fahimaz7

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For those working as an IC. Good luck with healthcare exchange? May need wife and child on it as well. I hear that most of the people in the group I am looking at goes through the exchange. Obviously without doing it myself, I have no idea how good the policies are and/or the cost.

Thanks.
 

Birdstrike

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I'm not an IC, but the group policy we have now, sucks so bad, the cost has gone up so high along with the deductible, I think I'm going with one of the exchange plans this year. Thanks for making my insurance worse and more costly, Pelosi and Democratic party. Thanks, If-You-Like-Your-Plan-You-Can-Keep-It Obama.

http://www.politifact.com/obama-like-health-care-keep/
 

GeneralVeers

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If you're a productive member of society who is reasonably responsible then all of the insurance products out there suck right now. The prices have gone up substantially since the ACA was enacted. But on the plus side you can feel good that you're paying for other people's lactation counseling, OB care, and substance abuse treatment.
 
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two guys

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It was cheaper before ACA but I still pay less than the total cost (employer donation plus employee cost) of my wife's or any siblings "real benefits."

In residency, my insurance cost $350/month ($25 out of my pocket) and was decent. Pre Obamacare I got a policy on the open market (Blue Cross) for $140/month with a much lower deductible (1500 vs 3000) and lower out of pocket maximum (1500 vs 600) than in residecny. That's because they could ask me about pre-existing conditions and I am young, healthy, didn't want mental health coverage and don't smoke. In other words, I wasn't paying for the average health of the employees of the large university where I was. I was able to keep that until this April when I had to get an ACA compliant plan. It went up to $250/month and the deductable and out of pocket max are higher. If I had added my wife and child it would've been 500. This is for a silver high deductible plan. There were similar silver plans that aren't HSA compatible with copays for pcp visits and coinsurance but higher out of pocket max.

*** Potentially sidetracking commentary: I don't want this to get political but it is more expensive than before obamacare. That being said, it's not just for lacatation consultants etc. I would bet one of the biggest reasons for the increased costs is limiting the pre-existing problem exclusion. I can't see how any of us would be against that. We all have friends who developed cancer or chronic illnesses in their 20's and became uninsurable. I don't want to pay extra, but will pay extra for that. I guess I should point out that lactation consultants are probably pretty cost effective too. Less breast cancer, higher iq and less infections in the first 2 years. I'm for all those things. As a guy, i'm not stoked to pay for pregnancy coverage but I was paying for it anyway for the unisured (ie every inunsured pregnant woman qualifies for medicaid) so that might be a wash.

I guess if I had a vote I would've been ok with standardizing certain coverages nationally (ie no preexisting exclusion, mental health, etc). But, I would've liked to see it turn into an open market for everyone. I had the choice of 5 different insurers before obamacare and could start coverage whenever. Now, I only have 2 companies to choose from and can only start during open enrollment. It'd be nice to see peoples insurance be unrelated to the size of the company they work for and coverages decided on by someone other than themselves (HR managers). *** Commentary over.

Go to ehealthinsurance.com - it's expedia for health insurance. You will have to say you have a qualifying event to get around the open enrollment timing but then you can compare all kinds of plans. For me, I care only about the deductible and out of pocket max.
 
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Birdstrike

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I don't want this to get political but it is more expensive than before obamacare..
None of this is political for me. It's personal. The ACA made my family's health insurance worse, and more expensive. In fact, it was promised multiple times to me (and hundreds of millions of people) that specifically, not to worry, those two things would not happen. It was lies all along. I don't appreciate that at all. I could give a rip about the politics of it all. That's personal. It's very personal.

If you're naive enough to think it was all a well intentioned accident, think again. Take it straight from someone who knew, was there, and shepherded the whole process along. Gruber: http://www.washingtonpost.com/news/post-politics/wp/2014/12/09/jonathan-gruber-i-am-embarrassed-and-i-am-sorry/
 
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Psai

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None of this is political for me. It's personal. The ACA made my family's health insurance worse, and more expensive. In fact, it was promised multiple times to me (and hundreds of millions of people) that specifically, not to worry, those two things would not happen. It was lies all along. I don't appreciate that at all. I could give a rip about the politics of it all. That's personal. It's very personal.

