Luckily, I'm pass 65 now and don't have to live through my nightmare year of 64 when I had Obamacare Cigna insurance. I bought it on Christmas Eve 2013, the last day I could sign up and have it for 2014. I had a really bad pre-existing condition with my back. I found that I had really just minutes to pick my policy and the words gold or platinum were my key words. They told me there were no platinum plans for me. Well, in early 2014 I got injured on a doc I was making in Libya and that's when my hell began. At that time, my operation was relatively simple and my doc when I was in the hospital upon my return lined me up with a good orthopedic surgeon. In June he was going to operate. I was already in the hospital with a pinched nerve as it had further deteriorated. The orthopedic doc came to my hospital room and was going to operate the next morning. I was woken up that morning in a morphine stupor and barely could understand anything but the doctor was there and rapidly asking me questions which I didn't understand. Suddenly he says he's not operating as he had been pulled out of my Cigna network,. This continued again with Cigna denying another operation. At this point my lumbar region of my back had become so bad that I could barely walk. All of this lead to me being homeless moths later as I could't work at all. Thanks goodness, in October I became 65. The insurance companies created these plans and in my opinion they were bogus plans.
1
America, the only nation in the world where holding an insurance card doesn't guarantee access to safe, quality afrodable health care diagnostics or treatments.
Bottom line is if a waiter in Canada, Taiwan, Japan, Switzerland, Germany, England or Ferance gets pneumonia, they get treated, and go back to work no worse off. However, if a waiter in NYC, LA, Dallas or Kansas gets pneumonia they either get sicker due to lack of care, die or go bankrupt paying for care.
However, we do have an incredibly healthy subsidized health insurance industry which employs only 1.2 million people while killing or maiming that many every year due to rationing of diagnostics, access and treatments.
Bottom line is if a waiter in Canada, Taiwan, Japan, Switzerland, Germany, England or Ferance gets pneumonia, they get treated, and go back to work no worse off. However, if a waiter in NYC, LA, Dallas or Kansas gets pneumonia they either get sicker due to lack of care, die or go bankrupt paying for care.
However, we do have an incredibly healthy subsidized health insurance industry which employs only 1.2 million people while killing or maiming that many every year due to rationing of diagnostics, access and treatments.
8
Health care in America remains the only industry in the world publicly or privately subsidized which doesn't compete capitalistically based on the quality or price of the product it manufactures and produces. the products of health care are clinical outcomes, preventative, medical, surgical and palliative outcomes.
Health insurance in America is the only insurance product in the world which removes and redistributes 30% of the total cap or value of the product it insures solely to profit their owners and bureaucrats and patron politicians, protected from all Federal Regulation by the McCarron Ferguson Act, yes including collusion.
when a builder builds a house, do they compete based on the shopping ans switching of mortgages or homeowners insurance? When a person buys a car do they purchase the car according to shopping and switching of loans or insurance on the car? Of course not, look how we've redistributed the capitalistic competition away from the products produced by health care into a subsidized communist style industry called health insurance which has no responsibilities or oversight to demonstrate any cost or quality improvements in the quality of health care produced in the USA.
What a scam.
Health insurance in America is the only insurance product in the world which removes and redistributes 30% of the total cap or value of the product it insures solely to profit their owners and bureaucrats and patron politicians, protected from all Federal Regulation by the McCarron Ferguson Act, yes including collusion.
when a builder builds a house, do they compete based on the shopping ans switching of mortgages or homeowners insurance? When a person buys a car do they purchase the car according to shopping and switching of loans or insurance on the car? Of course not, look how we've redistributed the capitalistic competition away from the products produced by health care into a subsidized communist style industry called health insurance which has no responsibilities or oversight to demonstrate any cost or quality improvements in the quality of health care produced in the USA.
What a scam.
2
I think that it's been enough of experiments, the time to adopt a single payer system has come. With single payer system we won't have to spend hours pursuing complicated health insurance plans, we will have a much cheaper medical care for all and we won't have to spend our time trying to fine-tune a miserable health care system we have today.
9
Cheaper health care in a Single Payer system?
How would that work, exactly?
Will Docs do what they do for less money, say what Medicaid Pays? You should ask Medicaid patients about how many docs will take their cases.
Will hospitals charge less? You should check how many are on the verge of going in the red based on the latest round of federal payment reductions.
Will drugs cost less? You should ask venture capitalists how much money they will invest in new miracle cures if there is no potential well paying population to consume those meds.
There is no direct evidence that changing the US system we now to a Single Payer system will save money AND preserve access as well. You might just end up trading cash for queuing.
The complexity will make PPACA implementation look like Romper Room. It will be anything but simple.
