Health insurance

[caligas]

For those of you that buy your own, what is your plan/thinking for next year? Premiums expected up 50%.

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[Noyac]

HSA

 

[caligas]

HSA

Lol, wish it was that easy. Although I agree they are a great idea and should be used as a retirement vehicle for most of us that can afford to do so.

We have an hsa plan and a $10,000 deductible. Still pay almost 20k for the annual premiums for my family on my private group's plan. Expecting that to go up 50% or more next year.

 

[Arch Guillotti]

HSA

I have an HSA but it is pretty expensive and the premiums go up as well.

 

[Precedexed Out]

Lol, wish it was that easy. Although I agree they are a great idea and should be used as a retirement vehicle for most of us that can afford to do so.

We have an hsa plan and a $10,000 deductible. Still pay almost 20k for the annual premiums for my family on my private group's plan. Expecting that to go up 50% or more next year.

Thanks Obama for not addressing the real issue of healthcare, the cost. The ACA was designed with one thing in mind, more profit for the health insurance companies. And their profits have reflected that.

 

[deleted171991]

Thanks Obama for not addressing the real issue of healthcare, the cost. The ACA was designed with one thing in mind, more profit for the health insurance companies. And their profits have reflected that.

Yeah, I can really see Obama obsessing about that.😆

The ACA was doomed to fail because the penalties for (healthy) uninsured people were a joke.

 

[caligas]

Yeah, I can really see Obama obsessing about that.😆

The ACA was doomed to fail because the penalties for (healthy) uninsured people were a joke.

Exactly! Actually a pretty good overall plan but with a huge, obvious, fatal flaw. I was screaming this from day one.

 

[Precedexed Out]

Yeah, I can really see Obama obsessing about that.😆

The ACA was doomed to fail because the penalties for (healthy) uninsured people were a joke.

I don't support an additional tax for lower income Americans. Most of the ACA plans are a joke. Five or ten thousand dollar deductibles before the insurance starts paying. Better off to pay the penalty and take chances. The real problem with healthcare, costs are too damn high. The ACA was written by health insurance companies to benefit health insurance companies. Sounds like a dream for these companies, help write a law that forces consumers to buy your product.

 

[Precedexed Out]

Exactly! Actually a pretty good overall plan but with a huge, obvious, fatal flaw. I was screaming this from day one.

It was not a pretty good overall plan, come done from your ivory towers and learn about the plans. They are horrible. My parents were on one of the plans, costed them over $1300 a month with a $16,000 deductible. How much sense does it make for one to pay that much each month for something that doesn't benefit them at all until they spend 16 grand when their combined salary is near 50k? It makes none for any rational person. Better off to pay the penalty and save that money.

 

[Precedexed Out]

Obamacare deductibles on the rise for 2017, along with monthly premiums

This article says everything about the failure called Obamacare. "Families enrolled in bronze plans will have average deductibles of $12,393."

Over $12,000 for a family after paying 4-5-600 or more premiums each month. That isn't practical for low income families.

It is clear that Obamacare was designed to benefit the insurance companies. Record profits for health insurance companies in combination with increasing premiums in the context of a law designed to force Americans to buy their product. A real winner for health insurance companies. A real loser for taxpayers and those who need to buy usable insurance.

Profits are booming at health insurance companies

Anyone who denies the ACA wasn't of tremendous benefit for the healthcare industry is in denial....aka @FFP. Noticed @FFP posted something and then deleted it quickly. Guess @FFP doesn't want to discuss, easier to ignore, especially when clearly wrong. Somehow the fatal flaw was not having a higher penalty??? You can't be serious. The fatal flaw is the plans suck and offer no practical benefit to consumers.

For example, I'll pay amount x on health insurance premiums with a deductible of y to reduce the risk of not being able to afford my medical bills. I won't pay 10x with a deductible of 15y because it isn't practical based on my income of 35x. It really isn't as difficult as you try to make it seem when considering why people aren't buying these garbage plans, but you would rather ignore facts and the reality of the circumstances of low income America.

 

[Precedexed Out]

Obamacare deductibles on the rise for 2017, along with monthly premiums

This article says everything about the failure called Obamacare. "Families enrolled in bronze plans will have average deductibles of $12,393."

Over $12,000 for a family after paying 4-5-600 or more premiums each month. That isn't practical for low income families.

It is clear that Obamacare was designed to benefit the insurance companies. Record profits for health insurance companies in combination with increasing premiums in the context of a law designed to force Americans to buy their product. A real winner for health insurance companies. A real loser for taxpayers and those who need to buy usable insurance.

