something ignored about obamacare

[jtw4796]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage. So in 2014 I will be better of to quit my job start drawing food stamps and let the government pay for my family's health insurance. I will not do that but they are the facts. So with obamacare the people who refuse to work and the ones who are just plain lazy will have better insurance than I am working and paying for.

 

[Ava]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage. So in 2014 I will be better of to quit my job start drawing food stamps and let the government pay for my family's health insurance. I will not do that but they are the facts. So with obamacare the people who refuse to work and the ones who are just plain lazy will have better insurance than I am working and paying for.

That last sentence may be true. But those people will have to look at themselves in a mirror everyday, and see a nothing....

 

[TNHarley]

It seems to me that is what obama is trying to do. Dependence on the gov't. I ******* hate this care BS. Only one it is helping is the lazy ***** who dont want to do anything with their life.

But those people will have to look at themselves in a mirror everyday, and see a nothing....
I'm sure they are satisfied with who they are, so that will not be a factor

 

[dblack]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage.

Hmm... these are precisely the kinds of changes we need to get control of health care inflation, so I'm begrudged to admit this as a (very rare) positive outcome of Obamacare. Do you have any indication as to why your policy changed? Did they cite any specific part of PPACA that prompted the change?

 

[peach174]

Yep our's is going up too.
All Cadillac plans will go up by 40%.
Any drug that you have that can not be generic is rising also.
One drug my husband uses, does not come in any type of generic drug. It has gone up three times now.
First it cost 32.00 then 53.00 and in just one month it has gone up to 86.00. This is what we are paying after insurance has paid for it. Seniors can't afford this huge continual hikes.
This is what the New Health Care Act bill does. punish the ones who cannot get generic drugs.

 

[oldfart]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage.

Hmm... these are precisely the kinds of changes we need to get control of health care inflation, so I'm begrudged to admit this as a (very rare) positive outcome of Obamacare. Do you have any indication as to why your policy changed? Did they cite any specific part of PPACA that prompted the change?

A couple of things are happening here. The biggest one has nothing to do with the ACA. Employers have been cutting back on health benefits and coverage for the last 20 years and the trend is accelerating. Employers who have been cutting back on health benefits now blame the ACA for what they had been doing and planned to continue to do anyway; shift more of the financial burden onto the employee.

Until America gets the cost of health care under control, fewer and fewer people (employers or employees) will be able to afford good insurance. Americans pay more than double what any other economically advanced nation pays and gets results that are best mediocre. The most successful American health care systems are single-payer like the VA system, Medicare, and the military. The same is true in other countries. I don't see any clear advantage to single-provider (managed care, HMO, or "socialized medicine" or whatever else you want to call it) but I do see that a single payer system can control costs and deliver better care.

The ACA will involve some increases in short term costs (2 or 3 years) for much of the health care and health care financing industries. Most of these effects will be offset by much larger cost savings in the future. For example, free cancer screenings and immunizations should reduce the cost of treating cancer by early detection reducing the number of cases detected at late stages which are more expensive to treat and reducing the pool of un-immunized people who could contract expensive to treat diseases. Similarly moving toward universal coverage, especially for people with pre-existing conditions, will result in more preventative care and earlier detection when diseases are less costly to treat.

I think there are three areas where the ACA could be improved that would yield huge benefits in both outcomes and cost and move us toward the average of developed economies. First is to extend the benefits of negotiated rates to as much of the health care industry as possible. Single-payer could do this fairly easily. If Medicaid can negotiate drug prices, why shouldn't Medicare?

Second, we should eliminate the bureaucracy that makes private health insurance incur 15--20% administrative overhead where the similar figure for Medicare is under 2%, USING THE SAME COMPANIES AS CLAIMS PROCESSORS. If insurance companies can no longer cherry-pick and have no incentive for denying claims on frivolous grounds, we end the game of ping pong with claims bouncing back and forth between providers and insurers and the savings could accrue to everybody in the system, insurers, providers, and patients.