WR
How would that work, exactly?
Will Docs do what they do for less money, say what Medicaid Pays? You should ask Medicaid patients about how many docs will take their cases.
Will hospitals charge less? You should check how many are on the verge of going in the red based on the latest round of federal payment reductions.
Will drugs cost less? You should ask venture capitalists how much money they will invest in new miracle cures if there is no potential well paying population to consume those meds.
There is no direct evidence that changing the US system we now to a Single Payer system will save money AND preserve access as well. You might just end up trading cash for queuing.
The complexity will make PPACA implementation look like Romper Room. It will be anything but simple.
WR
1
So it's just an optical illusion that the Western industrial countries with single payer systems actually spend half as much but still have equal or better outcomes than our vaunted system of health care?
You can't have single payer unless the status quo to which you refer is transformed by a new organizational and pricing discipline, which other countries seem to have mastered on behalf of their citizens.
You can't have single payer unless the status quo to which you refer is transformed by a new organizational and pricing discipline, which other countries seem to have mastered on behalf of their citizens.
3
Well read 29 only cares about the profitability of thei insurance industry, not the clinical outcomes which are the only products produced and manufactured by health care and have been steadily declining due to lack of access and insurance for decades
2
Obamacare or ACA is a perfect example of how holding a 'health insurance card' in America does not guarantee access to safe, quality affordable health care, diagnostics, medicines or treatments. It's a false panacea for the masses.
The insurance companies who are selling Obamacare ACA figured out a way to continue to redistribute 30% of all the money which is invested in health care in America solely for the profits of their bondholders, shareholders, executives, rationing bureaucrats and patron politicians. By increasing deductibles and co payments and combining this burden with high premiums, the health insurance industry is the only participant in ACA Obamacre which is healthy.
Isn't it time we treated our health care like we do our utilities? Why is clean reliable and affordable water and electricity a 'RIGHT' for all Americans delivered by limiting profitability of our public utilities to 7%?? Why is safe, quality affordable health care a PRIVILEDGE for those only with good full time jobs, those who hold public offices or those over 65 years old on Medicare Insurance who are able to afford a decent secondary insurance?
Obamacare is a subsidized scam benefiting the insurance industry leading to lots of insured people with very little access to quality affordable health care. There's no competition in health care based on the quality or price of health care delivered and therefore this is nothing but a clever scam to continue massive private and public subsidies.
The insurance companies who are selling Obamacare ACA figured out a way to continue to redistribute 30% of all the money which is invested in health care in America solely for the profits of their bondholders, shareholders, executives, rationing bureaucrats and patron politicians. By increasing deductibles and co payments and combining this burden with high premiums, the health insurance industry is the only participant in ACA Obamacre which is healthy.
Isn't it time we treated our health care like we do our utilities? Why is clean reliable and affordable water and electricity a 'RIGHT' for all Americans delivered by limiting profitability of our public utilities to 7%?? Why is safe, quality affordable health care a PRIVILEDGE for those only with good full time jobs, those who hold public offices or those over 65 years old on Medicare Insurance who are able to afford a decent secondary insurance?
Obamacare is a subsidized scam benefiting the insurance industry leading to lots of insured people with very little access to quality affordable health care. There's no competition in health care based on the quality or price of health care delivered and therefore this is nothing but a clever scam to continue massive private and public subsidies.
4
Carriers are required by federal law to maintain their overhead at less than 20% or issue rebates to their insured (on individual and small group policies). Their over head is limited to 15% on larger group policies.
Within that overhead, they fund PPACA taxes and fees, federal taxes, state taxes, local taxes, employee salaries and benefits, and the other normal parts of the operation of their businesses.
For the 50 millions insured by not-for-profit plans, there are no bondholders, no stockholders, no dividends, no profits, not anonymous benefactors or decision makers.
Their fraud rates in their claims paying are far below any government programs, making their overhead comparable to Medicare, and probably lower than Medicaid.
Be careful what you wish for.
WR
Within that overhead, they fund PPACA taxes and fees, federal taxes, state taxes, local taxes, employee salaries and benefits, and the other normal parts of the operation of their businesses.
For the 50 millions insured by not-for-profit plans, there are no bondholders, no stockholders, no dividends, no profits, not anonymous benefactors or decision makers.
Their fraud rates in their claims paying are far below any government programs, making their overhead comparable to Medicare, and probably lower than Medicaid.
Be careful what you wish for.
WR
2
That's totally false. The law says the insurance companies can remove 20% of all health care funds from health care (utiities only remove 7% max), however, the insurance companies have calculated and demonstrated that they can move the profits up (redistribution of funds away from doctors and their patients care) to 30% by raising premiums, deductibles, copyaments and non payments to doctors (float).
