High deductible heath plans maim and kill people

[eridani]

The Impact of High-deductible Health Plans on Men and Women: An Analysis of Emergency Department Care
http://journals.lww.com/lww-medicalcare/Abstract/2013/08000/The_Impact_of_High_deductible_Health_Plans_on_Men.2.aspx

Background: Prior studies show that men are more likely than women to defer essential care. Enrollment in high-deductible health plans (HDHPs) could exacerbate this tendency, but sex-specific responses to HDHPs have not been assessed. We measured the impact of an HDHP separately for men and women.

Methods: Controlled longitudinal difference-in-differences analysis of low, intermediate, and high severity emergency department (ED) visits and hospitalizations among 6007 men and 6530 women for 1 year before and up to
2 years after their employers mandated a switch from a traditional health maintenance organization plan to an HDHP, compared with contemporaneous controls (18,433 men and 19,178 women) who remained in an health maintenance organization plan.

Results: In the year following transition to an HDHP, men substantially reduced ED visits at all severity levels relative to controls (changes in low, intermediate, and high severity visits of -21.5% [-37.9 to -5.2],-21.6% [-37.4 to -5.7], and -34.4% [-62.1 to -6.7], respectively). Female HDHP members selectively reduced low severity emergency visits (-26.9% [-40.8 to -13.0]) while preserving intermediate and high severity visits. Male HDHP members also experienced a 24.2% [-45.3 to -3.1] relative decline in hospitalizations in year 1, followed by a 30.1% [2.1 to 58.1] relative increase in hospitalizations between years 1 and 2.

Conclusions: Initial across-the-board reductions in ED and hospital care followed by increased hospitalizations imply that men may have foregone needed care following an HDHP transition. Clinicians caring for patients with HDHPs should be aware of sex differences in response to benefit design.

Comment by Don McCanne of PNHP: One of the most important changes in health care financing taking place today is the tremendous surge in the use of high-deductible health plans. This is yet one more study that shows that we should question the wisdom of this policy intervention.

Males whose employers switched them from a traditional HMO to high-deductible health plan reduced their use of emergency department high-severity visits by 34 percent. That is, they did not go to the emergency department when the severity of their condition clearly warranted it. That was followed a year later by a 30 percent increase in hospitalizations. Lead author Katy Kozhimannil stated, "The trends suggest that men might have put off needed care after their deductible went up, leading to more severe illness requiring hospital care later on" (American Medical News, Aug. 26).

High-deductible health plans not only cause financial hardship, they also maim and kill people. And they aren't even necessary as a means to control spending. We can control costs more effectively and far more humanely through a publicly-administered single payer program that provides first-dollar coverage.

[customerserviceguy]

1. Anything misused can maim and kill people

And while I agree that switching from a more traditional pay-for-service plan to solely and only a high-deductible plan practically guarantees that some folks will indeed suffer misuse, I still maintain that it's a good thing to have a choice between the two, for those who will actually utilize the Health Savings Account that is designed to accompany a high-deductible plan. One thing an employer can do is what my employer does, and that's offer to put in a sum of money to the HSA.

They're rational choices for younger folks who lead relatively safe lifestyles, they allow an accumulation of savings during one's healthy years towards future medical expenses as one ages. The sums banked away can actually be used to pay deductibles and co-pays incurred during future years where a person is on low-deductible insurance that makes them ineligible to contribute to the HSA.

[Lars39]

2. Car accident in Nov., appendicitis in Feb

would wipe out savings. Neither event being the fault of the younger person. So what then happens to this younger person when the funds are needed later in life?
His or her healthcare is at risk because of events that happened in their twenties? Events that also probably sent them into bankruptcy.

[Ms. Toad]

4. The premiums are so dramatically lower than the premiums on standard plans

that even for people who blow through the out of pocket max (like our family) they are often better than buying a standard plan. Bank the difference in the premium, and in most instances you will be ahead - even if disaster strikes every year.

Our office switched to a high deductible plan AND pays all of our out of pocket costs (up to $6000/year per family) because it is cheaper for them to cover 100% of our costs than it is for them to offer a low deductible plan which shifts some of the costs (deductible, co-pays, and co-insurance) to us.

So - in your example - if the younger person is buying their own insurance the annual premiums would be more likely to send them into bankruptcy than two catastrophic health events, because they would have paid that much (or more) every year they had the coverage than the much lower premiums + the out of pocket max for two catastrophic events which occurred in different plan years.

I don't have numbers handy, but you should sit down with an insurance broker sometime if you don't believe it. I've price shopped plans and most of the time, even if you hit the out of pocket max every single year on a high deductible plan, you are still better off with that plan than paying the outrageous premiums you pay for a cadillac plan each and every year.