Profits are booming at health insurance companies

Anyone who denies the ACA wasn't of tremendous benefit for the healthcare industry is in denial....aka @FFP. Noticed @FFP posted something and then deleted it quickly. Guess @FFP doesn't want to discuss, easier to ignore, especially when clearly wrong. Somehow the fatal flaw was not having a higher penalty??? You can't be serious. The fatal flaw is the plans suck and offer no practical benefit to consumers.

For example, I'll pay amount x on health insurance premiums with a deductible of y to reduce the risk of not being able to afford my medical bills. I won't pay 10x with a deductible of 15y because it isn't practical based on my income of 35x. It really isn't as difficult as you try to make it seem when considering why people aren't buying these garbage plans, but you would rather ignore facts and the reality of the circumstances of low income America.

@FFP @caligas

Where are you in responding to this? Definitely plenty of substance here with some inconvenient facts. Normally you have no problem commenting, can't argue with facts? The fact is these plans suck and that is why people don't buy them. Even if they buy them, it is simply an addition tax to the health insurance companies because there is very little or no benefit in this type of health insurance for consumers.

 

[caligas]

@FFP @caligas

Where are you in responding to this? Definitely plenty of substance here with some inconvenient facts. Normally you have no problem commenting, can't argue with facts? The fact is these plans suck and that is why people don't buy them. Even if they buy them, it is simply an addition tax to the health insurance companies because there is very little or no benefit in this type of health insurance for consumers.

Please forgive me for spending Sunday with my family and not mentally masturbating on SDN, maybe FFP is available to debate with you.

 

[Precedexed Out]

Please forgive me for spending Sunday with my family and not mentally masturbating on SDN, maybe FFP is available to debate with you.

Enjoy the day with your family. I look forward to reading your response tomorrow.

 

[Lecithin5]

It was not a pretty good overall plan, come done from your ivory towers and learn about the plans. They are horrible. My parents were on one of the plans, costed them over $1300 a month with a $16,000 deductible. How much sense does it make for one to pay that much each month for something that doesn't benefit them at all until they spend 16 grand when their combined salary is near 50k? It makes none for any rational person. Better off to pay the penalty and save that money.

This

 

[chessknt]

Calling b.s. on the premium for lower income household being that high for a deductible that high. I see low income patients in a relatively low income state and they manage to afford these plans. I ran a premium for 2x 48 year old nonsmokers on healthcare.gov with 50k in kansas and it shows bronze premiums of 400/month after tax credit.

 

[Precedexed Out]

Calling b.s. on the premium for lower income household being that high for a deductible that high. I see low income patients in a relatively low income state and they manage to afford these plans. I ran a premium for 2x 48 year old nonsmokers on healthcare.gov with 50k in kansas and it shows bronze premiums of 400/month after tax credit.

Call BS all you want. That is the reality of these plans. I have helped my parents and others sign up (or not) for these plans. I have been on the exchange multiple times over years. The Bronze plans typically have a very high deductible ($12k or $16k is typical) with high premiums, usually at least 300-400 per month.

Don't forget the $400 premium is after the tax credit. Not surprising that the health insurance companies are making record profits. Talk about corporate welfare.

With the $400 premium, annual premium cost is $4800. Then you must spend at least $12,000 (sometimes $16,000) to utilize any benefits. That sum is $16,800 (or $20,800) and these are people making under $50,000 (often much less). Nothing about this type of insurance makes any sense, except for the insurance companies as they fatten the ole' wallet.

And you state "manage to afford." You're taking a huge portion of annual income that does nothing to benefit the consumer. That is the truth, no matter how you slice it.

 

[Onefellswoop87]

So @Precedexed Out , what’s your better solution? The rates of raise of the healthcare costs slowed after the ACA compared to pre-2008ish.

Repeal the ACA? And the insurance companies will drop their prices because they are altruistic? Nope. I predict even more healthy patients would drop out, and the pool then is relatively sicker so premiums need to rise to compensate. That’s my one sentence summary of the effect of repeal.

I hear you that you don’t like it. But what’s the next step? What do got propose to make it better and cheaper and maintain coverage? Cause pissing and moaning doesn’t add to the discussion or solve anything. I don’t know what to do. Except possibly a single payer, which makes the biggest pool. And we have near 50% on a governmental payer (TriCare, Medicare, Medicare, etc). Or “death panels” - though we arguably have those already by insurance pre-authorizations, but it’s just not done by the government cause that’s even scarier to people.

