Why Are People with Health Insurance Going Bankrupt?

[marmar]

from the Real News Network:

Dr. Margaret Flowers is a pediatrician from Baltimore who advocates for a national single payer health system, Medicare for all. She is an organizer of October2011.org/Occupy Washington, DC and co-director of ItsOurEconomy.us.

Kevin Zeese is co-director of It's Our Economy, an organization that advocates for democratizing the economy. He's also an attorney who is one of the original organizers of the National Occupation of Washington, DC.

.....(snip).....

JAY: So tell us now. You have been critical about this from the beginning. You were for single-payer during the health-care debate. But now it's passed. It's starting to be implemented. You have a better idea what it is. So how's it looking?

FLOWERS: Right. Well, it's looking pretty much like what we expected. Right now the United States is the only industrialized wealthy nation that has a market-based health care system, and the Affordable Care Act moved us further in the direction of a market-based health care system by requiring people who don't qualify for the public programs to purchase private health insurance. That will be going into effect. The exchanges where people will buy that insurance roll out in October of this year. By January 2014, people have to have insurance or face a penalty.

But what we're seeing in terms of the type of insurance that people are going to be offered and the trends of what people are actually purchasing right now is we're moving more in the direction of what we call underinsurance, where people may have an insurance plan, but there are significant financial barriers to getting actual care and significant financial risks if someone has a serious accident or illness.

.....(snip).....

FLOWERS: Right. And also, you know, the thing that I often point out is that the United States is already spending more than enough for a universal, comprehensive, high-quality health-care system. We spend two and a half times what the average OECD nation, you know, industrialized nation spends per person on health care. So we have the money to do this and we have the resources to do this, and it's really just up to us to demand that we have the kind of health-care system that we need. And you can't get the cost—that was my point was that you can't get the real cost savings unless you do this at a national level.

ZEESE: What I was laughing about was I was thinking about Congress (incompr.) all this craziness about deficit. Health care's 18 percent of our GDP and going up, and you're not going to solve the deficit for the long term without solving health care. .......................(more)

The complete piece is at: http://therealnews.com/t2/index.php?option=com_content&task=view&id=767&Itemid=74&jumival=9986

[MadHound]

1. The ACA is going to be a disaster for millions,

It is going to bleed the working and middle classes dry. The ACA simply provided the insurance industry with a mandated monopoly, with weak price controls, thus the insurance industry is pretty much free to charge what they want, with the government penalizing those who won't, or can't pay.

A public option would have alleviated much of this problem, but Obama broke that promise of his.

[Cal Carpenter]

2. It amazes me that people still see ACA as progress

on any fundamental level. There are some people who may benefit, sure, like some people benefited with cash for clunkers. But millions of people who don't currently have access to actual health CARE will continue to lack this access.

The bill codifies some of the worst aspects of our medical system. Embedding the private, for-profit insurance industry even deeper into our national health care system with underfunded mandates is NOT a step forward in any way, for anyone other than their top executives and shareholders.

This should be about PUBLIC HEALTH, not PRIVATE INSURANCE.

[zipplewrath]

16. Fixes old problems, ignores new ones

Look, there are some "good" things in it, like preventing pre-existing exclusions, and coercing many employers to provide group health insurance. The CHC's aren't bad either, presuming they can keep them funded. But these were solutions to "old" problems.

Employers often "wanted" to provide health insurance, but let's face it, it is expensive. Employers knew it could be good for attracting and keeping employees, but in the end it was becoming very expensive. coercing them just ignores why they weren't providing it in the first place.

And the insurance that already was being provided, was becoming more "expensive" to the insured. Co-pays, deductibles, and out of pocket limits were climbing fast. There was no shortage of the "bankrupt insured", people with insurance that couldn't afford the health care.

By the time ACA came along, employer based health care was a "last millenium" idea. It was the "Teddy Kennedy Memorial Solution" to problems that had long ago worsened to a point where new solutions were needed.

Truth is, "insurance" and health care are no longer really compatible. Insurance is a form of gambling. You pay for something you might not need, in hopes of getting more than you paid for if you do need it. With my auto insurance (so far) I've paid several multiples of any claims I've made in my life. I'm sure there are those that are making up for that. But with healthcare, pretty much everyone is going to have regular "claims". It doesn't really fit under the insurance economic model. It's an extended payment program with some catastrophic insurance features built in.

ACA tried to expand basically an insurance program, based upon an outdated economic model of health care. Give it 15 years and the cost of the care will cause a collapse of the existing system.

[bvar22]

23. What the Affordable Care Act accomplished:

The ACA postponed REAL Health Care Reform for another generation.

