Can someone explain to me the 20 million?

alfadriver wrote: What I don't get about all of this stuff is how there's such a profitable industry that all they do is launder my money for a fee, and it's about healthcare. It's one thing to have insurance for stuff where you can have basic coverage and make money doing it. But to have it where the goal is to keep people healthy, and business choices are made to prevent people from being actually healthy just for money, well... It's a moral grey area that I just don't understand why others are not questioning.

Oh it's been brought up in certain circles, but it's essentially the elephant in the room nobody wants to discuss for fear of biting the hand that feeds them. When a great deal of advertising revenue comes from the health care industry, is it surprising the media is hesitant to criticize it?

I have nothing to add about the numbers, but I'm furious about some BS that my girlfriend deals with.

She's a CMA in a private practice. Most of their patients are Medicare/Medicaid or other ACA type folks. They have to submit paperwork for all of those patients, as part of the wellness checks. I'm foggy on what exactly it is, but all they're submitting is a questionnaire, regarding how the patient has been the past year. You know, stuff the doctor should be asking as a matter of course, but the CMAs do before he gets in to see the patient.

The maddening part? He got a $50k bonus, for the office submitting the forms.

In reply to RealMiniParker:

Most of that 50k probably went towards his malpractice insurance. Which makes me wonder what affect the ACA has had on malpractice insurance. Anybody know?

In reply to RealMiniParker:

That's every industry lately. The people at the top get a bonus for making sure the peons do what they're told as efficiently as possible for as few pennies as possible.

My hospital just announced they were profitable for the last fiscal year again. In celebration, they've decided no raises this year, eliminating healthcare insurance options, and eliminated 25 positions.

But at least the administration got their bonuses!

Edit: ACA had no effect at all on malpractice, for good or bad.

I assume most of the rise in cost is because they are required to treat pre-existing conditions. There are a lot of people that now have coverage and will take more out than paying in. If you could go without car insurance but buy some right after an accident would you buy it? Now picture every damaged car on the road suddenly being fixed under insurance you bought Today.

In reply to MDJeepGuy:

Hard part is if you don't treat this stuff you just defer the maintenance until you need to really spend it. Then you just go to the ER and someone/everyone pays for the uninsured major stuff.

Pay now or pay later. Ain't no free lunch. Kinda like a European car. Hahah.

17 years ago I was discussing a particular treatment for an especially bad form of hemophilia in a class about such things.

Professor: "Treatment runs about $125,000 per MONTH."

Me: "Umm, so who pays for that?"

Professor: "Well their family insurance."

Me: "Well, ignoring the fact that insurance doesn't pay for anything, they just redistribute the money they bring in the form of premiums, but besides that most insurance policies have a million dollar lifetime cap, two million if your policy is really good."

Professor: "Then the government will pay for it."

Me: "Same thing applies except it's taxes and not premiums and your family has to be financially broken before you can get on Medicaid."

I know I'm a shiney-happy-person for even questioning the cost of treatment but unless and until the costs get reigned in dramatically, there isn't enough money to fill the well of health care costs.

MDJeepGuy wrote: I assume most of the rise in cost is because they are required to treat pre-existing conditions. There are a lot of people that now have coverage and will take more out than paying in. If you could go without car insurance but buy some right after an accident would you buy it? Now picture every damaged car on the road suddenly being fixed under insurance you bought Today.

The alternative is not being hireable because you have a pre-existing condition and your potential employer's insurance plans won't touch you.

Oh, one thing that drives me insane: Why is it so difficult to get preventative measures? I have a history of cancer in my family, and it is getting younger each generation. My dad paid for, out of pocket, a colonoscopy at age 45 because insurance wouldn't cover it. I'll now get one at 40 because of what they found for him, but I want it at 35, or earlier. Why not?

Similarly, my wife is a Dietitian. She complains that often times it is too late for her to do anything with her patients, or her patients are fighting a much more uphill battle than would have been necessary had insurance covered her visits much earlier.

Not sure how to fix it. I think eventually single payer will have to happen--whatever it is, I don't want what we have now.

Fueled by Caffiene, I think you may be on to something with the rising costs coming regardless of the ACA. No data here either, but I'd like to find some and see it.

Fueled by Caffeine wrote: My personal belief is that it'll get worse before it gets better. We'll go through a few rounds of messing it up in various ways until everyone gets fed up and goes single payer. Just my thoughts.

My personal belief is that was the real intention all along. And I'll leave further opinions on the topic as an exercise for the student.

Knurled wrote:

MDJeepGuy wrote: I assume most of the rise in cost is because they are required to treat pre-existing conditions. There are a lot of people that now have coverage and will take more out than paying in. If you could go without car insurance but buy some right after an accident would you buy it? Now picture every damaged car on the road suddenly being fixed under insurance you bought Today.

The alternative is not being hireable because you have a pre-existing condition and your potential employer's insurance plans won't touch you.

