about $10. That would make a huge difference to someone near the poverty level, but really doesn't matter much in my own calculations.

Of course, I won't be signing up, and that's no surprise either. The marketplace isn't really designed for someone in my position. However, it's nice to know that if I ever make enough money through writing to be able to ditch the day job, I could get insurance at a much more reasonable rate than I would if I kept my current plan via COBRA, especially since my wife has had cancer in the past.

All told, I'm fairly satisfied with the end-user experience that I've seen.

Edit: Ok, things aren't all running smoothly. You're supposed to be able to make "household groups" so that you can put different people on different plans. I was going to carve my son out of our plan to see how that affected premiums (as he's covered by my ex-wife's insurance anyway), but it won't let me create more groups to split up our coverage options. I'll have to take a look at how that works later when they have it fixed.
 
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Still get "system unavailable" whenever I try at healthcare.gov.

I wonder if the people actually getting through are doing so through state exchanges?
 
Still get "system unavailable" whenever I try at healthcare.gov.

I wonder if the people actually getting through are doing so through state exchanges?
I'm going through healthcare.gov. Once everything was working, it took me about 15 minutes (not counting the previous days login attempts) to input the family information and browse all the 31 insurance plans I qualify for.

Interestingly, there were no Platinum level coverages for me to look at.
 
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I'm going through healthcare.gov. Once everything was working, it took me about 15 minutes (not counting the previous days login attempts) to input the family information and browse all the 31 insurance plans I qualify for.

Interestingly, there were no Platinum level coverages for me to look at.
Which state? I wonder if it's just healthcare.gov's michigan support that's having an issue.
 

Dave

Staff member
https://www.healthcare.gov/find-premium-estimates/

Just got in to where I could browse plans without actually signing up. It would be too expensive for me to use the exchange for anything other than the lowest-cost plans, especially for family. Problem is I can't get reimbursed or a tax break because I have insurance available through my work.

Now, looking at my current insurance - which is myself only because I can't afford family through my work - I pay $108.69 per month with a $350 deductible. Were I to use the Marketplace, I would be paying $333 a month. The difference is that my employer pays $434.74 per month for my coverage. So while the Marketplace is actually cheaper, it would cost me more because the employer wouldn't put in their part. Now, I can get catastrophic insurance through the Marketplace for $113, but that would be dumb.

Looking at family coverage, my work would charge $538 a month for a $1500 deductible to $799.64 for the $350 deductible. Marketplace is anywhere from $383 (catastrophic) to $1124 a month for platinum.

For myself and spouse only, work is $389 - 578 while the Marketplace runs $276 - 812.

So how do I feel about Obamacare? I'm still for it. Yes, the $333 a month would be difficult for an individual and most families won't be able to afford the platinum plan. But what this does is is does give options for those who have not been able to get anything before and in most cases if they are not working they will get breaks on those prices that will make them a lot more affordable. (I can't see how good because I don't have access due to my circumstances.) It also pushes as many people to get jobs where they can get coverage.

Here's what I don't get. Why are so many people saying this is bad for the insurance companies? It seems to me that they are losing nothing and instead getting a massive influx of people who will be signing up. The Marketplace makes it so that there are more options instead of just having to take the two or three plans you could get now.

Verdict to me is that this will be a good thing. I could be wrong, but initial impressions makes me think that it's going to have a positive effect. Now we need a single payer system and we'll be cooking with gas...
 

GasBandit

Staff member
Here's what I don't get. Why are so many people saying this is bad for the insurance companies? It seems to me that they are losing nothing and instead getting a massive influx of people who will be signing up. The Marketplace makes it so that there are more options instead of just having to take the two or three plans you could get now.
The system eliminates discrimination based on pre-existing condition, which sounds nice and smiley and flowers, but it's death for a company that has to maintain a profit/satisfy shareholders. The only way this can be balanced is if the young, robust, healthy people who rarely need any sort of doctor at all sign up in droves. Fun fact - I didn't bother with insurance until I was 24, I kept the extra money instead, because I was young and healthy and wanted the extra money. There are a lot of people like I was. If you give these people the choice of spending $1200+ per year to get insurance (and closer to $3600 if you want something besides catastrophic), or pay a $100 annual tax fee tax, well, I know which one 19 year old me would have chosen without a moment's hesitation. Thus, we're back to the problem of people metaphorically waiting to buy fire insurance until after the house is on fire, which is the very antithesis of what makes insurance work. Furthermore it does nothing to address the disconnect between patient and medical costs - everybody still continues on saying "I pay my premiums, I need an MRI for my stubbed toe, bring it on and send the bill to Humana." So medical care costs stay high, as they are now. It's pretty much a custom tailored silver bullet to drive a private insurance company to bankruptcy. But that's pretty much the plan - this is just a stepping stone to make the transition to single payer less of a shock.

But don't worry, I'm sure the thousands of IRS agents they hired to enforce TACA compliancy will have this running like warm, fuzzy clockwork in no time.
 
Out of curiosity, I used the premiums link that Dave just listed and the Kaiser subsidy calculator to see how much I would pay for the private individual insurance that I had 3 years ago when I was job-hunting in NJ.

At the time, I was paying $296 in a monthly premium for what was essentially catastrophic/bronze coverage. Under the healthcare exchange, I can get a silver individual plan for $260/month and according to the Kaiser subsidy calculator, 90% of that would be subsidized, to the point where I would only be paying $240 for the whole year.

I am no longer in those circumstances at all and get decent insurance through work, but were I still in the same position as I was 3 years ago, the healthcare exchange would have substantially better options than what was available previously.
 

Dave

Staff member
I worked in insurance for a very long time and know pretty much everything there is to know about it. (I used to pay claims for a TPA - Third Party Administrator. I'll explain that only if asked.)

I see what you are saying about both the pre-existing, youth, and insurance abuse, but I think you are overly pessimistic whereas others are overly optimistic. The ACA won't cause private insurance companies to go bankrupt. Yeah, the shareholders and stockholders will take a hit, but the profit margins are just so damned high that it can be absorbed. Maybe not as easily as some think, but it can be absorbed. It'll be very interesting to see how companies like BCBS do in fiscal year 2014. And by the way, HIPAA hurt BCBS a LOT because they had to completely revamp their IT infrastructure. I was working at BCBS when we had to put that in. And even though they took a hit, we still got about 10% profit sharing the following year.

So I understand your points and think that they will, indeed, have an effect on insurance companies. But I don't think it'll be as bad as you think.
 
I'm pretty sure I'll see a unicorn before I hear a healthcare professional talk positively about HIPAA. I really hope it's benefit is worth the gigantic PITA it seems to be.
 
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