Yes, the deductibles for a lot of people really stink in ACA

[boston bean]

You're mandated to pay hundreds a month for insurance, to find out that get you very little coverage. The rest is billed to you in a deductible, usually in the thousands per year, where ins co's pay 50% and you the rest until a max is hit.. Most can barely afford premiums. If they find out they are out of pocket 1,2,3,4,5,6,7,8,9,10,11,12K per year for things not covered, above and beyond their premiums, you have to understand they aren't going to utilize their insurance, it's to costly.

It's a half baked solution, we need single payer, get these greedy ins co's off our backs.

I am happy many are being covered, but I don't see costs going down, because the system is set up for people to remain sick and not seek care.

[datasuspect]

1. i put insurance companies in the same categories as banks:

evil.

i thought i'd be able to finally get some diagnostic testing and procedures done.

i'll just keep working on eating healthy, exercising, and trying to stay healthy.

[boston bean]

2. And have peace of mind that you aren't on the hook for all costs

if something major you lived through happened. You'll just have your deductible. More manageable then hundreds of thousands or millions of dollars.

[datasuspect]

10. bankruptcies cost 1000

[mwooldri]

27. Medical costs can be that tipping point.

Let's say you have a health insurance plan that covers in-network providers very well, but when it comes to out of network providers.. no so good...

You take your child to the ER, and your child needs surgery right there and then... the hospital is in network but the doctor isn't - and there is no choice to choose an in network doctor. Both bill separately. The doctor bills a large amount of money... the insurance company pays what is "reasonable and customary", and the plan has a high part that you are responsible for. Example: the doctor bills $20,000. Insurance says $10,000 is reasonable and customary, and sends you a check for $7,000 because the plan pays 70% for out of network providers. You owe the doctor $13,000.

If instead the doctor was in network, the doctor may still bill for $20,000, the insurance determines that the doctor is owed $5,000, and your in network part is 10%, insurance pays 90%. Your bill is $500.

A lot of people could work out that $500... $13,000 not so much. If there are any other financial pressures... bankruptcy can look very tempting.

This happened to me, and I have good insurance coverage through my employer that is better than plans on offer in the marketplace, cheaper, and covers more procedures...

Medical bankruptcy or IVAs (similar to a US chapter 13 bankruptcy) due to the medical bills are rare in the UK. Bankruptcies and IVAs because of reduced income caused by a medical situation.... same as other people who lose income due to other external forces. In the land of the free.... bankruptcy because of medical bills alone aren't rare.

Is the ACA perfect? Far from it. It's better than what it was before.... but this is good news for low to moderate income families... especially those who couldn't get insurance.

"ObamaCare" is a horrible brand... States need to take it over, rebrand it in their own state, implement Medicare expansion, and even possibly expand Medicaid further with a "buy-in option" that can be made available on the marketplace. This will increase competition with the private insurance companies... or lead to single payer in that state. Instead of Medicare for all it could be Medicaid for all.

[Nuclear Unicorn]

9. But now we're mandated to contribute to their lobbying funds.

Now imagine if the USSC strikes down caps on campaign contributions.

[fitman]

29. Here is an unbiased opinion from a health insurance broker(me)

I like the ACA overall..I am no fan of insurance co's-trust me.. but the exchanges are not that great..high deductibles..yes you get a low premium (subsidized) but you end up paying out the wazoo if you get an illness or need treatment.

I can sell for the exchanges and so far most people with pre-ex conditions who were declined previously are going with private insurance..cost more because not subsidized but way lower deductibles and coinsurance..

The ACA is ABSOLUTELY great for older people age 50+ because their premiums are going to come down..terrible for young people-their premiums are going to double or triple...

ACA is GREAT for small business less than 50 employees-lower premiums, more rate stability..80% of my small groups premiums have come down or stayed the same due to the new MLR ratios and other factors..

However:

Business 50 + employees= ACA is terrible..too many penalties, extra fees, paperwork out the Wazoo.. the ACA really does force large business to drop insurance, drop employees benefits etc .. it was terribly written in that aspect. The ACA should have given 50+ business incentives to have health insurance on their employees but what it does in penalize them

[PATRICK]

3. When the government

cracked down on its own student loan program run through private loan companies, they ALL bailed. The fun profits and the narrow service they provided under the real rules made them fall back on private loans- which the students unhappily need even more than the government program. For some fairness and relief the government loan student sees his payment being socked away for Capitol play money by the billions instead of in the pockets of private loan execs.