A National, Publicly Owned, government Administered health Insurance Program (like Medicare for ALL) will be impossible now.
We will be stuck with the MANDATE to BUY Health Insurance from For Profit Corporations for a LONG time.

Now, whenever anyone suggests we try A National, Publicly Owned, government Administered health Insurance Program ,
they will be met with Screaming Choruses claiming that "We already tried that, and it doesn't work in America".
Even though it is not true, that IS what will be used to destroy ANY movement toward a national program, and it will succeed.

There will be NO Fixing it Later.
An opportunity like we had in 2009 comes only once in a generation.

[font size=4] Army of CHANGE, Jan. 21, 2009[/font]

[font size=4]"Oh, What could have been."[/font]

[zipplewrath]

34. The GOP will bring it to us

In probably 15 years, when health CARE costs have risen so much that the system is collapsing, single payer will come, and the GOP will probably bring it to us, much like they brought us Medicare Part D. Wait until we find out what mandates THEY will pass.

[CreekDog]

41. if one is disabled then ACA is the difference between coverage and none

and between paying more than everyone else and paying the same.

there are a lot of problems and unfixed issues with ACA, but to say it's a bad thing sounds like one who is not excluded from the insurance market or health care by preexisting conditions.

[bvar22]

43. There ARE elements that benefit certain small groups.

The elimination of the PECs for children was a HUGE gift to The RICH and the Upper Middle Class that can afford the steep Buy In price,
but excluded the Working Class who can't afford it.
The RICH couldn't get coverage for their children with PECs no matter how much money they had,
and NOW, they can.

The Insurance Corporations can NOT deny coverage for a Pre Existing Condition,
but they CAN refuse coverage if you don't have $500+ in disposable income every month.
The same financial exclusions are operative for allowing Parents to carry their children on their policies,
IF they have the money.

The extension of the PEC coverage to adults doesn't happen until 2014,
so we will have to see how that works out.

Never-the-less, giving the
For Profit Health Insurance Corporations The MANDATE
was NOT a fair trade for the handful of Beans we received.

2014 fast approaches.
We WILL see what happens.

Like marching into Baghdad, maybe we WILL be met with Cheers and Flowers as some predict.
I fear 2014, when 70 Million hard pressed Working Class Americans are MANDATED onto "The Exchange", will be more in line with the reality of marching into Baghdad,
and MILLIONS of very pissed off Working Class Americans forced to buy Junk ("Bronze&quot Health Insurance they can't afford to use.
...but one thing is for sure,
we WILL be marching into the future.

Investment money is POURING into the For Profit Health Insurance Corporations.
Most are posting RECORD profits.
WellPoint, Inc. is UP 50% since 2009.
Doesn't look like anybody is scared.

Every Nickle of PROFIT posted by the parasitic Health Insurance Corporations
is a Nickle of Health Care that WILL be denied to some American.

[Ms. Toad]

74. There are subsidies -

both for premiums and out of pocket expenses, and many people will be eligible to receive insurance (or Medicaid) without paying anything at all (something previously available only to children and pregnant or nursing women. Like everything else, the lower end of people who are above the cut-off for subsidies are the ones who will be hurt the most.

The premiums are unlikely to be $500/month. The PCIP premiums were generally $3-400/month to cover people with major pre-existing conditions (with some of the cost subsidized), but it is likely that premiums will be close to that range since that is about what it costs on average for care in this country (and profits are limited under the ACA).

[HiPointDem]

64. universal health care would do the same for everyone.

[geek tragedy]

6. So, you must favor repeal then.

You can't logically believe that the ACA is a disaster and favor keeping it.

[leftstreet]

8. The mandate should be repealed n/t

[Puzzledtraveller]

26. I agree

I do SNAP and Medicaid in Kentucky and we are doing the exchanges. Most caseworkers I know are in agreement. It's going to be a nightmare for many. The penalty can also greatly effect future tax refunds many struggling families rely on. These families and individuals that will not qualify for medicaid, or the subsidy yet struggle to put food on the table.

[SammyWinstonJack]

42. it doesnt get any simplier than that.

[Ms. Toad]

75. Everone has to be in the pool -

that is the only way the math works out. If only people who with expensive pre-existing conditions are in the pool, the pool will be the same cost as COBRA plans are now (or higher) because that is how much would need to be charged in order to cover paying the health care costs of those who are covered by the plan - no one but the very rich could afford them.