If you're naive enough to think it was all a well intentioned accident, think again. Take it straight from someone who knew, was there, and shepherded the whole process along. Gruber: http://www.washingtonpost.com/news/post-politics/wp/2014/12/09/jonathan-gruber-i-am-embarrassed-and-i-am-sorry/
Who didn't know it was going to be like that though? You can't cover more people and people with preexisting conditions without paying more
 

GeneralVeers

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The problem with covering "pre-existing conditions" is that it's not insurance. Insurance is based on risk and actuarial tables. You are paying for insurance based on what they estimate your average annual health expenditures will be. If you are diabetic, we know that your risk of being diabetic is 100% and that you are going to cost substantially more to "insure". Unfortunately goods and services cost money, and that money has to come from somewhere. Also unfortunate is that so many people in this country are so stupid, and naive as to believe the lies that we can cover more people for more stuff and "save" money. This is why most people should not be allowed to vote, as they lack simple reasoning ability and/or math skills.
 
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two guys

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It is personal. My insurance went up to. As I said, it went up $100/month and my deductible and out of pocket max both doubled. If my wife and child weren't covered it would've gone up another 100 for each of them.

I'm not pro-ACA or anti-ACA and (like birdstrike and Veers) I'm definitely pro-my bank account. That being said, it is worth knowing what you're paying for.

Veers: Yes, it is harder for the insurance companies to estimate risk without knowing pre-existing conditions. But, they work with risk and unknowns all day - that is their actual job. I'm not going to cry in my beer just because life is a little harder for Blue Cross now that they have to cover pre-existing conditions. Do you really not know anyone who developed cancer in their 20's or had a child with a lifelong illness? That's pretty damn personal. I'd be for other ways around this too (high risk pools, etc)

I'm probably a little more in favor of helping other people who get stuck in a bad situation then I am concerned about my bank account.

I don't personally know anyone as stupid as veers seems to think the world is. It's pretty basic math that insuring more things (ob, mental health, pre-existing) for more people will cost more. I can't find enough gumption to get angry at a politician for making things sound like milk and honey. That's essentially their job (unfortunately).

I don't lack simple reasoning or math but I'm not mad about the ACA. If that means you think I'm naive, then so be it - but I'm not sure where you get off calling strangers on the internet naive.

Now, if they asked ME to design the ACA it would look a whole lot different. But I'm not a politician or adviser so I don't get to choose. If you're asking me, this is what I'd do:
- keep the changes the ACA made for pre-existing conditions, lactation, ob, mental health etc.
- open insurance across state lines and make it free market with real competition.
- separate insurance from peoples jobs so they have to shop for and pay for it themselves. That would make the market truly free and people would know what they're paying for. Your average employee can't tell you what their employer pays for their insurance (its not free money - that should be in their check and they should be making the decisions about their plans)
- Enact some reasonable tort reform. IE limits on pain and suffering damages, requiring "experts" to be actively practicing in the specialty of the defendant and publishing a list of all expert witnesses and which side they testified for.

I'd happily pay an extra $100 for those things
 
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GeneralVeers

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Veers: Yes, it is harder for the insurance companies to estimate risk without knowing pre-existing conditions. But, they work with risk and unknowns all day - that is their actual job. I'm not going to cry in my beer just because life is a little harder for Blue Cross now that they have to cover pre-existing conditions. Do you really not know anyone who developed cancer in their 20's or had a child with a lifelong illness? That's pretty damn personal. I'd be for other ways around this too (high risk pools, etc)

I'd happily pay an extra $100 for those things
You are clearly not in the group I was talking about. As a physician you are educated and have some understanding of finances. I think however that if the majority of people had critical thinking skills, they wouldn't have believed the lies "you can keep your insurance, doctor, save money etc". If most people understood that we would have to tax everyone more, and pay more in premiums with higher deductibles, and that their networks would become narrower, and STILL have suport for the ACA, then I would have less criticism. I think if presented with the actual truths, the 90% of Americans who had some some sort of coverage would not have have supported it.

The actual number of uninsured was not 47 million. If you subtract 12 million illegals that number goes down to 35 million. Subtract from them people earning over 50K who refused to buy it, and that number is in the 15-20 million range. That is less than 10% of the US population, and I think we could have had a bipartisan healthcare deal to get that relatively small number of people some assistance WITHOUT destroying the existing system and the coverage most people had.

What irks libertarians like me even more is that the goal of the ACA architects was not to improve healthcare or cover the uninsured. What they want is a single payer system. The ACA was a thinly-veiled step on that road. Now that they've accomplished "reform", the system will fail as it's set up to do (36% premium increases this year in some areas). The socialists/Liberals will then hold this up as a failure of the "greedy" insurance companies and that we can't trust them, so naturally the alternative will be a "public option" or "medicare for all" that will finally usher in their golden utopia that they have so longed for.
 
