non political - anyone else screwed by healthcare marketplace?

I had to find a new job this summer, and luckily found one with insurance. Cobra would have been MUCH cheaper than the exchanges for me. Something even remotely like my previous coverage was going to be about a $1,000 a month with a high deductible. Ironically, my insurance now is considered a silver plan, and my pharmacy dropped me. They no longer take BC/BS plans like my current one. Doctors are going to be the same way. In the end, only the rich are going to get good treatment.

I have a bit of inside knowledge in that my wife runs her office and works for an Internist, who ironically was on Obama's big doctors panel. The amount of increased paperwork to meet the guidelines has increased their workload 10x compared to standards the insurance agencies have been using. They also cap what the doctor will make, to less than what it costs to run his office. Guess who will now pay for that? He has to average $95 a patient per visit to break even. Folks, this cost doesn't go away no matter who is paying the bill. You don't even want to start with malpractice insurance and costs of that.

Hospitals, they are in the same boat. A family friend is head of the board of directors for our largest local hospital. Many people have no idea of the costs involved in running a hospital, and why certain hospitals have higher bills than others. There are may factors, not the least of which is the number of bill write offs (almost $5 million in illegal alien treatments at his hospital last year alone), what types of equipment are used that need to be paid for, any specialties the hospital offers, and of course it costs money to get better doctors. Many hospitals now are forming alliances with others in order to get more buying power and reducing costs.

There is zero good about this bill. There were other ways to address the issues, this just made it a big mess for everyone, and as usual, the middle class will pay the price. The poor will still get "free" care, the middle class will get the tax, and the rich will be able to afford the best cash only doctors.

In truth, it was always about control. People that think this was about giving those without insurance, insurance, never truly understood it. If that were the case, it would have been MUCH cheaper just to buy them some.

I have nearly two decades of experience in process engineering and the last decade has been spent specifically in the Med Tech industry. In this time, I’ve accumulated a wide array of problem solving skills (Master Black Belt certifications in both Lean and Six Sigma, ASQ - Certified Quality Engineer, AAMI - Regulatory Compliance Engineer, TRIZ, Poke Yoke, etc., etc., etc.).

What is the goal – To provide high quality health care at an economical price to everyone. Anyone going to argue with me?

Did Obamacare accomplish the goal – No, net quality is down, net cost is up, and not everyone is covered. Trifecta of fail.

Why did it fail – Because it wasn’t designed to accomplish the goal. It was designed to increase the size and power of government, promote the redistributionist ideology, and create a profound legacy for the individual it’s named for.

Could the goal be accomplished – Absolutely and it wouldn’t even be difficult.

First, decouple insurance from employers (I call this take it with you). Rates would go up because the pool would be sicker but it wouldn’t be too much and most importantly, it would be honest and fair.

So long as you maintain your coverage, you can’t be dropped even if you change jobs, take time off from work, move, whatever. If your insurance company goes under, others have to take you at their standard rate which doesn’t reflect any prior conditions you may have. However, if you drop coverage and get sick, you get E36 ME Medicade if you’re broke or pay out of pocket if you’re not. Tough love, no gaming the system sticking others with your bills.

Second, implement basic tort reform to eliminate punitive damages. Somebody screws up, you’re entitled to full compensation for lost income, decreased quality of life, pain and suffering, and all medical expenses but that’s it..no more teaching those terrible people a lesson by tacking piles of money onto the settlement. Both the left and right agree that between 15% to 18% of all medical expense is defensive. That means performing tests and procedures not because they’re indicated but to provide protection from being sued.

Here’s where we can get a truly massive win-win of providing more care to the poor while reducing the total cost of the health care system. It’s a no brainer but it isn’t part of the ACA because Obama and his colleagues are attorneys and like things just the way they are.

Obamacare has taken us in the exact wrong direction where non value added activities have been increased rather than decreased. Under the ACA, we will collectively pay more to collectively get less.

I’m happy for the few folks that are coming out ahead but from a systems prospective, it has and will make things worse…much worse.

In reply to racerdave600:

Interesting you mentioned the cost of paperwork...

Last week I had to go to a "Doc in the Box" for an after-hours prescription. It was a a real facility, run by the largest local hospital.

When I told the receptionist I didn't have insurance, she asked me if I would be paying today or later. I said it depends on the cost.

She told me they have a 40% discount for payments made same day. I told her I would be paying that day.

rotard wrote: I think what he means is that no one should be forced to pay because someone else lost the genetic lottery.