If profits were truly cut across the board by 10% then their stock and bond values would demonstrate that in the market.
It's a scam...the only insurance product in the world which removes 30% of the market cap or value of the product itg insures solely for their bondholders, shareholders and bureaucrats.
If profits were truly cut across the board by 10% then their stock and bond values would demonstrate that in the market.
It's a scam...the only insurance product in the world which removes 30% of the market cap or value of the product itg insures solely for their bondholders, shareholders and bureaucrats.
2
Really Great American? Is it your contention that health insurance companies can now raise rates willy-nilly to preserve their profits? Aren't you forgetting something very important?
I mean of course the Patient Protection and Affordable Care Act (PPACA).
PPACA establishes national standards that require every single insurance carrier's every single rate for every single policy at every single age to be reviewed by state and federal entities for reasonableness and fairness. And if judged less than reasonable, that must be published nationwide and in most states, the rate returned for re-negotiation.
The Patient Protection and Affordable Care Act contains many more consumer protections, most of them aimed at "Keeping health insurance companies honest" as President Obama put it. Polices cannot be cancelled, health cannot be reviewed before someone signs up and rates established, prices cannot be raised with strict federal and/or state scrutiny, margins are limited and regulated, polices cannot have annual or lifetime limits, rates cannot discriminate on the basis of gender or health status, and over 50 USPSTF schedule A and B wellness benefits, check ups, immunizations, and counseling sessions with your doctor must be provided to every insured patient free of charge in their insurance policy. These are not optional, they are REQUIRED to sell health insurance in the United States today.
I find your lack of faith in PPACA disconcerting.
WR
I mean of course the Patient Protection and Affordable Care Act (PPACA).
PPACA establishes national standards that require every single insurance carrier's every single rate for every single policy at every single age to be reviewed by state and federal entities for reasonableness and fairness. And if judged less than reasonable, that must be published nationwide and in most states, the rate returned for re-negotiation.
The Patient Protection and Affordable Care Act contains many more consumer protections, most of them aimed at "Keeping health insurance companies honest" as President Obama put it. Polices cannot be cancelled, health cannot be reviewed before someone signs up and rates established, prices cannot be raised with strict federal and/or state scrutiny, margins are limited and regulated, polices cannot have annual or lifetime limits, rates cannot discriminate on the basis of gender or health status, and over 50 USPSTF schedule A and B wellness benefits, check ups, immunizations, and counseling sessions with your doctor must be provided to every insured patient free of charge in their insurance policy. These are not optional, they are REQUIRED to sell health insurance in the United States today.
I find your lack of faith in PPACA disconcerting.
WR
1
I think the assumption that all this "shopping" activity is a good sign is a bit overblown. Our experience has been that most of the "shoppers" moved plans strictly on a price basis, ending up in many cases with narrower networks and higher deductibles. In other words, they traded access to healthcare for access to immediate cash.
I'm not sure, in the long run, this will be a sensible tradeoff.
WR
I'm not sure, in the long run, this will be a sensible tradeoff.
WR
6
Health care in America, where shoppers don't actually buy a product. The product of health care is outcomes, clinical outcomes, not insurance. Heatlh care in America where the buyer can pay more for lower quality, that's communism not capitalism. And to think, we subsidized this insurance industry privately and publicly in order to get what? Higher prices and lower access and quality....Sounds like Russia in the 60's and 70's doesn't it?
1
There are three a couple things going on here.
1. Anyone who had to endure the fiasco of last years individual insurance marketplaces has learned enough about health insurance plans and price options to know that shopping around is absolutely necessary if you want to find the lowest premiums and best plan design. Whether people are becoming more health literate and responsible as consumers or they are just price-shocked is still to be determined. But as almost half of Americans enrolled in individual insurance are eligible for subsidies it makes sense they are looking for a plan that covers the greatest portion of their premium.
To be continued...
1. Anyone who had to endure the fiasco of last years individual insurance marketplaces has learned enough about health insurance plans and price options to know that shopping around is absolutely necessary if you want to find the lowest premiums and best plan design. Whether people are becoming more health literate and responsible as consumers or they are just price-shocked is still to be determined. But as almost half of Americans enrolled in individual insurance are eligible for subsidies it makes sense they are looking for a plan that covers the greatest portion of their premium.
To be continued...
I'm thinking of switching next year. I'm not happy with the plan I selected because it took them so long to mail out the benefits cards. They want payment at the beginning of each month but they don't get the bills out in time and then the bills are so poorly printed that the address doesn't show in the window when it's put into the envelope.