Similarly, the government- which in both cases is doing nothing about the whole situation- is enforcing profit trimming laws. Even with many new and healthy customers and people who cannot make claims because of the deductible and copay cost the wind has gone out of the greed sail. Many are finding ways to bail. I would hazard a guess though that it is the companies with the lowest profit margins and best service who surprisingly might bail first under the new system. The logic of health care especially defies a top up profit motive spread out over a whole pack of feeding sharks. A single pool, a single service mathematically cannot be beaten by a host of little guys. That is for niches. Unfortunately the government by the theory of the current illogical occupants wants the taxpayer to fund only the niche, making everyone in the process very unhappy.

Three banned words on the radio, TV and press for several decades: Medicare for all- as envisioned by LBJ. While many other nations with less resources have already progressed through this painful great divorce from the insurance game cartel.

[Puzzledtraveller]

4. Show us your bank account, tax returns, otherwise your post is bunk

[ScreamingMeemie]

5. It gets me in the door. And that is a start.

[Nuclear Unicorn]

11. But some others are being shown the door.

We have to help everyone.

[ScreamingMeemie]

12. You are misunderstanding me. My other thread sank but... 204/115 is my typical

daily blood pressure.

it didn't used to be that way. I was a compliant patient until I was dropped from my insurance after my husband died.

My monthly payment is going to be a major stretch for us, and the deductible is high.

I have a son. He doesn't have a dad anymore.

This gets me in the door.

This might give me a chance to live to see him grow to manhood.

This is a start for me.

No, we won't be eating out, or taking vacations, or buying the latest video games... but hopefully--next time--I won't be turned away at the dentist because my blood pressure is too high.

I don't think this is the best option...but yes, it gets me in the door.

Thank you.

[datasuspect]

13. i really hope it all works out for you

[ScreamingMeemie]

15. Thank you data. I've gone from "getting my affairs in order"

to lightening up a little bit.

I hope it works out for you as well. Life is so expensive.

[Nuclear Unicorn]

64. Keep fighting the good fight. Win, lose or draw it reveals courage and faith.

For whatever my words may be worth.

[Nuclear Unicorn]

14. I'm not begrudging you in the least

I said everyone needs care. You're part of everyone.

[MFM008]

53. yeah ur right

until we get a single payer plan....

[alcibiades_mystery]

6. I don't disagree

But right now the system is set up to deal with specific problems. Think back to Michael Moore's "Sicko:" the bankrupting of ordinary people by $100,000 or $200,000 or $1 million dollar medical bills. The system as it currently stands aims to prevent that. It make preventative care free for most, and essentially caps people's out-of-pocket at some figure within the realm of reason. OK, fine $6,000 is not reasonable for plenty, but it's a lot more reasonable than $100,000, which is what you might have been faced with before.

It's massive catastrophic care plan, which is, of course, something to sniff at, until you need that kind of care. Ideally, we will see it transform into something better. This is what could pass that Congress and get implemented. For millions of people who would otherwise go bankrupt and lose their homes, or worse - die from lack of care - it will be tremendously beneficial. But it is not a cure all for all populations: not yet. We have work left to do. But it's also nothing to sniff at if we realize the problems it is addressing.

[KG]

7. the ACA as presently configured is of no use to me.

[tillikum]

8. its feeling more and more like the "modernization" of pensions to 401Ks did....

an quasi-egalitarian "company store" scheme.

[Capt. Obvious]

16. This is not unique to ACA

This is standard fare.

If one's insurance isn't this crappy that count yourself lucky.

[boston bean]

17. i understand and you are correct, but now one is mandated to buy it.

It's a concern no? I'm not puttting it down, just trying to get some to understand this is not optimal.

It will be the same for those who had those crappy plans, for the new subscribers. Neither will utilize the insurance they pay for because they can't afford to. leaving sick people without access due to lack of funds. It's compounded this issues and added more people to this failed type of plan. I really hope it changes.

The one benefit I see with this model is catastrophic coverage and not having to pay more than your yearly deductible, if something major were to happen.

[Lex]

21. I think everyone knows the ACA's not "optimal"

but it is an improvement over the train-wreck that was in place.

[Capt. Obvious]

22. This has been the law of the land in my state for 7(ish?) years now

Yes, we're required to buy it. 2 years I had to pay the penalty.

1 year I didn't make enough to be required to buy it.