Third, we need to dismantle emergency facilities as the provider of first choice for any and all medical conditions. The best way to do this is a system adopted by many teaching hospitals. "Emergency services" is actually divided into four functions: triage, acute care, medical screening clinic, and surgical screening clinic. Triage evaluates patients and determines which of the other three areas is most appropriate. Acute care functions like what we see on the TV shows, dealing with life-threatening emergencies. The screening clinics have longer wait lines, often make appointments for non-immediate care at a later date, and frequently only provide sufficient care to hold people over until the later appointment. It's amazing how many people can be treated with acetaminophen, an antibiotic, and a mild sedative. In mass casualty situations, this model allows for all hands and resources to be assigned to triage and acute care.

Finally, one of the problems with the current system is that there are not enough health care resources to provide quality health care to everyone, especially in certain areas of practice such as primary care, care for elderly, and long-term care. Health financing reform needs to be coupled with a reorganization of health care delivery and an investment in both facilities and training. The role of PA's and NP's should be expanded and perhaps a two-tier system of licensing and training for physicians instituted.

We can't stay with a system that is sinking more each year and we can't go back to an ideal system that never really existed. We can either muddle along hoping to stabilize the system (which is all that the ACA really does) or we can use it to launch a health care delivery and financing system the American people deserve.

 

[dblack]

A couple of things are happening here. The biggest one has nothing to do with the ACA. Employers have been cutting back on health benefits and coverage for the last 20 years and the trend is accelerating. Employers who have been cutting back on health benefits now blame the ACA for what they had been doing and planned to continue to do anyway; shift more of the financial burden onto the employee.

And this is exactly what needs to happen to cure the health care market.

Until America gets the cost of health care under control, fewer and fewer people (employers or employees) will be able to afford good insurance. Americans pay more than double what any other economically advanced nation pays and gets results that are best mediocre.

It's rather obvious our health care market is deeply imbalanced. We're overinsured and under invested in our own health. Health care providers experience virtually no downward price pressure from health care consumers. People either have insurance and don't care much about costs because they're "covered", or they don't have insurance and don't care about costs because they can't afford the inflated prices.

Everything I've studied and read about the dysfunctions of the health care market points to over-insurance as the principle driver of health care inflation. Yet the entire zeitgeist of PPACA is that it is imperative to maximize the role of corporate insurance, positioning the insurance industry as middlemen (largely unnecessary middlemen) in every single health care transaction.

I think there are three areas where the ACA could be improved that would yield huge benefits in both outcomes and cost and move us toward the average of developed economies. First is to extend the benefits of negotiated rates to as much of the health care industry as possible. Single-payer could do this fairly easily. If Medicaid can negotiate drug prices, why shouldn't Medicare?

Because, especially if we get single-payer (but even if we don't), government agencies don't 'negotiate'. They dictate. What you're homing in on here is defacto government mandated price controls on health care.

... If insurance companies can no longer cherry-pick and have no incentive for denying claims on frivolous grounds, we end the game of ping pong with claims bouncing back and forth between providers and insurers and the savings could accrue to everybody in the system, insurers, providers, and patients.

Speaking of cherry-picking, I'm taking this somewhat out of context to ask about the bolded part. I'm just curious what removes this incentive? I see no reason to believe insurance companies won't challenge claims as aggressively as ever. What provisions of PPACA would have this effect? Does it actually outlaw challenging claims?

 

[OohPooPahDoo]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage.

Obamacare has nothing to do with that. That's your employer screwing you over. Stop being an idiot.

 

[whitetrashmama]

When is anyone in gov't, or even the general public, going to notice the obvious fallacy of all employer-provided health insurance? SICK PEOPLE DON'T WORK!!! The ONLY ones who have ever benefited in most jobs are the families of breadwinners. Once the breadwinner gets too sick to work, within a few months he/she is highly likely to lose the insurance coverage for ongoing expenses.

I don't know if Obama is consciously trying to force the American public onto a general everyone-pays system, but he is botching the job if he is because he is trying to turn it into a "no-one pays at all", not an "everyone pays a little" and the health providers know this. Somehow the drug companies will get paid just like the prostitutes in any society, but the providers? They are the abandoned lovers, already taking lower payments for medicare/medicaid patients.