We really need a single payer universal access system here. The biggest reason we don't have one is because the health insurance companies wouldn't be able to sustain themselves if it was put into place. We should be able to get the care we NEED not the care we can afford. It works that way in other countries, why not here?
We really need a single payer universal access system here. The biggest reason we don't have one is because the health insurance companies wouldn't be able to sustain themselves if it was put into place. We should be able to get the care we NEED not the care we can afford. It works that way in other countries, why not here?
8
I think if you dig a little deeper (take a good look at Vermont, for example) you will find the main reason their is so little political support for a Single Payer system today is the massive tax increases required. It might even be a zero sum game, i.e. you could take all the money currently spent on private premiums and give it to the government to run, but it still is going to look like a huge tax increase.
In Vermont, the estimates were 11.5% tax on individual earnings, and a corporate tax approaching 10%.
The plan has been shelved.
WR
In Vermont, the estimates were 11.5% tax on individual earnings, and a corporate tax approaching 10%.
The plan has been shelved.
WR
1
Single payer with a full nation risk spread would lower costs and improve outcomes, as per Canada where people live longer and are less sick and have better access to health care providers and institutions at half the cost compared to America.
Bottom line is a waiter in Vancouver can get pneumonia, recover and go back to work, no worse off.
If a waiter in Manhattan, Kansas or LA gets pneumonia, they either get sicker, die or go bankrupt paying for medical costs.
Bottom line is a waiter in Vancouver can get pneumonia, recover and go back to work, no worse off.
If a waiter in Manhattan, Kansas or LA gets pneumonia, they either get sicker, die or go bankrupt paying for medical costs.
2
Patients should be able to join, or perhaps found, a non-profit insurer.
2
They already are/have. See "PPACA Co-Ops".
At least the ones that are not in imminent fear of financial failure, that is.
WR
At least the ones that are not in imminent fear of financial failure, that is.
WR
2
The insurance industry non profits are meaningless due to the mccarron ferguson act which protects insurance companies from all Federal Regulations and allows for the redistribution of 30% of health care dollars away from health care into the industry.
1
Not terribly accurate, but I would encourage you to read a bit more.
MrCarron Ferguson simply allows all the BCBS plans around the country to respect each others territories without violating anti-trust rules.
Beyond that, Health insurance companies are now the most highly regulated industry in the U.S. They can't even pay a C-suite employee over $500k a year and deduct the salary, while any other company can go well over a $million and deduct it all day long.
I can see you are frustrated with health insurance. Certainly understandable, but you should Try not to let it cloud your judgment.
WR
MrCarron Ferguson simply allows all the BCBS plans around the country to respect each others territories without violating anti-trust rules.
Beyond that, Health insurance companies are now the most highly regulated industry in the U.S. They can't even pay a C-suite employee over $500k a year and deduct the salary, while any other company can go well over a $million and deduct it all day long.
I can see you are frustrated with health insurance. Certainly understandable, but you should Try not to let it cloud your judgment.
WR
Every time I read articles like these and the ensuing comments, I thank whatever powers there be that I live in a country (France) with single payer insurance and do not have sleepless nights or anxious days trying to figure out how to pay for my health care and negotiating with HMO's. When I had breast cancer that was the one thing I didn't worry about. The high taxes we pay for this are worth it, as the French at least long ago realized that " If you don't have your health, you have nothing." This afternoon I will visit two friends in hospital suffering from cancer and although I know we will speak of many things, financial worries about their care will not be one of them.
7
Hmm - sounds strangely like a free market system at work. Why are Republican's so against this?
1
When I think of the hours upon hours spent researching the intricacies of the various health plans and their many levels. And to redo it every year. What a waste of human effort.
7
Another possibility is that people have decided their 2014 plans or insurance providers are sub-par.
My former plan took months to get our cards out, talked us into switching to auto bill pay then neglected to deduct the premium from our checking account and customer service was terrible, leaving us on hold for a total of over for hours. We were never satisfied even when we finally made contact, nobody was ever able to answer out questions or resolve our issues.
I simply can't believe we are to prop up these insurance crooks when their tactics lead, apparently, to a doubling of the costs that other countries pay for superior health care.
My former plan took months to get our cards out, talked us into switching to auto bill pay then neglected to deduct the premium from our checking account and customer service was terrible, leaving us on hold for a total of over for hours. We were never satisfied even when we finally made contact, nobody was ever able to answer out questions or resolve our issues.
I simply can't believe we are to prop up these insurance crooks when their tactics lead, apparently, to a doubling of the costs that other countries pay for superior health care.