[leftstreet]

77. What nonsense

Not everyone is in the 'insurance pool' right now and costs get covered

You're talking about single payer NON-profit healthcare - where pools don't matter

[Ms. Toad]

78. Costs get covered for those who are insured.

Large employers have pools which include everyone - so their premiums reflect the average cost of the care they pay for (a few with large expenses like my families - at $60,000 a year, but by and large most of their employees will cost a few $100 a year. That makes the premiums reasonable.

Small employers like mine have premiums based on what is actually paid out - so because my family costs so much, we pay the top premium. The last time I knew, specifically, the premium for my family was $22,000 a year. Most small employers cannot or will not provide coverage at that price tag.

Individuals just can't get coverage unless they have pristine health. Everyone in my family has been rejected for health insurance. No insurance company will issue a plan for anyone in my family now, because they don't have to - and no one wants to take the risk of being the insurer the year my daughter needs a half million dollar liver transplant, or $100,000/year of anti-rejection drugs a year for the rest of her life.

So no. Costs do not get covered, except for those with large employers, or who have a small employer like mine who bites the bullet and pays premium rates, or the very healthy.

If insurance companies are forced to issue plans to anyone who wants them, without assessing health, they have to spread the cost of families like mine out over everyone covered. As premiums rise to cover those costs - which they do not currently have - those who have few health needs (and who know that once they do have health needs they can jump right in that plan) drop out. Whem the lower cost people are gone the price rises more, and more and more lower cost people drop out, driving the price up further, and it is a vicious cycle.

It is simple math, once you force insurance companies to issue non-discriminatory policies regardless of health. Premiums skyrocket driving out those who are healthy and making it unaffordable for those who are not.

I would much prefer single payer - but we were never going to get there. Since the reform is insurance based, the pool has to include everyone in order to make the economics work - that means a mandate, with subsidies both for premiums and out of pocket expenses for those who can't afford the premiums. I hope this is a start toward single payer - but at least this way no one can be denied insurance, as happens to millions now.

[SoCalDem]

3. Maybe because the premiums are like an extra house payment for many people

and then there is the cost of medicines.. some co-pays are $75 for rather routine meds....and there are still co-pays along with the premiums..and when procedures are denied, but are still necessary, there are out-of-pocket expenses..

When people are losing wages (as we have for FORTY YEARS) and costs have escalated, there is a breaking point..

[hunter]

7. Our medical insurance premiums and co-pays are greater than our mortgage payment.

And there's always medical expenses on top that the insurance won't pay.

I've had $180 "co-pays" on meds that have a list price of less than $180 in Canada or Mexico.

Our credit is shot because even with medical insurance we've had medical bills we couldn't pay.

Neither my wife or I could get medical insurance on our own; our current insurance is through her work and it's both expensive and incomplete.

Fortunately she is satisfied with her work, but there are millions of people frozen into jobs they hate, or who are reluctant to start new businesses on their own because they fear losing their medical insurance.

My wife and I have run out COBRAs, and my wife's been on state programs for people who are uninsurable, so we know very well that losing medical insurance is a very reasonable thing to fear.

A national single payer medical plan would benefit everyone but the big money players and corporations that use medical benefits to hold onto people who might otherwise quit to start their own innovative businesses or find better work with smaller competitors. A national single payer medical plan might get this stagnant US economy moving again.

[ctsnowman]

12. Exactly!

[ctsnowman]

14. Love the cat pic.

[leftyladyfrommo]

55. My premium was my house payment and my car payment. $600 a month.

Finally, I found one a lot cheaper but only until I turn 65 in a few months. Then I will have to change plans again.

[BlueManFan]

4. As A Lowly State Employee of Rick Perry's Texjezustan

we have the shittiest Healthcare provider out there--United Healthcare. After insurance paid their contribution, my out of pocket bills have exceeded $37,000. I'm afraid I'm going to be one of those who declare bankruptcy despite having insurance.

[alarimer]

50. When I worked there it was pretty good.

HealthSelect was BC/BS, which has its problems, but I guess they switched because of cronyism.

[kenny blankenship]

52. How could it possibly be bad?

Just look at its chart...

Jan '09 Obama is inaugurated - Obamacare is subsequently passed and signed - and just look at that puppy climb and climb!

That is one VERY HEALTHY looking chart. Supposedly we have been in some kind of economic downturn, and supposedly Obamacare was going to squeeze insurance companies dry - keeping 'em honest and making 'em pay ! But you sure can't see anything like that from this stock chart. Clearly, somebody forgot to tell Wall St how bad Obamacare was supposed to be for insurers. So I ask again, how in the world can having United Healthcare be so unhealthy?

