Affordable Care Act

[hattaresguy]

Originally Posted By: whip
Originally Posted By: Blaze
A good friend of mine with no health insurance went into cardiac arrest this past summer while driving. Fortunately he is alright but was stuck with a 145K bill for his new pacemaker etc. He went to an experienced bankruptcy attorney after he got the bill. His attorney told him to sit tight and work with the hospital. After meeting with the hospital they brought the bill down to 12K and he then brought the bill to his attorney to look over the itemization. The attorney told him settling with the hospital at 12K they still make money. The attorney told him their break even point was closer to 8-9K and keeping in mind the original bill started out at 145K!!

This is one of the problems I have with the current system. If your friend had insurance, the bill would have only been about $30,000. Why do the insurance companies get a reduced rate, but I have to pay full price if I don't?


Insurance companies have more bargaining power and the hospitals are trying to cover their costs from patients who just can't pay.

 

[hattaresguy]

Originally Posted By: cchase
I don't really care about political side of things, but I don't want health insurance and don't want someone telling me I have to get it.


No problem as long as you pay out of pocket. So if you get sick and don't have the money...guess that's it?

 

[pbm]

Originally Posted By: DBMaster
Originally Posted By: javacontour
I think you've hit on a key component of all of this.

Anytime Other People's Money is in play, prices are distorted.


Way to put it succinctly! I believe similar forces are at play with college costs.



Exactly!

College costs began to soar when "others' began to pay for it (no 2 students pay the same price for the same college, unless both have well off parents and pay full price).

I understand that something had to be done about rising medical costs, but the governments track record is not good precisely because they are spending other people's (OUR) money.
I also don't like all the 'carve outs' in the ACA. If it's good enough for us, why isn't it good enough for everybody (including Congress).

 

[SteveSRT8]

Government has NEVER made any business run more efficiently. There's more "pork" than usual in the ACA and that is hard to imagine!

The Insurance companies are still driving the vehicle here, all we needed to do was remove the protective state by state structure that their lobbyists had installed and allow folks nationwide to shop ANYWHERE for their coverage. Normal competition would have done the rest.

But that would have been way too easy and not resulted in any more control for the powers that be...

 

[JHZR2]

Originally Posted By: SteveSRT8
Government has NEVER made any business run more efficiently. There's more "pork" than usual in the ACA and that is hard to imagine!

The Insurance companies are still driving the vehicle here, all we needed to do was remove the protective state by state structure that their lobbyists had installed and allow folks nationwide to shop ANYWHERE for their coverage. Normal competition would have done the rest.

But that would have been way too easy and not resulted in any more control for the powers that be...


I agree with that. There ARE some good elements of this, and it would have been nice if they were incrementally implemented and then gone from there.

 

[TechnoLoGs]

Originally Posted By: JHZR2
Originally Posted By: SteveSRT8
Government has NEVER made any business run more efficiently. There's more "pork" than usual in the ACA and that is hard to imagine!

The Insurance companies are still driving the vehicle here, all we needed to do was remove the protective state by state structure that their lobbyists had installed and allow folks nationwide to shop ANYWHERE for their coverage. Normal competition would have done the rest.

But that would have been way too easy and not resulted in any more control for the powers that be...


I agree with that. There ARE some good elements of this, and it would have been nice if they were incrementally implemented and then gone from there.



Will I still have a paycheck left if I return that form about it they handed out to my employer?

 

[SteveSRT8]

Originally Posted By: JHZR2
Originally Posted By: SteveSRT8
Government has NEVER made any business run more efficiently. There's more "pork" than usual in the ACA and that is hard to imagine!

The Insurance companies are still driving the vehicle here, all we needed to do was remove the protective state by state structure that their lobbyists had installed and allow folks nationwide to shop ANYWHERE for their coverage. Normal competition would have done the rest.

But that would have been way too easy and not resulted in any more control for the powers that be...


I agree with that. There ARE some good elements of this, and it would have been nice if they were incrementally implemented and then gone from there.


Absolutely true. The best of intentions simply cannot make it through any committee run by our Govt.