9
It can be worth the effort. My Medicare Part D (PDP) tried to slip a 24% annual increase past me. Instead, I switched and got a 19% reduction for the exact same drug coverage. Pays to stay on your toes.
3
My first experience with ACA started with a high end BCBS plan due to a chronic illness which requires expensive medication. So far, BCBS changed speciality pharmacies without notifying me. I spent an afternoon on the phone with various people at CVS caremark, none of whom could help me. BCBS finally answered the phone and got me set up with CVS. But CVS cannot figure out what my benefits are, BCBS has been closed for days in NC due to snow, and even if my medication had been shipped when it was supposed to, it wouldn't get here because UPS isn't delivering (snow). So, if BCBS had done the right thing at the very beginning, notified my doc and me about the change in pharmacy none of this would have happened. Now I am without medication and will be throughout the weekend. if/when I re start it I'll probably have a day stay in the hospital for cardiac monitoring. So from BCBS's view: mission accomplished. I'll probably discontinue the medication because of the hassle. They don't want to pay the $5000 a month it costs and I certainly can't afford it.
5
I don't think this is a good sign. People are dissatisfied with their plans, the networks, etc. The healthy can switch, and the sick, who don't want to change their doctors, are stuck. If coverage were actually decent and affordable you wouldn't see this phenomenon.
15
You of course are long term supporter of the ACA...LOL.
This isn't about the ACA. It was even worse under private insurance when there were far fewer consumer protections. The insurance companies are predatory and dishonest. No, the ACA did not change the DNA of these monsters. Things are only going to improve when we remove them from the equation.
12
Megan, show us the polls that conclude "people are dissatisfied with their plans" under ACA.
And just why can't the sick change their plans and keep their doctors? Many plan options are on the exchanges of metropolitan markets. A number will have the same or very similar networks.
ACA coverage is more decent and more affordable than the vast majority of private insurance policies it forced out of the market
And just why can't the sick change their plans and keep their doctors? Many plan options are on the exchanges of metropolitan markets. A number will have the same or very similar networks.
ACA coverage is more decent and more affordable than the vast majority of private insurance policies it forced out of the market
In CA if your income changes you are required report the change within a set number of days. If your income changes your plan is automatically cancelled and a new one started.
1
Lindsay, Where did you get the idea that your plan would be cancelled and a new one started if your income changes? According to the FAQs on CoveredCalifornia, the only way that can happen is if your income drops enough that you qualify for Medicaid. Otherwise, the only thing that must change is your premium tax credit, if you are available for one.
I switched because I had such a bad experience with Blue Shield despite paying full price out of pocket for the allegedly best plan they had. It was a deception. The high-priced plan had no wider doctor network than the least expensive.
This year I am giving a chance to Blue Cross. We'll see if they are any better. So far, a major improvement, but I won't make any final decisions till later this year.
I will keep switching every year if I have to until I find a company that is minimally decent. I am paying MORE this year in an attempt to get better service and am willing to do so. The problem is paying the highest amount and you still get terrible service.
This year I am giving a chance to Blue Cross. We'll see if they are any better. So far, a major improvement, but I won't make any final decisions till later this year.
I will keep switching every year if I have to until I find a company that is minimally decent. I am paying MORE this year in an attempt to get better service and am willing to do so. The problem is paying the highest amount and you still get terrible service.
8
If you are paying then you obviously are willing to do so, listen to your inner voice.
We couldn't/can't get a single payer plan. We couldn't even get a public option and the votes to pass ACA. So, competition among insurers on the exchanges is the best we are going to get for some time. And, it is better than what we had when insurers could use deception and exclusions to avoid competing.
With ACA insurers have to compete head-to-head when the benefits covered, the premiums and the out-of-pockets (deductibles, co-pays, etc.) and drug coverage are right on the website. They also have to compete on networks, which are a bit harder for consumers to investigate but have to be available on the insurers' websites. The Dept of HHS is starting to clamp down on network information that is in error or out of date. HHS is also starting to enforce network adequacy standards in ACA, such as the minimum number of specialists of each type that can be in a network offered on the exchange.
The few remaining problems will be resolved.
And, the savings from shopping demonstrate that insurers are competing in ways that save consumers money. If an insurer offers a low premium one year and raises it too much the next year, enrollees will move to another plan that offers a better premium and overall deal.
With ACA insurers have to compete head-to-head when the benefits covered, the premiums and the out-of-pockets (deductibles, co-pays, etc.) and drug coverage are right on the website. They also have to compete on networks, which are a bit harder for consumers to investigate but have to be available on the insurers' websites. The Dept of HHS is starting to clamp down on network information that is in error or out of date. HHS is also starting to enforce network adequacy standards in ACA, such as the minimum number of specialists of each type that can be in a network offered on the exchange.
