Doctors: New Health Care Plans Raise Red Flags

[slipslidingaway]

Which providers can be accessed during a difficult time can make a world of difference!

http://blogs.wsj.com/washwire/2013/11/26/doctors-new-health-care-plans-raise-red-flags/

"Physicians groups told Obama administration officials Tuesday that they are worried that new insurance plans under the Affordable Care Act offer only limited networks of providers and low reimbursement rates for doctors, and that could make it difficult for millions of those enrolled to actually get health care.

As the Journal has reported, some health plans don’t include big brand-name health providers in their networks and are slashing how much they’ll pay medical practices for treating the newly covered..."



http://www.pnhp.org/news/2013/november/major-physician-organizations-concerned-about-impaired-access-through-exchange-pl

Comment:

By Don McCanne, M.D.

"The new health plans to be offered in the exchanges are avoiding excessive premium increases by using narrow networks of physicians and by lowering payment rates for health services. The leaders of our nation’s leading organizations of health care professionals are concerned enough about what this might do to patient access that they met with Obama administration officials at the White House.

The administration officials were already "acutely aware" of these problems. Of course, they were. They result from fundamental design flaws in the financing model of the Affordable Care Act. The model was designed by and for the private insurance industry.

It is likely that members of these professional organizations are not only concerned about the patients, narrow networks and lower payments have a direct effect on their livelihoods. In a well designed system, patients must always come first, but the professionals taking care of the patients should be content as well. Grumpy doctors and nurses detract from an optimal patient care environment.

There will be more discontentment as the Obamacare model of high-deductibles, narrow networks, and payment restrictions extend to employer-sponsored private plans. These trends will no doubt expand with the proliferation of private insurance exchanges catering to employers - exchanges outside of the government-operated Obamacare exchanges. Even the private Medicare Advantage plans are being modified in response to their overpayments being pared back. UnitedHealth, the nation’s largest private insurer, has notified thousands of physicians that they are being dropped from their Medicare Advantage network.

Do we really want to keep headed in this direction? ..."

[NYC_SKP]

1. Edited

Last edited Tue Dec 3, 2013, 11:14 AM - Edit history (1)

Wrong source. My bad. Carry on....

[slipslidingaway]

6. Speak to the narrow networks and not the news source ...

the in network providers can be a choice of life or death for some, unfortunately we know of a few people who did not make it because they did not have the chance we did.

Plus high deductibles might mean you have to sell your home, we just did a couple of months ago ... great insurance, high deductibles, but at least we had great in network providers for an annual out of pocket maximum of +/- 9 K. Going on four years later and that becomes a real burden ... not to mention the lost wages.

All that being said I am so thankful to the providers that were in network and the care they provided, they saved my husband's life, for how long we're still waiting ... and hoping.

Providers make a difference! We lived with people at the ACS Hope Lodge in NYC who did not have access to the providers we did and they wished they could go somewhere else. It is heart wrenching to see people not have access because of their insurance.

Obama should not have demeaned a national, not for profit system ... some of us believe that need, not money, should do more in determining access to care.

[TrollBuster9090]

37. I don't know where these mythical 'high deduction' plans are supposed to be. Of the plans I looked

at on the California exchange, the highest deductible was about $2500. I don't know about narrowing the networks, but I do know that one of the goals of Obamacare was to ELIMINATE junk plans that suckered people who believed they'd never get sick into buying plans that had low premiums in exchange for high deductibles.

[Glitterati]

39. Oh, they exist

Have no doubt.

Even the Platinum plans I have access to in Georgia are $6,500.00/per year, per person deductibles.

And the networks? Not one plan in Georgia includes my medical providers. Not. One.

Now, if you don't believe me, I'll be happy to bring up those pages and post the screen captures right here.

I will be buying the cheapest, crappiest plan available, because, quite frankly, these plans won't do a thing for my family except take money I don't have out of my pocket.

My endocrinologist costs me $25.00 per visit. And she's not on ANY provider list in Georgia. Yes, she's with a "pay based on income" group, but why wouldn't these policies be grabbing up these doctors?

I won't be changing doctors because some insurance company tells me to - my health is far more important to me than that. I have a life threatening disease, which hospitalized me last year and I'm going to let some insurance company tell me I'm not paying enough to the woman who literally saved my life???? NOT.

[TrollBuster9090]

41. Yes, please post the screen captures of the plans available in Georgia. Now I'm curious.

But "these plans won't do a thing for my family except take money I don't have out of my pocket," if it's literally money you don't have or can't afford you should qualify for a subsidy. That's the whole point.

But yes, post the screen capture. I'm curious now.

[Glitterati]

42. Here's the summary

Yes, I qualify for a subsidy. But, that's beside the point! I can't pay my CURRENT bills on my social security widow's benefit, how the hell am I supposed to pay these insurance premiums?

I have no car payments, no credit cards, nothing but necessities and struggle to pay THOSE bills. Where the hell am I suppose to get the $100.00/month for insurance I can't even use?

My doctors aren't on ANY networks on ANY of these plans. So paying to see my doctors, my prescriptions don't even count toward the deductible on these plans because they are OUT OF NETWORK.

So, I'm suppose to pay for insurance that is literally worthless to me.

[eomer]

44. And the screenshot shows that you are wrong about the deductibles.

The average deductible for the Platinum plans available to you is $1,000 so obviously they are not all $6,500. In fact none of them have a deductible of $6,500 because the highest deductible currently allowed under the law is $6,350.

[Glitterati]

46. Really?

That's how YOU read Maximum Out of Pocket?

OK, ROFL.

And, you know what? The difference between 6,500 and 6,350 is nitpicking. Exxxcccuse me for being off by a few pennies. Doesn't matter, though, I can't afford EITHER.

The difference between a hospitalization without insurance and a hospitalization with THIS insurance is STILL BANKRUPTCY.

[Demit]

48. I've been trying to follow what you're saying, but

I'm confused. You said earlier, "Even the Platinum plans I have access to in Georgia are $6,500.00/per year, per person deductibles." Yet the screenshot you posted clearly shows that the Platinum plan average deductible is $1000, and the average out-of-pocket maximum is $1500. Why do you say it is $6500?

And I'm curious: are you paying for insurance now? Or do you not have insurance at all? Is your only health cost now the visits to your endocrinologist?

[eomer]

49. Your statement was about deductibles for Platinum plans.

You said:

Even the Platinum plans I have access to in Georgia are $6,500.00/per year, per person deductibles.

In your screenshot, look at the line for Deductible and the column for Platinum and you'll see that the average deductible for the two Platinum plans available to you is $1,000. So you were off by $5,500.

And even if we switch from discussing deductibles to discussing out-of-pocket maximums, the average for that is $1,500 for the Platinum plans available to you.

So you were off by thousands of dollars, not by pennies.

And I haven't disagreed with the other things you say. But you have me wondering whether you're stating your situation accurately given how careless you were in your statements about deductibles. For one thing, what's your insurance status now? Are you insured or uninsured. And whichever it is, how much is it costing you to see your doctors and fill your prescriptions? And if your medications are not covered (due to the formulary in your state, drugs aren't classified as in or out of network), are there reasonable alternative drugs? Are you sure that the options on the exchange would cost you more, after finding the best solutions available to you?