 

[gofast182]

Originally Posted By: SteveSRT8
Government has NEVER made any business run more efficiently. There's more "pork" than usual in the ACA and that is hard to imagine!

The Insurance companies are still driving the vehicle here, all we needed to do was remove the protective state by state structure that their lobbyists had installed and allow folks nationwide to shop ANYWHERE for their coverage. Normal competition would have done the rest.

But that would have been way too easy and not resulted in any more control for the powers that be...

What you're going to eventually see a few years down the road are the insurance companies beginning to go out of business. With all of the policy mandates and a grossly overestimated pool to support them there's no long-term model for them to be sustainable.

Policies which used to be based more on the level of coverage you wanted now have an income component involved where a manager at a car dealership would pay considerably more for the exact same plan than the chef at the diner even if they are both the same age and both healthy. But its even worse because all of the mandated coverage makes the starting point much higher than most middle-class folks currently pay, thus the drastically rising premiums that are causing sticker shock and forcing lifestyle adjustments. It really boils down to another income tax.

And if anyone thinks the ACA is doing good by providing coverage to the "30 million uninsured" we used to hear so much about, they are sadly mistaken. All the ACA does is impose mandates and act as an insurance broker (which already existed privately) to provide access to plans, not provide coverage itself. In reality, it is entirely conceivable that more than 30 million people could be without an insurance plan under the ACA because not all of the "30 million" existing will sign up and people who are the victims of layoffs or hours cut-backs because of costly ACA regulations may not get coverage because they just lost the hours/income needed to buy a plan (coincidentally because of the same law that was supposed to help).

 

[kb01]

I doubt insurance companies will go out-of-business; however, I suspect they will start abandoning the non-group market in droves. It's already happening in my state. We only have one insurer (Highmark) selling non-group policies in 2014, compared to a half dozen in 2013.

 

[gofast182]

Originally Posted By: kb01
I doubt insurance companies will go out-of-business; however, I suspect they will start abandoning the non-group market in droves. It's already happening in my state. We only have one insurer (Highmark) selling non-group policies in 2014, compared to a half dozen in 2013.

If they don't go out of business I expect them to eventually be relying much more heavily on gov't subsidies to stay open. They are already barely able to charge market prices for the majority of plans because they are cost-capped with mandatory coverage requirements, at some point those two attributes don't work together. On top of that the funding for the high-risk pools was grossly over-estimated compared to the cost which will also come to a head eventually.

 

[eljefino]

Originally Posted By: SteveSRT8


The Insurance companies are still driving the vehicle here, all we needed to do was remove the protective state by state structure that their lobbyists had installed and allow folks nationwide to shop ANYWHERE for their coverage. Normal competition would have done the rest.


I had this, in a way, and it was not the nirvana anyone would think.

Maine is not particularly competitive but my work had an office in Pennsylvania so they got us all PA BC/8S.

None of the local providers were "preferred", they were all "participating". But we were promised (wink-wink) at the benefits seminar that since we were far from "home" they'd treat all providers as "preferred".

This led to snafus and misunderstandings as providers tried administering care by local BC/8S rules. IDK if I ever had to sue them if I'd have to go to a PA court to do so.

As much as a single payer scheme could plausibly have "shamed" the other supposedly non profit insurers, the single payer would have been "more fair" and attracted sicker-than-average folks, letting the insurance companies reap in profits at public expense.

 

[gofast182]

I truly believe if regs. were lifted and this became a common industry-wide practice dialog, understanding, and parity would quickly be achieved between different states/networks and you'd see the market positively impact prices in short order.

 

[JHZR2]

I dont see the doom and gloom that some seem to be putting out. We have a user on here (hatteresguy) telling us what he and his workers are paying, and saving, currently.

Everyone wants to look at the 30 million uninsuured coming into the ranks as a liability, but there is also a much greater pool of paying individuals. Remember that the healthy ones balance out the sick ones, like they always have.

Difference being that the sick ones who couldnt get insurance before - and thus had their treatments paid for via overinflated costs to the rest of us, now are just part of the risk pool.