 

[VA Hopeful Dr]

So @Precedexed Out , what’s your better solution? The rates of raise of the healthcare costs slowed after the ACA compared to pre-2008ish.

Repeal the ACA? And the insurance companies will drop their prices because they are altruistic? Nope. I predict even more healthy patients would drop out, and the pool then is relatively sicker so premiums need to rise to compensate. That’s my one sentence summary of the effect of repeal.

I hear you that you don’t like it. But what’s the next step? What do got propose to make it better and cheaper and maintain coverage? Cause pissing and moaning doesn’t add to the discussion or solve anything. I don’t know what to do. Except possibly a single payer, which makes the biggest pool. And we have near 50% on a governmental payer (TriCare, Medicare, Medicare, etc). Or “death panels” - though we arguably have those already by insurance pre-authorizations, but it’s just not done by the government cause that’s even scarier to people.

Read up on the plan that Rand Paul proposed.

 

[Onefellswoop87]

Read up on the plan that Rand Paul proposed.

https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf

Big emphasis on HSA. I’ll admit my ignorance cause I don’t use them (TriCare here). But doesn’t that just use pre-tax monies? Doesn’t seem to help those in lower income brackets. And why would they lower health care expenditure?

And a big emphasis on cross state line purchase. But don’t we effectively do that already? Blue Cross Blue Shield VA & NC for example, which already increases the pool of patients. And, I believe each state has different insurance requirements, which makes any other aspect of cross state coverage tricky.

And won’t all the association health plans just make lots of smaller pools and drive up costs?

I’m skeptical of its effect but thanks for directing me to check it out.

 

[chessknt]

Saying health insurance doesn't provide any benefit to consumers is a fundamental misunderstanding of how insurance works. It is something you buy to protect against catastrophic loss. Losing 40% of your annual income in an accident is better than still losing 10000%. THAT is the truth no matter how you slice it.

 

[acidbase1]

I had excellent affordable insurance prior to Obamacare

 

[vector2]

Saying health insurance doesn't provide any benefit to consumers is a fundamental misunderstanding of how insurance works. It is something you buy to protect against catastrophic loss. Losing 40% of your annual income in an accident is better than still losing 10000%. THAT is the truth no matter how you slice it.

I think this country framing healthcare as health "insurance" is a completely wrong narrative to begin with. Millions of people go their entire driving lives with never having to file an accident claim. Regular car maintenance is not paid for, but it's also typically affordable. On the other hand, literally everyone (barring a few nutjobs in bathtubs) required thousands of dollars worth of medical care as a newborn or a parturient. Almost every kid requires a decent amount of medical care as an infant and toddler. If we are to follow USPSTF guidelines, every woman needs reproductive health checks once they hit their late teens or twenties. Every person needs preventative health checks (mammo, colo, PSA etc) once they hit their 40s-60s. A service required this frequently is not something one should need "insurance" for

 

[Southpaw]

I had excellent affordable insurance prior to Obamacare

As a resident? Sure so did everyone during residency.

 

[Southpaw]

Call BS all you want. That is the reality of these plans. I have helped my parents and others sign up (or not) for these plans. I have been on the exchange multiple times over years. The Bronze plans typically have a very high deductible ($12k or $16k is typical) with high premiums, usually at least 300-400 per month.

Don't forget the $400 premium is after the tax credit. Not surprising that the health insurance companies are making record profits. Talk about corporate welfare.

With the $400 premium, annual premium cost is $4800. Then you must spend at least $12,000 (sometimes $16,000) to utilize any benefits. That sum is $16,800 (or $20,800) and these are people making under $50,000 (often much less). Nothing about this type of insurance makes any sense, except for the insurance companies as they fatten the ole' wallet.

And you state "manage to afford." You're taking a huge portion of annual income that does nothing to benefit the consumer. That is the truth, no matter how you slice it.

I thought you were a conservative. All about the free market and capitalism. This is end of that free wheeling road. All of the health insurance companies have consolidated to just a few, so they can essentially charge what they want. Am I wrong about your core beliefs?

P.S. If your parents were actually meeting their high deductible each year, they should've bumped up to a silver or gold plan. Higher monthly premium but much lower deductible. They also hopefully utilized a HSA and paid the deductible at least partially with pre-tax income.

 

[acidbase1]

As a resident? Sure so did everyone during residency.

