General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsMany Say High Deductibles Make Their Health Law Insurance All but Useless
But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.
Sara Rosenbaum, a professor of health law and policy at George Washington University who supports the health law, said the rising deductibles were part of a trend that she described as the degradation of health insurance.
Insurers, she said, designed plans with a hefty use of deductibles and cost-sharing in order to hold down premiums for low- and moderate-income consumers shopping in the public marketplaces.
Comment by Don McCanne of PNHP: The deductibles are out of control. The anecdotes in the full article (link above) demonstrate that many people find that their insurance is all but useless simply because they cannot afford to pay the deductibles. Anecdotes do not constitute a scientifically valid study, but they certainly do tell us what is happening to individuals out in the real world.
Insurers needed to keep premiums affordable in order to maintain a viable market of private plans. They do that by shifting costs to patients through ever higher deductibles. This was inevitable through the reform model selected for the misnamed Patent Protection and Affordable Care Act. Because of the large deductibles, actual health care is not affordable for individuals with modest incomes and thus patients do not have the protection that they need.
The three trillion dollars that we are already spending on health care is enough to provide all essential health care services for everyone. With a properly designed financing system there is no need to erect financial barriers to care since cost containment can be achieved through patient-friendly policies such as those of a single payer national health program.
Without proper reform, degradation of health insurance will progress. People will face greater financial hardship because of medical bills. People will suffer more because of forgone health care. People will die.
This isnt right. We need an improved Medicare that includes everyone.
n2doc
(47,953 posts)That is the ultimate goal.
rjsquirrel
(4,762 posts)You don't get a refund on home insurance or car insurance for not using it.
Health care should be provided as a public good. But until it is, we have insurance for catastrophic things, and we pay for other things we need or want.
One way or another health care is not free and in fact is crazy expensive because Americans are both bad at taking care of their own health and litigious.
As someone who pays $6500 a year to docs instead of an insurance company (the meaning of a high deductible plan, you self-insure the first $6k, and my spouse and I pay less than $1600 a year in premiums as a result, meaning we end up spending maybe. $7600 total on health care, which is less than the $10k a traditional low deductible insurance plan would cost us), I really like the high deductible plans.
Let m'e stress: my spouse has stage 4 cancer and we save money on a high deductible plan. Save, as in spend less than we used to.
pangaia
(24,324 posts)I have Medicare and a very good gap plan. (Well, it WAS good until last year when they changed the chemo coverage to include a 20% co-pay ! Smart, aren't they. :> )
I also had cancer, although much less serious than your wife's, if ANY cancer can be considered not serious. The coverage was excellent. And of COURSE it is not 'free.'
Best wishes for your wife.
SammyWinstonJack
(44,130 posts)But it was the best we could do.......
SickOfTheOnePct
(7,290 posts)A plan that is paid for and isn't used is being used for someone else that is able to use the coverage. That's the whole point of insurance.
But single payer is the way to go.
mythology
(9,527 posts)that's not an efficient way to make money given that they have to send money back.
n2doc
(47,953 posts)Fact is, the scheme is to incentivize poorer people to not use insurance for anything other than the most extreme events, and use that money to subsidize others, including those rich enough to buy the fancier plans that they can effectively use to do preventative care.
And of course, expenses get taken out anyway, including CEO salaries.
There are winners and losers. The American Dream.
SickOfTheOnePct
(7,290 posts)First, preventative care is free under all plans - that's part of the law.
Second, the "fancier" plans, as you call them, are much more expensive than the bronze plans, and they aren't being subsidized by the other plans, they're being paid for with high premiums.
As to your title, if the money isn't getting back to the actual policy holders, that isn't the fault of the insurance companies, that's the fault of whomever is administers the plans. For an employer sponsored plan, the money goes back to the employer, and they can choose to give it back to their employees in the form of cash, in the form of reduced employee premiums for the next policy years, or they can keep it themselves.
Yes, CEO salaries are included in expenses, which in the aggregate can't exceed 20% of the money they bring in.
Single payer is the way to go, IMO, but let's at least be intellectually honest about what the ACA does and doesn't do.
n2doc
(47,953 posts)Wishing that the system worked like you want it to doesn't mean that it does. That is being 'intellectually dishonest". I have read many articles interviewing people who do not use the insurance because they can't use the deductibles. Doesn't mean that no one benefits. Means there is a problem, that should not be minimized and ignored because of ideology.
I can state from personal experience that high quality plans with lower deductibles get used, and save money. But one has to be able to afford the monthly payments first.
SickOfTheOnePct
(7,290 posts)n2doc
(47,953 posts)Yes, they can undoubtedly go in once a year to see some doctor to poke and prod them. But if said doc finds anything wrong, well, they are screwed. Can't afford to fix it. That's what passes for health care for the working poor. Especially in Red states.