Interesting. My BIL was interviewing a perspective employee. As a business owner, he pays a good chunk of his employees premiums. This candidate told him his plans sucked, because she has a daughter with Leukemia. Oh great, now if he does not hire her she can sue because of the insurance deal. He ended up not hiring her. However, he told me if one or more of his employees (100+) gets cancer, he is out of business because of the cost of that healthcare.

mtn wrote: Oh, one thing that drives me insane: Why is it so difficult to get preventative measures? I have a history of cancer in my family, and it is getting younger each generation. My dad paid for, out of pocket, a colonoscopy at age 45 because insurance wouldn't cover it. I'll now get one at 40 because of what they found for him, but I want it at 35, or earlier. Why not?

Similarly, my father has Muscular Dystrophy. You wouldn't believe the hoops I had to jump through to get tested for it.

"Hi, I'd like to get tested for Muscular Dystrophy"

"Why?"

"My father has it. I want to know if I have it."

(call transfered to 20 other departments/offices/whatever)

"Well..." (10 questions follow regarding specific onset symptoms). "Sounds like you don't have it."

"Yes, but I want to know if I do or don't have it."

"You aren't showing any of the symptoms, why do you need a test?"

"Because I want to know if I could pass it to my children!! @#$%!!!!"

In reply to Duke:

It could be. I don't think so, but I don't see it getting better until it gets regulated heavily. Just my thoughts. I just don't see competition working in a market with such high barriers to entry. Hospitals are expensive to run and being a doctor costs lots of time and money. Sure competition can help, but I don't see it doing it on its own.

What I will say is that it scares the hell out of me that people are willling to travel to other countries for medical care to save money. I'm worried about what this place will be like for my kids. Will it be better off for them than I had it? Probably not.

Back on topic. The 20milion are not probably a mix of young adults who don't really "need" healthcare and poor people. Just a guess.

KyAllroad wrote: 17 years ago I was discussing a particular treatment for an especially bad form of hemophilia in a class about such things. Professor: "Treatment runs about $125,000 per MONTH." Me: "Umm, so who pays for that?" Professor: "Well their family insurance." Me: "Well, ignoring the fact that insurance doesn't pay for anything, they just redistribute the money they bring in the form of premiums, but besides that most insurance policies have a million dollar lifetime cap, two million if your policy is really good." Professor: "Then the government will pay for it." Me: "Same thing applies except it's taxes and not premiums and your family has to be financially broken before you can get on Medicaid." I know I'm a shiney-happy-person for even questioning the cost of treatment but unless and until the costs get reigned in dramatically, there isn't enough money to fill the well of health care costs.

Building on this, one thing that has come about recently that I think is a good thing, is the rise in non-traditional forms of insurance. Pooling money and paying it out in claims isn't a bad thing, but doing it for profit tends to muddy the waters a bit. Now that insurance is required, a lot of my self-employed friends belong to religious based non-profit groups that simply collect premiums, and dole out money for approved claims. This satisfies the Gov's requirements for health insurance, while being (slightly) more affordable than traditional insurers. There are no investors to satisfy or ultra expensive CEOs to pay. It's insurance in it's most basic form, and I appreciate that.

In reply to Fueled by Caffeine:

That was the point of the ACA. Bring in a pool of low cost users that could subsidize high cost users. That's the point of all insurance really. If you stay healthy then you win by being healthy and if you get sick you win by having others help pay for it.
The system is working to redistribute money exactly like it's supposed to really.

alfadriver wrote:

carguy123 wrote: Your cost has gone up astronomically and your choice of doctors shrunk just as astronomically as well as your choice of insurance companies because most of the big companies have been pulling out.

All of that happened even before the ACA, so I'm not sure how you blame that. When I started work, we had a huge choice of who to be insured by, and the set of doctors. Over time, that reduced to 2 traditional plans and a single HMO, with the cost going up every time.

No it hadn't. It was an instantaneous event once we went ACA

carguy123 wrote:

alfadriver wrote:

carguy123 wrote: Your cost has gone up astronomically and your choice of doctors shrunk just as astronomically as well as your choice of insurance companies because most of the big companies have been pulling out.

All of that happened even before the ACA, so I'm not sure how you blame that. When I started work, we had a huge choice of who to be insured by, and the set of doctors. Over time, that reduced to 2 traditional plans and a single HMO, with the cost going up every time.

No it hadn't. It was an instantaneous event once we went ACA

Uhhh... turn off Fox News. Please.