Both before and during residency. A lot of friends has great insurance before obamacare

In fact, obamacare went into effect my CA2 year. We went from having incredible insurance with no deductible to having to pay 5k every child we had. Was awesome

 

[nimbus]

Both before and during residency. A lot of friends has great insurance before obamacare

In fact, obamacare went into effect my CA2 year. We went from having incredible insurance with no deductible to having to pay 5k every child we had. Was awesome

I agree our insurance premiums have more than doubled since the passage of ACA. I also know 2 self employed people who previously couldn't get coverage because they've had cancer who now have something. So the rise in premiums may be the cost of coverage for people who previously could not get insurance or a boon for the insurance conglomerates. Probably a combination of both.

 

[Southpaw]

Both before and during residency. A lot of friends has great insurance before obamacare

Well yeah sure, and insurance companies were allowed to charge whatever whenever to people based on age/disease. They could also deny or withdraw coverage at a whim. You think that's healthy for an entire country? I'm guessing you're healthy and hence were happy before the change? So was I. I've personally, as a physician in private practice, watched my premiums almost double in the past 4 years. All for a very high deductible. Is it frustrating? Sure, but without a two-tiered system, or single payor, I don't see much of an alternative for insuring an entire country when there are 3-4 private companies who are gouging us.

I've read @Precedexed Out, you, and others complain about Obamacare, all without suggesting any real solution. I'm shocked that conservatives tout capitalism and the free market, and yet with healthcare it's absolutely failed you (and everyone). Reading between the lines, it appears to me that you're all arguing for single payor, or a two-tiered system, or maybe you're just okay with a significant percentage of the country (those with a serious health condition) being unable to obtain/afford insurance so that you can have lower premiums. I've yet to see anyone who complains about Obamacare present a healthy, sustainable alternative.

 

[chessknt]

I think this country framing healthcare as health "insurance" is a completely wrong narrative to begin with. Millions of people go their entire driving lives with never having to file an accident claim. Regular car maintenance is not paid for, but it's also typically affordable. On the other hand, literally everyone (barring a few nutjobs in bathtubs) required thousands of dollars worth of medical care as a newborn or a parturient. Almost every kid requires a decent amount of medical care as an infant and toddler. If we are to follow USPSTF guidelines, every woman needs reproductive health checks once they hit their late teens or twenties. Every person needs preventative health checks (mammo, colo, PSA etc) once they hit their 40s-60s. A service required this frequently is not something one should need "insurance" for

The bronze plans provide all routine care for free. If you require frequent or more advanced care you need a higher level plan with a lower deductible. You can call it insurance or a plan or a service--you have the choice to buy an appropriate plan in exchange for a service.

 

[vector2]

The bronze plans provide all routine care for free.

A mandated, comprehensive list of adult, women, and child preventive care and screening services at no additional charge was not a thing in American health insurance until Obamacare. Sure, HIC's probably increased their premiums in response to this, but it's still a bit shocking that no legislator had ever put this basic tenet to paper before 2009-2010. FYI, removing mandated preventive services is one of the key parts of any current GOP healthcare proposal. Do you think HIC's will likewise drop their premiums in response if a GOP bill passed?

 

[urge]

A mandated, comprehensive list of adult, women, and child preventive care and screening services at no additional charge was not a thing in American health insurance until Obamacare. Sure, HIC's probably increased their premiums in response to this, but it's still a bit shocking that no legislator had ever put this basic tenet to paper before 2009-2010. FYI, removing mandated preventive services is one of the key parts of any current GOP healthcare proposal. Do you think HIC's will likewise drop their premiums in response if a GOP bill passed?

Normal healthcare (screening, preventive, chronic drugs...) should not be part of healthcare insurance.

It would be analogous to having house insurance that covers paint jobs, kitchen and bathroom remodels, roof replacements, etc. Makes no sense. That would be extremely expensive. Yet you ask for the same for healthcare insurance and then complain about the cost.

Insurance should be for the unpredictable things.

 

[vector2]

Normal healthcare (screening, preventive, chronic drugs...) should not be part of healthcare insurance.

It would be analogous to having house insurance that covers paint jobs, kitchen and bathroom remodels, roof replacements, etc. Makes no sense. That would be extremely expensive. Yet you ask for the same for healthcare insurance and then complain about the cost.

Insurance should be for the unpredictable things.

I made your point a few posts above the one you quoted but used a car analogy instead of a house. Calling any part of health care "insurance" is silly when just the process of being born costs thousands of dollars, and it's especially silly given the inevitability of expensive diseases that will arise due to our much longer modern lifespans. Human beings are not cars. Human beings are not houses. We should stop framing the insurance narrative as if we are.

