Author Topic: Health Insurance Dilemma  (Read 1389 times)

The Gorn

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Re: Health Insurance Dilemma
« Reply #15 on: May 07, 2017, 04:42:46 PM »
The phrase "fake news" is being used to soften Trump's accountability and to denigrate real world concerns. That's what Trump himself is doing and IMO is using the phrase for cover, not as a true statement.

The fake news isn't helping, but the Trump admin does a poor job of communicating what is going on with healthcare and quelling people's fears.  Their message is disjointed, at best.  A little here, a little there, it isn't good enough.  It makes them look bad.

Absolutely NOTHING I have read about the last round of negotiation (the dead Ryan bill) and this time give me any hope nor any reassurance that normal humans will be able to afford health insurance.

Here's the deal. Benali72 alluded to this in his post:

Obamacare is an intricate, well-oiled machine that was hard wired to the present day reality of our health care system. Really. It wasn't thrown together by a bunch of liberal operatives in congress.  It was designed and engineered in a scholarly way by someone who deeply understands health care and insurance and statistics and who understands that insurance companies need a profit motive in order to operate.

ACA apparently contains well oiled legal definitions of triggers for reimbursing insurers for unexpected expenses in paying claims (risk corridors.)

I can disregard no-substance airheads like Nancy Pelosi saying "you'll have to make it law in order to read it and understand it."

But ACA sucks because the health care system it's attached to really sucks. I suspect that ACA under the covers is a masterwork of pragmatic financial engineering. It supports the "deep state" of health care in this country.

My opinion is that ACA is 10 billion times better than anything that conservatards on capital hill will throw together as ideological posturing.

AHCA is legislation thrown together hurriedly with no real information on insurance nor healthcare by partisan hypocrite assholes like Paul Ryan who are following a Republican ideology of increased hardship on individual payers while proclaiming "we lowered the deficit GREAT oh we do not hear that your family went bankrupt."

At this point I really believe Trump just spews words in order to push voter's buttons. Most are inspiring. Are some outright lies? We'll see.

I also simply do not believe that Trump has applied his intelligence to understanding that ACA is a deep piece of legislation that doesn't deserve to be labeled a pork barrel scam. Trump makes a shallow sound bite, raises his thumb and proclaims that the problem is solved.

ACA is probably the best possible solution to health insurance within the US medical system that provides the most coverage to the most insureds with the best access for individuals. Thick headed partisan idiocy on the part of conservatives prevents them from understanding or communicating that.

The point is, I'll believe that whatever Trump prods Congress to deliver is better when I see it. What I read for myself in terms of the impact on health insurance for ordinary people is scaring the shit out of me.

And it's not G*ddamned fake news, it's the TRUTH that things such as: preexisting conditions are totally up for grabs at this point and not acknowledged as such.
« Last Edit: May 07, 2017, 06:57:46 PM by The Gorn »
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The Gorn

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Re: Health Insurance Dilemma
« Reply #16 on: May 07, 2017, 07:02:36 PM »
It's conceivable that Trump is actually interested in single payer and will propose it as a solution when/if the Senate version of the legislation collapses as well.  Perhaps Trump is using the public outrage about the legislation as a tool to this end.

My respect for Trump will increase to the highest possible level if this is indeed his agenda, and he actually pulls it off. Medicare for all would force the health care system to contract its billing practices.

I predict that no matter what diehard Trump fans claim or believe, a replacement for ACA that incorporates private insurers will be an enormous financial hardship to anyone lacking an employer health plan. And may extend the hardship to employee health care insureds as well.
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benali72

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Re: Health Insurance Dilemma
« Reply #17 on: May 08, 2017, 08:11:34 AM »
Like the milliions of people whose access to insurance may be at risk for 2018, I don't care about Republican plans or Democratic plans.

What I care about is having health insurance in 2018.

Indications I get from friends in the insurance industry is that the individual market will be a disaster for 2018.

We'll see.

Since Republicans control both houses of Congress and the Presidency, I'm looking to them to fix it.

benali72

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Re: Health Insurance Dilemma
« Reply #18 on: May 26, 2017, 03:12:40 PM »
I saw an insurance company report today that said so far data has come in for 5 states. These are the filings by insurance companies for their plans for 2018 as required for participation in the ACA marketplace. All 5 have big rate increases -- about 20 to 40%. All insurers reported that uncertainty over the CSRs (cost sharing reimbursements) from the federal government is the reason. IOW, they're saying it's due to their belief that Republicans will not pay the ACA CSRs they depend on in 2018. Of course, that's why the insurers say... I have no way of verifying that one way or the other.

In any case, at this point it's becoming clear that 2018 rates will skyrocket no matter what the Senate does about healthcare. Whether or not the Republicans come up with a better healthcare system for the future, they have ensured 2018 will be a disaster for consumers. They needed a transition plan for whatever they're changing our system to.

Code Refugee

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Re: Health Insurance Dilemma
« Reply #19 on: May 26, 2017, 04:27:53 PM »
Hate to tell you this but what we currently have is ACA - Obamacare. It's not the Ryan or Trump plan.