The 2 years I was penalized I could have avoided the penalties by doing 1 or 2 things aside from buying insurance. 1st year the penalty was negligible. 2nd year was pretty high.

Yes, now everyone is "forced" to buy it.

But now everyone will get preventative care and as you mentioned, catastrophic coverage. And now everyone who works for a company large enough to be covered should now get it through their employer (ideally).

Employer based insurance isn't much better usually.

[boston bean]

24. I don't mind the law, I mind the plan.

It's not going to work well for people who can barely afford the prmiums,

[Barack_America]

18. That's the price of bringing the "uninsurable" on board, extending maternity and...

...mental health benefits to all...while splitting everyone up into small groups to keep the money coming in to the for-profit companies.

This is what the public option would have prevented.

[TBF]

19. No kidding. Public option is by far the better choice -

Medicare is in place and all we'd have to do is remove the age restriction gradually. Streamline Medicare/medicaid by combining into one plan, cover everyone under 21 first, drop it down to 60 next, eventually cover everyone. Payroll deduction just like Social Security.

This is the type of health care our representatives would vote in IF they gave a shit about the majority of folks in this country. But they don't - they are beholden to the special interests.

That is why we don't have this yet.

At least ACA opens the door ...

[moriah]

20. I agree single payer is needed, but ....

... my group policy with a very good company had a $2000 deductible. When I saw that was the lowest offered, I was scared. I use a lot of insurance.

But on that plan, primary care didn't go to the deductible (even updrafts given in office), nor did prescribed medications, or ER visits. I had to pay for lab work out of pocket (but at least at the negotiated rate), and each time my doctor had to give me a combination steroid/antibiotic shot in the behind when I got sick, I had to pay for that out of pocket. But I never went more than $500 into my deductible until I was hospitalized.

People don't need to just look at premiums and deductibles. What is paid for without a deductible? If going $500 higher on your deductible and $25 higher a month in payments means primary care is covered before deductible (and preferably ER visits as well for families, kids spike fevers at the worst times), you'll probably end up with cheaper out of pocket costs throughout the year if you're able to avoid a lot of diagnostic charges or hospitalization, but go to the doctor monthly and have 10 medications, than you would trying to find the lowest deductible but having to take care of it before getting *any* treatment.

[boston bean]

23. It's the lab costs. Hundred out of pocket for each....

even when labs are ordered for your annual physical.

Labs to me should be considered preventive, but they are not.

[moriah]

25. Now, those were covered under preventative for me.

And they *should* be, you'd hope, under the ACA. <crossing fingers>

Is something specifically saying under the preventative care section of the SOB (hahah, probably accurate) that the visit is covered, but the labs for that visit weren't?

[ScreamingMeemie]

26. I have been researching this and the plans that popped up on my account

all cover labs for things like cholesterol, diabetes, STDs, etc. Basically the labs that are run with preventative care visits appear to be covered.

http://www.bcbsil.com/affordable_care_act/pdf/preventive_services_il.pdf

[mwooldri]

31. Lab costs are heavily inflated.

The lab may bill $150 for a single test, the contracted rate with the insurance company may be $5. I've seen the figures... and yet the lab can make money on that $5 test as it can cost less than a dollar per sample... 5,000 of those tests performed at once by a machine can be done by a lab tech in 3-4 hours... factor in transportation costs by moving the samples from a wide region to a central processing facility that serves 1,000s of doctors and multiple hospitals.... still the lab makes money... of course the lab employees get to feel the pinch too... wages remain stagnant for loyal employees... to get an increase the way is to get a job offer from a competing lab ... lab techs are in demand. Doesn't mean that the lab employers make it a good working environment... more work is given to a smaller workforce with service commitments to the hospitals... they work hard for their $20/hr.... though lab assistants are paid less... $12/hr is the average I hear about. Yes, a college education is needed. Additional certification is required too!

But those lab bills are inflated.

[moriah]

36. No doubt they're inflated.

Which is one reason why having insurance, even if you're using up your deductible, is helpful. You pay the negotiated cost, not the uninsured cost.

[lunasun]

82. http://www.directlabs.com/

[mwooldri]

84. That's paying for privacy and skipping the doctor altogether.

At this time, directlabs.com are advertising a testosterone test for $49.

I had a recent testosterone test (yes I do have low T). So I pulled out that Explanation of Benefits... The lab billed $65, the plan discount was $43.63, and the plan paid $21.37. And still the lab that processed that specimen made money on it. The cost, not counting labour, overheads, etc to process that specimen is nowhere near that $21.37 that the insurance carrier paid that healthcare provider.

