(05-23-2015 09:39 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:42 PM)dawgitall Wrote:  

(05-23-2015 08:27 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:24 PM)dawgitall Wrote:  One would have to agree with your assertions above to agree with you. I think they tend to be overstated and in some cases completely incorrect.

Nope.

Please point out where you think they are.

costs, quality of coverage, taking away coverage

WTF?

in other words, he completely ignored what you said and instead argues with the voices in his head. Welcome to my world.

I know lots of PCPs and don't know one single one with an empty waiting room. The National average wait time is something around 20 days, which only proves it. It's closer to 45 days in Boston. I mean, if there were a surplus, they could probably see you within 24-48 hours. It's important to note that the sort of mild illness you're going to see a PCP for will be 'over' before you ever see them, so little has changed in terms of healthcare delivery, also as evidenced by the continued use of ERs. It's not because of habit... but because the PCP can't see them. We're paying more, and getting no more primary care.

Your analogy, Owl is absolutely spot on. Of course it's not as simple as 2 people and one doc, but instead is more like 300mm people and 250,000 PCPs...But the fact remains that we didn't have enough PCPs for the previously insured... as evidenced by the wait times to get into them... so adding tens of millions more without adding more doctors means that we're merely reshuffling the care from one group of people (the previously insured) to another (them, plus the newly insured)... which means some of the previously insured won't get care so that the newly insured can, just as in your example.

(05-23-2015 11:46 PM)RobertN Wrote:  

(05-22-2015 12:29 PM)UofMstateU Wrote:  

(05-22-2015 12:25 PM)GoodOwl Wrote:  In many cases, people are better off paying the penalty, I mean tax,

For now it probably has been. There were better options out there for those who were forced to the exchanges. Pay the tax, and join some other non-Obamacare compliant option. Far less expensive, and real insurance and healthcare involved.

However, that tax keeps increasing every year. So I dont know when the opt-out would no longer be financially viable.

It depends on the person's income. I know someone in a high deductible plan that pays about $20/month(subsidy included) with an income of about $17,000(which is technically middle class Mr. NCeagle) this year. If this person took the penalty/tax, it would be about $400. So essentially, this person would save roughly $200(which for someone making that amount is not pocket change unlike it is for the snobby people on here-you know who you are) and actually have coverage(though not very good) should the need arise to have to use it.

2 things
1) just because they don't pay more doesn't mean it doesn't cost more. You're ignoring the cost of the subsidy.

2) you're ignoring the deductibles and copays. The person paying $20/month is paying $240/yr for 2 check-ups, and probably has a $25-50 copay for that, meaning he's actually paying more like $300 for 2 check-ups, which isn't a bargain. They could have probably gotten 2 physicals/yr and paid cash... and of course that ignores that the actual COST of that care (which many people earning only marginally more than that guy has to pay entirely is a couple of thousand dollars for those 2 visits.

Now, If they actually get sick, depending on what we're talking about, they likely have to cover the deductible before insurance covers them. The annual deductible is usually somewhere between $2500 and $7500... which is obviously a large portion of their annual income. You said high deductible policy, so it might be even more for this guy... If they need $10,000+ in healthcare, then this is a good thing. If they need more like $5,000 in health care, then they're in exactly the same situation... not including the subsidy. If they don't get a subsidy, then they're still paying for more than they're receiving.

Oh, and according to the Washington Post, the average reimbursement for installing a pacemaker is $20,000... for a heart attack with 4 stents and major complications, less than 30k. Joint replacement reimbursements are between 12 and 15k... just to give you an idea of how much healthcare the average person needs before they will be meeting those annual deductibles. Now I understand that hospitals CHARGE far more than that, but every single one of them would be more than happy to receive that from the uninsured. More significantly, despite the insurance, the hospitals still aren't going to get paid for broken legs or pneumonia or other milder maladies, UNLESS it comes from the pockets of the poor, just as before.

People are far too often 'fooled' by the way that Hospitals used to do exactly what the ACAs Cadillac tax does... They bill $100,000 for something so that the very wealthy who choose not to have insurance pay $100,000 for the procedure that the insurance companies and Medicaid only pay $20,000 for... and Medicaid pays more like $10,000 for. If you're not wealthy.... they'll gladly take less.... because they're going to get less anyway. It does them no favors to force you into bankruptcy and get nothing.... but they get to 'write off' more from their taxes if they negotiate you down rather than simply billing less. But again, what do I know... I only do this for a living.

The 17,000 earner you're talking about is at about 150% of the FPL, and subsidies go up to 400%, so in other words, on average, subsidized insurance recipients are paying even more than $300 for those two annual well-checks. I've seen estimates that the number is closer to $1500.... and obviously, the average young healthy person doesn't need much care, so whatever care the Youtube 'watch me do something stupid' generation DOES need will likely not meet their deductible and come out of their pocket.