[Glitterati]

50. I posted above about my costs

My endo is $25.00/per visit. I go to a "pay based on income" clinic in Atlanta. In fact, I drive 70 miles round trip to see this endo, because I can't afford the local doctors. http://www.goodsamatlanta.org/

Please note....the copays on EVERY plan are more than or the same as I pay right now, except for the Bronze plan that saves me a whopping $3.00. EXCEPT THAT MY DOCTOR ISN'T IN NETWORK.

The local endo who saw me for 10 minutes in the hospital last November charged me $400.00 for 10 minutes in my room when she suggested surgery and I said I was uninsured and could not afford surgery.

My prescriptions are $146.00 every 2 weeks. Right now, I am off my meds because I can't afford them.

So, which should I pay for - my meds or lousy insurance? Those are simply the choices I have to make.

My status now is uninsured. Hell, I've been uninsured for more than 20 years and my 18 yr. old daughter has NEVER had insurance. I have a pre-existing condition. No one WOULD insure me and the ACA pre-existing insurance was $535.00/month for me.

So, just like the pre-existing condition insurance, I have discovered that ACA is a pipe dream that I can't afford.

[TrollBuster9090]

60. "My status now is uninsured."

Okay, you've proved me wrong in the sense that there ARE plans that have a $6500 deductible. (Similar to the junk plans that existed before Obamacare, and which are now being phased out because they charge people $150 bucks a month, but don't actually PAY for your hospital stay should you get sick. Good riddance to bad trash. These high deductible/low premium Catastrophic plans at least cover you if you DO get sick.)

So, I was wrong about the maximum deductibles, but I'm still confused about why you're whining about Obamacare.

1. You said you're uninsured. NOW you'll be insured. If you're actually THAT poor, you'll qualify for a subsidy. Or (if you lived in a civilized state where a Republican Governor hasn't sabotaged the Medicade Expansion) you'd get Medicade for free.

2. If you're really that poor, just don't buy insurance. You'll pay a fine ($60) and be GIVEN Medicade. Ironically, since you live in a state where you can't get the medicade, they can't fine you either. You only pay the fine if you can AFFORD the insurance but refuse to buy it. If that's not the case, you don't have to worry. In either case, I'm pretty sure you'll qualify for a near 100% subsidy.

3. You just said the Endochrinologist recommended surgery, but you can't afford it and you're uninsured. With Obamacare, one way or the other you'll BE insured and you CAN have the surgery. I don't see how that's worse. The only thing that's 'worse' is that your favorite Endochrinologist might not be in your network, which seems to be a small price to pay for HAVING the Endo you want, but not being able to afford the treatments he/she recommends. I don't see how Obamacare is anything but an improvement on that.

4. You mentioned that you haven't had insurance for 20 years, and that nobody would insure you because you have a pre-existing condition. A) Under Obamacare they now HAVE to insure you, and B) Under Obamacare IT'S ILLEGAL for them to charge you MORE because you have a pre-existing condition. So, again, I don't see Obamacare as anything but an improvement.

You've gone for 20 years without insurance, which means if you ever get sick...YOU PAY 100% out of pocket, if you've got any money at all. This way, if you've got money, you pay for the insurance, and pay a MAXIMUM of $6500 in the worst case scenario that you actually get sick. I don't see how that's worse. The other scenario is that you literally have no money, in which case you qualify for a subsidy, which would pay for most or all of the plan anyway.

So, did you look at the subsidy calculator to see if you qualify for a subsidy?

[Glitterati]

68. I'm done explaining this

But, please understand the following:

1. Those prices you see ARE WITH a subsidy. LOL, do you think ANYONE could get insurance of any kind for ~100.00/month without a subsidy?

2. I DO live in a state with a republican jerk Governor who refused the Medicaid expansion.

3. The ONLY reason I would like to get insurance is for my daughter, who, alone, doesn't make enough to qualify for a subsidy and WOULD qualify for Medicaid if our governor jackass had accepted it but is screwed unless *I* buy insurance and keep her on MY policy. She works at a retail store who told her when they hired her, that they couldn't give her more than 25 hours BECAUSE OF OBAMACARE.

You should note, I don't WANT to see that endo from the hospital. Any doctor who only wants to discuss the MOST expensive treatment, is not a doctor I ever want to see. I have multiple treatment options and will make the decision which way to go long term, once I am past the crisis I am currently under, with a doctor who is willing to discuss all options - my current doctor.

[TrollBuster9090]

71. Unless you earn more than $46,000 per year, those prices are not with a subsidy.

If you want a rough calculation of how much of a subsidy you'll get, and how much you'll pay based on income, you can go to the Kaiser Foundation's calculator and get an estimate.

http://kff.org/interactive/subsidy-calculator/

As I posted below, according to the calculator, a 40 year old single person living at a 30301 (Georgia) Zipcode who earns $12,000 (the Federal Poverty Level) should only pay $20/month ($240 per year) for the Silver plan, with the rest being subsidized by Obamacare. If you raise it to $18000 you pay $65/month for a Silver plan. (And, obviously, if not for your asshole governor refusing the Medicaid money, people earning under $16,000 would qualify for free Medicaid coverage, but that's a different story.)

(And I'm a little surprised you believed what that retail said about only hiring people part time 'BECAUSE OF OBAMACARE.' I wonder how they explain the fact that they've been doing this to service workers for thirty years BEFORE Obamacare? The trend of screwing service industry workers by limiting their hours to part time, so that they don't have to give them health or pension benefits began a hell of a long time before Obamacare. Stop believing their propaganda.)

[Glitterati]

72. You are unbelievable

Do you read anything?

I already said the plans I posted are WITH a subsidy. MY subsidy! I get a subsidy of 517.00 per month on the ACA insurance plans.

The subsidy is included in what I posted. I posted that back several posts ago.

WHAT I POSTED ARE THE PRICES I WILL PAY WITH A SUBSIDY.

I called the 800 number today to confirm that, and that those are family plan prices. The website showed information that confused me, so I called to make sure the quotes I posted in that screen capture WERE the family plan.

My daughter is in that loop that the Supreme Court created with their ruling - she makes enough to qualify for Medicaid and not enough to get a subsidy. Since our jackass governor refused the medicaid expansion, unless I get a family plan, she's screwed. She doesn't qualify outright for Medicaid because she lives at home, so they use HOUSEHOLD income to determine eligibility and my income combined with hers disqualifies her.

As for the Obamacare BS from her employer, did I say I believed it? I was simply repeating what THEY SAID TO HER when they hired her.

The bottom line is simply that the only plans available to me which will actually mean medical coverage are the Platinum plans at $146-160.00/month. The other available plans have deductibles which mean the insurance policies available to us are useless. Yes, the other plans are cheaper, but we'll never meet the deductibles without a major medical crisis, which means we can pay for catastrophic plans that are only 25-50.00/month cheaper than a plan we might actually USE. At $1,000.00 deductible, 90 days worth of my prescriptions will meet the deductible every year. Then, at least her prescription for birth control and chiropractic visits will be covered.