[CANDO]

7. People aren't going to bank the difference.

There are too many drains on income for that. I gladly pay the higher premium for the lower deduction plan. Depends on where a person is getting their insurance, I guess. Mine is through my employer. If it was completely on an individual basis, then I'd opt for a slightly higher deductible. At any rate, we need Medicare Part E (everyone).

[Ms. Toad]

8. So you would pay

$750 a month, every single month for a plan with a $250 deductible and a $1000 out of pocket max, rather than $200 a month, with a $3000 deductible and a $6000 out of pocket max.

Low deductible plan - Guaranteed costs per year: $9,000 - Max per year: $10,000 per year
High deductible plan - Guaranteed costs per year: $2,400 - Max per year: $8400 per year

(Those aren't numbers from any specific plan because I don't have access to premium costs at the moment - but they are approximately the difference based on the last time I did price check the two kinds of plans, where even the maximum you could ever pay on a high deductible plan is below what you would have to pay every single year in premiums alone on a low deductible plan.)

In other words, in most instances, you have a bigger drain on your income by choosing the low deductible plan than you could ever have by choosing a high deductible.

[CANDO]

15. It all depends on the plans offered and the comparative details.

There are many variables to take into account. The coverages beyond just the deductible are also different. Doctor office visits, ER visits, even after the deductible is satisfied there are differences in what percentage the insurance covers. HD plans often pay 80% after deductible, my plan pays 90% after deduction is met. It's ok for everyone to figure out what fits for them, and also take into account what plans are offered and by whom, and what subsidies are picked up by your employer. I'm on the lowest deductible plan($450 per individual, $900 max/family for in network care) for myself and family through my employer and my weekly cost is $72. I'm signed up for a whole range of other benefits such as eye, dental, life insurances, disabilities, etc, and it all totals only $98 per week. I'm not sure where you got your numbers, perhaps from premiums individually through an insurance company. I certainly feel for people who don't have good employer subsidized plans. But I've also seen some scrappy plans offered through employers.

[Ms. Toad]

36. My numbers come from both direct shopping

when I did not have insurance through work, as well as general knowledge of what my employer is currently paying for our insurance - and what they used to pay under the PPO.

The numbers I gave take into account take into account whether the plan pays 50% after the deductible or 100% or 0%. Whatever portion you have to pay stops when you hit the max out of pocket - the only thing co-pays or co-insurance impact is how quickly you reach your maximum spend. So the minimum is premiums only (assuming you never ever went to visit the doctor). The maximum is the absolute most you would ever have to pay in a single year, even if millions were spent on your behalf. That is the total premiums + the annual out of pocket maximum.

You're missing a critical number to do that calculation for yourself - the annual out of pocket maximum.

It is worth it to do the calculation whenever you're evaluating insurance plans, because many insurance companies rely on the fact that way too many people just buy the lowest deductible, highest coinsurance they can afford on a weekly/monthly basis - and never pay any attention at all to the fact that many can get coverage significantly cheaper if they buy the lowest coverage available - EVEN if, like my daughter, she hits the $3000 out of pocket maximum in January or February every year.

[customerserviceguy]

72. Many won't bank the difference

But many will. If it's a free choice between high deductible with HSA and Cadillac insurance, why shouldn't people have the right to make that choice, if they feel they have sufficient financial discipline?

[Lars39]

11. I had an $8,000 deductible. Out $16,000+. Went bankrupt.

Your personal example hinges on a generous employer.

[Ms. Toad]

14. It actually doesn't

If you are purchasing your own insurance the numbers are generally the same.

You seemed to be arguing that there is no place for high deductible plans, because unexpected innocent events would wipe out younger individuals. My point is that if you are truly interested in getting the best comprehensive coverage (either personally or for your employees) it is very often much more cost effective to buy a high deductible policy - even if you hit the out of pocket max every year (or you pay for 100% of your employees out of pocket expenses) - because of the difference in cost of the premiums.

I'm not saying that insurance is cheap - or that you won't go bankrupt because of unexpected medical expenses - or that employers aren't very different in what they provide. An employer who is truly interested in providing health care for its employees can very often provide better coverage for the same or lower cost by providing a high deductible plan and an HRA. An employer who isn't interested in providing health care may, of course, only provide a high deductible plan without reimbursement - or none at all. That has nothing to do with whether high deductible plans can play a responsible role in coverage of health care needs.

[CANDO]

6. Aren't the HSA's supposed to be used yearly?

Or you lose the money in them? Or am I getting it wrong. Any HSA that I've seen explained said that you have to use it yearly or you lose it.

[Ms. Toad]

10. FSAs are annual.

HSAs roll over.

[customerserviceguy]

70. Exactly

Thanks for clarifying that.

[eridani]

17. Placing bets on whether or not serious health care expenses will fuck you over--

--should be illegal. When you win, someone else loses. "Fre market" applied to health care = mass murder.