My point is simply that all of the problems that people have been convinced that Obamacare will solve still remain. They're slightly different perhaps, and obviously SOME people are made better off... but the numbers are staggeringly smaller than the numbers of people who are worse off, or we were lead to believe would be worse off.

Millions of people are being made $200 worse off, which as you note, is a meaningful amount to lots of people... so that one person now only has to declare bankruptcy for his $7500 deductible rather than his whole $20,000 bill.... because obviously by definition, they can't afford the deductible, since they couldn't afford the insurance to begin with.

(05-24-2015 12:41 PM)Hambone10 Wrote:  

(05-23-2015 09:39 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:42 PM)dawgitall Wrote:  

(05-23-2015 08:27 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:24 PM)dawgitall Wrote:  One would have to agree with your assertions above to agree with you. I think they tend to be overstated and in some cases completely incorrect.

Nope.

Please point out where you think they are.

costs, quality of coverage, taking away coverage

WTF?

in other words, he completely ignored what you said and instead argues with the voices in his head. Welcome to my world.

I know lots of PCPs and don't know one single one with an empty waiting room. The National average wait time is something around 20 days, which only proves it. It's closer to 45 days in Boston. I mean, if there were a surplus, they could probably see you within 24-48 hours. It's important to note that the sort of mild illness you're going to see a PCP for will be 'over' before you ever see them, so little has changed in terms of healthcare delivery, also as evidenced by the continued use of ERs. It's not because of habit... but because the PCP can't see them. We're paying more, and getting no more primary care.

Your analogy, Owl is absolutely spot on. Of course it's not as simple as 2 people and one doc, but instead is more like 300mm people and 250,000 PCPs...But the fact remains that we didn't have enough PCPs for the previously insured... as evidenced by the wait times to get into them... so adding tens of millions more without adding more doctors means that we're merely reshuffling the care from one group of people (the previously insured) to another (them, plus the newly insured)... which means some of the previously insured won't get care so that the newly insured can, just as in your example.

(05-23-2015 11:46 PM)RobertN Wrote:  

(05-22-2015 12:29 PM)UofMstateU Wrote:  

(05-22-2015 12:25 PM)GoodOwl Wrote:  In many cases, people are better off paying the penalty, I mean tax,

For now it probably has been. There were better options out there for those who were forced to the exchanges. Pay the tax, and join some other non-Obamacare compliant option. Far less expensive, and real insurance and healthcare involved.

However, that tax keeps increasing every year. So I dont know when the opt-out would no longer be financially viable.

It depends on the person's income. I know someone in a high deductible plan that pays about $20/month(subsidy included) with an income of about $17,000(which is technically middle class Mr. NCeagle) this year. If this person took the penalty/tax, it would be about $400. So essentially, this person would save roughly $200(which for someone making that amount is not pocket change unlike it is for the snobby people on here-you know who you are) and actually have coverage(though not very good) should the need arise to have to use it.

2 things
1) just because they don't pay more doesn't mean it doesn't cost more. You're ignoring the cost of the subsidy.

2) you're ignoring the deductibles and copays. The person paying $20/month is paying $240/yr for 2 check-ups, and probably has a $25-50 copay for that, meaning he's actually paying more like $300 for 2 check-ups, which isn't a bargain. They could have probably gotten 2 physicals/yr and paid cash... and of course that ignores that the actual COST of that care (which many people earning only marginally more than that guy has to pay entirely is a couple of thousand dollars for those 2 visits.

Now, If they actually get sick, depending on what we're talking about, they likely have to cover the deductible before insurance covers them. The annual deductible is usually somewhere between $2500 and $7500... which is obviously a large portion of their annual income. You said high deductible policy, so it might be even more for this guy... If they need $10,000+ in healthcare, then this is a good thing. If they need more like $5,000 in health care, then they're in exactly the same situation... not including the subsidy. If they don't get a subsidy, then they're still paying for more than they're receiving.

Oh, and according to the Washington Post, the average reimbursement for installing a pacemaker is $20,000... for a heart attack with 4 stents and major complications, less than 30k. Joint replacement reimbursements are between 12 and 15k... just to give you an idea of how much healthcare the average person needs before they will be meeting those annual deductibles. Now I understand that hospitals CHARGE far more than that, but every single one of them would be more than happy to receive that from the uninsured. More significantly, despite the insurance, the hospitals still aren't going to get paid for broken legs or pneumonia or other milder maladies, UNLESS it comes from the pockets of the poor, just as before.