The few remaining problems will be resolved.
And, the savings from shopping demonstrate that insurers are competing in ways that save consumers money. If an insurer offers a low premium one year and raises it too much the next year, enrollees will move to another plan that offers a better premium and overall deal.
8
Lousy customer service, high price, limited coverage, too many denials for items that were supposedly covered and a huge increase in what would have been this year's premium. Why would i stay with this policy? (Not to mention their cybersecurity is laughable as are their so-called customer relations).
There were better choices available and I bought the best one for me. I call this smart buying. Yes, It took some time to sort it all out. That is how i maximize my what i get for my money, whether buying health insurance or a car or food.
Given the cost of health insurance and health care, there is no reason to put up with bad product and service, assuming there is more than one choice available. Thankfully this year, there was.
Assuming there is a marketplace next year, I will do the same evaluation, based on my needs and experience with this year's insurer. Works for me!
There were better choices available and I bought the best one for me. I call this smart buying. Yes, It took some time to sort it all out. That is how i maximize my what i get for my money, whether buying health insurance or a car or food.
Given the cost of health insurance and health care, there is no reason to put up with bad product and service, assuming there is more than one choice available. Thankfully this year, there was.
Assuming there is a marketplace next year, I will do the same evaluation, based on my needs and experience with this year's insurer. Works for me!
13
Perhaps this is because people realized that the "affordable" plans they purchased are useless.
7
A friend of mine with a silver plan had to wait weeks to get his leg set after it was broken when he fell off a ladder. Unbelievable.
4
Mindless negativity John Do you realize what a person went through with a chronic illness before the ACA . The price of a policy and or medical bills bankrupted more Americans than for any other reason. That's if they could buy coverage. Why do you think 10 million signed up? for one reason !!! affordable coverage, Insurance companies had to compete for a huge market. This is the beginning. We should have single payer and have the medical providers put on a financial diet.
In the meantime you don't appreciate what the chronically ill, independently employed and people who lost their jobs went through. For goodness sake do some homework on the subject before making negative statements. Kentucky did a great job for their citizens.
In the meantime you don't appreciate what the chronically ill, independently employed and people who lost their jobs went through. For goodness sake do some homework on the subject before making negative statements. Kentucky did a great job for their citizens.
2
John
Please tell us what plan option you chose on the exchange in Louisville and what plan, premium, deductible and co-pays/coinsurance and benefits covered you had before that?
I'd like to look it up and see for myself how unaffordable and useless your ACA plan is compared to the private plan you must have had
Please tell us what plan option you chose on the exchange in Louisville and what plan, premium, deductible and co-pays/coinsurance and benefits covered you had before that?
I'd like to look it up and see for myself how unaffordable and useless your ACA plan is compared to the private plan you must have had
Employers are reluctant to change insurance providers. They have to hold meetings with their employees to explain the plan changes, which dents productivity. HR has to deal with a new sign-up system, and changes in procedure and policy.
Insurance companies negotiate knowing they can use that "inertia" to extract agreement to a higher than "market competitive" rate. In the ACA markets insurers have to be competitive on price and service.
If you've ever had a dispute with an employers insurance company, you know the Insurer works for the customer, your employer, and HR has little skin in the game (the company signs your paycheck, so shut up), and you have no leverage, or recourse.
My employer offers healthcare insurance, but I would rather get it via the ACA. That way I can switch insurers if I'm not satisfied, and my employer can't use rising insurance rates as the reason I'm not getting a raise... again.
Insurance companies negotiate knowing they can use that "inertia" to extract agreement to a higher than "market competitive" rate. In the ACA markets insurers have to be competitive on price and service.
If you've ever had a dispute with an employers insurance company, you know the Insurer works for the customer, your employer, and HR has little skin in the game (the company signs your paycheck, so shut up), and you have no leverage, or recourse.
My employer offers healthcare insurance, but I would rather get it via the ACA. That way I can switch insurers if I'm not satisfied, and my employer can't use rising insurance rates as the reason I'm not getting a raise... again.
10
I get it. Shopping around a lot saves money on your health insurance premiums. But in this model, there is a price to be paid in healthcare delivery, quality and familiarity.
I hope future studies will measure whether putting the emphasis on costs rather than cures makes healthcare less effective for the patient.
I hope future studies will measure whether putting the emphasis on costs rather than cures makes healthcare less effective for the patient.
8
A.Goldstein:
PPACA a does have features that promote better health care delivery and quality than our prior health coverage system. Just what alternative are you saying does a better job of delivery, quality and familiarity.