All part of living in a society wherein taking care of those less fortunate than you is expected as we are kind, generous, and caring people. The benefits of this behavior isn't often readily apparent.

A bit like folks without kids saying they shouldn't have to pay for public schools. They should. The reason being that they benefit in other ways from kids being better educated, better cared for, and those same kids becoming contributing members of a society that will care for those childless people when they are too elderly to care for themselves.

mazdeuce wrote: In 2014 there will be $XXX in healcare used in the USA. All of that will be paid for somehow. The drugs will be paid for, the doctors will be paid, the lights will be on. The question is, how do we as a society want to pay for it? We've already decided that old people and poor people get a pass because they can't afford their own health care. That leaves everyone else. How do we do it? Do you pay yourself? Do you hope your employer catches it? Do you gamble that nothing really bad happens until you make it to the old people group? Remember, all of the health care distributed this year is going to be paid for one way or another, every dollar is coming from someone's pocket.

Keep in mind, the prices quoted publicly are vastly inflated. One of the issues of vast importance. $50 aspirin is now joke. Google "hospital charge master" if you're interested in reading more about it.

Curmudgeon wrote: I'm at the point where I believe we will have no choice but to go to a single payer system. I hate government intervention in a lot of stuff but we may not be able to keep things going otherwise.

You and many economists. The greed in the medical care industry is astounding. I'm not talking about health care providers like our own Dr Hess. I'm talking about insurance companies, Pharma companies, and hospitals.

Datsun1500 wrote: Private plans have been offered for a long, long, time. If you buy a private plan when you are 21 years old and don't depend on someone else (like your employer) on providing it for you, then pre-existing conditions, lack of coverage, losing coverage between jobs, etc. will not be an issue. There are plenty of people that take that route and are OK. If you choose to let someone else provide it for you, then you have to play by their rules.

Because everyone is able to pay for ins coverage out of pocket no matter their life circumstances or events for the entire duration of their life. Even considering that prior to the ACA Cobra costs often exceeded what most families paid for housing. Also consider there are vast differences in cost of healthcare that is dependent on your location. What holds true in one locality will not in another. That could mean a different state or just across your own metro area.

Here are a sample of costs in my area. No tax subsidies are included. In an effort to cut through the BS.

~ Family of 4 consisting of Mom, Dad, a 3 yr old, and an infant (under a year) Aetna plan for $672/month. It's insurance score is 82.

~ For a 40 yr old man. Aetna plan for $230/month. Score is 86.

~ For a 21 yr old man. $90/month. Score is 61.

These costs are in central VA. Next I'll list costs geographically for this 21 yr old man.

Annandale VA - $81/month. Score is 58 Norfolk VA - $160/month. Score is 52 Abingdon VA - $162/month. Score is 52

If you want to compare other states feel free to post your own numbers.

SVreX wrote: ...It's a pretty simple math problem. The fines are low enough that I have to choose to pay them, because there is no way the insurance thing is gonna happen...

Just wanted to point out that just taking the fines will become more difficult since they will ramp it up over the years. Math may still work, but the increasing of the fine is for the exact reason you point out.

The penalty increases every year. In 2016 it’s 2.5% of income or $695 per person. After that it's adjusted for inflation.

Is that for the year? Still does not seem like an oppressive penalty (e.g. if you make $100,000 you penalty is $2500 a year). Maybe it will go higher?

What I never understood is why I need an employer to join a group health insurer.

Why the hell can't I join "Grassroots Motorsports Health Insurance Plan"?

This whole debacle was organized by the insurance industry. Democrats bought in because they liked getting more people medical coverage. Republicans bought in because the industry liked it. Why wouldn't they, the government is now telling a few million Americans they need to buy their product, but they can't shop around outside state lines.

I'll actually be very surprised if the new majority repeals it simply because it would allow a lot of unhappy American's the ability to once again, ditch insurance, and that would cost the insurance companies a lot of money.

PHeller wrote: What I never understood is why I need an employer to join a group health insurer.

Because, on average, people that get health insurance as a byproduct of getting a job incur significantly less medical expense than those that purchase health insurance directly.

In the first case, the person is well enough to work, gets through the interview process and typically even passes a physical. In the second case, many say, oh E36 M3, I’ve got some huge oozing weird thing growing out the side of my head, I better run out and get health insurance because it’ll probably cost a fortune to treat and I sure don’t want to pay for it.

A lot of “experts” claim the striking difference in insurance premiums between employer provided and individual is attributable to scale effect.