I don't know if such a thing exists, but aren't there programs where people show an "insurance card" for medical services... but it's not insurance, you pay the negotiated rate between the insurance company and that provider?

DirectLabs is a good idea, but if your plan allows it, I think it's worth getting your doc to order these tests as part of an annual wellness checkup. In my case, it looks to be cheaper than going direct. Even if I have to pay the contracted rate.

[PoliticAverse]

35. Your post excellently highlights how complicated the insurance issue can be. n/t

[antigop]

28. Obamacare: is a $2,000 deductible "affordable"?

http://money.cnn.com/2013/06/13/news/economy/obamacare-affordable/index.html

Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges.

But what will enrollees actually get for that monthly charge?

States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures: $2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs.

Those are just some of the charges enrollees will incur in a silver-level plan in California, which recently unveiled an overview of the benefits and charges associated with its exchange. That's on top of the $321 average monthly premium.

For some, this will be great news since it will allow them to see the doctor without breaking the bank. But others may not want to shell out a few thousand bucks in addition to a monthly premium.

It's not just the premiums -- it's the deductibles, co-pays, and max out of pocket.

[Rstrstx]

75. Not to many, BUT

it sure beats raking up a $100,000+ hospital bill. $2000 can be paid off over time, most hospitals work with patients who can't pay all at once

[antigop]

81. did you read the article AND my post? Max out of pocket $6400 for individual.

You have to look at premiums, copays, deductibles, and max out of pocket.

76% of Americans are living paycheck-to-paycheck
http://money.cnn.com/2013/06/24/pf/emergency-savings/index.html

http://thinkprogress.org/economy/2013/09/26/2686691/nearly-four-in-ten-americans-are-living-paycheck-to-paycheck-each-week/
Nearly Four In Ten American Workers Are Living Paycheck To Paycheck Each Week

More than four years since the economy shifted from recession to recovery, 36 percent of U.S. workers always or usually live paycheck to paycheck according to a survey released Wednesday by CareerBuilder.com. Another 40 percent say they sometimes do.

$6400 max out of pocket for an individual that takes a silver plan. That's for an INDIVIDUAL, not a family.

http://www.huffingtonpost.com/nathan-newman/obamacares-secret-subsidi_b_4078125.html
Cost sharing subsidies only available up to 250% FPL for family of four: $58,000

Rarely discussed in the media are the so-called "cost sharing subsidies" for people making up to 250 percent of the poverty line ($58,000 or below for a family of four). These rules sharply limit the copays and total out-of-pocket expenses those families will ever have to pay for health care.

I honestly do not understand what world DU'ers live in if they think a family of four making $60,000 will be able to afford a family max out of pocket plus premiums. Yes, that family will get a subsidy for the premiums, but I don't know how that family can afford the premiums, and FAMILY (not individual) max out of pocket.

One last edit: DO THE MATH. I'm really tired of trying to explain this to people on DU.

[JVS]

32. They need to scrap the individual mandate. Without the ability to walk away the consumer cannot...

get a reasonable price.

[jeff47]

44. Sorry, adverse selection would destroy access to medical care.

Let's say there's no mandate. So what happens? The healthy don't sign up - the average 20-something only needs insurance if they're hit by a bus.

If the healthy don't sign up, there's no cost-sharing. Which means insurance becomes much more expensive. Which means the slightly-unhealthy (or 20-somethings that play in traffic) don't sign up. Which means insurance becomes much more expensive. Which makes it unaffordable for the moderately sick, so they don't sign up. Which means insurance becomes much more expensive. Which means the sick can't even afford it. I think you know where it goes from here.

Fact is there's too much FUD for a national single-payer to pass. It would be far cheaper and far better, but it could not get through the Senate. Mostly due to Lieberman, the senator from Aetna.

What the ACA does is allow us to destroy that FUD. We can get "public options" or single-payer in blue states relatively easy. When those don't result in a massive pile of dead bodies, we can expand to purple states. Which eliminates enough national-level FUD to get a national-level plan.

The ACA isn't the end. It's the end of the beginning. With the battle moving to blue states, we will be able to make a lot of advances without the Republicans being able to stop us....as long as we stop pretending the ACA is the end.

[JVS]

46. The mandate needs to go because without the ability to say no, there is no cost control.

[jeff47]

47. Again, no mandate means no cost sharing, which means no insurance for anyone.

The technical term is "adverse selection" if you want to google and read up on it.