Now, I just have to figure out where I'm going to get $146.00/month.

[TrollBuster9090]

73. Okay, so the screencapture you posted is for a FAMILY plan, not an individual plan.

If it's a family plan, how many people are covered? Two? You and your daughter, I presume?

[Glitterati]

74. Correct, 2

As I said in my first post, I am a widow. My income is Social Security Widow's benefits. And, since you're being nosey, that's $1,390.00 per month.

My daughter makes minimum wage x 25 hours per week.

Oh, and this week she got a $50.00 bonus for being employee of the month (her first month on the job)!

So, go ahead.....do your math and you'll discover those numbers you've been touting and beating people over the head with are VERY, VERY, VERY WRONG.

[TrollBuster9090]

75. No, they're not wrong. I posted numbers for individuals, not families,

and you never specified that the screenshot you posted was for a family plan, not an individual one. But I'm still finding it hard to believe that somebody is complaining that Obamacare is bad because under the ACA she's now able to insure TWO PEOPLE with a PLATINUM comprehensive insurance plan for $80/month each.

That's somehow WORSE than things would be without the ACA? Without it your daughter STILL wouldn't qualify for Medicaid, and you'd still have no insurance either. If you really think the ACA is so bad, just don't buy any insurance and things will be the same as they were before it. The worst they'll do to you is fine you $95, which they'll never collect unless you're entitled to a refund.

[Glitterati]

76. OK, I'll make you a deal

Since YOU think that's so cheap, you pay my premium and I'll be happy to quit proving you wrong.

The bottom line is simple, I can't AFFORD ACA. I couldn't afford insurance before and I still can't.

Simple.

[TrollBuster9090]

78. I'm sorry about your situation, but...

I don't agree that you're worse off as a result of the ACA.

Before the ACA, you'd have a household of two people with a combined income of $2090/month, and neither of you would have any kind of health insurance at all.

After the ACA, you'd have a household of two people with a combined income of $1930/month (after insurance payment, which you can deduct from your taxes, if you have any), and you BOTH now have comprehensive health insurance, INCLUDING free preventative screening tests such as: mammograms, colonoscopy screens, well-woman visits; gestational diabetes screening; human papillomavirus (HPV) DNA testing for women age 30 and older; sexually transmitted infection counseling; human immunodeficiency virus (HIV) screening and counseling; FDA-approved contraceptive methods and contraceptive counseling; breastfeeding support, supplies and counseling; and domestic violence screening and counseling, none of which will charge a copay or a deductible.

I think it's completely unacceptable that you should have to pay ANYTHING for health insurance with an income that low, but having said that, you're not worse off than you were before the ACA. Sorry, but that's just a fact.

[Glitterati]

79. See, you're still wrong

Because I can get ALL of those quoted "benefits" for a visit to the clinic I go to NOW for $25.00/per visit. And, yes, that includes all labs, all tests, everything.

I have blood draws every 2 weeks for my Graves disease and see my endocrinologist for $25.00.

So yes, I pay $25.00-50.00 per visit for myself and my daughter for all medical care. $25.00 per person, per visit. All labs, counseling and specialist care needed.

[TrollBuster9090]

80. 1. I just said you'll get all those tests for FREE now,

which beats $25-50/per visit., and

2. You DO NOT pay $25-50.00 per visit for 'all medical care.' If one of those tests finds a tumor in your lung, your $50 clinic visit fee will NOT pay to have it taken out to save your life.

True, you could go to your clinic, pay $50 to find out there's something catastrophically wrong with you, and then go to the ER to have the hospital treat it for free, and have the cost absorbed by other peoples' health premiums. That was certainly the 'system' before the ACA. But, as I said, if you really liked that system so much, you can keep it. Just don't buy any insurance! Then you'll be in exactly the same situation you were in before the ACA. Case closed. The fine is only $95, which they would never collect from somebody in your situation. Simple enough.

[Niceguy1]

81. what if you don't have the $80 a month per person

then what?

[TrollBuster9090]

82. Then, as I said to her...

Just DON'T BUY ANY INSURANCE. You'll be in exactly the same situation you were in before the ACA, if you think that situation was better.

The fine is only $95, which they collect by withholding any tax refunds. For people who are really that poor, they wouldn't collect it.

So, I don't see what the problem is. If the system was actually better before the ACA, just don't buy insurance, and you can keep the old system.

As I said, I'm not a fan of the ACA. I want a single payer, Medicare for all system. But, having said that, the ACA is FAR better than what we have before it. Anybody who thinks otherwise needs to have their head examined (something that's also free, without a copay under the ACA).

[Glitterati]

83. So, in other words

Just don't tell the truth. Keep. Your. Mouth. Shut.

Right?

No one in your world is allowed to be HONEST about ACA. At least not publicly.

Do you really think other people in my situation aren't smart enough to figure it out despite your LIES?

[TrollBuster9090]

86. Keep your mouth shut about what?

You can choose to call me a 'liar' if you don't mind looking childish, but nothing I've said is a lie.

And I think a lot of people in your situation are simply misinformed. That's not surprising, giving the amount of disinformation the other side is spreading on this issue.

[TrollBuster9090]

85. Incidentally, I'd follow up with HHS on those premiums if I were you, because I just entered your

numbers into the Subsidy Calculator, and got a monthly premium of $28/month for the two of you, with the ACA subsidy.

I entered a Georgia Zipcode of 30301, a family of two (one 40 year old adult and one 21 year old child, both non-smokers) and a yearly income of $16680 (your $1390 figure multiplied by 12), and got a premium of $5356 per year and a subsidy of $5023, leaving you with $334 to pay per year, or a grand total of 28 bucks a month.


Try it for yourself, and then quote those numbers to the HHS representative you talked to. Alternatively, talk to a representative at the Kaiser Foundation to see what your options are.

http://kff.org/interactive/subsidy-calculator/

[Glitterati]

89. So you managed to ignore my daughter's income completely

And, you've got the ages wrong completely.

You're number are completely and utterly wrong. And, you should stop doing this and giving people misinformation.

My daughter's income would be 7.50 x 25 hours per week, 52 weeks - 9,750.00

So, with the correct data, your handy little caculator comes to 108.75 per month. WAAAAAY off your "28 bucks" and a WHOLE LOT closer to exactly what I was quoted on healthcare.gov (which was $113.18). So, really, you should STOP.

PLEASE stop misinforming people.

http://postimg.org/image/6i526m2q9/

[TrollBuster9090]

92. Yes, it comes out to $108.75 if you count your daughter's income as part of the household income

rather than as an adult dependent child, provided she's under 26.

And how, exactly, was I supposed to know your ages, OR your smoking habits, for that matter? I did it as an estimate, for your benefit.

And calculated at $108.75, we're now down to $54 per person from $80. Frankly, I'm still amazed that somebody would whine about how horrible the ACA is, for making it possible for two people who would otherwise have had NO health insurance to get comprehensive health insurance, with free preventative screening tests for $54/month.