People are far too often 'fooled' by the way that Hospitals used to do exactly what the ACAs Cadillac tax does... They bill $100,000 for something so that the very wealthy who choose not to have insurance pay $100,000 for the procedure that the insurance companies and Medicaid only pay $20,000 for... and Medicaid pays more like $10,000 for. If you're not wealthy.... they'll gladly take less.... because they're going to get less anyway. It does them no favors to force you into bankruptcy and get nothing.... but they get to 'write off' more from their taxes if they negotiate you down rather than simply billing less. But again, what do I know... I only do this for a living.

The 17,000 earner you're talking about is at about 150% of the FPL, and subsidies go up to 400%, so in other words, on average, subsidized insurance recipients are paying even more than $300 for those two annual well-checks. I've seen estimates that the number is closer to $1500.... and obviously, the average young healthy person doesn't need much care, so whatever care the Youtube 'watch me do something stupid' generation DOES need will likely not meet their deductible and come out of their pocket.

My point is simply that all of the problems that people have been convinced that Obamacare will solve still remain. They're slightly different perhaps, and obviously SOME people are made better off... but the numbers are staggeringly smaller than the numbers of people who are worse off, or we were lead to believe would be worse off.

Millions of people are being made $200 worse off, which as you note, is a meaningful amount to lots of people... so that one person now only has to declare bankruptcy for his $7500 deductible rather than his whole $20,000 bill.... because obviously by definition, they can't afford the deductible, since they couldn't afford the insurance to begin with.

You are a broken record. We need more doctors. That is no reason to wipe out the progress we have made in getting more people insured and making coverage affordable for those left out prior to the ACA.

(05-24-2015 02:13 PM)dawgitall Wrote:  

(05-24-2015 12:41 PM)Hambone10 Wrote:  

(05-23-2015 09:39 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:42 PM)dawgitall Wrote:  

(05-23-2015 08:27 PM)Owl 69/70/75 Wrote:  Nope.

Please point out where you think they are.

costs, quality of coverage, taking away coverage

WTF?

in other words, he completely ignored what you said and instead argues with the voices in his head. Welcome to my world.

I know lots of PCPs and don't know one single one with an empty waiting room. The National average wait time is something around 20 days, which only proves it. It's closer to 45 days in Boston. I mean, if there were a surplus, they could probably see you within 24-48 hours. It's important to note that the sort of mild illness you're going to see a PCP for will be 'over' before you ever see them, so little has changed in terms of healthcare delivery, also as evidenced by the continued use of ERs. It's not because of habit... but because the PCP can't see them. We're paying more, and getting no more primary care.

Your analogy, Owl is absolutely spot on. Of course it's not as simple as 2 people and one doc, but instead is more like 300mm people and 250,000 PCPs...But the fact remains that we didn't have enough PCPs for the previously insured... as evidenced by the wait times to get into them... so adding tens of millions more without adding more doctors means that we're merely reshuffling the care from one group of people (the previously insured) to another (them, plus the newly insured)... which means some of the previously insured won't get care so that the newly insured can, just as in your example.

(05-23-2015 11:46 PM)RobertN Wrote:  

(05-22-2015 12:29 PM)UofMstateU Wrote:  

(05-22-2015 12:25 PM)GoodOwl Wrote:  In many cases, people are better off paying the penalty, I mean tax,

For now it probably has been. There were better options out there for those who were forced to the exchanges. Pay the tax, and join some other non-Obamacare compliant option. Far less expensive, and real insurance and healthcare involved.

However, that tax keeps increasing every year. So I dont know when the opt-out would no longer be financially viable.

It depends on the person's income. I know someone in a high deductible plan that pays about $20/month(subsidy included) with an income of about $17,000(which is technically middle class Mr. NCeagle) this year. If this person took the penalty/tax, it would be about $400. So essentially, this person would save roughly $200(which for someone making that amount is not pocket change unlike it is for the snobby people on here-you know who you are) and actually have coverage(though not very good) should the need arise to have to use it.

2 things
1) just because they don't pay more doesn't mean it doesn't cost more. You're ignoring the cost of the subsidy.

2) you're ignoring the deductibles and copays. The person paying $20/month is paying $240/yr for 2 check-ups, and probably has a $25-50 copay for that, meaning he's actually paying more like $300 for 2 check-ups, which isn't a bargain. They could have probably gotten 2 physicals/yr and paid cash... and of course that ignores that the actual COST of that care (which many people earning only marginally more than that guy has to pay entirely is a couple of thousand dollars for those 2 visits.

Now, If they actually get sick, depending on what we're talking about, they likely have to cover the deductible before insurance covers them. The annual deductible is usually somewhere between $2500 and $7500... which is obviously a large portion of their annual income. You said high deductible policy, so it might be even more for this guy... If they need $10,000+ in healthcare, then this is a good thing. If they need more like $5,000 in health care, then they're in exactly the same situation... not including the subsidy. If they don't get a subsidy, then they're still paying for more than they're receiving.