Oops, I see now you have United Healthcare insurance. My bad. I thought you had the stock. You should really own the stock instead: it's a golden ticket now that they have a captive market and their own private pipeline to the US Treasury.

[abelenkpe]

5. I know people still being denied coverage

The place I used to work went bankrupt in February. The new company dropped the old healthcare coverage, refuses to insure any family members or spouses and is a tiered system that charges older employees more than younger ones. Those let go are paying up to 1770 a month for cobra which is about to expire. Many have been trying to get affordable coverage for themselves and their families. It's not easy. Two close friends in their mid forties have been denied by blue cross blue shield because they have had minor surgeries in the past couple of years, but are generally healthy otherwise. I didn't realize people could still be denied coverage!

It is sad that families can be thrust into bankruptcy and poverty for no other reason than they are aging and/or have been unlucky enough to have a serious illness or pre existing condition. What is wrong with our country? We lose good paying joins to offshoring by burdening employers with providing healthcare. We have an aging society. Single payer is the only humane and sensible solution and everyday that goes by without single payer people suffer unnecessarily unable to afford needed medical help. It's insane. Our system is a death panel.

[riderinthestorm]

15. I just tried to switch policies for my husband (who has a very serious PEC). Denied.

Have to wait til January 2014. The insurance companies are being real sticklers about it. The options for shopping won't open until October 2013 so its a waiting game to see what's going to be offered.

I predict October is when the shit will really hit the fan as the reality becomes apparent.

[abelenkpe]

22. I am so sorry to hear that!

I hope you guys can make it until then. The older I get the faster time seems to slide by....but October or January? That seems so far away. Hope our country can come around to real reform ASAP.

[Ms. Toad]

72. The changes don't take effect until 2014.

People (on both sides of the political aisle) keep lamenting the fact that the ACA has not solved the problem, when the bulk of the changes don't take effect until 2014.

It isn't going to be a panacea - but since the big step toward making insurance accessible hasn't happened yet, it is way too soon to declare it useless.

As to the families whose COBRA is about to expire - they are entitled to purchase a private policy under HIPAA - which they should be told about by the employer or the insurance company (not sure which when the company is gone). They will need to do so within a very small window after the end of the COBRA policy (~ 2 months) - and it will almost certainly cost as much as the COBRA policy does (they are guaranteed issue, but there are no price caps). Since that is about half what my 22 y/o daughter's routine expenses are - that is still better than not purchasing it...but it is no picnic.

[L0oniX]

9. I guarantee ACA is going to fail for a lot of people.

ACA is majorly flawed IMO. Insurance is basically designed to screw people. They are not there to help you. Here's another thing ...we are subsidizing insurance when we pay taxes that go for bankruptcy. Those unpaid bills add up to a lot of profit taxes that don't get paid but are written off and worse ...turned over/sold to scum bag collection sharks. I have a wife who is on SSD now because some asshole committed suicide with his vehicle. It wasn't her fault of course but insurance is fighting her. She has to go to court to fight Travelers ...her own insurance company ...lawyers will be the only ones getting any money ...oh and Etna ...Etna is NOT an insurance corporation by any description other than their propaganda. They fight you from day one and if you get any compensation from anywhere they want the money back ...that is NOT insurance. The corporate insurance system is so corrupt ...how anyone can be confident that they will be really taken care of is beyond me.

[KentuckyWoman]

60. Your story is exactly why we need universal single payer medical care.

No one in my family thought much of "socialist medicine" as we called it until it was our turn to get screwed. It was about 10 years ago..... My brother has a similar story. Broken leg thanks to someone's idiocy and missed 6 months of work. His own medical insurance company sued him to recover what they paid for his medical care after the court awarded a judgement from the at fault party . The court eventually gave the entire award he got to the medical insurance and the lawyers and actually left him in the hole to pay his own lawyer.

We absolutely positively have to get the insurance companies out of medical care.

[JayhawkSD]

10. Insurance is only part of the problem, and a smaller part to boot.

"The ACA simply provided the insurance industry with a mandated monopoly,"

Well, not really, since there is more than one insurance company and, in theory, they compete with other for the available business. ACA made that business mandated rather than voluntary, but it certainly did not give all of that business to one insurance provider. Ironically, single payer would have created a monopoly, which would have been vastly better for our economy.

What does create pernicious monopolies is state governments and their licensing practices, which results on only one, or very few, insurance providers in individual locations. That is not a product of ACA and it has been going on for many years. It's well intended, to prevent insurance companies from ripping off customers, but it has backfired. Insurance companies still rip people off, and they do so at higher prices.