In reality, at most, scale effect accounts for no more than a few percent of the difference. The real cost driver is selection bias.

PHeller wrote: What I never understood is why I need an employer to join a group health insurer. Why the hell can't I join "Grassroots Motorsports Health Insurance Plan"? This whole debacle was organized by the insurance industry. Democrats bought in because they liked getting more people medical coverage. Republicans bought in because the industry liked it. Why wouldn't they, the government is now telling a few million Americans they need to buy their product, but they can't shop around outside state lines. I'll actually be very surprised if the new majority repeals it simply because it would allow a lot of unhappy American's the ability to once again, ditch insurance, and that would cost the insurance companies a lot of money.

You're not asking the right question.

Don't be fooled that group health insurance is actually significantly cheaper, because it's not.

Also: it's EXTREMELY inaccurate that the whole thing was organized by the insurance industry. The biggest players in the US market were very outspoken AGAINST ACA, because whether it's their fault or not, the insurance companies always get the blame.

And in this case, there's no way that ACA was going to address the actual issues,or make anything cheaper for the majority. This is bad for everyone, including the insurance companies, despite now being forced to take on millions more customers.

ACA has increased the operating costs, JUST IN MY SMALL DEPARTMENT by over $300k.

PHeller wrote: What I never understood is why I need an employer to join a group health insurer. Why the hell can't I join "Grassroots Motorsports Health Insurance Plan"?

This, properly fixed, would solve a lot of the problems that ACA tried, and failed at fixing.

mazdeuce wrote: Somehow we've made the problems of some into the problems of many. Instead of the lack of healthcare completely screwing people with chromic conditions or those underinsured who had an emergency, it's now slowly screwing everyone participating. The system was always broken, but now it's broken for more people in smaller ways. If all they wanted to do was engage a larger portion of the public in the healthcare debate, they couldn't have possibly written better legislation.

Astute.

I do believe it was written to do exactly that.

Xceler8x wrote: Here are a sample of costs in my area. No tax subsidies are included. In an effort to cut through the BS. ~ Family of 4 consisting of Mom, Dad, a 3 yr old, and an infant (under a year) Aetna plan for $672/month. It's insurance score is 82. ~ For a 40 yr old man. Aetna plan for $230/month. Score is 86. ~ For a 21 yr old man. $90/month. Score is 61. These costs are in central VA. Next I'll list costs geographically for this 21 yr old man. Annandale VA - $81/month. Score is 58 Norfolk VA - $160/month. Score is 52 Abingdon VA - $162/month. Score is 52 If you want to compare other states feel free to post your own numbers.

what does the score indicate ?

tuna55 wrote:

PHeller wrote: What I never understood is why I need an employer to join a group health insurer. Why the hell can't I join "Grassroots Motorsports Health Insurance Plan"?

This, properly fixed, would solve a lot of the problems that ACA tried, and failed at fixing.

What would it fix, and how?

PHeller wrote: What I never understood is why I need an employer to join a group health insurer. Why the hell can't I join "Grassroots Motorsports Health Insurance Plan"?

I have heard the origin of this practice (not sure if true) was from employers being restricted as to how much they pay workers (WWII?) so paying for insurance was a benefit they could offer without increasing salary. Kind of like how stock options have been used more recently.

Swank Force One wrote:

tuna55 wrote:

PHeller wrote: What I never understood is why I need an employer to join a group health insurer. Why the hell can't I join "Grassroots Motorsports Health Insurance Plan"?

This, properly fixed, would solve a lot of the problems that ACA tried, and failed at fixing.

What would it fix, and how?

If you or I could buy insurance ourselves at the group rate, and our employers benefits package accommodated that (or rather, never evolved into its present state) which means we either get paid more or you get a bonus for health insurance it automatically removes the 'I lost my job and have no health insurance' stuff. It also makes the true cost of health insurance immediately available to everyone's eyes.

If your employer is paying your auto insurance, and you get in an accident: You would not know that the body shop charged the insurance company $400 per hour before being negotiated down, and did fourteen unnecessary tests because they were covered but not the three that were really important because those were not covered. You would not know how much the premiums cost, all you would know is how much they take out of your check.

In other words, most of us have reasonable suspicion that the healthcare industry is under control of a bunch of people who aren't the people receiving the care. Single payer won't fix it either. A real insurance model would.

I don't think you're understanding what the group rate is, though... and neither is Pheller.

Yes, there's people in this thread that probably pay $50/month for their insurance. (I pay about $320/month for two people. The cost of my plan is somewhat over $1200/month.)