[customerserviceguy]

71. So, someone who has used an HSA

to save up the required high deductible is going to get fucked over for medical expenses in the year they have to use up that money? The vast majority of younger folks simply aren't going to have anything like that happen.

High deductible insurance means paying for a lot of little stuff yourself, and keeping the expenses of bureaucracy out of it. If your auto insurance policy covered oil changes, windshield wipers, and a new set of tires every three years, what do you think it would cost per year?

[eridani]

76. If they win, someone else loses

HSA is just unjustified bonus points for the healthy and affluent. You can live without a car, but you can't live without a body. Applying the insurance analogy from the former to the latter is just amoral sociopathology.

[customerserviceguy]

79. Again, there you go

to extremes to describe those who disagree with you. Anyone who does that is either a sociopath or a murderer to you, you've said it numerous times on this thread.

Someone else here said that Wall Street wants to steal our HSA money, I really think that YOU want to take it.

[eridani]

81. Yes--I want to take it to put it into the general pool which would fund health care for ALL

--regardless of income or orther circumstances. The less healthy and affluent would not be singled out for the punishment you would mete out to them.

[customerserviceguy]

92. At least you admitted it

What else of mine would you like to take to give to someone else? Including insurance executives?

[eridani]

94. I want to take your money to build roads and schools too

You don't believe in funding public goods? Then don't use them. Stay off the freeways and the internet, both constructed with money stolen from you.

[dflprincess]

52. Current law alllows the deductibles in these plans to be just over $6000 annually (single coverage)

this amount can go up annually. And the deductible doubles for family coverage.

The same law allows people to only put about $3000 (maybe a bit more) into a pretax HSA every year. A person with a chronic condition is probably not going to be able to amass much of a savings account - and if all you can afford is a high deductible plan, can you afford to stash $3,000+ away every year?

The other thing with HSAs is that once you have 3 or 4 thousand in them you can "invest" it in a 401K like account. Leading me to believe that the whole thing is just another scam cooked up by Wall Street --- just hope the market is up when you need that bypass surgery.

[Art_from_Ark]

66. It all sounds so confusing

[customerserviceguy]

74. I don't know what the deductibles are for every plan

But the law authorizing HSA's allows a single individual to put in $3,250, and a family to set aside $6,450. Add $1,000 to each of those figures for folks 55 and over, such as I am.

Yes, I'm sure there are Wall Street scammers trying to get that money. I have the opportunity to do so in my plan, but there's a monthly fee that I don't think I would recoup, especially when measured against the risk. Right now, my HSA is in a money market fund for free, and the four tenths of a percent they pay me is about four times what my bank is paying me on my savings account.

HSA's and high-deductible policies are clearly for people who have financial discipline. They're not for people who go running off to the doctor on a frequent basis. Part of investing a portion of one's HSA involves not sticking all of the eggs in one basket, but diversifying among a variety of things, leaving at least the annual deductable (or better yet, the maximum out-of-pocket costs for a year) in money market style investments that don't take market risks.

[jpak]

3. K&R - and bookmarked

yup

[cbdo2007]

5. That's why I prefer HMO, so all the costs are fixed and usually lower than PPO

plans with deductible.

[Ms. Toad]

9. Not the ones I'm familiar with.

(Although that is how the theory is supposed to work).

In fact that is the specific comparison our office made: The quintessential HMO (Kaiser) with employees picking up the coinsurance/copay/ out of pocket max v. Medical Mutual PPO with a $3000/$6000 annual out of pocket max which was fully reimbursed by our employer.

It was cheaper for our employer to pay the Medical Mutual AND 100% of our out of pocket costs remaining costs than it was for them to pay only the Kaiser premiums and shift the remaining out of pocket costs to us.

[penultimate]

12. I have a high deductible insurance plan

It's a $5,000 deductible with 100% coverage after that's met. But even now, I only have to pay like $30 for doctor visits and a small percentage for my prescription. It's about $166/mo, so it's not too bad. I feel like it offers me decent protection and will allow me to go to the doctor and get any meds w/o getting screwed. Then if something really bad happens, that $5,000 will quickly be reached. My only worry is that they will screw me over by finding ways to no cover anything.

I also have some insurance from my work, but it's one of those fixed benefit plans. It's fairly cheap for me to have it, but the coverage sucks.

[CANDO]

16. Pray you don't get sick toward the end of the year.

Say you're out $4500 in late Nov. Didn't quite get there. Calender turns to January and you get sick again.... start all over at $0! At least you'd stand a chance at actually getting some coverage if you met the deduction earlier in the year.

[penultimate]

21. Yeah, that would suck...

But it's better than the alternative. I don't think it would be possible for me to have a $350/mo low deductible plan (I pay around $150/mo now)

[BlueCheese]

29. Can you explain more?

It's only $30 for a doctor's visit even before you've met the deductible?