Oh, and according to the Washington Post, the average reimbursement for installing a pacemaker is $20,000... for a heart attack with 4 stents and major complications, less than 30k. Joint replacement reimbursements are between 12 and 15k... just to give you an idea of how much healthcare the average person needs before they will be meeting those annual deductibles. Now I understand that hospitals CHARGE far more than that, but every single one of them would be more than happy to receive that from the uninsured. More significantly, despite the insurance, the hospitals still aren't going to get paid for broken legs or pneumonia or other milder maladies, UNLESS it comes from the pockets of the poor, just as before.

People are far too often 'fooled' by the way that Hospitals used to do exactly what the ACAs Cadillac tax does... They bill $100,000 for something so that the very wealthy who choose not to have insurance pay $100,000 for the procedure that the insurance companies and Medicaid only pay $20,000 for... and Medicaid pays more like $10,000 for. If you're not wealthy.... they'll gladly take less.... because they're going to get less anyway. It does them no favors to force you into bankruptcy and get nothing.... but they get to 'write off' more from their taxes if they negotiate you down rather than simply billing less. But again, what do I know... I only do this for a living.

The 17,000 earner you're talking about is at about 150% of the FPL, and subsidies go up to 400%, so in other words, on average, subsidized insurance recipients are paying even more than $300 for those two annual well-checks. I've seen estimates that the number is closer to $1500.... and obviously, the average young healthy person doesn't need much care, so whatever care the Youtube 'watch me do something stupid' generation DOES need will likely not meet their deductible and come out of their pocket.

My point is simply that all of the problems that people have been convinced that Obamacare will solve still remain. They're slightly different perhaps, and obviously SOME people are made better off... but the numbers are staggeringly smaller than the numbers of people who are worse off, or we were lead to believe would be worse off.

Millions of people are being made $200 worse off, which as you note, is a meaningful amount to lots of people... so that one person now only has to declare bankruptcy for his $7500 deductible rather than his whole $20,000 bill.... because obviously by definition, they can't afford the deductible, since they couldn't afford the insurance to begin with.

You are a broken record. We need more doctors. That is no reason to wipe out the progress we have made in getting more people insured and making coverage affordable for those left out prior to the ACA.

And $7,500 deductibles are few and far between.

Well, I was directly affected, as many here. Again, the goals of the ACA (increasing access to those who were not deemed eligible for health care previously being the primary one) are largely being met. I think this access will over time make things better.

So count me as a proponent of the goals of the ACA with the admittance that the growing pains have been a bit rough for me personally (as it has for many middle income professionals).

The Freelancers Union was my health care provider since 2011 until they killed it in late 2014. Previously I had high copays (I want to say $30-ish/$65-ish primary/specialist), but a pretty low deductible and some solid options. The Freelancers Union was a GREAT option for self employed.

Then this (and it pains me to link the Standard, obviously ):
http://www.weeklystandard.com/blogs/anot...08460.html

When they killed it, we went to FAR worse coverage under 'Bronze', paid more, and got a ridiculous deductible. Only benefit is the FLU kept their clinic in Brooklyn, so my primary care is actually fully covered. So if I stay healthy my $393/mo is all I pay. If not...

The proposed rate increase I am facing is ~14%. So my coverage at $325 in 2011 will likely cost $448 in 2016 with remarkably worse coverage (no-co pay, just straight I-pay on specialists).

I support the goal of universal coverage, but this is a zero sum game. I am paying more, for less, to subsidize those that were previously uncoverable (long term illness, cancer, etc). I'll admit this is annoying, but it really boils down to:

1. Did you understand this was what was going to happen? (I mostly did).
2. Is the added cost worth it to you to pay for the well being of those who otherwise would have none (grudgingly, through gritted teeth I am )

My real beef with the ACA is the whole 'you like your insurance, you keep your insurance' thing. Clearly wasn't true, b/c I am far less annoyed by the price increases (health care went up a ton in the 2000s as well, every year my boss would exclaim how much the coverage was going up, with similar percentages), but more annoyed that I seem to be getting so much less for my money.

Having said that, I have family members who couldn't get coverage before ($ / illness) and now can. There is something to be said for that.

(05-24-2015 02:13 PM)dawgitall Wrote:  

(05-24-2015 12:41 PM)Hambone10 Wrote:  

(05-23-2015 09:39 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:42 PM)dawgitall Wrote:  

(05-23-2015 08:27 PM)Owl 69/70/75 Wrote:  Nope.

Please point out where you think they are.

costs, quality of coverage, taking away coverage

WTF?

in other words, he completely ignored what you said and instead argues with the voices in his head. Welcome to my world.