In an earlier post you suggested I should pay your $80 premiums. Well, first, that's pretty much what I've BEEN doing for a lot of people who don't buy insurance, and just go to the ER for treatment when they need it. And second, I'd gladly pay the $95 fine for you every year to go back to having NO health insurance, just to stop your childish whining.

[Glitterati]

93. Because, if you had bothered to READ any of my posts

than to spend your time trying to call me an idiot, you would have seen I already stated ALL THOSE FACTS.

You call TRUTH whining. Lovely.

So, now that I've proven you completely wrong and told you to stop spreading lies, I'm whining............nice way to bring more folks into the ACA fold, there, buddy. NOT.

[TrollBuster9090]

94. Actually, I've read what you've said very carefully. Let's recap it, shall we?

(For the record, I never called you an idiot. And you accused me of being a 'liar' several times before I ever accused you of being a whiner. The difference is that I'm not lying, but you definitely are whining.)

Let's recap what you've said:
1. You have a pre-existing condition (Graves Disease)
2. You've been uninsured for 20 years because nobody would insure you with a pre-existing condition.
3. You pay $25-$50 twice a month JUST FOR TESTS at a clinic ($50-$100 in total), without actual medical coverage.
4. You have a struggling, adult daughter, who works part time, but doesn't qualify for Medicaid, and you'd like to help her.


Without the ACA:
1. You STILL couldn't get coverage at all, because of your condition.
2. You'd STILL be paying $100 JUST FOR TESTS, without actual MEDICAL coverage.
3. Even if you could GET insurance, probably for several hundred dollars a month due to your condition, you would NOT have the option of adding your daughter to it.

With the ACA:
1. You CAN get insurance, despite your pre-existing condition.
2. It's ILLEGAL for the HMO to charge you extra because of your condition.
3. If you were just interested in insuring yourself, you could get complete, comprehensive medical insurance for just $20/month with the subsidy...ONE FIFTH of what you used to pay JUST FOR TESTS at the clinic.
4. You now have the option of adding your daughter to your policy, and covering BOTH of you for just $56 each...JUST SLIGHTLY MORE than YOU ALONE used to spend on JUST BLOOD TESTS.


So...remind me again, WHY is the ACA so horrible?

[Glitterati]

103. You have your first #4 wrong entirely

4. You have a struggling, adult daughter, who works part time, but doesn't qualify for Medicaid, and you'd like to help her

My 18 yr. old daughter needs health insurance. The only way for her to get it is with ACA because:
1. Because of the Supreme Court decision making Medicaid a state decision, the jackass governor of my state declined the Medicaid expansion
2. Because my daughter makes so little money, she doesn't qualify for a subsidy.
3. Without Medicaid or a subsidy she will continue to go uninsured unless *I* buy a family policy and put her on it because insurance is as much as she currently makes annually.

Additionally, your original #3 is incorrect simply because a clinic visit for me is $25.00, including labs and medical specialties, i.e., my endocrinologist. The $50.00 was only if BOTH my daughter and I went to the doctor at the same time - $25.00 each.

So the final argument, as stated throughout this discussion can only be answered as follows:
With the ACA:
1. You CAN get insurance, despite your pre-existing condition.

Yes, this is true. But I STILL can't afford it.

2. It's ILLEGAL for the HMO to charge you extra because of your condition.

Which is moot because of #1 above.

3. If you were just interested in insuring yourself, you could get complete, comprehensive medical insurance for just $20/month with the subsidy...ONE FIFTH of what you used to pay JUST FOR TESTS at the clinic.

Again, your math is wrong (because you like to change the subject instead of addressing issue #1 above) and your incorrect math and interjection that the cost excludes anything but TESTS. I never said any such thing and, in fact, explicitly stated that everything was included for $25.00 per person, per visit.

4. You now have the option of adding your daughter to your policy, and covering BOTH of you for just $56 each...JUST SLIGHTLY MORE than YOU ALONE used to spend on JUST BLOOD TESTS.

Once again, changing the subject entirely, and ignoring the fact that I cannot afford your IMAGINARY "$56 each" while making up your own set of facts.

Nice try changing the subject again, though.

But, once again not the way to win folks to ACA by calling them idiots while you make up your own set of facts.

[WillowTree]

84. Chances are the chiropractic visits will only be covered.......

.......subject to network limitations and the deductible being met. So far as I know, only predominantly preventive services will be covered as "first dollar" expenses. Actual treatment, which is what one gets from a chiropractor, is subject to the other limitations.

I could be wrong about that, but I don't think so. You might want to verify that one way or the other so you don't have any more unpleasant surprises down the road.

[Glitterati]

87. Yes, I see that

All of the plans have limitations on chiropractic care - most are 20 visits per year only, and, of course after deductibles are met. Thankfully, her chiropractor is in network on the plans we've looked at.

We have looked at all the plans and quite frankly dismissed all but the Platinum plans as workable. The others are simply nothing more than catastrophic only. We simply wouldn't meet the deductibles on any of the others unless a major medical issue came up, and my meds aren't even covered on most of them - because there is only one manufacturer of the medications I take and they are not generic. There is no generic, which is also why this medication is so expensive. The Kaiser Permanente plans are truly junk with reference to medications and in network doctors, and all the Gold, Silver and Bronze plans are only KP.

We've done tremendous research on this.

[Nine]

47. How much were you paying for your doctors and prescriptions before? (nt)

[Glitterati]

51. See Post #50 n/t

[wercal]

52. This is actually better than what is available in my county in Kansas

Platinum has $1,500 individual/$3,000 family deductible, max out of pocket $7,000 per person in network/ $14,000 per person out of network - $386 per month.

Bronze plan has $6,300 individual/$12,600 family deductible, max out of pocket $6,300 individual/$12,600 family in network and $22,000/$44,000 out of network - $174 per month.

What you've got in Georgia is a lot better than what we've got in Kansas.

[Glitterati]

54. Hey, but you know....these high deductible plans don't exist

Right?

I had high hopes for ACA, but it's doing nothing for me at all except forcing me to pay for something completely worthless to me.

Welcome to the club.

[wercal]

55. The KS Platinum plan is comparable to

What I have now - at least the deductible is. The premium is much higher, since that rate is 'per person'.


I think the problem lies with the people who can only afford the bronze plan....in alot of ways its just throwing $174 away every month....yes it insures against catastrophic illness, but thats about all.

[eomer]

61. You have a range of deductible options available, including as low as $1,000.

That option is almost surely a better deal for you than what was available before Obamacare since apparently you're eligible for a subsidized premium. But I understand you may still not be able to afford it and I think that is a travesty.

I wish you the best, hope things improve one way or another and you can get the treatment you need. Like many others who enter the discussion to correct misstatements about Obamacare, what I really support is single payer. I'm in favor of you getting the treatment you need no matter what, for everyone's care to be paid for by progressive income taxes, transaction taxes on financial trading, and other similar sources. But Obamacare is still better than what we had and we need for it to succeed and to stick while we continue to fight for single payer in Vermont and then the rest of the country.