You say that screening, preventive, chronic drugs shouldn't be insured, but yet three hundred million people still need these things. I don't think these things should be "insured" either- I think these (along with the rest of healthcare, catastrophic or not) should be available to everyone and funded by taxpayers. But I don't think that was what you were getting at when you said they shouldn't be a part of healthcare insurance?

Me, personally, I'm a fan of the Australian system. Everyone gets a government plan that covers basic preventive and catastrophic, and if you want to go to some fancier hospital or get a concierge primary you can buy supplemental insurance or pay out of pocket. Does such a system result in some people having to wait 6 months instead of 3 weeks to get their knee replaced? Probably. Do I think that a prolonged wait time is worth getting 10-30 million people some healthcare instead of no healthcare? Yep.

 

[VA Hopeful Dr]

Something that no one ever talks about it's just how inexpensive the vast majority of preventive care is. That is why I don't think that health insurance should pay for it.

I think one can make an exception for vaccinations, as those can be expensive but most importantly are very much a public health good.

 

[Planktonmd]

Thanks Obama for not addressing the real issue of healthcare, the cost. The ACA was designed with one thing in mind, more profit for the health insurance companies. And their profits have reflected that.

He couldn't address the "real issues" because the republicans did everything they could to prevent it. The initial plan was to start the transition towards a single payer system which is the only viable solution, but the republicans wouldn't allow it because it hurts the fat cats of the insurance and pharmaceutical mafias.
The result was a complicated and sub-optimal solution but it still allowed millions of people who never had health insurance to be insured.
Now they have decided to cripple that solution and hold the American healthcare system hostage for a stupid political gain and an idiotic campaign slogan.

 

[Planktonmd]

Something that no one ever talks about it's just how inexpensive the vast majority of preventive care is. That is why I don't think that health insurance should pay for it.

I think one can make an exception for vaccinations, as those can be expensive but most importantly are very much a public health good.

So you think it's better to pay for the complications that result from the lack of preventive medicine than try to invest in improving health?

 

[aneftp]

To put things into perspective for all you ACA lovers.

1.2013 pre ACA we paid as a family of four $750/month for full blown PPO with $6000 max in network deductible.

2014 it went up to $1100/month with $7200 deductible PPO

2015 it went up to $1400/month with $7200 deductible

2016 it went up to $1600/month with $7200

2017 up to $1750 with $7200 PPO (or I could pay $1050 with a whopping $12700 deductible)
(Or I could pay $1450 with a more restricted (EPO, like a cross between hmo and PPO)

Of course I got maternity coverage!! From all this with the ACA. Yet my previous self employed insurance was only $400 in 2010 (plus the $200 a month maternity rider for family )

U see the ACA jacks up prices for healthy people making over 400 percent of poverty.

The obama administration and the liberals try to downplay the huge rate increases only increase for a few people. Well 400 percent of poverty is roughly 45k for single person and 100k for a family of four. That’s a lot of people getting affected.

 

[BLADEMDA]

Most of the party’s potential 2020 presidential candidates have now endorsed the single-payer idea, including Sanders, Harris, Sen. Cory Booker of New Jersey, Sen. Elizabeth Warren of Massachusetts, New York Sen. Kirsten Gillibrand and Minnesota Sen. Al Franken.

Competing Democratic healthcare plans are due out soon, including one that would allow Americans to buy coverage through Medicaid and another that would expand Medicare, efforts less disruptive than Sanders’ proposal. But the authors of both have cast them as bridges to a time when a single government plan can gain a majority.


Turning aside risk, Democrats rally to Bernie Sanders' single-payer health plan

 

[Planktonmd]

To put things into perspective for all you ACA lovers.

1.2013 pre ACA we paid as a family of four $750/month for full blown PPO with $6000 max in network deductible.

2014 it went up to $1100/month with $7200 deductible PPO

2015 it went up to $1400/month with $7200 deductible

2016 it went up to $1600/month with $7200

2017 up to $1750 with $7200 PPO (or I could pay $1050 with a whopping $12700 deductible)
(Or I could pay $1450 with a more restricted (EPO, like a cross between hmo and PPO)

Of course I got maternity coverage!! From all this with the ACA. Yet my previous self employed insurance was only $400 in 2010 (plus the $200 a month maternity rider for family )

U see the ACA jacks up prices for healthy people making over 400 percent of poverty.

The obama administration and the liberals try to downplay the huge rate increases only increase for a few people. Well 400 percent of poverty is roughly 45k for single person and 100k for a family of four. That’s a lot of people getting affected.