I know lots of PCPs and don't know one single one with an empty waiting room. The National average wait time is something around 20 days, which only proves it. It's closer to 45 days in Boston. I mean, if there were a surplus, they could probably see you within 24-48 hours. It's important to note that the sort of mild illness you're going to see a PCP for will be 'over' before you ever see them, so little has changed in terms of healthcare delivery, also as evidenced by the continued use of ERs. It's not because of habit... but because the PCP can't see them. We're paying more, and getting no more primary care.

Your analogy, Owl is absolutely spot on. Of course it's not as simple as 2 people and one doc, but instead is more like 300mm people and 250,000 PCPs...But the fact remains that we didn't have enough PCPs for the previously insured... as evidenced by the wait times to get into them... so adding tens of millions more without adding more doctors means that we're merely reshuffling the care from one group of people (the previously insured) to another (them, plus the newly insured)... which means some of the previously insured won't get care so that the newly insured can, just as in your example.

(05-23-2015 11:46 PM)RobertN Wrote:  

(05-22-2015 12:29 PM)UofMstateU Wrote:  

(05-22-2015 12:25 PM)GoodOwl Wrote:  In many cases, people are better off paying the penalty, I mean tax,

For now it probably has been. There were better options out there for those who were forced to the exchanges. Pay the tax, and join some other non-Obamacare compliant option. Far less expensive, and real insurance and healthcare involved.

However, that tax keeps increasing every year. So I dont know when the opt-out would no longer be financially viable.

It depends on the person's income. I know someone in a high deductible plan that pays about $20/month(subsidy included) with an income of about $17,000(which is technically middle class Mr. NCeagle) this year. If this person took the penalty/tax, it would be about $400. So essentially, this person would save roughly $200(which for someone making that amount is not pocket change unlike it is for the snobby people on here-you know who you are) and actually have coverage(though not very good) should the need arise to have to use it.

2 things
1) just because they don't pay more doesn't mean it doesn't cost more. You're ignoring the cost of the subsidy.

2) you're ignoring the deductibles and copays. The person paying $20/month is paying $240/yr for 2 check-ups, and probably has a $25-50 copay for that, meaning he's actually paying more like $300 for 2 check-ups, which isn't a bargain. They could have probably gotten 2 physicals/yr and paid cash... and of course that ignores that the actual COST of that care (which many people earning only marginally more than that guy has to pay entirely is a couple of thousand dollars for those 2 visits.

Now, If they actually get sick, depending on what we're talking about, they likely have to cover the deductible before insurance covers them. The annual deductible is usually somewhere between $2500 and $7500... which is obviously a large portion of their annual income. You said high deductible policy, so it might be even more for this guy... If they need $10,000+ in healthcare, then this is a good thing. If they need more like $5,000 in health care, then they're in exactly the same situation... not including the subsidy. If they don't get a subsidy, then they're still paying for more than they're receiving.

Oh, and according to the Washington Post, the average reimbursement for installing a pacemaker is $20,000... for a heart attack with 4 stents and major complications, less than 30k. Joint replacement reimbursements are between 12 and 15k... just to give you an idea of how much healthcare the average person needs before they will be meeting those annual deductibles. Now I understand that hospitals CHARGE far more than that, but every single one of them would be more than happy to receive that from the uninsured. More significantly, despite the insurance, the hospitals still aren't going to get paid for broken legs or pneumonia or other milder maladies, UNLESS it comes from the pockets of the poor, just as before.

People are far too often 'fooled' by the way that Hospitals used to do exactly what the ACAs Cadillac tax does... They bill $100,000 for something so that the very wealthy who choose not to have insurance pay $100,000 for the procedure that the insurance companies and Medicaid only pay $20,000 for... and Medicaid pays more like $10,000 for. If you're not wealthy.... they'll gladly take less.... because they're going to get less anyway. It does them no favors to force you into bankruptcy and get nothing.... but they get to 'write off' more from their taxes if they negotiate you down rather than simply billing less. But again, what do I know... I only do this for a living.

The 17,000 earner you're talking about is at about 150% of the FPL, and subsidies go up to 400%, so in other words, on average, subsidized insurance recipients are paying even more than $300 for those two annual well-checks. I've seen estimates that the number is closer to $1500.... and obviously, the average young healthy person doesn't need much care, so whatever care the Youtube 'watch me do something stupid' generation DOES need will likely not meet their deductible and come out of their pocket.

My point is simply that all of the problems that people have been convinced that Obamacare will solve still remain. They're slightly different perhaps, and obviously SOME people are made better off... but the numbers are staggeringly smaller than the numbers of people who are worse off, or we were lead to believe would be worse off.

Millions of people are being made $200 worse off, which as you note, is a meaningful amount to lots of people... so that one person now only has to declare bankruptcy for his $7500 deductible rather than his whole $20,000 bill.... because obviously by definition, they can't afford the deductible, since they couldn't afford the insurance to begin with.