[enlightenment]

56. You are quite fortunate to live in CA.

They have how many providers enrolled? I think I read it was over a dozen, perhaps more. Many states have far fewer - I believe one of the smaller East Coast states has three.

I can't speak for those states but I can speak for Nevada, since I live there. There are a total of 39 plans available from FOUR providers. Of those 39 plans, 14 have deductibles of $4000 or over; eight of those fourteen plans have deductibles of $5000 and over. Two "Bronze" plans and one "Silver" plan offer no payment until the deductible is met - their deductibles range between $5000 and $6300.

Since we're only talking about deductibles, I'll leave it at that - but do take a moment to widen your horizons (you can enter dummy data on the NV health exchange and pull this information up yourself if you think I'm making this up - https://www.nevadahealthlink.com/).

It is not a "mythical" situation for many people, it is a reality.

[TrollBuster9090]

62. Yes, I've admitted I was wrong about the deductible on the low-premium plans.

But I still fail to see how this is anything but an improvement over the current situation. (And I'm not a fan of Obamacare, I'm a single payer advocate.) The range of deductibles for the Georgia plans that were posted is between $1000 and $6500, while the range of premiums is between $100 and $160. Therefore, I'm puzzled why anybody with even moderate financial resources would risk a $6500 deductible, when the difference in premiums is only $60/month. (A 650% higher deductible in exchange for only a 30% reduction in premiums.)

As for people who don't even have THAT kind of money to throw around, they're (theoretically) supposed to qualify for either a subsidy for most of it, or Medicaid for FREE. (At least if you live in a state where a Republican Governor isn't denying poor people free Medicaid purely out of political spite.)

IMHO, the only people who will be put out by this system are people who can afford healthcare insurance, but simply refuse to pay for it, and would rather be free-riders. And this would be true whether we're talking about this crappy, free-market 'compromise' healthcare system, or a single payer, Medicare for all system, where people with more money would have to pay higher taxes to pay for the system (and rightly so). Either way, the right people (those who can afford it) are paying for the healthcare system, as opposed to the wealthy and the healthy screwing the poor and the sick who have no healthcare at all.

[enlightenment]

63. I'm not going to argue with you.

You seem to have made up your mind that anyone who says they really cannot afford it must be lying or terminally stupid, I guess - but they can't be simply relating the truth as they see it. I suspect you don't mean it badly, but you sound pretty self-righteous. "Only $60 a month" may mean something very, very different, depending on who is holding that $60 in their hand - and theories don't mean a lot when what you are "supposed" to qualify for isn't as much as you hoped (and by the way, Medicaid carries no premium, but it does carry co-pays - which went up under the ACA. $3.50 for a doctor visit may not seem like much of anything, but try telling that to the guy standing on the street corner begging for spare change - three bucks may be as much as he collects in a day . . . so the value of a dollar is entirely relative to where you're standing).

I am also a single-payer (true single payer, not the "public option&quot advocate and I believe your heart is in the right place; I'm just not convinced that you're really thinking this through when it comes to people's issues with the ACA.

[TrollBuster9090]

65. If you 'really cannot afford it,' what were you doing for healthcare before the ACA?

What were you doing for healthcare before the ACA? What kind of a plan did you have (if any), what was your co-pay, what was your out of pocket deductible, and (most importantly) what was your coverage? (As an example, what was the maximum per diem amount your old plan [if you had one] would pay for a hospital visit?)

Have you tried to sign up for this? If so, did you qualify for a subsidy? That's the key question, because the entire ACA was carefully designed to avoid stinging people who legitimately could not afford to pay the premiums and co-pays, while at the same time eliminating junk policies that appeared cheaper on face value, but didn't actually cover you if you got sick. (ie-they covered a daily rate for hospital visits of $1000 per day, which sounds adequate until you find out that the daily cost is actually closer to $2000, on average.)

[enlightenment]

66. Why are you trying to make this about me?

My personal situation is both irrelevant to this conversation and none of your business.

The bottom line is that there are going to be people who feel that those crappy Bronze plans with high deductibles, high co-pays, and narrow restrictions are the best they can afford, subsidy or not. And like many, many employed people with employer subsidized health insurance now, they are going to self-ration their healthcare (that is part of the "careful design of the ACA", you know) - probably to their own detriment.

It's not so simple as people making bad choices - they're not stinting themselves on the insurance to afford a new x-box, really.

[TrollBuster9090]

67. I made it about you because I assumed you were speaking from personal experience.

My position is that the ACA is deeply flawed, and not as good as a single payer system, bur for all it'\s flaws it's light years better than the status quo for almost every group (income group, gender etc.). Several groups may THINK they're ending up in a worse situation because of the ACA (ie-people with cheap, junk policies that they don't realize are inadequate until they actually NEED them), when in fact it's only very wealthy people with cadillac plans that will end up paying more for the same coverage.

You accused me of thinking that anybody who claims they can't afford coverage under the ACA is 'terminally stupid.' In fact, I think most are just terminally misinformed. That's not hard to believe given that Republicans and their plutocratic backers have A) spread disinformation, B) cut HHS funding that was earmarked for spreading the CORRECT information, and C) used State laws to actually BLOCK Navigators who were trying to help people understand how to use the ACA. I think you're just misinformed.

First, you claimed that Medicaid copays have 'gone up' under the ACA. Medicaid copays are determined by States, not by the ACA. It was like that before the ACA, and it's still like that. The ACA has nothing to do with Medicaid copays, so I don't know why you'd even bring it up. Furthermore, not only does the ACA not raise copays, it actually BANS copays for all preventative screening tests, thus encouraging early detection, and putting emphasis on preventative medicine.

Next, you claim the 'crappy' bronze plans have high deductibles and high copays. While the deductible is higher, it's eligible for subsidies, just like the premium; and in the Georgia example posted above, I don't see any difference in copays. The Bronze copay is $22 and the Platinum copay is $25, a grand difference of three bucks.

Finally, you talk about poor people not being able to afford the extra $60 to spring for the Platinum plan (or perhaps even afford the $100 for the crappy Bronze plan). When, in fact, even in a spiteful state like Georgia (as an example), were the Republican State government has refused the Medicaid expansion purely out of spite, you can still buy private insurance on the exchange for a massive subsidy if you're poor. Let's take the Silver plan as an example: in a civilized state you're eligible for FREE Medicaid up to 138% of the Federal Poverty Line, which is about $12,000. Thus, you get FREE health insurance if you make $16,000 or less in participating states. And you get a SUBSIDY for up to 400% of the FPL, which would be $46,000! Please, don't tell me that somebody who earns $3800/month can't afford a $167/month health insurance premium. And let's look at the other extreme. Let's say you make the Federal Poverty Level, and still don't qualify for Medicaid in a callous state like Georgia. According to the Kaiser Foundation subsidy calculator, a person who makes $12,000 in Georgia, almost your entire premium for a Silver plan will be subsidized, and you'll pay a maximum of $20 per month. (I did the calculation for a single, 40 year old non-smoker living in Atlanta.)