"with weak price controls, thus the insurance industry is pretty much free to charge what they want"

Well, not really. With the 80% limit insurance companies cannot charge unlimited amounts for premiums. The downside is that they are essentially guaranteed a substantial profit margin.

The real driver of our high cost of health care is not insurance, it is the health care providers. Insurance companies do not generate health care costs, they actually pay those costs. Those costs are generated by hospitals, clinics, laboratories, pharmaceuticals, and doctors. The insurance is in the middle. It's the health care providers that we should be heaping our criticism on.

The people who are "charging whatever they want" are, to repeat, hospitals, clinics, laboratories, pharmaceuticals, and doctors.

[LibDemAlways]

18. Jayhawk, it's the perfect storm. Health care providers and insurance

companies are both out to maximize profit. I started a thread the other day on the topic of health care provider greed and was met with outrage by some on this board who have no problem with physicians looking at patients as simply insurance cash cows to be milked for every dime.

[roamer65]

44. Goddamn right!

...and it will stay that way until we go to a true socialized system like Britain's NHS.

[hunter]

53. The insurance companies have no incentives to control costs.

The bigger the stream of money they control the more money they can siphon off.

The people who run the health care industry -- the heads of the insurance, hospital, and pharmaceutical corporations, people who pay themselves a million dollars a month -- are all hanging out at the country club together figuring out new ways to screw patients, nurses, doctors and anyone else who is not in their club.

The modern USA is a plutocracy. The very wealthy direct the economy for their own benefit at the expense of everyone else.

[HiPointDem]

65. Insurance overhead is a huge part of the problem.

Given the sheer magnitude of the estimated excess spending, it is fair to ask American health care providers what extra benefits the American people receive in return for this enormous extra spending. After all, translated into total dollar spending per year, this excess spending amounted to $570 billion in 2006 and about $650 billion in 2008. The latter figure is over five times the estimated $125 billion or so in additional health spending that would be needed to attain truly universal health insurance coverage in this country.

One thing Americans do buy with this extra spending is an administrative overhead load that is huge by international standards. The McKinsey Global Institute estimated that excess spending on “health administration and insurance” accounted for as much as 21 percent of the estimated total excess spending ($477 billion in 2003). Brought forward, that 21 percent of excess spending on administration would amount to about $120 billion in 2006 and about $150 billion in 2008. It would have been more than enough to finance universal health insurance this year.

The McKinsey team estimated that about 85 percent of this excess administrative overhead can be attributed to the highly complex private health insurance system in the United States. Product design, underwriting and marketing account for about two-thirds of that total. The remaining 15 percent was attributed to public payers that are not saddled with the high cost of product design, medical underwriting and marketing, and that therefore spend a far smaller fraction of their total spending on administration.

http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/

[woo me with science]

11. Huge K&R.

Our health insurance premium just jumped again by an obscene amount. And I just watched someone else in despair after getting his first paycheck since his company was sold. At the same salary, but under the new owner's health insurance program, his paycheck declined from an inadequate but livable amount to the equivalent of FIVE DOLLARS PER HOUR. This for someone who has worked in this management position for over a decade.

This person has a family and children to support. Health insurance is out of control and destroying lives, and the cruelly, ironically named "Affordable Care Act" entrenches these bloodsucking middlemen into the system.

[hibbing]

13. legalized robbery

Hi,
I of course realize that services cost money and am willing to pay. Single payer is the way to go, but I don't see that happening. I am fortunate to have both health and eye insurance, although they take a shitload out of my check every month for health. I recently had to have some physical therapy and my portion of the bill was almost a thousand dollars, so if I would need some more serious medical care I am expected to spend my life savings on it even with insurance? What a racket.

Peace

[Bonobo]

17. Yes, and all the "negotiation" points were used up with this one...

Thanks to Obama, no serious attempt at Health Care reform will be seen for a long, long time.

We had our shot. But we chose the wrong person to make it.

[DallasNE]

19. Underinsurance Is Exactly Where We Are At

The way the insurance rules work means most of the costs are borne by the insured. It usually takes about $5,000 in out of pocket before a $1,500 deductible can be reached. The primary benefit of insurance is the negotiated reduction in what the provider may charge. Without insurance a procedure may cost $3,000 but the insurance plan knocks that down to $1,750 so that helps a lot but it is dishonest for the providers to try and rip people off with the higher charge in the first place.

Bottom line, the only way to get around the problem of underinsurance is with single payer, along the lines of Medicare for seniors, but first people need to be better educated in what the true issues are and how much they overpay for the coverage they have.