One of the other sneaky parts of Obama-care is a new loophole that will punitively refuse payment to any clinic/hospital that has a "complication" arise requiring re-treatment of a patient. You know how they will handle that? Of course: they'll just refuse treatment to any case that looks difficult or risky.

It is all slow genocide or national collective suicide of the USA, whether intentional or not... really, it is just too weird to consider what Obamacare really will accomplish.....

 

[oldfart]

Employers who have been cutting back on health benefits now blame the ACA for what they had been doing and planned to continue to do anyway; shift more of the financial burden onto the employee.

And this is exactly what needs to happen to cure the health care market.

Most studies I have seen indicate that consumers do a petty good job of controlling their own over-utilization of medical services. While a nose job might be attractive with a face lift, few people are insisting on a triple bypass when they think an angioplasty will do.

But if we wanted to encourage this kind of self-rationing, then we should equalize the "cost" of medical care by scaling the copays or deductibles to income. Everybody could probably pay a $5.00 copay for an office visit, but that's not enough for a person making $200,000 a year to worry about cost containment. Apart from the logistical problems, people would intensely dislike such a system.

It's rather obvious our health care market is deeply imbalanced. We're overinsured and under invested in our own health.

Couldn't agree more!

Everything I've studied and read about the dysfunctions of the health care market points to over-insurance as the principle driver of health care inflation. Yet the entire zeitgeist of PPACA is that it is imperative to maximize the role of corporate insurance, positioning the insurance industry as middlemen (largely unnecessary middlemen) in every single health care transaction.

I'm not sure I agree with about the causes of medical cost inflation, but I agree that feeding more money into the health care financing industry without reforms to reduce its monopoly and monopsony power is a bad idea.

Because, especially if we get single-payer (but even if we don't), government agencies don't 'negotiate'. They dictate. What you're homing in on here is defacto government mandated price controls on health care.

But if the problem is a concentration of market power, there really is no alternative. If someone has an idea how to make medical markets behave like competitive markets, I'd say give it a try. As things now stand care is often rendered before the patient ever sees a cost estimate or bill. How can a competitive market work when consumers don't even know what the prices are?

... If insurance companies can no longer cherry-pick and have no incentive for denying claims on frivolous grounds, we end the game of ping pong with claims bouncing back and forth between providers and insurers and the savings could accrue to everybody in the system, insurers, providers, and patients.

Speaking of cherry-picking, I'm taking this somewhat out of context to ask about the bolded part. I'm just curious what removes this incentive? I see no reason to believe insurance companies won't challenge claims as aggressively as ever. What provisions of PPACA would have this effect? Does it actually outlaw challenging claims?

I was more than a little uncomfortable when I wrote that section, but couldn't think of a brief way to be clearer. In a single-payer system like Medicare, the claims processor contracts with the payer (the government) for compensation that does not depend on the validity of the claim (that's the job of a separate contract for investigation and ultimately fraud prosecution). If the paperwork is in order, the claim will be paid the appropriate amount determined by the government and the processor gets paid the fee. This is the reason for the much lower administrative cost in Medicare. BCBS or any other claims processor cannot increase their fee or profit by denying a proper claim. But BCBS as an insurer can increase profit by denying claims without adequate basis. This is an inherent feature of single-payer systems. There is nothing in the ACA that I am aware of which would achieve this result, which is why I propose it as an area where the ACA can be improved.

While you did not raise this issue, I think the nut is that we cannot create a system with effective cost control, unlimited choice, and universal coverage. Insisting on all three merely guarantees failure. Of the three, I view unlimited choice as the one we can curtail. The question is whether we ration by plan and public policy or entirely by cost. Rich consumers will always be able to find boutique care. The question is what kind of care most of the population will get.

 

[lovemymutts]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage.

Hmm... these are precisely the kinds of changes we need to get control of health care inflation, so I'm begrudged to admit this as a (very rare) positive outcome of Obamacare. Do you have any indication as to why your policy changed? Did they cite any specific part of PPACA that prompted the change?