SickOfTheOnePct
(7,290 posts)But the rest of what you said and that I responded to? Not so much.
TM99
(8,352 posts)very negative outcome of the ACA.
It is proving to be true.
My partner has simply not purchased a plan because being self-employed the costs for a Bronze plan PLUS the high deductibles are such that she might as well just pay out of pocket. She has no medical issues but does get yearly physicals, pap smears, and such which she can do for a fraction of the cost out of pocket at the medical clinic attached to the naturopathic medical school here in Tempe.
But heaven's forbid if she needs emergent care or develops a chronic or life-threatening illness.
Health care should not be a gamble. And it pisses me off that we are one of the few if only major world economies that has its citizens weighing costs over care.
rjsquirrel
(4,762 posts)Because we can afford to self insure the first $6000 we pay very little for the premium every month. But my spouse has a serious illness that guarantees we will hit the out of pocket max by mid-year. We end up keeping a good deal more than we used to with an all-in plan.
High deductible plans make sense for the very healthy and the very sick, if you have resources. But others, especially lower income folks, are getting suckered by the low premium.
You don't get something for less without making a compromise. It is a stupid way to run a health care system, and someday we will have a public option for everyone. But until then, if you go cheap up front make sure you understand the financial risk and can afford to take it. If you only want catastrophic coverage, don't complain when you're out of pocket for minor procedures. Read the fine print.
WinkyDink
(51,311 posts)Number9Dream
(1,563 posts)This keeps the premiums just barely affordable.
My wife's Silver Scripts keeps moving her generic drugs into much more expensive tiers.
Affordable Care... yeah right. National single-payer now!
Response to eridani (Original post)
IHateTheGOP This message was self-deleted by its author.
dembotoz
(16,852 posts)got switched to an hmo this year....don't let me get started.....anyway
first time with new doc...i am rather older >60 and he wanted to know when i had my last
colonoscopy...told him never? eyebrows raised....never had decent enuf insurance...eyebrows back down....
Omaha Steve
(99,758 posts)K&R!
Didn't Hillary say Saturday night that won't work? That means she won't try to do it.
OS
dsc
(52,169 posts)just like other insurance. Medicaid is the insurance that doesn't have those.
Omaha Steve
(99,758 posts)dsc
(52,169 posts)Medicare has a 5040 deductible for a family of 4 (the 12k dedecutible you referred to is for such a family).
Omaha Steve
(99,758 posts)Doesn't Medicare for all look better at much less cost?
https://www.healthcare.gov/see-plans/#/plan/results
dsc
(52,169 posts)not one so divide them by four and Medicare is lower but not out of reason lower.
Omaha Steve
(99,758 posts)So it does make a difference.
Improved Medicare and for profit insurance companies out of the picture. Technically Blue Cross NE is non-profit. Ya right.
dsc
(52,169 posts)but the deductible is clearly labeled as applying to a family of 4.
Omaha Steve
(99,758 posts)fasttense
(17,301 posts)You have to pay $200 to $1000 a month, depending on you income and which parts you have, as a premium for it. Then you have to pay 20% of the bill for everything else.
My husband is on dialysis and let me tell you that 20% can add up quickly to tens of thousands.
eridani
(51,907 posts)Copays will depend on how the details are negotiated.
Atman
(31,464 posts)I feel as if we're just handing over thousands of dollars to Big Insurance, because I'd have to have a brain transplant and all of my organs replaced in order to meet the deductibles. We're fairly well off, we make too much money for any subsidies. At this point, it really makes more sense to pay out-of-pocket for all basic procedures and doctors visits, then buy insurance if something catastrophic happens. As it stands, I should probably see a doctor, as I'm 56. My physical last year was A-OK. I'm not on any meds or have any known health issues. But I can't afford for him to find out anything now. My wife's medical practice is likely to be bought out by one of the giant hospital chains in the region, early next year. If that happens, we'll be covered with high-end insurance and normal, reasonable deductibles. But until then, I'm just crossing my fingers and sending money to pay for some CEO's billion-dollar salary.
elias49
(4,259 posts)As a T-shirt I saw last week said: In a perfect world, all man's problems would be fixed with Duct tape and WD40.
But it's not a perfect world.
Cal Carpenter
(4,959 posts)the only one among our peers who do NOT have a simple, single payer system or some other version of health care for all.
We are behind the global curve in a major way on this.