Cost control in the exchanges is supposed to come from the requirement that each exchange have multiple companies offering plans.

[JVS]

48. They shouldn't have created a mandate until they got costs in line.

[jeff47]

54. Once again, no mandate means that can not happen.

The mandate is required to get enough healthy people into the insurance plan for cost sharing to "get the costs in line".

What do you think happens to the cost of health insurance when only people with cancer buy it?

This isn't just an insurance company give-away. There's actual reasons behind the need for the mandate.

[JVS]

55. Bullshit. And I don't care what happens to the health insurance companies. They're the problem.

Trying to make them part of the solution was foolish.

[jeff47]

57. Not bullshit. Reality

I'll just quote myself.

Let's say there's no mandate. So what happens? The healthy don't sign up - the average 20-something only needs insurance if they're hit by a bus.

If the healthy don't sign up, there's no cost-sharing. Which means insurance becomes much more expensive. Which means the slightly-unhealthy (or 20-somethings that play in traffic) don't sign up. Which means insurance becomes much more expensive. Which makes it unaffordable for the moderately sick, so they don't sign up. Which means insurance becomes much more expensive. Which means the sick can't even afford it. I think you know where it goes from here.

No mandate results in no cost sharing which results in no insurance for anyone. You can't control costs without healthy people, and you can't get healthy people without a mandate - it makes more sense for them to gamble on not needing insurance.

And I don't care what happens to the health insurance companies. They're the problem. Trying to make them part of the solution was foolish.

Again, single-payer could not get through the Senate. Neither could public option. Lieberman, Snowe and the others would join the filibuster.

So the ACA moves the battle for single-payer to blue states. Where we don't have to fight against assholes like Lieberman and Snowe. Getting single-payer in those states is far, far easier. Heck, Vermont already has.

The success of single-payer in blue states will let us bring about single-payer nationally. Just like how Canada got single-payer.

[datasuspect]

63. this isn't about access to medical care

this is about compulsory purchase of insurance.

[jeff47]

66. And that purchase provides access to medical care.

You're also free to pay up-front. But unless you're a Koch brother, that's going to be difficult for all but the most basic services.

So there's a need for some form of insurance. The ACA creates a bastard system in the short run, but provides fantastic tools for us to get single-payer in the end.

[datasuspect]

68. from what i've been able to gather

it's perfect for catastrophic care, but terrible for routine doctor visits, testing, diagnostic procedures, etc.

like i said, i want really bad for this not to suck.

[jeff47]

71. That's because a lot of the people complaining about deductibles

are not checking into what actually applies to the deductible.

Doctor visits, most tests, and most diagnostic procedures are preventative care, and not covered by the deductible. They're covered immediately (may have co-pay, depending on plan).

Gonna have a kid next year? You'll be hitting that deductable. Just getting a checkup? Then the deductible doesn't apply.

[grantcart]

33. lol garbage. I am mandated to pay taxes.

I am getting half of my taxes back in subsidy for my health care.

No deductibles.

This is a bad deal how?

[boston bean]

38. Very good for you. That is not how it will work for many people.

[enlightenment]

56. You just have a peachy deal

grantcart. Of course other people's mileage is going to vary - and few are going to have the unbelievable deal that you seem to have found. Would that we all were in your situation . . .

but we're not.

[grantcart]

61. Everyone who has my income gets a 'peachy deal

Many others have reported the same thing

http://www.democraticunderground.com/10023819690

My peachy deal is that I couldn't buy any insurance for 14 years and now I can.

There are 40 million people in that category.

As to the subsidy, tens of millions are going to qualify for it. Ironically I don't expect that I will. I expect (providing the government goes back to work) that my income will return to normal years and that my subsidy will diminish significantly or be eliminated.

You make it sound as if I benefited from some type of random lottery ticket rather than a plan that tens of millions are going to benefit from.

I would have been delighted to simply have some form of catastrophic insurance.

So far the comments I have seen from people who are disappointed that the ACA didn't do more are all from people who currently have good insurance.

[enlightenment]

69. I think you're wrong about the numbers.

You are suggesting that you will be paying a subsidized premium for a plan that carries no deductible - and that 40 million others will be able to do the same?

I don't think so. You are making broad comments relating to specific information you provided about your own situation and trying to convince me that it will apply to 40 million people.