[Half-Century Man]

20. Silly Question

People with insurance go bankrupt because it is designed to happen. As long as you pay on time and don't need any of the "benefits" you are a model customer. When you have the effrontery to submit a claim, you having become a liability instead of an asset. An extremely rude choice made by the policyholder; the equivalent to backing up to the head table at their corporate dinner party to fart loudly and giggle. Such rude behavior on the policyholder part, allows rude payback on the part of the company.

I contracted Precursor T-cell leukemia/lymphoma most probably due to benzine exposure. I spent 365 days treating and recovering from the treatment of the cancer. It was declared "in remission"in only 6 months, but chemotherapy and radiation treatment have a well deserved brutal reputation. I returned to work on the very last day before I would have been tossed aside as corporate waste. I worked for A***a for the next seven years until they closed our plant.
12 manufacturing centers in a 50 mile radius closed within an 18 months span. A few thousand skilled workers hit the job market at the same time. I, as a fifty year old with a history of cancer, was not picked up for any of the few jobs there were. Within the three years I was unemployed my health deteriorated (my oncologist had told me I would age prematurely, the equivalent of a quick 15+ years). I was assessed to being physically disabled 8 months ago.

I am unable to get any insurance, even burial insurance through AARP. We lost our home, we lost the majority of our possessions. My adjusted gross income this year (2012) was - $287 (negative $287). We have to hit a food pantry a week on top of food stamps to eat. Because we get overdrawn every month, a significant portion of my disability is lost. The only reason we have a roof is because of section 8 assistance (thankfully we qualified before the sequester, there is no more for the next people through the meat grinder of our economy). Two out of five members of my family have no insurance, nor the chance of getting a job which has benefits. There are some part time jobs for those just starting out. however....

I know that a health system which values anything over serving patients is in direct violation of the Hippocratic oath (yeah, only doctors swear that oath..I ask, is that enough? Doctors are not the only persons in health care). I fail to understand why survival requires everything you have. I fail to understand the 'one strike and you're out" policy when it comes to insurance.

How dare they call the system we have Health care; It is, in fact, Health ambivalence.

[LibDemAlways]

32. Half-century man, I feel your pain. I posted elsewhere on this

forum yesterday about an experience I had with a physician the other day who cared only, and I mean only, about my 90 year old mother's insurance. Never even asked about her condition. (More than one DUer was upset with me for mentioning it.)

The Hippocratic oath means nothing. The only allegiance is to chasing the almighty dollar.

I am very sorry for the horrible problems you are facing. Too many people end up in a living hell due to circumstances beyond their control.

[Skeeter Barnes]

36. Sorry you are being put through this.

I have health insurance but can't afford to use it.

Early this year I went to the doctor to see about a sinus infection that wouldn't go away and kept getting worse. It was just an office visit to a general practitioner but I ended up paying almost $500. I'm still paying on it and will be for months. If I had to go to the hospital, I guess I'd have to declare bankruptcy.

The message is clear, pay your premiums but *do not* file claims!

Insurance is not healthcare!

[LibDemAlways]

51. I was in my dentist's waiting room and heard the

Last edited Fri May 3, 2013, 08:48 PM - Edit history (1)

appointment scheduler flat out turn away a man in pain because he still owed the office $300.00 on a bill he was paying down. It upset me so much I changed dentists.

A friend today told me she has paid over $10,000 out of pocket for cancer meds in the last 4 months - and she has insurance!

The state of health "care" in this country is shameful.

[Skeeter Barnes]

56. Glad you did that.

I hope you told them why, too!

How are people supposed to come up with all this money even during the best of times? 10 grand for medicine is disgraceful.

Mandating insurance fixes nothing!

[LibDemAlways]

59. I posted the dentist story here just the other day and had more than one

response to the effect that the dentist was right to turn the guy away. Shakes head.

Welcome to DU, by the way. You will soon find that no matter what you post, people will attack you. It's the nature of the beast.

[Skeeter Barnes]

61. I'm not surprised.

A lot of people that have what they need don't care about others. They never imagine the class war affecting them. They got the breaks they needed to live a comfortable life. It feels good to them, looking down on others less fortunate.

Workers will have their time again. We won't tolerate this forever.

[Skittles]

39. worthy of its own thread, H-C M

we hear you buddy

[Safetykitten]

63. Agree, and it is insane you have to endure this.

[OwnedByCats]

21. I don't trust insurance companies

and having experienced single payer somewhere else, I'm very disappointed in the whole concept of ACA.

Single payer is desperately needed, but our government isn't interested in investing in it's own citizens in regard to health care. Instead taxpayer money in the trillions is being wasted on things that it shouldn't have been used for, and continues to be used for.