You are a broken record. We need more doctors. That is no reason to wipe out the progress we have made in getting more people insured and making coverage affordable for those left out prior to the ACA.

No, YOU'RE a broken record. You've been proven wrong time and time again by people who work in the medical field and/or hospitals, yet you continue to trot out the same tired debunked talking points. We need more doctors you say? Well Mr. Zerocare expert, how do you go about solving that problem? No, you cannot use your pro-ACA talking points to "solve" the problem.

To correct Ham, there is no co-pay on an annual check up. I'm pretty surprised that he would get that wrong, given that he is a hospital administrator.

"Under Section 2713 of the ACA, private health plans must provide coverage for a range of preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services. These requirements apply to all private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party payer – with the exception of those plans that maintain “grandfathered” status."
http://kff.org/health-reform/fact-sheet/...lth-plans/

(05-24-2015 04:14 PM)DefCONNOne Wrote:  

(05-24-2015 02:13 PM)dawgitall Wrote:  

(05-24-2015 12:41 PM)Hambone10 Wrote:  

(05-23-2015 09:39 PM)Owl 69/70/75 Wrote:  

(05-23-2015 08:42 PM)dawgitall Wrote:  costs, quality of coverage, taking away coverage

WTF?

in other words, he completely ignored what you said and instead argues with the voices in his head. Welcome to my world.

I know lots of PCPs and don't know one single one with an empty waiting room. The National average wait time is something around 20 days, which only proves it. It's closer to 45 days in Boston. I mean, if there were a surplus, they could probably see you within 24-48 hours. It's important to note that the sort of mild illness you're going to see a PCP for will be 'over' before you ever see them, so little has changed in terms of healthcare delivery, also as evidenced by the continued use of ERs. It's not because of habit... but because the PCP can't see them. We're paying more, and getting no more primary care.

Your analogy, Owl is absolutely spot on. Of course it's not as simple as 2 people and one doc, but instead is more like 300mm people and 250,000 PCPs...But the fact remains that we didn't have enough PCPs for the previously insured... as evidenced by the wait times to get into them... so adding tens of millions more without adding more doctors means that we're merely reshuffling the care from one group of people (the previously insured) to another (them, plus the newly insured)... which means some of the previously insured won't get care so that the newly insured can, just as in your example.

(05-23-2015 11:46 PM)RobertN Wrote:  

(05-22-2015 12:29 PM)UofMstateU Wrote:  For now it probably has been. There were better options out there for those who were forced to the exchanges. Pay the tax, and join some other non-Obamacare compliant option. Far less expensive, and real insurance and healthcare involved.

However, that tax keeps increasing every year. So I dont know when the opt-out would no longer be financially viable.

It depends on the person's income. I know someone in a high deductible plan that pays about $20/month(subsidy included) with an income of about $17,000(which is technically middle class Mr. NCeagle) this year. If this person took the penalty/tax, it would be about $400. So essentially, this person would save roughly $200(which for someone making that amount is not pocket change unlike it is for the snobby people on here-you know who you are) and actually have coverage(though not very good) should the need arise to have to use it.

2 things
1) just because they don't pay more doesn't mean it doesn't cost more. You're ignoring the cost of the subsidy.

2) you're ignoring the deductibles and copays. The person paying $20/month is paying $240/yr for 2 check-ups, and probably has a $25-50 copay for that, meaning he's actually paying more like $300 for 2 check-ups, which isn't a bargain. They could have probably gotten 2 physicals/yr and paid cash... and of course that ignores that the actual COST of that care (which many people earning only marginally more than that guy has to pay entirely is a couple of thousand dollars for those 2 visits.

Now, If they actually get sick, depending on what we're talking about, they likely have to cover the deductible before insurance covers them. The annual deductible is usually somewhere between $2500 and $7500... which is obviously a large portion of their annual income. You said high deductible policy, so it might be even more for this guy... If they need $10,000+ in healthcare, then this is a good thing. If they need more like $5,000 in health care, then they're in exactly the same situation... not including the subsidy. If they don't get a subsidy, then they're still paying for more than they're receiving.

Oh, and according to the Washington Post, the average reimbursement for installing a pacemaker is $20,000... for a heart attack with 4 stents and major complications, less than 30k. Joint replacement reimbursements are between 12 and 15k... just to give you an idea of how much healthcare the average person needs before they will be meeting those annual deductibles. Now I understand that hospitals CHARGE far more than that, but every single one of them would be more than happy to receive that from the uninsured. More significantly, despite the insurance, the hospitals still aren't going to get paid for broken legs or pneumonia or other milder maladies, UNLESS it comes from the pockets of the poor, just as before.