I have also been without insurance for a very long time and I guarantee that the plans I see within my subsidized price range (bronze and a few silver) are not even close to "no deductible". For the most part, they amount to little more than catastrophic, because the deductibles and co-pays are high enough that I will still (as I have being uninsured) avoid any but the most serious of emergent care.

I am not going to try and guess where you live; what plans you have available or what kind of premium you can afford to pay, but in general I will say that by the time plans reach the "no deductible" stage they are also charging premium rates that are not within the reach of many, many people.

So really, good for you - I'm glad that you and your family have benefited - but please don't assume that because it has worked out well for you that the same will be true for others . . . and certainly not for the whole 40 million. Some percentage, yes - but for many it will not be as happy a tale.

I realize that you - and some other DUers - find posts critical of the ACA tiresome and (to a few) downright wrong. I realize that some are even convinced that those posts are just lies designed to undermine the ACA and the President's legacy.

It would be nice if you would realize that your situation, as happy as it is, does not carry more weight than those who are saying their situation is not as rosy under the ACA.

[grantcart]

73. AZ

I went up to a gold plan to get "no deductible" and will pay $ 444.

You are suggesting that you will be paying a subsidized premium for a plan that carries no deductible - and that 40 million others will be able to do the same?

never said that

It would be nice if you would realize that your situation, as happy as it is, does not carry more weight than those who are saying their situation is not as rosy under the ACA.

Here is what I said:

http://www.democraticunderground.com/10023777148

Some here have health insurance and don't realize what it is like to go a decade without access to good care when you have a serious problem (and this was after I had very high level PPO plans for 20 years but lost it when I got sick).

I know that there will still be some for who this plan isn't going to deliver as much help as they need.

But, at least in my case, it was a much much better plan than I think even the more optimistic of us thought. If the shutdown is concluded and I can get back to work I will be able to finish the year at a level that may make them take back the subsidy and that would make me very happy but I was stunned to see how big the subsidy was based on last year's numbers.

This is going to be a major improvement in a lot of peoples lives and that is why the Republicans are trying so hard to sabotage it.

You seem to be particularly concerned about the level of the deductible, which isn't that big an issue for me. I was expecting a substantial deductible.

Tens of millions are going to get a better health insurance deal than they now have. That is a 'peachy' deal.

[enlightenment]

76. I was responding to your last post, not the one prior to that.

Like I said, grantcart - I'm delighted that you can afford a good plan. I'm glad you got some subsidies that bring your premium to a level you can afford.

However, moving the goalposts every time I address what you say isn't convincing me that you are willing to engage in any real dialogue about this.

Of course I am concerned about the deductibles. People have to pay the deductibles unless - like you - they can afford to pay the extra money for high premium plans.

You insist that because your situation is good, we should be convinced it will be that good for "tens of millions" of other people. You just cannot throw out numbers like that and have anyone take you seriously.

Really.

[malokvale77]

85. ^^^this^^^

[Sunlei]

34. yes,we need single payer & deductibles stink. actual medical costs/rx drugs are still to high.

ACA Insurance means less worry about a catastrophic health issue that costs everything you have.

[JVS]

50. Not really. It just means that insurers and hospitals get their money and you don't make a mess.

It's like putting yourself in a glad sack before jumping off a building so that you don't splatter everywhere and make a mess for the medical industry.

It used to be that the uninsured came to the hospital late in the game and ran up a huge bill that the hospital would have to eat because the patient was too dead to pay it. Now the hospital won't have to eat it because they'll be insured. Of course they'll still arrive late in the game because they can't afford to use their insurance, but at least the insurance companies and the hospitals will be happy and that's what really counts.

[Sunlei]

70. people will use their wellness exams. insurance companies & hospitals will price gouge each other.

I want to use my savings and house, for fun stuff

[sendero]

37. My company offers ONLY high-deductible..

... plans before the ACA. I'm pretty sure that is where it is all going. The idea here is to put people a little more in touch with what their medical care costs, instead of getting any service you want and just letting some big company pick up the tab.

I'm pretty sure I agree with this direction. The first step to controlling costs is to stop making everything a blank check to the consumer.

[boston bean]

39. Well, I agree with you in some ways.

I do think most will be forced into high deductible plans even if they were in a plan with their employer where the deductible was low or nothing at all.

What I don't agree with is that people didn't pay for their services. The low deductible plans run in the thousands/employee contribution.

[NoOneMan]

41. "stop making everything a blank check to the consumer"

Why do single-payer system, which make it illegal for a consumer to even see a bill, have lower per capita costs than the US if this were true?