Also, it really sounds like your plan puts the "high" in high deductible.

[penultimate]

30. Yeah, the plan waives the deductible for office visits.

I'm not sure how it really works though, because I have another fixed benefit plan from work that seems to covers my portion of the $30 I would usually have to pay.

[leftyladyfrommo]

13. I was paying $650/mo for a $5,000 deductible

that covered nothing.

Now I am on Medicare - thank goodness. The cost of the insurance was draining all of my savings. And I was getting absolutely nothing in return.

Once I got close to 65 I was able to get a high deductible from Blue Cross for $220 a month.

[DisgustipatedinCA]

18. I have a high deductible plan with a health savings account...I love it.

Similar to what another poster mentioned, I have a $5K deductible to pay before insurance will pay a cent. But my company already pays 3000 of that 5000, and I have a certain amount going out of my payroll automatically to cover the rest. As a result, anyone in my family can now go to the doctor, the dentist, or the eye doctor. I've had insurance at several different employers, but in many cases, I was afraid to go to the doctor anyway, because I couldn't afford the deductible. That's covered now, and I don't have to worry about my kids being "not sick enough" to go to the doctor. The company kicking in most of the deductible seems to make all the difference.

[eridani]

19. I hope you 85% folks realize what you are doing here

I mean the 85% of people in every demographic slice who account for 15% of the health care costs in that group. You are colluding in bankruptcy and murder for the 15% who account for 85% of costs. You should also realize that your status in the lucky 85% may not be permanent.

[Quantess]

20. "You are colluding in bankruptcy and murder..."

What a delightful comment! Have a nice day.

[eridani]

23. Right. Just fuck expensively sick people

They need to go bankrupt or die so you can save a few bucks a month. Alterantively, we could all start fighting for single payer health care at the state level, which, going by the experience of all the civilized countries in the world, will cost half as much to give everyone (no exceptions) first dollar coverage.

[Quantess]

25. Single payer is the best way to go.

The American health care system pisses me off to no end, and I'm generally a very healthy person. It's bad for everyone! The only people who actually like it are the insurance company fat cats.

[eridani]

26. There may be a single payer activist group in your state

http://www.pnhp.org/stateactions

[pnwmom]

35. The 85% who pay insurance premiums that will mostly cover OTHER people are colluding

in their bankruptcy and murder?

Get a grip.

[eridani]

37. What the 85% are doing is mostly making insurance companies rich

It's people who blow off the 44,000 Americans who die every year because they can't pay for health care who need to get a grip. The bankruptcies will continue as usual with this shitty non-coverage. After 5 years of "reform" in MA, medical bankruptcies are still 50% of all bankruptcies (down from 59%).

I'm not sick = other people who are should just die and save me some money.

[pnwmom]

38. Are you aware that medical bankruptcies are sharply down since Romneycare was enacted

in Massachusetts? And it's basically the same plan as the ACA?

[eridani]

39. 59% to 50% is not "sharply down" to sane people

MANDATORY INSURANCE IS WORSE THAN NONE AT ALL
By Steffie Woolhandler and David U. Himmelstein
http://www.pnhp.org/news/2007/september/health_reform_failur.php
The Boston Globe
September 17, 2007


IN 1966 - just before Medicare and Medicaid were launched - 47 million Americans were uninsured. By 1975, the United States had reached an all time low of 21 million without coverage. Now, according to the Census Bureau’s latest figures, we’re back where we started, with 47 million uninsured in 2006 - up 2.2 million since 2005. But this time, most of the uninsured are neither poor nor elderly.

The middle class is being priced out of healthcare. Virtually all of this year’s increase was among families with incomes above $50,000; in fact, two-thirds of the newly uncovered were in the above-$75,000 group. And full-time workers accounted for 56 percent of the increase, with their children making up much of the rest.

The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth, 651,000 residents are uninsured, 65 percent more than the figure used by state leaders in planning for health reform. Their numbers came from a telephone survey done in English and Spanish. But that misses people who lack a land-line phone - 43.9 percent of phoneless adults are uninsured, according to other studies.

It also skips over the 523,000 non-English speakers in Massachusetts whose native language isn’t Spanish (e.g. Portuguese, Chinese, or Haitian-Creole), another group with a high uninsurance rate. In contrast, the Census Bureau goes door-to-door for its survey and has translators for almost every language. It gets a more complete picture.

In sum, Massachusetts health reform planners have been wishing away a quarter of a million uninsured people. Recent Patrick administration claims that health reform is succeeding are based on cooked books. According to the state’s figures, almost half of the previously uninsured gained coverage under the health reform bill by July 1. But according to the Census Bureau, the new sign-ups amount to less than one-quarter of the uninsured. Moreover, it’s likely that much of that gain has already been wiped out by shrinking job-based coverage - a longstanding and nationwide trend.