A couple of things are happening here. The biggest one has nothing to do with the ACA. Employers have been cutting back on health benefits and coverage for the last 20 years and the trend is accelerating. Employers who have been cutting back on health benefits now blame the ACA for what they had been doing and planned to continue to do anyway; shift more of the financial burden onto the employee.

Until America gets the cost of health care under control, fewer and fewer people (employers or employees) will be able to afford good insurance. Americans pay more than double what any other economically advanced nation pays and gets results that are best mediocre. The most successful American health care systems are single-payer like the VA system, Medicare, and the military. The same is true in other countries. I don't see any clear advantage to single-provider (managed care, HMO, or "socialized medicine" or whatever else you want to call it) but I do see that a single payer system can control costs and deliver better care.

The ACA will involve some increases in short term costs (2 or 3 years) for much of the health care and health care financing industries. Most of these effects will be offset by much larger cost savings in the future. For example, free cancer screenings and immunizations should reduce the cost of treating cancer by early detection reducing the number of cases detected at late stages which are more expensive to treat and reducing the pool of un-immunized people who could contract expensive to treat diseases. Similarly moving toward universal coverage, especially for people with pre-existing conditions, will result in more preventative care and earlier detection when diseases are less costly to treat.

I think there are three areas where the ACA could be improved that would yield huge benefits in both outcomes and cost and move us toward the average of developed economies. First is to extend the benefits of negotiated rates to as much of the health care industry as possible. Single-payer could do this fairly easily. If Medicaid can negotiate drug prices, why shouldn't Medicare?

Second, we should eliminate the bureaucracy that makes private health insurance incur 15--20% administrative overhead where the similar figure for Medicare is under 2%, USING THE SAME COMPANIES AS CLAIMS PROCESSORS. If insurance companies can no longer cherry-pick and have no incentive for denying claims on frivolous grounds, we end the game of ping pong with claims bouncing back and forth between providers and insurers and the savings could accrue to everybody in the system, insurers, providers, and patients.

Third, we need to dismantle emergency facilities as the provider of first choice for any and all medical conditions. The best way to do this is a system adopted by many teaching hospitals. "Emergency services" is actually divided into four functions: triage, acute care, medical screening clinic, and surgical screening clinic. Triage evaluates patients and determines which of the other three areas is most appropriate. Acute care functions like what we see on the TV shows, dealing with life-threatening emergencies. The screening clinics have longer wait lines, often make appointments for non-immediate care at a later date, and frequently only provide sufficient care to hold people over until the later appointment. It's amazing how many people can be treated with acetaminophen, an antibiotic, and a mild sedative. In mass casualty situations, this model allows for all hands and resources to be assigned to triage and acute care.

Finally, one of the problems with the current system is that there are not enough health care resources to provide quality health care to everyone, especially in certain areas of practice such as primary care, care for elderly, and long-term care. Health financing reform needs to be coupled with a reorganization of health care delivery and an investment in both facilities and training. The role of PA's and NP's should be expanded and perhaps a two-tier system of licensing and training for physicians instituted.

We can't stay with a system that is sinking more each year and we can't go back to an ideal system that never really existed. We can either muddle along hoping to stabilize the system (which is all that the ACA really does) or we can use it to launch a health care delivery and financing system the American people deserve.

Please go back and reread YOUR paragragh that starts with -There are a couple of things happening-You will realize that you shot yourself in the foot.I worked for Humana for 15 years and let me tell you it is ALL about greed.

 

[Luddly Neddite]

I have a job making decent money but thanks to Obamacare my health insurance deductable will go up 300% and I am losing my prescription coverage. So in 2014 I will be better of to quit my job start drawing food stamps and let the government pay for my family's health insurance. I will not do that but they are the facts. So with obamacare the people who refuse to work and the ones who are just plain lazy will have better insurance than I am working and paying for.

Where do you people get this crap? What you have posted about your deductible going up 300% is not true. You either made it up, heard it from someone who made it up or your insurance company is breaking the law.

No, you are not losing your scrip coverage. The only way that could be true is if you'rea woman and Mitt gets elected.