What system puts the emphasis on cures rather than costs?
PPACA a does have features that promote better health care delivery and quality than our prior health coverage system. Just what alternative are you saying does a better job of delivery, quality and familiarity.
What system puts the emphasis on cures rather than costs?
2
What's better than the ACA model is single payer, e.g., Traditional Medicare, not Part C. Part A/B plus supplemental insurance is marvelous compared with what I see others having to deal with under the ACA. It's bad having to abandon good doctors and health facilities every year so you can save a few dollars. That said, I applaud Obama for what he has accomplished compared with what was.
3
Medicare is only available to seniors. I, too, would prefer a single payer system. But, our Congress is not going to extend Medicare to all citizens or pass any other form of single payer coverage any time soon. So, I believe we should make what we have better rather than criticizing it from all sides.
I worked in the health sector for 30 years. It took many years to make Medicare what it is today. I believe the same would happen if Congress passed single payer coverage. It would take many years for the administrators to develop thousands of regulations (like Medicare has today) to translate the language of a law into specific policy directions that guide how insurers (as intermediaries), providers and patients must behave to get reimbursement/coverage.
I worked in the health sector for 30 years. It took many years to make Medicare what it is today. I believe the same would happen if Congress passed single payer coverage. It would take many years for the administrators to develop thousands of regulations (like Medicare has today) to translate the language of a law into specific policy directions that guide how insurers (as intermediaries), providers and patients must behave to get reimbursement/coverage.
Let's just institute single payer so we can spend our time doing something like going for a walk instead of gazing into an imaginary crystal ball trying to decide on a health plan for the year.
36
Great idea.
But, totally impossible as long as voters continue to believe what Republicans tell them and vote for them.
Democrats have a major re-educatation campaign in the years ahead to counter 25+ years of organized media propaganda and Frank Luntz talking points.
But, totally impossible as long as voters continue to believe what Republicans tell them and vote for them.
Democrats have a major re-educatation campaign in the years ahead to counter 25+ years of organized media propaganda and Frank Luntz talking points.
11
Republicans? I doubt it was Republicans that shelved the Vermont Single Payer plan this year.
Rumor has it the plan required very large tax increases, which the Dems were reluctant to foist on the public.
Not exactly Republican propaganda in the real world.
WR
Rumor has it the plan required very large tax increases, which the Dems were reluctant to foist on the public.
Not exactly Republican propaganda in the real world.
WR
Theresa, I guessing you aren't Medicare eligible. Medicare is the best example we have of single payer coverage (for seniors only) we have in this country.
When I am going through the enrollment process, I go out to take walks - to relieve my eye strain and stress level from comparing Medicare Part A+B+D to the many Part C (Medicare Advantage Plans). I come back refreshed, make a decision and then consider whether the premiums and coverages of numerous supplemental plans would be worth adding to A+B+D.
Then I take a nap before picking my combination of plans for the next year.
It's almost March and I am still wondering if I made the best choice this year!
Single payer coverage will not be a walk in the park for consumers. It will be even less of a picnic for providers, because government uses laws/regulations and its single purchasing power to limit prices and services of hospitals, doctors and all other medical professionals and facilities.
Our health costs are 2 times higher than those in Canada. Health care is almost 20% of our economy. No matter how full of liberals, I do not believe any future U.S. Congress is going to cut providers' revenue in half. That would cause massive layoffs, defaults on facilities and equipment and, perhaps, a recession. If and when Congress passes single payer, I believe will will still have deductibles, etc. and pay 20-30% of the cost (like we do now) so the shock to providers will not be too great.
When I am going through the enrollment process, I go out to take walks - to relieve my eye strain and stress level from comparing Medicare Part A+B+D to the many Part C (Medicare Advantage Plans). I come back refreshed, make a decision and then consider whether the premiums and coverages of numerous supplemental plans would be worth adding to A+B+D.
Then I take a nap before picking my combination of plans for the next year.
It's almost March and I am still wondering if I made the best choice this year!
Single payer coverage will not be a walk in the park for consumers. It will be even less of a picnic for providers, because government uses laws/regulations and its single purchasing power to limit prices and services of hospitals, doctors and all other medical professionals and facilities.
Our health costs are 2 times higher than those in Canada. Health care is almost 20% of our economy. No matter how full of liberals, I do not believe any future U.S. Congress is going to cut providers' revenue in half. That would cause massive layoffs, defaults on facilities and equipment and, perhaps, a recession. If and when Congress passes single payer, I believe will will still have deductibles, etc. and pay 20-30% of the cost (like we do now) so the shock to providers will not be too great.