And yeah, with the constant premium increases, with exchanges not even available in some areas, or with plans that don't cover any local hospitals or specialists, people are losing heath care. Under the ACA/Obamacare. This is before Trumpcare or Ryancare comes in. It's Obamacare that is what is presently bad and causing people to lose coverage or have totally inadequate coverage bordering on genuinely useless.

And yeah the new system will be bad too. So? The answer is singlepayer. Clinton didn't want that, Trump doesn't want that, no one wants it (exceptions: Sanders and Stein except wait Sanders supports ACA so he's part of the problem). Everyone wants a system that ensures profit and wealth for everyone connected to the medical and insurance industries with no controls on costs. So, given those constraints, we have a system. Is it going to be bad? Of course it is. And that's not Trump or Ryan's fault. That's the fault of the population wanting to live under this system.

Everyone here has senators and representatives and gets to vote. These congressmen didn't support single payer, they didn't vote for it, and they never seriously considered it. So you voted them out of office because of that? No you didn't. So the problem is in the mirror.

benali72

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Re: Health Insurance Dilemma
« Reply #20 on: May 28, 2017, 11:50:34 AM »
Hate to tell you this but what we currently have is ACA - Obamacare. It's not the Ryan or Trump plan.

Insurers rely on the cost sharing subsidies (often call the CSRs) of the ACA when making their Marketplace pledges. Since the President and Republicans have made clear they won't pay the CSRs going forward, insurers are filing 2018 Marketplace plans based on that assumption. Early information I'm receiving as someone who has supported insurance IT for many years indicates insurers are hiking rates drastically for 2018 plans based on this situation.


JoFrance

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Re: Health Insurance Dilemma
« Reply #21 on: May 28, 2017, 12:45:23 PM »
The ACA was failing before Trump even took office because it was too expensive.  Insurers kept dropping out because they were losing money.  The entire structure of the ACA was not based on a solid foundation.  Healthy people opted out and paid the penalty instead of signing up.

I don't know that single payer is any more sustainable than what we have now.  The VA has a single payer system and look at that hot mess.  Romneycare crashed and burned, Vermont wanted to do it and found it was too expensive.  CA is considering their own system, but they don't know how they will pay for it.   The biggest complaint about any government healthcare anywhere is you have to wait long periods of time for care.

I read somewhere that about 5% of the population is very sick and they drive premiums up for everyone.  If the government subsidized them and took them out of the pool, it would decrease premiums for the rest of us.  Also, for us older folks, why not expand Medicare a little bit to cover people over 55 or 60.  After 55, healthcare is very expensive.  The one-size-fits-all aspect of the ACA isn't good enough.  Different age groups have different needs.

Healthcare for everyone is a complex problem to solve.  Our problem is that our legislators have turned this into a political issue when the public just wants something that works. 

 


pxsant

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Re: Health Insurance Dilemma
« Reply #22 on: May 28, 2017, 02:24:03 PM »
The VA has a single payer system and look at that hot mess.

I assume that you mean single payer since the VA is a government department?  I seriously dispute your statement that the VA care is a "Hot Mess".
  I get my medical care from the VA and their care is as good or better than a private doctor and hospital.  Do you have any specific experience with VA care?  Whether there is any issue with VA care depends on the region you are located in and the competence of the administrators in that particular region.   Only the bad stuff gets publicity, not the good care from most VA facilities.

Code Refugee

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Re: Health Insurance Dilemma
« Reply #23 on: May 28, 2017, 03:24:49 PM »
I have a doctor friend who accepts VA patients. Accepting VA patients is optional BTW.

The reimbursement is very very low, far below what is reasonable for professional services.

VA seems to hire tens of thousands of obstructionist bureaucrats whose job is to find fault with claims.

No matter what you do there is often a problem.

For a typical hour of consultation and tests the reimbursement is around $30. To claim that $30 you will have to spend about 4-8 hours studying regulations, making calls, being on hold on the phone and filling in forms and mailing in forms and receiving faxes.

So you spend 6 hrs and get $30. You are making $5/hr, and that's before you pay taxes on it. That's a lot less than the minimum wage in all 50 states. As a doctor you spent over 10 years in school and residency and are smart enough you could have just gotten a job working for Goldman Sachs. So why didn't you? Exactly. You tell your kids "Don't be a doctor."

While I love single payer I do know that when we get it the quality of our health care will go absolutely to shit as anyone with the slightest bit of sense switches career paths.

pxsant

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Re: Health Insurance Dilemma
« Reply #24 on: May 28, 2017, 05:14:39 PM »
I have a doctor friend who accepts VA patients. Accepting VA patients is optional BTW.

You must be talking about the Veterans Choice Program where the vet may go to private physicians if they qualify based on certain specific criteria.   Basically if the vet can't get an appointment at the VA within 30 days or they are too far from a VA medical facility or they are disabled and can't travel, they may get approved to go to a private physician.

Along both coasts most veterans are not eligible because there are many VA facilities.   Even in the central region of the US there are many VA medical facilities but there the distance could come into play.   Just for info, here are the VA facilities throughout the US.  https://www.va.gov/directory/guide/allstate.asp

I personally have a VA clinic 10 minutes from my house so I am not eligible to go to a private physician and have the VA pay.    I have no idea about the compensation but just doing a Google search, it appears that physicians have a difficult time getting paid at all.   I suspect that program will go away given the problems.