So I can't help but point out how odd it is that you characterize Americans as hard to please about this.
dsc
(52,169 posts)There are very few single payer systems in the world. The rest of your post is accurate in terms of universal care but the only major countries with single payer are the UK and Canada.
zipplewrath
(16,646 posts)Yes it is poorly worded, but it is a variation of what Bernie is talking about. The vast majority of our major trading partners have some variation of universal access/care. Furthermore, most (nearly all) of our major "first world" trading partners pay easily 1/3rd of what we pay for health care. Yes, many countries actually have "insurance" companies. They are HIGHLY regulated and in favor of the individual. And the costs that are paid are well within the "affordable" range because of the underlying "social safety net" that those countries have. Our systems sucks and the ACA was a minor improvement on the system. Mostly it just federalized the regulation of the health insurance industry. Currently it has accomplished little except to increase the number of insured by about 5 - 7%. The point of this article is some fraction of that is insured but basically still not getting health CARE.
Humanist_Activist
(7,670 posts)mostly government operated.
The only reason to advocate for single payer here in the United States is because the transition should be easier and faster than adapting other systems.
We could keep the system of subsidies and such, but greatly expand them, but that may end up costing more than single payer, especially if the US is still toothless in price negotiations and/or price controls for medical services and drug costs.
eridani
(51,907 posts)--chose single payer. Taiwan and South Korea.
Doctor_J
(36,392 posts)How presumptuous
elias49
(4,259 posts)Who thought life could be so friggin hard!
Skittles
(153,209 posts)FLPanhandle
(7,107 posts)To me insurance is insurance against a health care disaster.
I'd rather pay less in premiums and reallocate the savings to the cost of minor health care cost.
Insurance is just to guard against the massive bills that would take the house and savings.
peace13
(11,076 posts)Now imagine a person paying high premiums on a policy mandated by law, who doesn't have money for the huge deductible or big premiums and doesn't have a home or savings. That person will never benefit from the policy....ever. At least you are insuring your home and savings with the health policy. Now if the person who doesn't have a home or savings gets sick and goes to the hospital...the hospital will get paid but the patient will still be billed a large amount for the deductible that will seem small to some but not to theses with nothing. This piece of the puzzle is the huge markup by the hospital. So in the end the hospital gets paid and the patient is still in the desperate hole to refill the hospital's gravy boat!
lumberjack_jeff
(33,224 posts)But prior to the law, you didn't have access to the free checkup that detected whatever it is that you're seeing the doctor for now. Left untreated, prior to 2014 that illness became a crisis that resulted in bankruptcy.
It's not useless if for no other reason than it's an order of magnitude better than what existed before.
My wife is going to have both knees replaced in the near future. We were surprised to find that our $1100 monthly (both of us) insurance annual maximum out of pocket cost is $5000. I find this reasonable for a $100,000 surgery.
If we're going to complain about costs, we need to look at the medical bills themselves, not the insurance.
You could fly to India, buy a condo, pay for the surgery, and fly home for less than the cost of the surgery here - even if you walked away from the condo.
zipplewrath
(16,646 posts)Yes, I did have access to that. The model that the ACA used to create this feature (which is now federally mandated) existed in many plans prior to the ACA. My plan prior to the ACA look much like the "Gold" plans now being sold. It was very close to being a "Cadillac" plan.
And people are still going bankrupt from illness, however there are fewer.
And I'm not sure how you get from 5-7% to an "order of magnitude". Do you even know what that means?
Runningdawg
(4,526 posts)-100$ Price to see Dr - 45$. Total of lost income for the week - 145$ This is before gas money, test or Rx.
This is with a private insurer through my husbands job, not ACA. We STILL can't afford to get sick, preventive care is a joke, just like the policy.
colsohlibgal
(5,275 posts)For profit healthcare is evil and sadistic. They want to gouge profit....we want to stay well and alive. We have different priorities.
It is one big scam and we the public are the losers.
agnostic102
(198 posts)Im self employed in california. There is a good local doctor that charges 79 dollars per visit and 50 dollars per xray.. walmart has "DECENT" drug prices.. im torn between keep paying cash for the few times a year if at all of using the doctor.. or pay the monthly premium just in case my bladder explodes LOL its tough.. the deductibles kind of do suck.
theaocp
(4,245 posts)IIRC, SiCKO was a movie designed to shed light on those WITH health insurance that couldn't afford to use it. I. despise. health. insurance. companies. They have a financial incentive to avoid paying out coverage. Monsters.
Duppers
(28,127 posts)area51
(11,924 posts)Skittles
(153,209 posts)the only thing that has REALLY changed is that the taxpayers are now helping in funding this fraud
Fumesucker
(45,851 posts)We were chumped.
Erich Bloodaxe BSN
(14,733 posts)That pulling out and dusting off a decades-old Republican 'Healthcare' plan would wind up screwing over many 'consumers'?
Freddie
(9,275 posts)Why don't they sell Obamacare supplement plans for just this reason?