People are far too often 'fooled' by the way that Hospitals used to do exactly what the ACAs Cadillac tax does... They bill $100,000 for something so that the very wealthy who choose not to have insurance pay $100,000 for the procedure that the insurance companies and Medicaid only pay $20,000 for... and Medicaid pays more like $10,000 for. If you're not wealthy.... they'll gladly take less.... because they're going to get less anyway. It does them no favors to force you into bankruptcy and get nothing.... but they get to 'write off' more from their taxes if they negotiate you down rather than simply billing less. But again, what do I know... I only do this for a living.

The 17,000 earner you're talking about is at about 150% of the FPL, and subsidies go up to 400%, so in other words, on average, subsidized insurance recipients are paying even more than $300 for those two annual well-checks. I've seen estimates that the number is closer to $1500.... and obviously, the average young healthy person doesn't need much care, so whatever care the Youtube 'watch me do something stupid' generation DOES need will likely not meet their deductible and come out of their pocket.

My point is simply that all of the problems that people have been convinced that Obamacare will solve still remain. They're slightly different perhaps, and obviously SOME people are made better off... but the numbers are staggeringly smaller than the numbers of people who are worse off, or we were lead to believe would be worse off.

Millions of people are being made $200 worse off, which as you note, is a meaningful amount to lots of people... so that one person now only has to declare bankruptcy for his $7500 deductible rather than his whole $20,000 bill.... because obviously by definition, they can't afford the deductible, since they couldn't afford the insurance to begin with.

You are a broken record. We need more doctors. That is no reason to wipe out the progress we have made in getting more people insured and making coverage affordable for those left out prior to the ACA.

No, YOU'RE a broken record. You've been proven wrong time and time again by people who work in the medical field and/or hospitals, yet you continue to trot out the same tired debunked talking points. We need more doctors you say? Well Mr. Zerocare expert, how do you go about solving that problem? No, you cannot use your pro-ACA talking points to "solve" the problem.

I haven't been proven wrong time and time again. Ham throws out some long winded deflection and declares that he has proven me wrong. That isn't the same thing.

I want to see more medical professionals going forward as much if not more than anyone. I have looked into and offered some examples of a few ways to help improve the situation. Every time I do Ham simply disregards them.

What do you have to offer in way of solving the problem?

(05-22-2015 07:42 AM)Machiavelli Wrote:  I remember before ObamaCare our premiums would go up more than 9.6% a year. Heck one year in the late 90's our premiums when up 16%. This isn't a new phenomena Socratic.

It's NOT what Obama and the democrats promised. Obama PROMISED the average middle class family of 4 would save $2,500/yr. and costs would trend down over time. That might have been true if coverage requirements (sex changes, $0 copay for birth control pills, etc.) had not changed. With only high-risk and older people buying coverage there is no way costs don't continue increasing by double digit rates until a new market equilibrium is reached.

Here's the real sorry ass truth of the matter; as has been confirmed by the Kaiser group, a large majority of insured can no longer afford to get care because the deductibles are so high. So if this is happening, why in the hell are the rates going up?

The only thing Obamacare has done is to insure a few million more people who werent insured before, and basically eliminated most healthcare for the average family because they can no longer afford it.

There's an easy way to keep premiums from going up--reduce quality of coverage. That's what's happened in the health insurance market. Explain to me how someone looking at $3,000 of medical expenses is better off with a policy with a $5,000 deductible than with no policy. And s/he didn't have to pay for the no policy.

Health insurance =/= health coverage =/= health care.

(05-24-2015 09:18 PM)UofMstateU Wrote:  Here's the real sorry ass truth of the matter; as has been confirmed by the Kaiser group, a large majority of insured can no longer afford to get care because the deductibles are so high. So if this is happening, why in the hell are the rates going up?

The only thing Obamacare has done is to insure a few million more people who werent insured before, and basically eliminated most healthcare for the average family because they can no longer afford it.

That is simply not true! Have you read the Kaiser Report that just came out? First of all the Kaiser Report defines high deductible plans as those over $1,500 for individuals and $3,000 for families. Four in ten enrollees (40 percent) have a plan with a high deductible. This includes a lot of the Grandfathered plans. Another four in ten (43 percent) have plans with lower deductibles. The others in the survey didn't know exactly what their deductible was.

"Over half (57 percent) of those with ACA-compliant plans say they feel well-protected by their plan, but nearly four in ten (38 percent) feel vulnerable to high medical bills (similar to 2014). Those with new plans purchased under the ACA are not the only ones feeling financially precarious; a similar share (34 percent) of those with pre-2014, non-ACA compliant plans says they feel vulnerable to high medical bills."