[sendero]

42. With single payer...

.. the payer gets to decide what they will pay. For example, Medicare pays a lot less than managed care for the same procedures. And Medicare pays differently based on some pretty complex criteria.

While some providers won't accept Medicare, they would have no choice with single payer. Well, they could move to Russia I guess.

[jeff47]

45. Sorry, but it's actually illegal for Medicare to negotiate prices.

Medicare can't actually negotiate prices, by law. They get the prices that private insurance is able to negotiate.

Which kinda damages your overall "consumer must see some price to control costs" theory.

[sendero]

58. Well..

... I don't know where you get your information, but I work in the industry and Medicare does not "negotiate" prices, it "dictates" them. As do Medicaid programs. Actually, to be more precise, Medicare dictates reimbursements. A hospital can charge whatever it wants, but Medicare is going to pay $X, period.

There are a few exceptions, such as certain medical devices but overall, Medicare has a payment system for inpatient based on DRG, and for outpatient based largely on procedures performed.

[jeff47]

59. Apparently you don't work in the accounting part of the industry.

Medicare is required by law to pay the best price that private insurance companies negotiate.

Medicaid is allowed to negotiate. Which is why Medicaid pays much less than Medicare.

[Warren Stupidity]

89. He's likely referring to the prescription plan, which is barred from negotiating or dictating.

[Fumesucker]

87. There's not that many medical procedures that are ~fun~ to have done

And going to the doctor can easily eat up half a day or more in boredom and overall unpleasantness.

Most normal people aren't running to the doctor at every opportunity, that's a right wing frame if I ever heard one.

[sendero]

93. Well...

..... my doctor and I have talked about this extensively. He is hardly a wingnut. And this is what he believes.

A lot of people do in fact abuse the medical system, sorry if you find that incredible, that is HIS opinion.

[Fumesucker]

94. Odd how they don't have that problem in Canada

Or Britain either.

Evidently Americans really ~are~ special.

[sendero]

96. You don't really know WHAT they..

.. have in Canada, but one thing I can assure you they don't have is you walking into a doctor's office, demanding a CAT scan and getting it that day on someone elses dime.

[Fumesucker]

98. Oh yes, anyone in America can ~demand~ a CAT scan and get it immediately..

[Warren Stupidity]

88. Health care is not a discretionary consumer purchase.

The right wing framing of health care efficiency through "consumer choice" is horseshit. You don't shop around for bargains on your heart attack.

What happens when the access cost is high is that people don't get care until they no longer have a choice, and then the care they get is catastrophically expensive. Quite opposite to the right wing framing, lowering access costs, like to zero as many first world countries do, lowers per capita costs and delivers superior outcomes.

[sendero]

95. On its face..

.. I would agree. But according to my own doctor, lots of folks show up with complaints he doesn't think are worth his time. And, he is constantly bombarded with folks who want tests that he doesn't think are medically necessary, but he usually gives in because of the way the system is set up.

If folks had to kick in a couple hundred bucks for that CAT scan, they would be less likely to demand one when the doctor doesn't think it is needed.

Go ahead and write everything that you don't see as a "right wing frame". Doesn't make it so. And I find it incredibly difficult to understand why a person should not have to pay some portion of thier income for health care. Even if we had an efficient system, which we clearly do not, it costs money to deliver it.

I think insurance should pay for 1) most of the cost of catastrophic care and 2) almost all for the indigent and poor. In normal circumstances with middle income folks, they can pay.

Those who can afford to pay need to pony up.

Single payer is still my preferred solution, simply because that is the only way to really control costs. When/if we get that then everybody will have to pony up less.

[Fumesucker]

97. Even the plural of anecdote does not mean data

Your doctor's opinion means as much as the opinion of anyone else.

[NoOneMan]

40. The purpose of deductibles and copays is to make poor people stay home

This law will manifest in poor people self-rationing and experiencing less positive health care outcomes than the upper classes. Yet their pitiful levels of care are "acceptable" by law as a minimum. Why do they deserve a higher infant mortality rate and a higher cancer mortality rate? Why?

[sendero]

43. Copays and deductibles..

... should certainly be means-based.

[NoOneMan]

49. They should certainly not exist in an egalitarian system

[Egalitarian Thug]

65. That's how the American system works. Those on the bottom support and

subsidize those above them at an ever-increasing rate until they have no more capacity to pay.