When someone says single payer couldn't be done - that is utter BS. We can do it, but it would mean less money would have to be spent on stupid shit. God forbid that happens.

I could be wrong about ACA, I know it isn't fully implemented yet, but I'm doubtful. I guess I'll have to wait and see before making a complete judgement, but it's not looking good.

[Egalitarian Thug]

24. Even their most rosy, heavily slanted projections of this slow-motion disaster show

that tens of millions of Americans will still not be covered nor have access to health care. But then again, passing a law that requires the purchase of insurance is not really a health care law, is it?

That's why I've always called it HIIPPA, the Health Insurance Industry Profit Protection Act. It does nothing to make health care better or more available, all it really does is make the insurance industry, through force of law, the only arbiter of health care in WorkCamp America.

[bvar22]

25. In Civilized Nations, the term "Medical Bankruptcy" is UNKNOWN,

but it will still be Big Business here in the USA even after ALL the provisions of ObamaCare
are fully implemented,

Maybe even BIGGER Business as MILLIONS of near broke Working Class Americans attempt to access Health CARE with their MANDATED "Bronze" (junk) Health Insurance.

"The Uniquely American Solution."




You will know them by their WORKS,
not by their promises or excuses.
[font size=5 color=green]Solidarity99![/font][font size=2 color=green]
--------------------------------------------------------------------------------------------------------------------------------[/center]

[graham4anything]

27. malarky

[marmar]

28. Wow. What a counter-argument !!!

[Puzzledtraveller]

31. The "Obama's sh*t don't stink" contingent has spoken

[ForgoTheConsequence]

38. Oh?

Guarantee you wouldn't say that to the face of someone with a terminal illness staring down bankruptcy.

Its easy to be a cold blooded jerk behind a PC screen isn't it?

[Skittles]

40. yes, that pretty much describes your response

[HiPointDem]

66. it's 'malarkey,' word-salad man.

[closeupready]

29. Years ago, health insurance picked up EVERYTHING.

At some point, they started shifting costs to policyholders. I think that's when things started going downhill.

[Zoeisright]

33. Because insurance companies are fucking evil.

They'll deny care, claim that your costs are above the average, etc. etc. Plus, sick leave is a laugh in this country. Many people can't work when they're sick and they lose income. It's just a downward spiral from there.

[KG]

35. the 'uniquely american solution'

[LibDemAlways]

37. Had breakfast this morning with a friend who has been

battling breast cancer for a year now. She has what she described as "the best" insurance. She's still had to shell out over $10,000 since January alone. God help you if you get sick and don't have a lot of money socked away. If the disease doesn't kill you, the stress of having to pay for it will.

[DiverDave]

45. Obama screwed us again-getting used to it now

All the effort to get him in there and turns out he disdains us.

[senseandsensibility]

46. K and R

eom

[CrispyQ]

47. Kick for the abysmal condition of health "care" in the greatest nation on the planet.

"USA! USA! USA! We're number one!"

~puke

[LibDemAlways]

49. Walk into a doctor's office today in the U.S. and the first question has nothing

to do with what ails you. How well insured you are is the only thing on their minds. Puke is right.

[forestpath]

48. Because above all else, Obama cares about helping the rich get richer.

[madamesilverspurs]

54. Max Baucus screwed us royally.

He walked away from doing the right thing in order to accomodate his buddies in the insurance industry.

Max Baucus owns any failures of the ACA.

[kenny blankenship]

58. They don't call it "Baucuscare"

for two good reasons: one is that he doesn't actually care, and two is that he's not the only one.

[slipslidingaway]

69. I'm so tired of the blame Baucus and Obama is powerless excuse...

according to some people Baucus was in control of the initial WH summit on HC when those in support of a national HC system were denied access. Baucus was also in control of the WH town hall meeting on HC when Obama's personal physician of 20 years was invited and then canceled at the last minute because his question would focus on a national not for profit HC system.

Poor Obama, no one ever told him Baucus was in charge.

Every time I read this sad excuse I can only picture Obama as Eeyore hanging his head low and accepting misfortune instead of trying to prevent it.

Poor Obama, Baucus was in control, nobody would listen to me.

http://journals.democraticunderground.com/slipslidingaway/86

How do you win a fight if you silence the harshest critics of those who hold power....

Posted by slipslidingaway in General Discussion: Presidential (Through Nov 2009)
Wed Sep 02nd 2009, 12:04 PM

Please do not tell me that you are fighting the entrenched interests when you invite them to the discussions and private meetings and exclude those who have been fighting the For Profit companies for decades.

President Obama calls on Karen Ignagni of AHIP to speak on HC reform.