The insurance companies raised your premiums not the ACA, and the reason they can do that is because the republicans would not allow effective regulation of the insurance companies. So you are basically paying the insurance industry to compensate for the cost of the ACA since the ACA was not allowed to include mechanisms to hold insurance companies accountable for sucking your blood.

 

[caligas]

Call BS all you want. That is the reality of these plans. I have helped my parents and others sign up (or not) for these plans. I have been on the exchange multiple times over years. The Bronze plans typically have a very high deductible ($12k or $16k is typical) with high premiums, usually at least 300-400 per month.

Don't forget the $400 premium is after the tax credit. Not surprising that the health insurance companies are making record profits. Talk about corporate welfare.

With the $400 premium, annual premium cost is $4800. Then you must spend at least $12,000 (sometimes $16,000) to utilize any benefits. That sum is $16,800 (or $20,800) and these are people making under $50,000 (often much less). Nothing about this type of insurance makes any sense, except for the insurance companies as they fatten the ole' wallet.

And you state "manage to afford." You're taking a huge portion of annual income that does nothing to benefit the consumer. That is the truth, no matter how you slice it.

would it suffice to agree with you that the Obama administration blew it, that the results are a disaster, and we are all literally paying a huge price?

That was the original point of starting the thread, trying to figure out a way of paying $30-50k on health premiums next year.

My comment in support of the law in general is based on my belief that the law, in its essence, was not intended to enrich insurance executives but to get everyone covered at reasonable cost. This task may have been and continue to be impossible. How can government correct a problem when half the country is rabidly apposed to government intervention in that problem. “Keep government out of health care, and keep your hands off my Medicare!!!” The viable solution for the Obama administration was to cover the gap through private insurance, subsidizing those who need it. The crux, and where the law was wise in concept but inept in execution, was getting young and healthy people into the insurance pool. Why have such a ridiculously low penanlty for failure to comply? Clearly this incentivized the young and healthy to avoid buying insurance, leading to the vicious cycle of increasing costs, leading to a sicker older insurance pool, leading to higher costs. Trump sees that he can easily finish the bill off by further destabilizing the exchanges.

 

[VA Hopeful Dr]

So you think it's better to pay for the complications that result from the lack of preventive medicine than try to invest in improving health?

Yes because that's obviously what I said.

Why don't you go actually look and tell me how much all of the preventive medicine stuff we do costs before you accuse me of something ridiculous.

 

[Planktonmd]

Yes because that's obviously what I said.

Why don't you go actually look and tell me how much all of the preventive medicine stuff we do costs before you accuse me of something ridiculous.

I am not accusing you of anything! Just confirming that you think that the majority of people in this country are smart enough to pay out of pocket for preventive medicine even if it costs pennies. You are obviously an optimist.

 

[Southpaw]

Yes because that's obviously what I said.

Why don't you go actually look and tell me how much all of the preventive medicine stuff we do costs before you accuse me of something ridiculous.

Not disagreeing with you, but right or wrong most Americans feel health insurance should cover preventative care, including regular checkups. Perhaps part of any solution will involve changing that mindset.

 

[Southpaw]

The obama administration and the liberals try to downplay the huge rate increases only increase for a few people. Well 400 percent of poverty is roughly 45k for single person and 100k for a family of four. That’s a lot of people getting affected.

Beyond playing the blame game (liberal is such a dirty word!!), could you explain why you’re blaming the government, or an administration, for an insurance company increasing your costs of coverage? Why isn’t your scorn directed at Aetna/Anthem/lobbyists?

 

[vector2]

Something that no one ever talks about it's just how inexpensive the vast majority of preventive care is. That is why I don't think that health insurance should pay for it.

I think one can make an exception for vaccinations, as those can be expensive but most importantly are very much a public health good.

Inexpensive or not, just the fact that it costs something (or has the appearance of costing something) makes people use it less. This is what is borne out epidemiologically. Time and time again, the research demonstrates that humans are terrible at evaluating actuarial risk (also here and here) when the risk is not immediately visibly apparent. It's an attractive and intuitive idea to just tell people to take responsibility and take care of themselves using out of pocket expenses. Unfortunately, that mindset leads to whole populations of uninsured 20 year olds getting into polytraumas and uninsured 50 year old prediabetics having someone else foot the bill (no pun intended) for their amputation. As a healthy person who hasn't been to a doctor in like 6 years, I don't mind paying my premium and contributing to someone else's LDL check and Lipitor script if that means I hopefully don't have to pay for their CABG.


Preventive Health Care | Gateway to Health Communication | CDC
--------------
Preventive Health Care

What's the Problem?