So lets see, a majority (57%) feel well-protected which is the opposite of what you claim and a significant minority (38%) feel vulnerable. And those with policies that are non-compliant grandfathered plans (the same policy they had pre-ACA and wanted so much to hold on to) had 34% feeling vulnerable. Now remember feeling vulnerable doesn't mean they can't afford to get care. The same report showed that 16% of those with ACA compliant plans and 5% with grandfathered plans had trouble paying medical bills. 18/6% didn't fill a prescription because of costs, and 11/5 % needed medical care but didn't get it because of costs. Those percentages are extremely far from a majority.

The survey also shows that 60% of exchange policy holders are satisfied with their deductible. 74% rate their overall insurance coverage as good or excellent.


http://kff.org/health-reform/poll-findin...es-wave-2/

So 40%, give or take, are not satisfied, and that's okay with you?

(05-24-2015 09:21 PM)Owl 69/70/75 Wrote:  There's an easy way to keep premiums from going up--reduce quality of coverage. That's what's happened in the health insurance market. Explain to me how someone looking at $3,000 of medical expenses is better off with a policy with a $5,000 deductible than with no policy. And s/he didn't have to pay for the no policy.

Health insurance =/= health coverage =/= health care.

This. I spent 6600 last year on a 5K ded. BCBS plan and made 2 doctors visits that probably amounted to $400 total expense. That is an outstanding ROI.

(05-25-2015 12:20 AM)Owl 69/70/75 Wrote:  So 40%, give or take, are not satisfied, and that's okay with you?

Yes. The End justifies the means with these people. The End is of course expansion of the welfare state....which is exactly what this is all about.

Health Insurance was supposed to protect the covered for catastrophic health issues, insurance companies realized they could reduce the risk of such events by providing coverage for preventive exams so those were added at nominal cost in the 1980's. Obamacare pays for a lot of elective items such as birth control pills, sex changes, and a whole lot of other special interest elective stuff. Because cost of these items and every other possible covered procedure are included in everyone's coverage you get premium's that are anything but affordable.

(05-25-2015 12:20 AM)Owl 69/70/75 Wrote:  So 40%, give or take, are not satisfied, and that's okay with you?

UofM made a completely false and misleading statement. I corrected him. Are you saying that it is okay to make false statements and not be corrected?

(05-25-2015 07:37 AM)Fo Shizzle Wrote:  

(05-24-2015 09:21 PM)Owl 69/70/75 Wrote:  There's an easy way to keep premiums from going up--reduce quality of coverage. That's what's happened in the health insurance market. Explain to me how someone looking at $3,000 of medical expenses is better off with a policy with a $5,000 deductible than with no policy. And s/he didn't have to pay for the no policy.

Health insurance =/= health coverage =/= health care.

This. I spent 6600 last year on a 5K ded. BCBS plan and made 2 doctors visits that probably amounted to $400 total expense. That is an outstanding ROI.

Are you talking about a employer provided group or individual plan? Is the 5k deductible for one individual or is it for a family? Is the 6,600 you spent including premiums and out of pocket costs. Does it include anything else?

(05-25-2015 09:11 AM)dawgitall Wrote:  

(05-25-2015 12:20 AM)Owl 69/70/75 Wrote:  So 40%, give or take, are not satisfied, and that's okay with you?

UofM made a completely false and misleading statement. I corrected him. Are you saying that it is okay to make false statements and not be corrected?

His statement was false in that he said that a large majority had problems. I thought about making that specific point in my referenced post, and in retrospect probably should have.

Your statement is misleading in that it seems to be wanting to say, no problem, it's only 40% that are having problems, not a majority. If that's not what you intended, then I misinterpreted.

My point is that 40% having problems is at best only slightly better than a majority having problems. And back before Obamacare, weren't the numbers something like 20% that were dissatisfied? That's what I recall, feel free to correct me if I'm wrong.

(05-25-2015 12:20 AM)Owl 69/70/75 Wrote:  So 40%, give or take, are not satisfied, and that's okay with you?

Actually there is an easy solution for those 40%. They can just shop around and purchase a lower deductible policy. It will cost more in premiums up front but if they need much care they will save money in the long run. If I were a healthy 20 something without a family I would certainly buy a bronze plan. For most anyone else I think a lower deductible, higher premium cost policy makes a lot more sense. But that is just me.

Also remember that 74% rate their overall satisfaction with their coverage as good or excellent. Some of the rest rate it as fair.

(05-25-2015 09:29 AM)dawgitall Wrote:  Actually there is an easy solution for those 40%. They can just shop around and purchase a lower deductible policy. It will cost more in premiums up front but if they need much care they will save money in the long run. If I were a healthy 20 something without a family I would certainly buy a bronze plan. For most anyone else I think a lower deductible, higher premium cost policy makes a lot more sense. But that is just me.

Which, of course, defeats the purpose of an Affordable care act.