But that's not how much their insurance costs.

Why would a large business put you on their large group coverage and subsidize your insurance plan when you don't even work for them?

wbjones wrote:

Xceler8x wrote: Here are a sample of costs in my area. No tax subsidies are included. In an effort to cut through the BS. ~ Family of 4 consisting of Mom, Dad, a 3 yr old, and an infant (under a year) Aetna plan for $672/month. It's insurance score is 82. ~ For a 40 yr old man. Aetna plan for $230/month. Score is 86. ~ For a 21 yr old man. $90/month. Score is 61. These costs are in central VA. Next I'll list costs geographically for this 21 yr old man. Annandale VA - $81/month. Score is 58 Norfolk VA - $160/month. Score is 52 Abingdon VA - $162/month. Score is 52 If you want to compare other states feel free to post your own numbers.

what does the score indicate ?

On that site it states the score indicates how well the plan covers you and what out of pocket costs you can expect while using it. Higher score means better coverage and lower out of pocket costs per the website.

Swank Force One wrote: I don't think you're understanding what the group rate is, though... and neither is Pheller. Yes, there's people in this thread that probably pay $50/month for their insurance. (I pay about $320/month for two people. The cost of my plan is somewhat over $1200/month.) But that's not how much their insurance costs. Why would a large business put you on their large group coverage and subsidize your insurance plan when you don't even work for them?

The group rate is not the large part of what I was hitting at, but it is a part. Simply put, it is weird that health insurance is tied to your employer and it should not be. Is your car insurance? Food? Shoes? Why health insurance? 'tis silly. Causes lots of issues and makes the true cost go crazy and we have to trust the medical providers, health insurance companies, and our own employers to get it all right before it gets to us. Why?

If you want to see a well done review of how a 5 other (western) countries handle the issue:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

One thing that stands out is that most tend to assume other countries use a single payer style system but in reality, a sort of hybrid insurance system is used in some (most?). Of note, and mentioned in the video, is the fact that the general rising costs are an issue for everyone.

Here is an overview of the systems covered:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

tuna55 wrote:

Swank Force One wrote: I don't think you're understanding what the group rate is, though... and neither is Pheller. Yes, there's people in this thread that probably pay $50/month for their insurance. (I pay about $320/month for two people. The cost of my plan is somewhat over $1200/month.) But that's not how much their insurance costs. Why would a large business put you on their large group coverage and subsidize your insurance plan when you don't even work for them?

The group rate is not the large part of what I was hitting at, but it is a part. Simply put, it is weird that health insurance is tied to your employer and it should not be. Is your car insurance? Food? Shoes? Why health insurance? 'tis silly. Causes lots of issues and makes the true cost go crazy and we have to trust the medical providers, health insurance companies, and our own employers to get it all right before it gets to us. Why?

There's probably some sort of advantage to the employer. Tax break or something.

Also: I still like it just for the simple reason of "Oh it's time to choose my benefits, i think i'll check here... and here... and here, and click submit. Done!"

It's just part of a benefits package. I can waive it if i so choose. I just choose not to. It's no different from retirement packages, STD/LTD, etc etc etc.

Honestly, the costs have very little if anything to do with employer-driven plans. Or i should say, employer-driven plans have very little to do with costs. It's not hurting anything. Or at least not anything worth being concerned about until we've fixed a few thousand things up the ladder.

You can now add me to the "You like your plan? Too bad, you can't keep it" list.

In reply to Datsun1500:

In most states it is required to have car insurance. However, the way health insurance is used makes the analogy to car insurance an apples & oranges comparison. Imagine if your car insurance was required to pay for the upkeep of your car: oil changes, new tires, general repairs, etc. That is essentially what health insurance is used for. Some would argue that's not how it should be.

In reply to Ian F:

If there was no requirement to do basic maintenance (oil changes and such) to keep the powertrain warranty on a car, people wouldn't do it. They'd just wait for the motor to blow and let the dealer put in a new one. That's what we face when there is no preventative health care being used.

I think the whole "group rate" thing is a bit of a farce.

The rate I will have to pay through my employer is HIGHER than if I bought it myself, and the coverage is much worse.

Plus, now that I am employed, I can't buy it myself anymore.

Additionally, group rates can be available to almost anyone. If you are self employed, buy it through an organization like the National Association for the Self-employed. If you are old, buy it through AARP. There are plenty of group plans which are (were) available.

But the rate is not necessarily lower.

My employer is required to make a health plan available.

He is NOT required to pay for it. He leaves that to us.