Talk to your employer. Your employer is getting a fat tax credit because of ACA. If they don't know that, they may tell you something that's not true.

Talk to your insurance company. Most of should know by now that they cannot raise your premium. They should also know by now that the law states they must spend 80 cents out of every dollar of your premium on patient care.

EDUCATE YOURSELF and stop believing shit you hear over the back fence OR from people like me on the internet.

EDUCATE YOURSELF.

As for the last, that IS true. Under our current SOCIALIST system, you can get free care at the emergency room. Doesn't matter if you're illegal, having a baby, or if you need an abortion - if you choose not to pay your bill, its free and the rest of us have to pay your bill. If YOU have insurance then, yes, YOU are paying for those people's care.

 

[Luddly Neddite]

When is anyone in gov't, or even the general public, going to notice the obvious fallacy of all employer-provided health insurance? SICK PEOPLE DON'T WORK!!! The ONLY ones who have ever benefited in most jobs are the families of breadwinners. Once the breadwinner gets too sick to work, within a few months he/she is highly likely to lose the insurance coverage for ongoing expenses.

I don't know if Obama is consciously trying to force the American public onto a general everyone-pays system, but he is botching the job if he is because he is trying to turn it into a "no-one pays at all", not an "everyone pays a little" and the health providers know this. Somehow the drug companies will get paid just like the prostitutes in any society, but the providers? They are the abandoned lovers, already taking lower payments for medicare/medicaid patients.

One of the other sneaky parts of Obama-care is a new loophole that will punitively refuse payment to any clinic/hospital that has a "complication" arise requiring re-treatment of a patient. You know how they will handle that? Of course: they'll just refuse treatment to any case that looks difficult or risky.

It is all slow genocide or national collective suicide of the USA, whether intentional or not... really, it is just too weird to consider what Obamacare really will accomplish.....

NO.

Not true.

Post your PROOF.

 

[Luddly Neddite]

Yep our's is going up too.
All Cadillac plans will go up by 40%.
Any drug that you have that can not be generic is rising also.
One drug my husband uses, does not come in any type of generic drug. It has gone up three times now.
First it cost 32.00 then 53.00 and in just one month it has gone up to 86.00. This is what we are paying after insurance has paid for it. Seniors can't afford this huge continual hikes.
This is what the New Health Care Act bill does. punish the ones who cannot get generic drugs.

PROOF.

Post PROOF because, as you already know, this is ALL lies.

 

[Luddly Neddite]

It seems to me that is what obama is trying to do. Dependence on the gov't. I ******* hate this care BS. Only one it is helping is the lazy ***** who dont want to do anything with their life.

But those people will have to look at themselves in a mirror everyday, and see a nothing....
I'm sure they are satisfied with who they are, so that will not be a factor

It is, of course, just the opposite.

Surely you know that.

POST PROOF.

I am so sick of you idiot rw's refusing to EDUCATE YOURSELVES but you never get tired of LYING. And, you never tire of believing the next lies you hear.

 

[dblack]

Most studies I have seen indicate that consumers do a petty good job of controlling their own over-utilization of medical services. While a nose job might be attractive with a face lift, few people are insisting on a triple bypass when they think an angioplasty will do.

The problem isn't over-utilization, it's inverted consumer motivations. There's virtually no price shopping in the health care market. Health care consumers with low-deductible, high-coverage plans have no incentive to look for bargains in their health care choices. Arguably, they have the opposite incentive - as long as someone else is paying for it, why not pick the most expensive treatments available?

But if the problem is a concentration of market power, there really is no alternative. If someone has an idea how to make medical markets behave like competitive markets, I'd say give it a try.

That's the best approach in my view. We need to look at all the structures and regulation we've built up around health care and remove those that are promoting the market distortion.

As things now stand care is often rendered before the patient ever sees a cost estimate or bill. How can a competitive market work when consumers don't even know what the prices are?

They have to want to know what the prices are first. In other words they have to care. In other other words, they need to be spending their own money, instead of cashing out like they've just won the health insurance lottery.