So, no, I don't think somebody earning $46,000 per year can legitimately claim they can't 'afford' a $167/month premium for a silver plan; and anybody who earns less than that gets a significant subsidy to pay for their premiums.

[enlightenment]

88. Just as an FYI,

I'm capable of reading without bold print.

You're not telling me anything I don't know - and you're still talking apples and oranges. Premiums versus healthcare costs in deductibles and copays (on top of premiums).

As for the rest:

You're right about the Medicaid - it wasn't specifically the ACA rules. It was a recommendation from HHS to the states that they could raise the maximum co-pay to $4.00 . . . BECAUSE of expanded Medicaid (which is an ACA move).

Preventative screenings. Yes, yes, I know. They're free *sing hosannah, etc, etc* I'm sure the person who is struggling to pay the premium for their healthcare will be thrilled to find out (for free) that they have a chronic disease that they will necessitate multiple doctors visits, and lab work, and who knows what else. Those, unfortunately, will not be free.

I don't know where you got anything from me about Platinum tier plans. I never discussed them. Perhaps you are confused with another poster?

Finally, you are on some sort of weird rant in that last paragraph. First you tell me that someone below 138% of the FPL is eligible for Medicaid - yep, that's true, but it's not what this discussion is about.
Then you tell me that the subsidy goes to 400% of the FPL - yeah, that's what the brief says. Now, take your imaginary non-smoking 40 year old Atlantan and pop them into the Kaiser calculator with that income you talk about. $46000. What kind of subsidy are they eligible for?

Try that imaginary person with an income of $40000?
How about an income of $35000? $34000?
Let me make it easy for you. The subsidy kicks in at $32952 - it's a whopping $1.00 That's 282% of the FPL. Their monthly premium is about $250.00 per month.

( Don't believe me? Do it yourself. Here is precisely what I entered at the Kaiser Subsidy calculator: Georgia/zip code: 30303/2014 dollars/income: 32952 (or the other figures)/no employer coverage/1 person in the family/1 adult/age: 40/no tobacco use/no children )

With a take-home pay of (being generous) about $2114 a month, that means the premium is actually closer to 12% of their income, not the 9.12% that the ACA sets.

Look; we're not really in disagreement here. The ACA is better than what went before - but I say that in the same way that I would say that a measles epidemic is better than the bubonic plague. I just find it disingenuous and, frankly, annoying when DUers insist that it's a great thing without stopping to consider realities.

The realities are that there are a lot of people who are going to struggle with this financially. Gross income and MAGI income are two different things - and while a thousand more or less may not mean that much to some people, it can be the difference between scraping by and not scraping by for others.
When you say that you cannot fathom how a person making $46000 (or, more realistically - in Georgia - closer to $35000) can quibble over $167 every month, I see someone who is using broad strokes and big boxes to categorize individuals.

[TrollBuster9090]

91. I think THIS idiotic comment pretty much nullifies anything sensible you might have to say.

Preventative screenings. Yes, yes, I know. They're free *sing hosannah, etc, etc* I'm sure the person who is struggling to pay the premium for their healthcare will be thrilled to find out (for free) that they have a chronic disease that they will necessitate multiple doctors visits, and lab work, and who knows what else

Right. Those people are better off not knowing, and the ACA's emphasis on cheaper, preventative care, over ER catastrophic care is a waste.

As I said, anybody who really thinks they're worse off WITH the ACA than they were before it can just refrain from buying any insurance. The worst that will happen to them is the IRS will levee a $95 fine, which they won't even collect unless you're entitled to a refund.

[enlightenment]

96. It isn't about not knowing.

Christ on a pogo stick - if you can't pull the blinders off, I'm not going to waste any more time trying. You are clueless - and that tired refrain of "so just pay the fine" is proof that you simply refuse to see any nuance at all.

Enjoy your rosy colored glasses.

[onpatrol98]

77. Winners and losers

Unfortunately, there will be not only winners, but some losers. There are some people with deductibles even higher than that. I know a family whose deductible is supposed to be $12,500. I think some people see large premiums and deductibles and assume, oh you must be rich, so who cares. But, I have found people tend to live up to their means. So, you can make 20k and live on 19k...or make 85k and end up living on 84k. It depends on where you live, your household expenses, etc. Regardless, most people don't have a large enough cushion to easily take on larger premiums and deductibles.

Thankfully, many people who have been without insurance, will be able to get it. But, it may also be true, that some people will not find themselves better off and just might find themselves worse off. Insurance companies are thieves, and they know how to play the risk game.

We will be dead in the water during the next election, if our attitude toward people whose situation did not improve or got worse is one that lacks empathy.

Hopefully, the people who did benefit will carry the day. But, for people who didn't benefit, perhaps we can work on solutions.

[cheapdate]

64. There are many low deductible plans available on the federal exchange marketplace for Tennessee.

Many with lower deductibles than my current plan. It's astonishing, really.

[TrollBuster9090]

23. The source for the Op/Ed is the WSJ, but the comment is from PNHP, a Medicare-for-all advocacy group

The last paragraph of the comment was cut off. It says:

The traditional Medicare program does not use narrow networks. Patients have their choice of their health care professionals. Medicare payment rates are higher than the rates expected to be offered by most of the exchange plans. It would not take much to improve Medicare, and then it would be an ideal program for covering everyone.

You can bet that the representatives of these professional groups didn’t ask for single payer to be put on the table. Too bad.

If even some of the problems the WSJ exist, the simplest and most obvious way to fix them is to provide a Public Option, which, I believe, can probably be done by Executive Order. (ie-just sign a piece of paper that says anybody is allowed to buy in to Medicare with its unlimited networks, and 1.5% OVERHEAD.)

[Chuuku Davis]

90. If you mean unlimited physician provider networks

"If even some of the problems the WSJ exist, the simplest and most obvious way to fix them is to provide a Public Option, which, I believe, can probably be done by Executive Order. (ie-just sign a piece of paper that says anybody is allowed to buy in to Medicare with its unlimited networks, and 1.5% OVERHEAD.)"

There is a problem

Only 30% of physicians here accept medicare

[TrollBuster9090]

95. That may be, but it can probably be fixed by adjusting the Medicare fee schedule.

And by enrolling everybody onto Medicare, which has an overhead of 1.5%, compared to the private HMOs that have overheads ranging from 15-20%, the entire system would save enough money to pay doctors a lot more, and nobody would refuse to participate because of the fee schedule. That's been my experience with single payer systems, anyway. I have a lot of experience with the Canadian system (a bad example of a good system--as opposed to France and Norway, which are good examples of a good system), and some experience with various State systems. Louisiana being the worst one I've ever experienced.

[enlightenment]

53. PHNP is not the Wall St Journal.

The quote you cite is from the second source.

[cheapdate]

2. "...the Obamacare model of high-deductibles, narrow networks, and payment restrictions"

Bullshit. Don McCanne, M.D. can kiss my ass.

[Luminous Animal]

3. Yes. Because universal health care is soooo old Europe.

[slipslidingaway]

8. Have you been in that life or death situation ...

where the in network hospital has done the procedure once or twice instead of going to another hospital where they have done the procedure 600 times? Have you known people who have died because the in network providers did not have the experience?