Why has progress been so meager? Because most of the promised new coverage is of the “buy it yourself” variety, with scant help offered to the struggling middle class. According to the Census Bureau, only 28 percent of Massachusetts uninsured have incomes low enough to qualify for free coverage. Thirty-four percent more can get partial subsidies - but the premiums and co-payments remain a barrier for many in this near-poor group.

And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don’t buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.

While the middle class sinks, the health reform law has buoyed our state’s wealthiest health institutions. Hospitals like Massachusetts General are reporting record profits and enjoying rate increases tucked into the reform package. Blue Cross and other insurers that lobbied hard for the law stand to gain billions from the reform, which shrinks their contribution to the state’s free care pool and will force hundreds of thousands to purchase their defective products. Meanwhile, new rules for the free care pool will drastically cut funding for the hundreds of thousands who remain uninsured, and for the safety-net hospitals and clinics that care for them. (Disclosure - we’ve practiced for the past 25 years at a public hospital that is currently undergoing massive budget cuts.)

Health reform built on private insurance isn’t working and can’t work; it costs too much and delivers too little. At present, bureaucracy consumes 31 percent of each healthcare dollar. The Connector - the new state agency created to broker coverage under the reform law - is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare’s and 11 times those in Canada’s single payer system. Single payer reform could save $7.7 billion annually on paperwork and insurance profits in Massachusetts, enough to cover all of the uninsured and to upgrade coverage for the rest of us.

Of course, single payer reform is anathema to the health insurance industry. But breaking their stranglehold on our health system and our politicians is the only way for health reform to get beyond square one.

Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded Physicians for a National Health Program and are primary care doctors at Cambridge Hospital.

Physicians for a National Health Program
29 E Madison Suite 602, Chicago, IL 60602
Phone [phone] | Fax: [phone] | email: [e-mail]

Having Health Insurance Does Not Mean Having Health Care
Statement of Rachel Nardin, MD., President, Massachusetts Chapter of Physicians for a National Health Program, neurologist at Beth Israel Deaconess Medical Center in Boston, and assistant professor of neurology at Harvard

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs twelve prescriptions a month to stay healthy. She told us “Under Free Care I saw doctors at Mass. General and Brigham and Women's hospital. I had no co-payments for medications, appointments, lab tests or hospitalization. Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That's $340 per month, provided I stay well.” Now that she's “insured,” Kathryn's medical expenses consume almost one-quarter of her take home pay, and she wonders whether she'll be able to continue taking her life saving medications.

[pnwmom]

40. Your article was from 6 years ago -- 2007 was the year Romneycare PASSED.

How could it show instant results?

[eridani]

42. Is 2012 recent enough for you?

http://healthcarecompact.org/blog/2012-04-02/lessons-massachusetts-bankruptcy

But a recent study of bankruptcies in Massachusetts, compiled by Kayla D. Badding, E. Frank Stephenson, and Melissa M. Yeoh of the economics department at Berry College and published in Applied Economic Letters, finds that the insurance mandate had no effect on bankruptcy filings. Cutting to the chase, the authors found:

Our results indicate that, contrary to expectations, bankruptcy filings increased in Massachusetts after the enactment of health care reform.

Now you might be thinking that something happened between 2006 and 2010 that had an impact on bankruptcies in Massachusetts -- a little something called The Great Recession. Well, the authors controlled for factors including changes in personal income, unemployment, and foreclosures. And still the results shows that personal bankruptcies increased in Massachusetts, even as the number of people without health insurance was drastically reduced.

[pnwmom]

44. The problem with that study and others is that medical costs are usually only a part

of what causes individual bankruptcies, and ALL bankruptcies were up during the years starting in 2008 because of the general economy.

Also, many of the people cited in research started out with insurance and then lost it during their illness, when they lost their jobs, too. No medical care plan is going to fix the problem of people going bankrupt because they got sick and then lost their jobs.

[eridani]

46. You'e kidding, right? Of course there is a "medical care plan

--that is going to fix the problem of people going bankrupt because they got sick and then lost their jobs." It is called single payer, and in one form or another it is what the rest of the civilized world does to provide health care for EVERYONE, at somewhat more than half per capita what we pay.

[pnwmom]

48. You don't get it. If you lose your job you can STILL go bankrupt even if you have Medicare.

Medical expenses aren't the only expenses people have to pay every day.

[eridani]

49. Then it won't be a health care bankruptcy, will it

You'd still be able to access all the health care you need, even if bankrupt.

[pnwmom]

50. Most health care bankruptcies are from a combination of factors,

one of which is often job loss. Another is losing health insurance because of the job loss and not being able to get any other insurance.