I noticed you don't cover this data, the only one people care about: Americans still pay twice as much as any other country.
32
Note: Canada & Germany have health care costs of approx. 11% of GDP, the
USA has health care costs of approx. 17.5% to 18% of GDP. They both have rich plans and better outcomes than USA, but double the costs is NOT true.
Britian is the only large comparable country with costs 8.5% to 9% of GDP, which is double USA costs; but very strick guidlines on who gets expensive health care for older people & others and not better outcomes than USA.
USA has health care costs of approx. 17.5% to 18% of GDP. They both have rich plans and better outcomes than USA, but double the costs is NOT true.
Britian is the only large comparable country with costs 8.5% to 9% of GDP, which is double USA costs; but very strick guidlines on who gets expensive health care for older people & others and not better outcomes than USA.
Fair enough, Ralph. Throw in some extra dollars for mental health and drug abuse costs related to dealing with the stress of our system, and let's call it double.
Our one hundred year long experiment in subjecting the access and delivery of health care to the vagaries of the market has been a total failure, as demonstrated by the fact that we pay more than any other country and have significantly worse health outcomes.
So let's end the insanity and adopt a single payer system so we don't have to spend hours perusing complicated health insurance plans, so we can have cheaper medical care for all and, lastly, so that talented journalists like Ms Sanger-Katz don't have to spend their time trying (in vain) to put a veneer of respectability on the recent attempt to fine-tune a miserable health care system.
So let's end the insanity and adopt a single payer system so we don't have to spend hours perusing complicated health insurance plans, so we can have cheaper medical care for all and, lastly, so that talented journalists like Ms Sanger-Katz don't have to spend their time trying (in vain) to put a veneer of respectability on the recent attempt to fine-tune a miserable health care system.
43
We always give in to fear mongering. Doctor and hospital lobbying groups argue that if medicine goes to a single-payer system like that of the UK & France, they won't practice for $120,000/year salaries, and the quality would be awful.
The U.S. is still the greatest nation for opportunities for the working age group, but those who are older or have a chronic illness have a better quality of life in countries such as Australia, Canada, UK, France, etc...
The U.S. is still the greatest nation for opportunities for the working age group, but those who are older or have a chronic illness have a better quality of life in countries such as Australia, Canada, UK, France, etc...
3
Well said. In the United States we pay twice as much for an inferior health delivery system ranking last among the top 11 major economies in healthcare outcomes while ranking number 1 in per capita cost.
5
Sanger-Katz is undoubtedly right that this competition and plan-switching drives down the cost of insurance and potentially the cost of the underlying services - ie medical care.
But the high switching rate has a hidden cost. Our bodies are like cars: with time they inevitably deteriorate, but with proper maintenance they can last a long time before doing so. Maintenance can be expensive in the short term but beneficial and less costly in the long term. Trouble is, insurance companies expecting that each customer will probably switch within a few years have little incentive to invest in the long-term health of their customers, since they will bear the short-term costs (ie preventive medicine) but none of the benefits (ie avoided future medical costs). To use the analogy again, do you have an incentive to do expensive maintenance on a rental car? Of course not... The same type of situation exists here.
But the high switching rate has a hidden cost. Our bodies are like cars: with time they inevitably deteriorate, but with proper maintenance they can last a long time before doing so. Maintenance can be expensive in the short term but beneficial and less costly in the long term. Trouble is, insurance companies expecting that each customer will probably switch within a few years have little incentive to invest in the long-term health of their customers, since they will bear the short-term costs (ie preventive medicine) but none of the benefits (ie avoided future medical costs). To use the analogy again, do you have an incentive to do expensive maintenance on a rental car? Of course not... The same type of situation exists here.
17
Norman writes: "... Our bodies are like cars: with time they inevitably deteriorate, but with proper maintenance they can last a long time before doing so...."
Bodies have immune systems that repair; cars do not.
Bodies have immune systems that repair; cars do not.
5barris,
Yes, but that difference is irrelevant to the analogy. And in any case you can keep a car in a museum so that it will not deteriorate at all. But you cannot do the same with human bodies. My body, your body, and the bodies of all living things will inevitably deteriorate and die.
Yes, but that difference is irrelevant to the analogy. And in any case you can keep a car in a museum so that it will not deteriorate at all. But you cannot do the same with human bodies. My body, your body, and the bodies of all living things will inevitably deteriorate and die.
2
Norman, PPACA requires insurers who offer plans on the exchanges to cover an extensive set of preventive services. Most of them did not cover such preventive services prior to ACA - for the reasons you mentioned. But that is no longer true - they have to cover prevention now.