Imagine if P. Obama had called upon Dr. Maria Angell to speak at the WH summit instead of Karen Ignagni, members of Congress might be pleading for a public option.

[HiPointDem]

70. +1. it's unbelievable how powerless obama is. he can't do anything. one wonders why we even

have a president, since they're so damn powerless.

[slipslidingaway]

71. Very true and the picture some paint is unflattering ...

although a likeable character I cannot get the picture of Eeyore out of my mind every time I read this same tired excuse.

I bet if you asked a dozen people on the street who Baucus is they would not know he was in charge of the country on this important issue ... and someone had to tell Obama to just be quiet or something and he hung his head.

What a sad excuse that too many people believe ... woe is me.

[KentuckyWoman]

57. My personal case history

In my 50's. Have "decent" HMO coverage but my income is so low that by the time I pay the premiums it's hard to afford a doctor for anything that is not threatening to life or limb.

Recent acquisition, a pacemaker/defibrillator - which I have needed for more than 10 years but keep putting off because of the cost. Finally getting it done because it became a life threatening issue - but it meant I went into this sicker and more expensive.


For this one event

$125 ---- for 5 primary care visits at $25 copayment
$450 ---- for 9 specialist visits at $50 copayment
$97 ---- for 4 prescriptions - paid retail for generics since cheaper than $35 generic copayment using insurance.
$1250 ---- bill from anesthesia - hospital contractor - outside network - not covered by HMO (WTF?)
$2431 ---- "member responsibility" portion of hospital bills.
$307 ---- spendable income lost for one week lost work

I had $450 in the bank, which was not easy to amass at my income level that is now gone. I had a credit card with no balance and a $3000 limit that is now maxed out with a 16.9% interest rate.

And I am still getting 3-4 collections calls a day because I can't figure out how to pay the rest since they won't let me make a few $ a month payments on it.

The Credibility people tell me bankruptcy is my best option, which I'm determined to avoid and just might as a local charity is helping me negotiate with the hospital to write that part off to indigent care.

And this is with "good" insurance. Many people don't even have that to rely on.

[progressoid]

68. Your story sounds familiar.

We're trying to pay off old med bills too. With more to come. We pay off one debt only to have to deal with a couple more.

I hope you can find a way out of this mess.

[Safetykitten]

62. The real fun starts this fall. It will be quite a spectacle of HC nightmares.

It will be funhouse of HC situations that will come up and people will see that it really is was not a good idea. But the one constant will be that you will pay more and get less.

[newmember]

67. Historically it will go down as one of Obamas biggest failures

[slipslidingaway]

73. Do not look at your annual deductible, look at your annual out of pocket maximum...

and ask yourself what would happen if you had to pay that sum for the rest of your life?

On top of that figure add in travel expenses to and from a treatment center, lost wages etc. and it is easy to see why so many people in the U.S go bankrupt that have good health insurance.

Health Care Reform Bills - Does Actuarial Value Trump Medical Loss Ratio?

http://journals.democraticunderground.com/slipslidingaway/183

"The Affordable Health Care for America Act introduced in the House on October 29 would require any health insurer in the small or large group market to issue rebates to enrollees if its medical loss ratio (the proportion of the insurer’s income from premiums that it uses to pay medical claims) fell below 85%. A quick review of major health insurers’ current medical loss ratios, as reported by the insurers themselves, indicates that most would have to beef up benefits paid, reduce their administrative costs, or provide rebates to their members...


The American Medical News on August 24 reported that, for the second quarter of this year, the average medical loss ratio of the largest publicly traded health plans was 85.2%, but ranged from 82.9% to 86.8%.

But limiting insurers’ administrative expenses is not necessarily the most beneficial strategy for insureds. Ensuring a high actuarial value of benefits provided would be best. The Congressional Research Service earlier this year reviewed “actuarial value” issues. The actuarial value provides an estimate of the proportion of health care expenses a plan likely will pay. As the economy has deteriorated, so has the actuarial value of employer-sponsored health insurance. Individuals covered by employer-sponsored health insurance these days get lower actuarial values and less protection..."

http://pnhp.org/blog/2009/10/27/the-actuarial-squeeze-on-low-and-middle-income-families/

"...The best private insurance available today – employer-sponsored health plans – have an actuarial value of 80%. That means that the insurance pays 80% of the covered costs of health care and patients are responsible for the other 20%. Patients also are usually responsible for out-of-network services and for services and products that are not benefits of the plans.

The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families..."

[gopiscrap]

76. Because the medical industry

is filled with greedy fuckers who aren't regulated and checked by society