[eridani]

51. Single payer solves the second problem, right? n/t

[slipslidingaway]

56. IF, medical insurance was not tied to employment ...

then it would be different. Too bad the Dems blocked any meaningful discussion of a national HC system and invited the insurance companies to the WH.



Bottom line is to be productive as a country we need healthy individuals, we're not doing so well in making people healthy.

Health has become a luxury

[pnwmom]

57. But unemployment is also tied to bankruptcies, obviously.

And since many of the people who lost insurance did so as a result of losing their jobs, the various reasons for bankruptcy are intertwined.

[slipslidingaway]

59. But, should you need to be employed to have access to HC ...

that is the question?

Of course they are intertwined, that is the US for profit HC system!

Undoubtedly, we have more bankruptcies in the US because of the system in which we allow companies to profit, and yes I'm blaming the Dems here as well.

Should we see HC as more of a human right where we all pool our resources to provide some basic care for everyone?

Do you think a country where fewer and fewer of our people are healthy will be a prosperous one for all?

How will we compete in the global market where the basics of HC are provided to all in many other industrialized nations and not our own?

These are tough questions that should have been addressed in the HC debate, but we never had a real debate.

I'll be one of the those to sadly say the Dems blocked an open discussion when the door was wide open and the majority of the country was focused on HC.

[pnwmom]

61. No you shouldn't. And under Obamacare you will be able to get Medicaid

if your income is low enough, or a subsidy helping you buy insurance if it is too high for Medicaid but still in the middle income range (defined as under $92K for a family of 4).

[eridani]

62. Only if you live in a state accepting Medicaid money and agreeing to the expansion

And if you get a job making you ineligible before your approval, then what? That is the truly ridiculous thing about Obamacare--peoples' circumstances change so rapidly it will be damned near impossible to figure out what you are eligible for at any given time.

Single payer now! Join a state activist group and get busy.

[pnwmom]

65. It's not the Democrats' fault that some Repub governors are evil.

First things first. I'm helping people I know get the help that is already available before I start fighting for something else. I'm not going to be one of the ones hoping it's a trainwreck and helping to blow it up. Anyone who works at discouraging other people from signing up is part of the problem.

[eridani]

68. What happens when you sign up and your circumstances change?

The system can't possibly keep track of that. Single payer does not NEEd to keep track of that.

[pnwmom]

69. Then you re-sign up. I'm sure you're not the first person who thought of that question -- it's

a good one. I'm expecting that they will have an answer.

But even when Medicare started up, there were lots of glitches. It wasn't the first perfect law. I expect there will be problems with the ACA, too, and everyone who cares will do their best to work through them. Everyone except the Rethugs who will continue to try to obstruct everything.

[eridani]

83. Once you are on Medicare, you STAY on Medicare. Your eligibility doesn't change

I can see someone losing a well-paying job and being eligible for Medicaid. Then in two months they get another job making them ineligible. But you still had inadequate (perhaps no) income for a couple of months. Do you get dinged at a higher rate? Medicare is single payer for people over 65. ACA is not. However, it DOES allow states to implement single payer, which is our only hope going forward.

[pnwmom]

85. Yes, I would prefer Medicare! But the ACA is what we have now,

and I think we should give it a chance and not help all the obstructionists.

[eridani]

86. Yes--let's give that ACA provision for state single payer a chance.

As long as red states keep electing amoral sociopaths, that is the only way to get it.

[pnwmom]

87. Are there any groups pushing for that in Washington? I'd be happy to support them. n/t

[eridani]

88. Yes, there are

Physicians for a National Health Program--Western Washington
http://www.pnhpwesternwashington.org/

Health Care for All--WA
http://www.healthcareforallwa.org/

[pnwmom]

89. Thanks! Maybe you should try to get the word out about the work being done by these orgs

instead of just complaining about the ACA.

[eridani]

90. This whole argument of "let's just wait and see how the exchanges work"

--does nothing but delay single payer. We know what will happen because we see the results in MA. Medical bankruptcies are STILL 50% of all bankruptcies there. Granted, that's down from 59%, but still totally unacceptable.

[pnwmom]

91. If this fails that will be the end of any more experiments for decades. Forget single payer.

If it succeeds long enough to let Vermont's experiment in single payer play out, then we have a chance.

[eridani]

93. Agreed. If other states get on board with single payer, the chances of it spreading improve n/t

[hunter]

45. Yep.

People never think the shit will fall out of the sky onto them until it does.

Anyone want to pay my "after insurance" cardiologist bill? It's sitting on my desk and I'm not doing anything with it today.

I'm on the crappy credit rating medical-collections-for-life plan.

We've run out Cobras to the bitter end in our household. I'm on friendly terms with medical collection agencies. It doesn't even stress me out to talk to them anymore.