Tell me about it!

[Glitterati]

40. No, sorry, NOT bullshit

very true.

[cheapdate]

57. Yes, it's true that "network providers" existed both before and after the ACA.

Last edited Tue Dec 3, 2013, 07:18 PM - Edit history (1)

It's a major consideration in any insurance plan. What's "bullshit" is Don McCanne, M.D.'s assertion that "...high-deductibles, narrow networks, and payment restrictions" are intentional and intrinsic elements of "the Obamacare model", as he puts it.

The US has a mixed system of public and private health care and health insurance, with some people getting public insurance, some people getting insurance through their employers, some people purchasing it individually, and other uninsured either through circumstances or by choice. The fractured nature of our health care system is one of its biggest weaknesses, but it arguably has an upside as well. For good or not, the ACA works with the US health care system as it is.

I think Don McCanne, M.D. is probably just another asshole who talks shit about the downsides of the ACA while completely ignoring any upside and also ignoring everything that was and is wrong with private health insurance prior to the ACA.

[BlueStreak]

4. Uhhh, the Docs CHOOSE not to be in the networks

A doc blaming the program or the insurance companies because the Doc decided not to participate in the network makes no sense.

This is a basic problem of depending on a thing we call the "free market"m when in fact it is a cartel engaged in collusion and price-fixing in most markets.

Many of the insurance companies are proud of the fact that they have created "special" ACA networks that have very few providers because the reimbursements are so low.

But if a particular Doc chose not to be in that network, I don't see where he has a gripe.

It isn't like this is a new problem? Insurance companies have been playing these games for 20 years or more. It is worse this year because they are taking advantage of the "fog of war" so to speak.

Customers have to take responsibility to check the provider networks. If your docs are not in the network, don't buy the insurance.

[slipslidingaway]

11. Exactly, and people have to check who is in network ...

and not just the monthly premium.

I'm not speaking to my local doc being in network, you have to look at the hospital that is in network. If you have a serious condition one needs to look at the hospitals that are in network, the docs work in teams.

[SharonAnn]

17. No, these days Insurance companies make that decision. There are doctors who

want to be in the network but are denied entrance to the network.

It's a funny world, these days.

[taught_me_patience]

29. Wrong... you have to apply and be invited into the ACA plan network

even if you are a provider with that insurance company. It's pretty shitty for doctors that want to provide continuous care to patients that are switching.

[Cha]

5. Self Delete..

[Luminous Animal]

10. Yes. Those universal health care people are soooo suspect.

He should keep his yap shut because Obamacare is perfect and if single payers advocates stay very very quiet, someday, like magic, Obamacare will transform into a perfecter single payer system.

Shhh. Like magic.

[slipslidingaway]

12. Your response does not make sense and is repulsive, unless your intention is ...

to not engage in reality. People do die because they do not get the best care ... they do not have the money to access all providers. They are out of network!

[Cha]

13. Sorry, I misunderstood in my

rush. Going to delete.

[slipslidingaway]

15. Delete!!! Why rush away, what exactly did you misunderstand...

here is what you posted below. This might not shed a good light on the current ACA plan but do not back away so quickly if you feel it is right!

People are dying because they do not have access to the proper providers, that is what Dr McCanne is trying to highlight ... do not fade into the background, people are dying!

Cha ... "I'll just bet it raises a "Red Flag" for you, Don McCanne MD"

What did your comment mean?

[Pretzel_Warrior]

16. Quit trolling Cha. She deleted her post and moved on.

Perhaps you should too.

[slipslidingaway]

20. If someone cannot back up their posts then people should just ignore ...

whatever they say. Can she not defend what she said?

Trolling??? I'm not sure I've ever replied to one her posts.

A bit too defensive? For what reason I have no clue, her post contained nothing of substance, she was just attacking the messenger.

Get a life pretzel warrior ... whatever that name means!

[FourScore]

34. If your going to start attacking DU user names...This whole thread shows you're slip sliding away!

[slipslidingaway]

97. You were correct about making fun of names ... until you made the same mistake. n/t

[pnwmom]

7. And none of these doctors will complain a bit

if we have universal Medicare, because they love Medicare reimbursement rates, right?



Maybe they should have spoken up when Congress was considering a public option.

[slipslidingaway]

18. The media, including the so called liberal media, decided not to cover the whole story...

and many docs tried to speak up. Even Obama's personal physician of 15 years plus was initially invited to the WH town hall meeting and then was uninvited at the last minute. But Obama did call on the CEO of a major insurance company during the White House TH meeting, Ron Williams of Aetna to speak ... where as his personal physician Dr. Quentin Young was left out when his question was about universal HC.

Are you so blind as to not know who gets access to speak and who does not?

Even with the original WH summit on HC, the kickoff conference so to speak, the proponents of a national HC were literally left outside the gates of the WH.

You really need to pay attention.

My daughter was accepted to med school during the whole HC debate and is now a third year resident and we've co-signed for her med school loans. Shortly afterwards my husbands was diagnosed with MDS/AML and has had a bone marrow transplant. So we've seen this from both angles.

My daughter enjoys her time rotating between hospitals, most of all she enjoys her time at the VA because she does not have the pressure of 'billing time' for insurance purposes, she can take the time she needs with patients. This month she is on the oncology ward, not a great subject, although she did speak of a 35 year patient who was recently diagnosed with AML and who had started induction chemo, somethings are just too close home ... been there, done that.

Sometimes I read comments from people and just have to wonder if you have a clue, from a patient perspective, a doctor's perspective or a caregiver's perspective?

[pnwmom]

26. With your daughter being in medical school, I'm sure you know

there is a huge divide between the specialists -- who are reaping most of the financial rewards from the current system -- and the primary care practitioners, who are not. The specialists are the ones who are objecting the loudest to the reimbursement rates of Obamacare.

Conversely, most of the support for Obamacare has come from primary care physicians, not specialists.

[slipslidingaway]

27. True, but there was support from a significant number of physicians ...

including Obama' s personal physician of 15-20 years who was invited by the network of the televised WH townhall meeting and then was cancelled at the last minute because his question was going to be about National HC. But Ron Williams of Aetna was still invited and Obama just happened to call upon him during the televsion event.

You cannot ask where were the docs, without asking who controls what and who we see?

The WH is powerful, they invite who they want, do you disagree?

[pnwmom]

35. Obama's personal physician is a primary care doctor,

so that confirms my point.

Primary care doctors aren't the ones, by and large, who are complaining about Obamacare or Medicare.

[slipslidingaway]

98. Many doctors, including Obama's personal physician, did try and speak up ...

but they were not invited to speak.

I'm not sure how that proves your point.




In general over 50% of physicians surveyed a few years ago, including primary care, emergency physicians wanted a national HC system, but they were not allowed to speak. And that is when the Dems were in charge, we cannot blame that on the Repubs.

[TrollBuster9090]

22. In fact, that's exactly what the full 'comment' says. The story is from the WSJ, and the 'comment'

is from PNHP, a single-payer, Medicare for all advocacy group.