Nationally, Americans use preventive services at about half the recommended rate. Cost-sharing such as deductibles, co-insurance, or copayments also reduce the likelihood that preventive services will be used. One study found that the rate of women getting a mammogram went up as much as 9% when cost-sharing was removed.

Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Americans each year and account for 75% of the nation’s health spending. These chronic diseases can be largely preventable through close partnership with your healthcare team, or can be detected through appropriate screenings, when treatment works best.

Eating healthy, exercising regularly, avoiding tobacco, and receiving preventive services such as cancer screenings, preventive visits and vaccinations are just a few examples of ways people can stay healthy. The right preventive care at every stage of life helps all Americans stay healthy, avoid or delay the onset of disease, keep diseases they already have from becoming worse or debilitating, lead productive lives, and reduce costs.

And yet, despite the benefits of many preventive health services, too many Americans go without needed preventive care, often because of financial barriers. Even families with insurance may be deterred by copayments and deductibles from getting cancer screenings, immunizations for their children and themselves, and well-baby check-ups that they need to keep their families healthy.

The Affordable Care Act (ACA) makes preventive care affordable and accessible by requiring certain private health plans to cover certain recommended preventive services without charging a deductible, copayment, co-insurance, or other cost sharing. Under this new requirement, those services including well-woman visits, support for breastfeeding equipment, domestic violence screening and counseling, became more broadly available without cost sharing. More information on the requirement that insurers cover cost-free preventive care is available at: Shining a Light on Health Insurance Rate Increases

For people with Medicare, The Medicare Improvement for Patients and Providers Act (MIPPA) of 2008 established a three-part standard for Medicare coverage of preventive services, and the ACA directs Medicare to waive beneficiary co-insurance and deductible liability for certain covered preventive services.

Who's at Risk?

Opportunities for prevention impact all Americans, regardless of age, income, or perceived health status. Each year, potentially preventable chronic diseases (e.g., heart disease, cancer, diabetes) are responsible for millions of premature deaths among Americans. The five leading causes of death in the U.S. are heart disease, cancer, chronic lower respiratory disease, stroke, and unintentional injuries. Because health problems impact productivity, health problems are a major drain on the economy, resulting in 69 million workers reporting missed days due to illness each year. This loss of productivity reduces economic output by $260 billion per year.

Although most Americans underuse preventive services, individuals experiencing social, economic, or environmental disadvantages are even less likely to use these services. Examples of obstacles include lack of access to quality and affordable health care, lack of access to healthy food choices, unsafe environments, and a lack of educational and employment opportunities.

The ACA has already helped women in private plans with cost-sharing, like waiving coinsurance or deductibles for certain preventive services such as mammograms, cholesterol screenings, and flu shots, amongst other benefits.

Can It Be Prevented?

Preventing disease is key to improving America’s health and keeping rising health costs under control. When we invest in prevention, the benefits are broadly shared. Children grow up in communities, homes, and families that nurture their healthy development, and adults are productive and healthy, both inside and outside the workplace. Businesses benefit because a healthier workforce reduces long term health care costs and increases stability and productivity. Furthermore, communities that offer a healthy, productive, stable workforce can be more attractive places for families to live and for businesses to locate. Further discussion of these benefits is available in the National Prevention Strategy at Prevention & Getting Care.

The ACA has already helped women in private plans with cost-sharing, like waiving coinsurance or deductibles for certain preventive services such as mammograms, cholesterol screenings, and flu shots, amongst other benefits.
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[VA Hopeful Dr]

Not disagreeing with you, but right or wrong most Americans feel health insurance should cover preventative care, including regular checkups. Perhaps part of any solution will involve changing that mindset.

I think we can all agree there are a number of Paradigm shifts that need to happen in patient attitudes. From where I sit, we need to divorce everyone from the idea that insurance should pay for an expensive things. One of the biggest drivers of cost is the fact that no one knows what anything actually costs and insurance pays for it anyway.

That lipid panel and Lipitor prescription that someone mentioned previously, cost $7 per test and around $5 per month if you pay cash. If insurance pays for them, they are more like $50, and $30 per month respectively.

 

[VA Hopeful Dr]

I am not accusing you of anything! Just confirming that you think that the majority of people in this country are smart enough to pay out of pocket for preventive medicine even if it costs pennies. You are obviously an optimist.

Not so much an optimist as a realist. If things are inexpensive, patients will pay for them. This is coming from a guy who ran a successful cash only Family Medicine office for 2 years. I know what I'm talking about with regards to this.