I did delay interaction with my personal physician in the most recent shit-storm because I owed him money, but eventually I hurt bad enough, I called him, and he saw me even though I owed him money. We go way back. I always pay him before I pay the faceless corporations.

[Lex]

22. Sometimes the choice is between a HDHP and not affording coverage at all.

Believe me, I know.

[eridani]

24. It's "coverage" only if you are in the lucky 85%

If you are in the unlucky 15%, it's bankruptcy or death.

[penultimate]

31. I'm not following you with that

As I said above, I have a $5,000 deductible plan with no payout limit. I also can see my primary care physician for $30 visit and specialist for $60 a visit. If I go see my doctor for a checkup because something doesn't feel right, and then he refers me to see a specialist, that's only $90. Even if I have to go in a few times, we're talking a couple hundred dollars max. Now, if it turns out I have an illness that will cost a lost (bankruptcy making stuff), I might end up having to pay $5,000 (maybe $10k), but that's not going to make me go bankrupt. I'd be in far worse shape if I didn't have that high deducible plan though.

[eridani]

32. Please re-read post #11

You could one day be Lars39--or not. It's out of your hands either way. For many people, people not "poor" enough to qualify for Medicaid, $30, $60 and $90 are insurmountable barriers to care.

[hunter]

47. Well, first a chronic illness or accident eats away your net worth...

... and then you get knocked out of work and can't pay the premiums.

What's your job like? Will they keep you on during chemotherapy when you are puking and falling down and the whole world is vague and fuzzy to you?

That's when the fun begins!

Trouble with the U.S.A. is so many people think they have good health insurance until they realize they don't.

[slipslidingaway]

54. ^^^^^ n/t

[libodem]

27. .

[unblock]

28. touted as "getting the incentives right", they in fact get the incentives all wrong.

people naively claim that this gets the incentives right by making the patient pay the cost of the health care, so that they will be more selective in their health care decisions.

this is a great example of taking market theory and applying it thoughtlessly where it doesn't belong.

in fact, it gets incentives all wrong.

first, once you hit the deductible, you're fully or mostly covered, so we're back to the traditional "problem" that the patient doesn't pay the cost and has zero financial incentive to turn down expensive procedures and test once the deductible is hit, or is going to be hit that year.

second, and most important, is that the health care decisions in the below-the-deductible range are often the ones you WANT patients to be making! these are the office visits for "i think this might be something but if it's going to cost me hundreds of dollars for a quick visit and a lab test, then i'll ignore it until it gets worse". if everyone's lucky it's just a minor virus that goes away, but if it's something more serious, then it later becomes a very expensive problem that could have been headed off by a simple test.


part of the problem is that the health insurance companies have several big financial incentives to defer costs. first, obviously, they earn interest on money they pay later. but more importantly, the patient might well die or switch to a different carrier before the major bills hit. this is the real flaw and crime with competing health insurance providers. they have a natural incentive to deny proper health care that overall costs people and the economy health and money.

overall they are doing damage to the health of the people in the country while extracting wealth, doing further damage to the health of the country itself.

[Supersedeas]

41. very very good post

[FreeJoe]

33. Living the dream right now

I had a small problem last week. I won't go into details. I went to the company doctor. He narrowed it down to two possibilities: nothing to worry about or a small chance that it is something like cancer. He recommended that I get a CT Scan to be safe.

Here's the deal. I am enrolled in an HDHP. When you add in all the incentives, it is a better deal for me financially than the LDHP would have been under any circumstances. But, and this is the big "but", it puts me in this situation. I can spend $1,000 on a CT Scan to be prudent or I can pocket that money. I'm very secure financially, so I'm going to spend that money, but I know a lot of other people that would keep the $1,000 in their pocket (or HSA) and take their chances. The HDHP/HSA system essentially bribes them into neglecting their medical needs for short term gains.

[eridani]

34. ^^this^^ n/t

[unblock]

43. this is exactly what i was talking about in post #28.

the decisions in the first $4,000 or so are NOT the ones you want patients to be opting against for financial reasons.
the decisions in the first $4,000 or so are the diagnostics and the (comparatively) cheap procedures that prevent or mitigate far more expensive problems down the road.

if they wanted to get the incentives better (within the f-ed up world of private health insured health care), they would make the first $4,000 or so completely free or with very minimal co-pays, and then have the patient pay something like the SECOND $4,000, after which it is all paid for.

if they really wanted to get the incentives right, they would do it based on actual procedures and issues. initial office visits and diagnostics should be free or very cheap, procedures that are expensive but could have been avoided or mitigated with earlier medical intervention that the patient opted against should cost the patient more.

e.g., mammograms are free, and stage 1 lumpectomies are cheap, but procedures relating to advanced breast cancer after failing to get mammograms would be expensive.


having said all this, single payer is far more sensible anyway.