I was more than a little uncomfortable when I wrote that section, but couldn't think of a brief way to be clearer. In a single-payer system like Medicare, the claims processor contracts with the payer (the government) for compensation that does not depend on the validity of the claim (that's the job of a separate contract for investigation and ultimately fraud prosecution). If the paperwork is in order, the claim will be paid the appropriate amount determined by the government and the processor gets paid the fee. This is the reason for the much lower administrative cost in Medicare. BCBS or any other claims processor cannot increase their fee or profit by denying a proper claim. But BCBS as an insurer can increase profit by denying claims without adequate basis. This is an inherent feature of single-payer systems. There is nothing in the ACA that I am aware of which would achieve this result, which is why I propose it as an area where the ACA can be improved.

Ok. Thanks for clarifying.

While you did not raise this issue, I think the nut is that we cannot create a system with effective cost control, unlimited choice, and universal coverage. Insisting on all three merely guarantees failure. Of the three, I view unlimited choice as the one we can curtail. The question is whether we ration by plan and public policy or entirely by cost. Rich consumers will always be able to find boutique care. The question is what kind of care most of the population will get.

I don't think we need to 'curtail' anything, other than the bad tax and regulatory schemes that have painted us into such a corner. Markets don't work unless consumers have the freedom and incentive to make frugal decisions. There's no sense in even having a market if we can't get that through our heads. It's frustrating to read that you're suggesting we limit that very freedom, especially so given that I have no confidence that trading away our freedom in this way would even gain us anything worthwhile in the bargain. We're trading away our self-determination to the insurance industry for vague promises of guaranteed issue and greater "oversight".

We're setting up an entirely different game for the insurance industry, where the primary factor in profits and losses will be their ability to negotiate regulation. I wonder how that struggle will pan out. Who do we think has more lobbyists and lawyers, the insurance industry - or consumer advocacy groups?

 

[minichell04]

Obama care allows Americans to become even lazier than we already are. Giving more welfare to people who clearly dont work for their money is ridiculous, thats not building america thats us getting babysit-ted by the government. We will all get so dependent on the government that when it all fails, WHAT ARE WE ALL GONNA DO!?

 

[oldfart]

Obama care allows Americans to become even lazier than we already are. Giving more welfare to people who clearly dont work for their money is ridiculous, thats not building america thats us getting babysit-ted by the government. We will all get so dependent on the government that when it all fails, WHAT ARE WE ALL GONNA DO!?

Well, as for me, I intend to live modestly on my Social Security and retirement, advise my son who has taken over the businesses when he asks, practice my professions and keep my licenses up to date, read more history, do a little writing, play with my grandchildren, practice my faith, eat well, sleep well, chill out and keep fighting the good fight issue by issue. I hope your plans are for something similar.

 

[editec]

But if the problem is a concentration of market power, there really is no alternative. If someone has an idea how to make medical markets behave like competitive markets, I'd say give it a try. As things now stand care is often rendered before the patient ever sees a cost estimate or bill. How can a competitive market work when consumers don't even know what the prices are?

And THAT is the crux of the matter.

Health care is never EVER EVER going to work like most consumer spending works..

First of all, because the PROVIDER, not the consumer, decides what the consumer will consume.

Secondly, because there is no substiution possible in most cases of serious HC crises.

Thinking that market forces work for health care, like they work for everything else, is the DELUSION of people who do not understand economics and/or HUMAN BEHAVIOR.

 

[dblack]

Health care is never EVER EVER going to work like most consumer spending works..

First of all, because the PROVIDER, not the consumer, decides what the consumer will consume.

That's not true. The consumer has the final say. They just rarely bother to exercise it because there's no incentive to. As long as you're insured, any sane person will prefer the best (and most expensive) health care available. And, of course, so will their doctor. That can't not produce inflation. I don't see how people can continue to ignore this. The health care market is broken NOT because we, in general, lack coverage - but because we are over-insured.

Thinking that market forces work for health care, like they work for everything else, is the DELUSION of people who do not understand economics and/or HUMAN BEHAVIOR.

You haven't made your case. Market forces don't "work" for health care because we actively pervert them.