Their services and treatments were always being paid for, it was just out of control in terms of what they would be charged (forcing bankruptcy since most dont have the means to self-insure), or financial ruin.

It was always a zero sum game, the doctors were always going to get the funds for their yacht, and the administrators were always going to get their bonus, no matter how the system was set up. Who/how it was paid for is somewhat immaterial.

But helping the consumer via allowing longer-term COBRA, allowing people to pool risk in far larger groups to obtain buying power, etc. are all valuable and smart things - there really was no reason to prevent that kind of thing. To allow those who couldnt get coverage to be covered is a humane thing to do from a society basis. And it puts their care into a managed, structured system so the outcome should be better. Of course the cost of that needs to be paid, but why should it only be paid by those of us responsible enough to carry health insurance? Expanding the paying pool is the only way to keep costs down, but it too is a reasonable thing to expect, IMO. Im already paying for MANY peoples' coverage via my taxes, which will subsidize others' care. Why should my premiums go for it too, when there are tons of other folks electing not to buy?

The choice is to allow the folks with preexisting conditions to wither and die with highly expensive care costs that the insured folks are already paying for, or to spread that burden on other folks who also are a liability, healthy or not, because of their lack of insurance coupled with their lack of means to self-insure.

 

[javacontour]

I think it's a pipe dream to assume they are going to pay.

How many will stay on their parents policies until they are 26? Doesn't seem to be any additional revenue from that. My employer offered coverage doesn't charge based on how many kids. There are four prices:

Employee
Employee and any number of children
Employee and Spouse no kids
Employee, Spouse and any number of children.

How many uninsured will simply pay the fine/tax and continue to go uninsured? Or play chicken and insure-up if they determine they have some sort of medical issue?

I'm not saying doom and gloom. But I don't see a rosy picture either.

We shall see how this plays out.

After all, they collected taxes to help pay for this for four years before it even began to offer insurance at an exchange. How long until that pot is exhausted?

Originally Posted By: JHZR2
I dont see the doom and gloom that some seem to be putting out. We have a user on here (hatteresguy) telling us what he and his workers are paying, and saving, currently.

Everyone wants to look at the 30 million uninsuured coming into the ranks as a liability, but there is also a much greater pool of paying individuals. Remember that the healthy ones balance out the sick ones, like they always have.

Difference being that the sick ones who couldnt get insurance before - and thus had their treatments paid for via overinflated costs to the rest of us, now are just part of the risk pool.

Their services and treatments were always being paid for, it was just out of control in terms of what they would be charged (forcing bankruptcy since most dont have the means to self-insure), or financial ruin.

It was always a zero sum game, the doctors were always going to get the funds for their yacht, and the administrators were always going to get their bonus, no matter how the system was set up. Who/how it was paid for is somewhat immaterial.

But helping the consumer via allowing longer-term COBRA, allowing people to pool risk in far larger groups to obtain buying power, etc. are all valuable and smart things - there really was no reason to prevent that kind of thing. To allow those who couldnt get coverage to be covered is a humane thing to do from a society basis. And it puts their care into a managed, structured system so the outcome should be better. Of course the cost of that needs to be paid, but why should it only be paid by those of us responsible enough to carry health insurance? Expanding the paying pool is the only way to keep costs down, but it too is a reasonable thing to expect, IMO. Im already paying for MANY peoples' coverage via my taxes, which will subsidize others' care. Why should my premiums go for it too, when there are tons of other folks electing not to buy?

The choice is to allow the folks with preexisting conditions to wither and die with highly expensive care costs that the insured folks are already paying for, or to spread that burden on other folks who also are a liability, healthy or not, because of their lack of insurance coupled with their lack of means to self-insure.

 

[Win]

Originally Posted By: javacontour
I think it's a pipe dream to assume they are going to pay.

......


How many uninsured will simply pay the fine/tax and continue to go uninsured? Or play chicken and insure-up if they determine they have some sort of medical issue?