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Birdstrike

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You are clearly not in the group I was talking about. As a physician you are educated and have some understanding of finances. I think however that if the majority of people had critical thinking skills, they wouldn't have believed the lies "you can keep your insurance, doctor, save money etc". If most people understood that we would have to tax everyone more, and pay more in premiums with higher deductibles, and that their networks would become narrower, and STILL have suport for the ACA, then I would have less criticism. I think if presented with the actual truths, the 90% of Americans who had some some sort of coverage would not have have supported it.

The actual number of uninsured was not 47 million. If you subtract 12 million illegals that number goes down to 35 million. Subtract from them people earning over 50K who refused to buy it, and that number is in the 15-20 million range. That is less than 10% of the US population, and I think we could have had a bipartisan healthcare deal to get that relatively small number of people some assistance WITHOUT destroying the existing system and the coverage most people had.

What irks libertarians like me even more is that the goal of the ACA architects was not to improve healthcare or cover the uninsured. What they want is a single payer system. The ACA was a thinly-veiled step on that road. Now that they've accomplished "reform", the system will fail as it's set up to do (36% premium increases this year in some areas). The socialists/Liberals will then hold this up as a failure of the "greedy" insurance companies and that we can't trust them, so naturally the alternative will be a "public option" or "medicare for all" that will finally usher in their golden utopia that they have so longed for.
I don't know that they have a pathway to single payer at this point. The ACA has entrenched private insurance companies even more than ever. Two tier system, with a public option? That may well happen.
 

GeneralVeers

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It's already in the exchanges as Medicaid programs administered through insurance are an option and many people get forced into it. There is nothing from stopping the government form putting their own single-payer plan in the exchanges, and either having existing insurance administer it, or just simply undercut commercial options.
 

Birdstrike

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It's already in the exchanges as Medicaid programs administered through insurance are an option and many people get forced into it. There is nothing from stopping the government form putting their own single-payer plan in the exchanges, and either having existing insurance administer it, or just simply undercut commercial options.
Well that would not be "single" payer. Single payer bans all other payers, wild outlaw any private payers, eliminate Medicaid, VA insurance, any and all other others except for one. Do you really see that happening? Especially considering how much the politicians are in bed with the insurance corporations and how they pulled their strings to get the individual mandated insurance? I know they want it, I just don't see it happening in my lifetime. There's too many special interests to unravel. These politicians (Dem & Repub) have much more to gain by fueling the insurance company status quo.
 

GeneralVeers

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Well that would not be "single" payer. Single payer bans all other payers, wild outlaw any private payers, eliminate Medicaid, VA insurance, any and all other others except for one. Do you really see that happening? Especially considering how much the politicians are in bed with the insurance corporations and how they pulled their strings to get the individual mandated insurance? I know they want it, I just don't see it happening in my lifetime. There's too many special interests to unravel. These politicians (Dem & Repub) have much more to gain by fueling the insurance company status quo.
Not in the near future. My statement was that "Single Payer" is the stated goal of the leftmost wing of the Democratic party. While they can't have their way immediately as far as that goes, the ACA is a step in that direction. The first thing you have to do in Single Payer is get control of the insurance companies through strict regulation and requirements on what needs to be covered. The next step is to offer a "public option" once the insurance companies have "failed". Their eventual goal is to drive insurance companies out of business through regulation and by making their business unprofitable.

It's an interesting schism in the Democratic party, as the more moderate portion of the party is clearly in bed with insurance companies. The left-wing portion wants single payer as they are true believers and really think government should control all healthcare. Which side will win out? Well the left-wing portion is far more rabid and devoted to their cause. The changeover to single payer will not be immediate, it will involve a gradual chipping away of privately offered insurance and increasing numbers of people enrolled in government healthcare. Single payer in the U.S. will certainly look differently than in other countries and won't be single-payer as strictly defined. We might have 80% of people in the government insurance, while a small number of people who can afford to escape that system will be able to get private insurance, or pay cash for services.

One interesting thing to consider is that in Canada they have a true single payer system, however the U.S. represents a safety valve for Canadians, as many of their citizens can come to the U.S. for care to escape the queue. Once we go to such a system, where will be the safety valve for U.S. citizens?