[Travis_0004]

53. Yet the high deductible plan saved you 1,000.

So you could pay the 1,000 and still be ahead of somebody with a low deductible plan.

I also have an HSA with my high deducible plan, so if I was in that situation, I would pay the 1,000, and it wouldn't take a dime out of my pocket, it would take it from the HSA, which has several years of max deductibles in it.

I'll agree they may not be for everybody, but I like the plan I have, and I don't want to switch just because some other people are idiots.

[eridani]

64. No, they aren't for everybody. They are a bonus point system for the healthy and

--affluent. Because of your good fortune, you get an extra tax break.

[Travis_0004]

67. Shouldn't I pay less?

In my adult life, I have never had a major claim on health insurance. Besides a checkup, I've had to go a few times when I had the flu, and that's about it. I'm sure health insurance companies love me, and in return, I can get a high deductible plan and pay a bit less.

[customerserviceguy]

75. You've framed the decision incorrectly

It's a matter of you paying $1,000.00 so that your doctor won't get sued. That money for the test is not out of his/her pocket, so hey, why not suggest the test, whether a person has a LDHP or a HDHP? It's all someone else's money, right?

The way we deal with malpractice in this country makes a lot of doctors very, very eager to order unnecessary tests, just to cover their own asses. Having an HSA and HDHP means you make your own educated decisions about whether or not you want to protect your doctor from your lawyer.

[eridani]

77. Like to take a guess as to what the average monthly malpractice premium is in--

--actual civilized countries? For a GP, about $100/month. In Japan that is your medical society dues and you also get the monthly journal. Specialists may pay $400-$900.

So how come people aren't always suing medical practitioners in these countries? Because in the event of an unfavorable outcome (whether just bad luck or actual malpractice), you are guaranteed the care necessary to deal with it as a right of citizenship. Here, people sue just to get money to pay their extra expenses, regardless of whether malpractice was involved. Therefore in sane societies doctors make decisions on appropriate tests based on medical criteria alone.

[customerserviceguy]

78. Oh, I know it's a pittance compared to what they pay here

We have a system that causes unnecessary tests to be ordered, makes good doctors fear daily for their financial security, and when damage is done by a negligent practitioner, it takes many years of great uncertainty before the victim knows that they'll be made whole. And they never will, because court costs, expert witnesses and attorneys fees eat up a substantial portion of the settlement. Also, gag orders in settlements protect the guilty.

I'm sure the other countries you mention have a whole different way of handling the issue other than providing a playground for lawyers.

[eridani]

80. The way they handle the issue is to give EVERYONE health care as a human right

Anyone with a bad outcome, regardless of whether malpractice was involved or not, is made whole by automatically getting all necessary extra care. That's why few patients sue--that happens only in the case of truly egregious fuckups.

[slipslidingaway]

55. I really want to know when the Dems will Allow an open discussion ...

of a national HC system. We can blame the 'other party' all we want, but we need to take a close look at how open, or closed shall I say, the discussion has been when Dems held the WH.
Sorry to say they have blocked any meaningful discussion of a national system funded by taxes for decades, when do we hold them responsible?

[eridani]

63. At the national level, never

That is why it is so important for people to get involved with single payer efforts at the state level.

[pnwmom]

58. And so do policies with annual and lifetime limits,

which will no longer be allowed under Obamacare.

I don't think anyone here is arguing that the ACA is preferable to single payer or any other universal insurance. However, it was the best AVAILABLE option given the composition of the House and Senate. It is the best that any Congress could do since Medicare was passed in the 60's. So why not give it a chance instead of joining the Rethugs in dumping on it before it's even taken effect?

[slipslidingaway]

60. Oh BS, thankfully we did not have a lifetime limit on our policy and ...

it had nothing to do with the ACA and please tell me what the annual out of pocket is in our state (NJ) and when that takes effect because the five figures out of pocket annual maximum is a hardship. I'm still waiting for the annual premiums to decrease by 2K + per year, I think that was the figure quoted during the campaign, when does that happen?

If you want something you have to ask for it, and you do not start by compromising from the get go.

Just because someone has a different opinion does not mean they side with the Repubs, that is a tired old phrase, and one worth dropping if you want to have a meaningful discussion.

[Zorra]

73. That's what our healthcare system does. It's a heinous system. nt

[Trillo]

82. It is a simple continuation of the Class War against poor people.

I myself find it exceedingly sad.

Everytime a poor person, that generally means a working class person, goes to a doctor, they ARE getting ripped off, and if you say anything about that ripoff to them, they most often take umbrage.

[kenny blankenship]

84. Bronze Plan leads to a Pine Box.

"Hey - if that's what they could afford they shoulda worked harder!" "No Free Lunches!" - Obamacare supporters.