Yep, it's designed for them to do exactly that. The best reason a young, healthy, person justifies the expense of health insurance is to avoid the pre existing condition, denial of coverage.

If I understand it correctly, the new statutory arrangement mandates that all pre existing conditions be covered, so I see no reason why someone would not just pay the fine, and buy insurance at the last possible moment. I hope that I have misunderstood it.

Where are the doctors going to come from?

I know quite a few physicians who have just up and quit medicine since the enactment of this act. If you have other businesses, why even fool with this trainwreck? You can continue to dumb down the admission requirements to med schools to get more warm bodies in, but it takes decades to replace decades of practical experience.

Are the illegals going to have to pay into this plan? Is there anything to stop an illegal alien from walking into an ER, getting treatment, and walking back out again, never to be heard from until he's arrested for some crime? Ditto for a crazy homeless person?

 

[javacontour]

The fines are administered by the IRS. No tax return, no fine is likely how it will work.

 

[demarpaint]

Originally Posted By: Win

Are the illegals going to have to pay into this plan? Is there anything to stop an illegal alien from walking into an ER, getting treatment, and walking back out again, never to be heard from until he's arrested for some crime? Ditto for a crazy homeless person?


Nope they'll get the same free coverage they get now by walking into the ER. They use the ER around here for their primary care doctors too. So nothing will change for them.

 

[itguy08]

Originally Posted By: Clevy

You are mistaken on your point about age dependent care. My grandmother was on dialysis until she died when she was 92.
The care provided is triage type. If a patient needs it and its a potential life or death issue they get seen immediately,pushing someone who is less in need back.


Then it must have been the UK's medical system then. I do remember reading about it from multiple sources but it was a while ago.

Quote:
There are a lot of inaccuracies floating around America about our health care system. Most of the misinformation is parroted by people trying to sell or push an agenda and they try to cite examples of the shortcomings of our system when the truth is more complicated.


Most definitely everyone molds things to fit their agenda and finding unbiased sources is tough if not impossible.

Personally, I don't want the government in anything relating to my healthcare (or many other things). I'm able to seek the information on plans, etc, decide what best meets my needs as a person and for my family. And most importantly live with those decisions.

The only thing we have a God given right to in the USA is Life, Liberty, and the Pursuit of Happiness. Not a right to healthcare (maybe some want none or want to waste their lives), not a right to a "fair" life, not a right to retirement, etc.

Work for what you have and don't be ashamed. I shouldn't have to subsidize others who choose to not to work hard. I shouldn't have to subsidize others who don't take care of themselves, make poor life choices, etc. Sure, there are some things that "just happen" - cancer, altzheimers, etc, and that's what insurance is for, not to make up for your diabetes from being a fat slob for 50 years.

I think if we let the market work with some stipulations it will work well. Reduce malpractice suit amounts (yes it sucks for malpractice but it should not be a payday), let insurance companies sell across state lines, etc. There will be reduced prices as regulations tend to drive up costs for everyone and that is good for nobody.

 

[itguy08]

Originally Posted By: JHZR2

Everyone wants to look at the 30 million uninsuured coming into the ranks as a liability, but there is also a much greater pool of paying individuals. Remember that the healthy ones balance out the sick ones, like they always have.


But I have to wonder how many of those 30 million will now get care because they can? I mean if you had a cold for a week before you may have dealt with it, but now that you are insured you can go to the Dr. Or if you are out and mess up your knee/ankle, etc before you may have dealt with it. Now you can go to the Dr, get the X-rays, meds, physical therapy, etc.

And then you also have to wonder how many of those 30 million have expensive pre-existing conditions that now they can get treated for. Before they may have been dealing with it and now they can get treated.

I don't know the answer but the answers we have now are not working well.

 

[Win]

Originally Posted By: demarpaint


Nope they'll get the same free coverage they get now by walking into the ER. They use the ER around here for their primary care doctors too. So nothing will change for them.



So if it's not going to do anything to stop the existing moochers from continuing to mooch, if it's not going to force uninsured people to buy insurance, what's the point of the thing?