KyAllroad wrote: 17 years ago I was discussing a particular treatment for an especially bad form of hemophilia in a class about such things. Professor: "Treatment runs about $125,000 per MONTH." Me: "Umm, so who pays for that?" Professor: "Well their family insurance." Me: "Well, ignoring the fact that insurance doesn't pay for anything, they just redistribute the money they bring in the form of premiums, but besides that most insurance policies have a million dollar lifetime cap, two million if your policy is really good." Professor: "Then the government will pay for it." Me: "Same thing applies except it's taxes and not premiums and your family has to be financially broken before you can get on Medicaid." I know I'm a shiney-happy-person for even questioning the cost of treatment but unless and until the costs get reigned in dramatically, there isn't enough money to fill the well of health care costs.

Very well said,

As a Process Engineer with twelve years of experience in health care, here’s what I’m using as a litmus test to determine what’s going to happen going forward:

If politicians, experts, etc. bloviate (pro or con, it doesn’t matter) about people staying on their parents insurance until they’re 26, men paying for woman’s health procedures, health savings accounts, etc., we can reliably conclude that the exponential increase in cost and reduction in value will continue. These things do nothing to improve overall system efficiency, they’re just mechanisms to pick winners and losers.

If the discussion turns to tort reform (elimination of punitive damages), non-negotiable, publically disclosed pricing (26 year old male presents with a compound fracture to his right femur = $12,637…makes no difference if he’s on a PPO or if he’s an illegal alien with no insurance, the care provider is to be paid $12,637 - period), increased role of nurse practitioners that work with a to-be-developed application that can diagnose and proscribe treatments as good or better than the average physician for 50%+ of individuals presenting for care, decoupling of insurance and employers (leaving my job would have the same effect on my health insurance as it currently does on my auto and homeowners insurance; zero), and some other stuff but this is the critical few that would signal to me that we’re going to fix this E36 M3.

When the ACA was announced, my phone never rang nor did the phone of the 500+ contacts in the field I have nor did any of them report that they knew somebody who’s phone rang nor has a single white paper (or even a little value stream analysis for that matter) been submitted for peer review.

Here’s to hoping my phone rings.

Fueled by Caffeine wrote: In reply to Duke: It could be. I don't think so, but I don't see it getting better UNTIL IT GETS REGULATED HEAVILY.

Said no one ever!!

What do you think ACA is, but heavy regulation.

As far as not being hireable due to a preexisting condition, what I use to see is that you could be hired, you just might not qualify for insurance.

In reply to mtn:

You mean turn off my personal experience is what you mean. My insurance costs went way the hell up and my coverage way the hell down and my list of doctors who would work with us was almost non-existant.

Another thing is that they use the county in which you live to choose your potential doctors. I live 1 mile inside a small county next to a big, populous county and even tho the doctors are closer to me I have to drive much further away to see an ACA doc or hospital.

Ok, then look away from your anecdotal evidence. ACA didn't automatically flip a switch for many, many people. It was already trending that way for most places across the country--I remember in 2004 or 2005 my mother complaining about the options being down to a single provider and a single option (PPO) for our family. And that was the only option.

Continuing the anecdotal thing just a bit.

US system, I brought an exchange system to the ER for verification of strep throat. Literally they did not lay a finger on her and she had her own meds from home already. Bill: $800

Cambodia: A buddy of mine last month while visiting the ruins of the temple something or other fell out with severe Dengue fever and had to be hospitalized for three days. Bill: $200 (he paid cash)

carguy123 wrote: In reply to mtn: You mean turn off my personal experience is what you mean. My insurance costs went way the hell up and my coverage way the hell down and my list of doctors who would work with us was almost non-existant. Another thing is that they use the county in which you live to choose your potential doctors. I live 1 mile inside a small county next to a big, populous county and even tho the doctors are closer to me I have to drive much further away to see an ACA doc or hospital.

So my experience doesn't count??? Like I said, all of our cuts and price increases happened when Bush was the President. So he came up with the ACA, then.... Good to know.

Chill out everybody. Some people definitely saw their health insurance situation drastically changed for the worse with the ACA. Some for the better.

I can only say that, on average, the increase of medical and insurance coverage costs has outpaced inflation since well before the ACA passed in 2010, and continues to outpace inflation at about the same rate.

But back to the OP, here's some numbers. During 1Q 2016, 8.6% of Americans lacked health insurance. In 1Q 2008, that same number was 14.6%. That's a drop of 6 percentage points. The population of America is 319 million, 6 percent of which is...

19.14 million.

mazdeuce wrote: In reply to Fueled by Caffeine: That was the point of the ACA. Bring in a pool of low cost users that could subsidize high cost users. That's the point of all insurance really. If you stay healthy then you win by being healthy and if you get sick you win by having others help pay for it. The system is working to redistribute money exactly like it's supposed to really.

And that was also the part of the ACA that didn't quite work as well as hoped - young people who are reasonably healthy didn't get insurance to help offset the ones who enrolled because they really needed it. Many just decided to pay the penalty instead or selected the cheapest plan they could, which I don't understand why they are surprised about.

When I get home from work, I'll check my records and compare my paycheck deductions from pre-ACA to now.