[Puzzledtraveller]

78. Bingo!

[TheKentuckian]

60. Medicare for all is catchy and familiar branding but I'm not sure it should be a goal

It is still just an 80/20 plan with shittier than average prescription coverage. Probably better than bronze and silver offerings now in some ways but you definitely need secondary policy (a lot of folks still need medicaid).

Our whole system is garbage, I'm more of a Tricare for all or a VA for all type but even that stuff should be a way point to a completely single payer system and that a possible a waypoint to a NHS.

Medicare is not single payer, it is just less fucked up with less fat than traditional insurance.

[Xithras]

52. Remember, the ACA was written by INSURANCE EXECUTIVES, not the Democratic Party

The primary author of the ACA was Liz Fowler, a longtime lobbyist, former VP with Wellpoint (a large HMO), and who is now an exec in the pharmaceutical wing of Johnson & Johnson.

The ACA was designed to accomplish one single goal...to get everyone insured while guaranteeing profits for the insurance companies. In EVERY SINGLE INSTANCE where the bill had to make the choice between "patient care" and "insurance company profits", the patients lost.

The ACA really is the best of all worlds for the insurance companies. They get to jack up the rates for the people who don't qualify for subsidies (increasing their profits), they get the government to pay the increased rates for people who DO qualify for subsidies and didn't previously have insurance (increasing their profits), and they get to apply sky-high copays and coinsurance limits to the coverage, discouraging anyone who doesn't have a small fortune in the bank from actually USING the insurance they're paying for (increasing their profits).

I've never understood the dogged defense of the ACA by Democrats. It's a bill designed to transfer government wealth to the investor class by offering NOMINAL amounts of overpriced insurance to people who can't afford to use it anyway. It's a farce masquerading as a fix.

[datasuspect]

62. i honestly didn't want to believe this is the case

but you put into words all of my suspicions.

[historylovr]

79. +1

[solarhydrocan]

86. Senator Max Baucus Received More Campaign Money from Insurance Industry...(Democracy Now)

Senator Max Baucus Received More Campaign Money from Health and Insurance Industry Interests than Any Other Member of Congress.

Montana Senator Max Baucus, the chair of the Senate Finance Committee, is the Senate’s point man on healthcare reform. A new article in the Montana Standard finds that Senator Baucus has received more campaign money from health and insurance industry interests than any other member of Congress. The article says, "In the past six years, nearly one-fourth of every dime raised by Baucus and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals."

excellent video here:
http://www.democracynow.org/2009/6/16/report_senator_max_baucus_received_more

[ProSense]

67. Not accurate

"You're mandated to pay hundreds a month for insurance, to find out that get you very little coverage. "

There is extensive free coverage available.

Link to list of free preventive services
http://www.democraticunderground.com/10023828253

[0rganism]

72. agreed - we really need a single payer system

but right now we can't even get the "loyal opposition" to agree to this modest change. How the hell do we go about getting something better?

[wercal]

74. I'd love to see some standardization with ACA posts, discussing rates

1. State
2. Age
3. Single or with dependents
4. Income

Then when somebody says their premium will only be $24 a month with a $1,500 deductible, and somebody else says they have to pay $500 a month for a $6k deductible, some sort of comparison can be made.

[bvar22]

77. "Medical Bankruptcy" is a term that is virtually UNKNOWN in civilized countries,

....but will STILL be Big Business in the USA,
perhaps even BIGGER as struggling Working Class Americans try to access actual Health CARE with their mandated "Bronze" Insurance.

THAT is the "Uniquely American Solution".

[BlueCheese]

92. A large fraction of medical bankruptcies today...

... are by people who have health insurance. I forget the number, but I think it was well over half.

[historylovr]

80. K & R

[tapermaker]

83. I don't see where it can be much better short of single payer.

I found on cover Oregon a Kaiser gold plan below

$546
per month






Ex Value Option 10000

KP OR Gold 0/20
HMO
71287OR0420001-01




Deductible: $0

OOP Max: $6,350


Plan level:


Gold
this is for a single person 54yrs old non smoker. making 25,000.00 a yr. The subsidy on this plan is 197.00 a month so my out of pocket is 349.00 for a GOLD plan.

[Matariki]

90. +1

As if the goal was to funnel money to the insurance companies while being able to *say* more folks are covered.

It's a start but we need to keep pushing for single payer. A WAY more reasonable solution.

[munster69]

91. You don't get hosed by ACA

That award goes to for profit Health care.