The missing paragraph at the bottom says:

The traditional Medicare program does not use narrow networks. Patients have their choice of their health care professionals. Medicare payment rates are higher than the rates expected to be offered by most of the exchange plans. It would not take much to improve Medicare, and then it would be an ideal program for covering everyone.

You can bet that the representatives of these professional groups didn’t ask for single payer to be put on the table. Too bad.

[spanone]

9. the media champions ACA failure...rupert murdoch owned propaganda rag

[slipslidingaway]

30. It has nothing to do with the failure of ACA, IT HAS EVERYTHING TO DO ...with a more equitable

access to care ... based on need!

I'm Really not sure why that is such a hard concept to understand.

It is about networks, which providers you can see and which are off limits when they could mean the difference between life or death. All because a hospital is in network or not ... it could be life and death for your spouse or your child.

Not everything has to do with which party you aligned with most of the time.

[PSPS]

14. You better duck. The swooners will shortly lob the snowballs.

It's kind of like the NSA's lawlessness. If you object to it, you're a racist, hate obama, and are a RW troll.

The ACA is a big change and it does have its shortcomings. The first step in making it better is to accept that reality. Besides the sticker shock for those with individual policies, there is this problem of sparse participation of providers. If people don't even want to admit the facts, it's hard to see how anything will ever be done to make the ACA better.

[slipslidingaway]

19. So very true about admitting the facts, but those pesky facts ...

could mean life or death. Remaining silent is the easy way, just have seen too much in the way of providers in the past few years ... they do make a difference and we need to understand the difference

[TrollBuster9090]

21. Any Particular Reason Why You Cut Off The Last Paragraph, Which Says...

The traditional Medicare program does not use narrow networks. Patients have their choice of their health care professionals. Medicare payment rates are higher than the rates expected to be offered by most of the exchange plans. It would not take much to improve Medicare, and then it would be an ideal program for covering everyone.

You can bet that the representatives of these professional groups didn’t ask for single payer to be put on the table. Too bad.

[slipslidingaway]

25. No and thanks, just trying to abide by the narrow limits of cut and paste ...

the Dems did nothing to advance the issue of a SP HC system, unfortunately and quite the opposite they helped to bury the issue.



I've stated that before and will continue to state it, I'm not going to to turn a blind eye to which party took it off the table.

[CorrectOfCenter]

24. Fools like this want Obamacare to fail.

And their tantrums are getting old.

[slipslidingaway]

31. BS, some recognize the shortcomings and say so ...

and those who want the for profit system are getting old.

[kelliekat44]

28. Then let's have a cadre of Federally employed physicians who are willing to heal people.

Lots of young med graduates are looking for jobs in their field and a Fed employer might be able to give them work in their profession and help out with the malpractice insurance (another insurance scam against consumers.).

[slipslidingaway]

32. Which political party has proposed that? Trust me, young med graduates are not lacking ...

for employment opportunities in their field.

[TrollBuster9090]

38. Actually, in urban areas they are, and in rural areas they're not. That's a problem that both

That's a problem that both 'free market' medical care countries like the United States, as well as single payer countries like Canada have. For whatever reason, Doctors prefer to A) specialize (hence the top heavy ratio of specialists to GPs), and B) practice in the city. The shortage of GPs, and especially country GPs is severe; but there's a glut of urban specialists. The only reason they can command such high fees is because State licensing bodies usually limit the supply of LICENSED physicians by excluding (not recognizing) those trained in countries that have perfectly good medical programs, but which they like to claim do not. (ie-South Africa, Ireland, Australia, certain Indian medical schools etc.). But that's a whole other discussion.

[Recursion]

33. The "and low reimbursement rates for doctors" shows what this is about

Doctors want to keep their cash cows. Sorry, guys...

[6000eliot]

36. What is the REAL point of posting all of these anti-ACA threads on Democratic Underground?

Just asking.

[Puzzledtraveller]

69. ACA is the best law ever!!!!

[6000eliot]

70. It's far from the best law ever, but it's the law we have,

and millions of people will be able to afford healthcare as a result. RW trolling will not change this.

[slipslidingaway]

99. To make people aware of all the facts, too many are looking at just the monthly costs ...

and not paying enough attention to the providers in their plan along with the annual out pocket expenses.

Two-thirds of the people who filed for medical bankruptcy HAD insurance, which turned out to be inadequate when they became ill.

That is the real point.

[BrotherIvan]

43. This is a question I have that I cannot find a good answer for

My current plan has *doubled* in the past three years. When I called to change my plan to an ACA compliant one, the guy on the phone was pushing hard for me to keep my current one. I thought, sure guy, what I have now costs 150% more than an ACA one. Finally he said, the networks that Anthem Blue Cross has chosen are so narrow, it's basically worthless. If you have to use medical services out of state, you may not be reimbursed at all!!

I really don't know what to do as my insurance costs are so high as to be impossible. If the ACA insurance not only has such a high deductible that I won't use it and as a person who travels quite a bit, does not work except in my home state, I just don't know how to make it all work. If anyone from CA has any more info, I would love to hear from you.

This is not about Obama bashing, this is how the insurance companies are using the loopholes they wrote in to screw people. The OP is correct in their concern that people not be fleeced by these vultures. It's really awful.

[WinkyDink]

45. The words that matter: "low reimbursement rates for doctors". The rest is obfuscation.

[Orsino]

58. Doctors are concerned that private health insurance providers might suck?

That would indeed be awful.

[flamingdem]

59. Yeah now they complain

but their complaints have some merit. I'm distressed at the narrow networks in LA. Part of this is the fault of doctors not wanting lower reimbursement and the other part is fear over how things will pan out and having a new flood of patients on top of that. Part of it must be insurers too but I'm not sure which part, probably reimbursement.

I have to bid to get to see a top doctor at UCLA. They might take me if my case is interesting enough? There are too many patients as it is. As usual there are hurdles when seeking good care.

Care however is available, but good care is something else.

[slipslidingaway]

100. Some tried to voice their concerns during the debate, but they were ignored ...

unfortunately if your case is interesting enough that means you are usually pretty ill, not a place any of us want to be.

[flamingdem]

101. Too true! I am currently auditioning to see a doctor

at UCLA. I used the old nightclub / business technique of dropping the name of another doctor to this department, he is the head of a department in their area, who I worked with several years ago. Thus, I'm part of the tribe almost! Even with crappy EPO insurance.

I'm still not sure they'll bother with me. It's true that my case is not dire yet I care about getting a diagnosis and that takes talent.

Good luck to those on programs that require a referral, it will get stickier if one is careful and preventative when up against dire cases.

I am not that happy with ACA but it's sooo much cheaper for me, so I'll deal.

[slipslidingaway]

102. Good luck with you "audition" never thought of it in those terms ...

you have to use what you can! Getting the right diagnosis does take talent, I cannot tell you how many people we have met over the past few years who did not receive a proper diagnosis for months and their treatment was delayed. In addition we met people who did not have access to hospitals with the latest knowledge and experience, unfortunately some did not make it.

Best of luck!