 

[Southpaw]

One of the biggest drivers of cost is the fact that no one knows what anything actually costs and insurance pays for it anyway.

I agree. I quote this part of your post because I’ve come to believe hospitals and pharmaceutical companies have played an active role in hiding costs (and exorbitantly overcharging). As an anesthesiologist, it’s somewhat difficult to get answers on how much something costs (and when I find it, it’s what the hospital is charged). I’m still clueless as to what patients are actually charged. And that’s murky due to insurance plans/deductibles/co-pays. You’d have to be really dense to think some, or all, of that isn’t intentional.

 

[d9sccr]

Well yeah sure, and insurance companies were allowed to charge whatever whenever to people based on age/disease. They could also deny or withdraw coverage at a whim. You think that's healthy for an entire country? I'm guessing you're healthy and hence were happy before the change? So was I. I've personally, as a physician in private practice, watched my premiums almost double in the past 4 years. All for a very high deductible. Is it frustrating? Sure, but without a two-tiered system, or single payor, I don't see much of an alternative for insuring an entire country when there are 3-4 private companies who are gouging us.

I've read @Precedexed Out, you, and others complain about Obamacare, all without suggesting any real solution. I'm shocked that conservatives tout capitalism and the free market, and yet with healthcare it's absolutely failed you (and everyone). Reading between the lines, it appears to me that you're all arguing for single payor, or a two-tiered system, or maybe you're just okay with a significant percentage of the country (those with a serious health condition) being unable to obtain/afford insurance so that you can have lower premiums. I've yet to see anyone who complains about Obamacare present a healthy, sustainable alternative.

I hardly agree with Precedexed Out but do you really believe that healthcare ever was or is a free market? Sure you can "shop" for a PCP you like but that's not on a cost basis. You certainly don't get any emergency care on a cost basis. There's no competition outside state lines much less country lines for the vast majority of people. You can even argue that the ability to provide competition within a state has largely passed to the wayside with Obamacare (i.e. there are 1-2 large hospitals that run healthcare in most places now). Healthcare is not a "free market". Pharmaceutical and device companies patent everything, helping further innovation at huge consumer costs.

There is no easy or right answer for healthcare in this country. The prior model favored young and healthy people. Obamacare only truly helps the destitute and sick at the expense of the rest of the population. People love to tout all these international healthcare models that don't really apply that well to our population. The access in the French system is nice and accounts for less money than we spend but at least theoretically hampers innovation. Beyond that, compare the two population's BMI. WE WAY underestimate how obesity skyrockets healthcare costs. I personally think we need some degree of personal accountability built into whatever system is settled upon.

 

[Southpaw]

I hardly agree with Precedexed Out but do you really believe that healthcare ever was or is a free market?

No, not at all. I said it was certainly with tongue in cheek. It’s very regulated. It has to be - if it weren’t the poor, the sick, and the old would be unable to obtain coverage unless the government stepped in which fortunately it has (hence the regulated marketplace). But hospitals, pharmaceutical companies, insurance companies, and lobbyists share a great bit of blame. I just wanted to point out that solving the problem of healthcare is extremely complex, it will never be perfect, and laying blaming on Obama or any particular administration (as physicians and medical students have done in this thread) says more about the messenger than anything else.

 

[Ignatius J]

Yeah, I can really see Obama obsessing about that.😆

The ACA was doomed to fail because the penalties for (healthy) uninsured people were a joke.

More regulations was never a way to get this done. We’ve spent a good chunk of money on consultants and staff for these new quality care measures. That gets passed on to patients.

 

[urge]

I made your point a few posts above the one you quoted but used a car analogy instead of a house. Calling any part of health care "insurance" is silly when just the process of being born costs thousands of dollars, and it's especially silly given the inevitability of expensive diseases that will arise due to our much longer modern lifespans. Human beings are not cars. Human beings are not houses. We should stop framing the insurance narrative as if we are.



Me, personally, I'm a fan of the Australian system. Everyone gets a government plan that covers basic preventive and catastrophic, and if you want to go to some fancier hospital or get a concierge primary you can buy supplemental insurance or pay out of pocket. Does such a system result in some people having to wait 6 months instead of 3 weeks to get their knee replaced? Probably. Do I think that a prolonged wait time is worth getting 10-30 million people some healthcare instead of no healthcare? Yep.

We are definitely not houses or cars but insurance is insurance no matter how you dice it.

That’s not specific to Australia. Every socialized healthcare system has 2 tiers. Since the public one always sucks (because of rationing), the people who can afford it get their care, unrationed, privately.