The Gorn

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Re: Health Insurance Dilemma
« Reply #25 on: May 28, 2017, 05:17:00 PM »
While I love single payer I do know that when we get it the quality of our health care will go absolutely to shit as anyone with the slightest bit of sense switches career paths.

So what's the solution to our present free-market, hostage-taking, gold plated, ultra-low-value-per-dollar, Beverly Hills plastic surgeon wanna be profit margin, health care cost structure?

As far as switching career paths, everyone needs to switch career paths ASAP to the better thing they're qualified for, since everyone is being screwed by their current career choice. Not just doctors, everyone. It's unfair, I tell you.

Nah, I don't buy it. It takes a specific kind of dweeb to be interested in doctoring, and the same individual is likely not a top choice for Goldman Sachs.
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benali72

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Re: Health Insurance Dilemma
« Reply #26 on: May 29, 2017, 03:06:46 AM »
This article summarises what I've been saying about the decisions insurers are making right now for 2018 --
www.nbcnews.com/politics/congress/blame-game-driving-health-insurance-costs-n765256

Whatever the future of healthcare (hopefully much better), the powers that be have ensured that the short term looks pretty grim.

Code Refugee

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Re: Health Insurance Dilemma
« Reply #27 on: May 29, 2017, 06:49:59 AM »
You must be talking about the Veterans Choice Program where the vet may go to private physicians if they qualify based on certain specific criteria.   Basically if the vet can't get an appointment at the VA within 30 days or they are too far from a VA medical facility or they are disabled and can't travel, they may get approved to go to a private physician.

Along both coasts most veterans are not eligible because there are many VA facilities.   Even in the central region of the US there are many VA medical facilities but there the distance could come into play.   Just for info, here are the VA facilities throughout the US.  https://www.va.gov/directory/guide/allstate.asp

I personally have a VA clinic 10 minutes from my house so I am not eligible to go to a private physician and have the VA pay.    I have no idea about the compensation but just doing a Google search, it appears that physicians have a difficult time getting paid at all.   I suspect that program will go away given the problems.

That's very interesting, I didn't know about that. Come to think of it in the past when I've heard vets complaining about the VA it's generally about what they see as substandard care at VA Hospitals, sometimes which are far away. For example the neighbor who died that I've talked about often mentioned how he was having to travel a great distance and then was getting shafted or the run around when he got there. He definitely had a lot of anger about the VA as a patient.

I see on your link the closest VA Hospital is far away, but there's tons of VA Community Clinics all around including very close nearby. Not sure how that figures in to the program you mention. My friend has described the process that the VA calls him, describes a case, which usually involves a long history of failed treatments for stuff like Gulf War Syndrome or neurological problems, and asks if he'll take the patient. He has had to cap the number of patients because there's an unending number of them and they'll take up all his slots if he accepts every one. He rejects many who have any other insurance at all because he found that the VA has an infinite loop error in their bureaucratic process where if a patient has other insurance the VA won't pay until the other company has issued a written rejection letter of coverage for the specific problem, even when it's not something they normally cover at all. The problem is that even when the VA gets this letter they keep asking for it or bouncing back and forth between offices, and its never reimbursed. So he asks if they have other insurance. If they do, that other insurance always sees him as out of network and won't pay so he turns those patients down. There's still a lot, he sees many every day, and says he only does it at all at this point because he wants to help vets and he can see they are really getting screwed over. He's real patriotic and most of his family was in the military.

I'll ask him about that program next time we get together.

JoFrance

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Re: Health Insurance Dilemma
« Reply #28 on: May 29, 2017, 02:11:35 PM »
My father was a vet and he was stationed in NK in the 50's in the Navy.  He depended on the VA, which was never good even back then.  I remember going to the hospital in East Orange NJ and was appalled at the level of care there, it was run down and substandard in every way.  I was afraid to even go in there.  I remember it as a dimly lit hospital and dirty.

That facility was about 50 miles or so from our house.  It took the government years to have another facility set up in NJ in Lyons in the '80s.  That was much better, but a long time coming.  It was too late for my father though.  Back then, they didn't recognize the mental illness that comes from being in war.  I saw it in my father.  He showed me a lot of pictures of the ugliness of war when I was a kid.  I never forgot that.

That's why I criticize the VA today for not doing enough.  We should have the best for anyone that goes into the service.  They have special needs.  A lot of people, like my father, suffered with dealing with the horrors of war on their own back then.  They didn't even recognize PTSD back then.

When I look at the VA today, I think its a slap in the face to our vets that they can't get care when they need it.  Backlogs are not acceptable and that's why I call the VA a hot mess.  Also, that they tried to cover up the backlogs in some places.  Its just atrocious.

David Randolph

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Re: Health Insurance Dilemma
« Reply #29 on: May 30, 2017, 11:31:17 AM »
The best outcome for doctors and possibly us as patients is when the doctor stops accepting insurance. Either you pay or go elsewhere.
In some cases, the costs are lower than if you had insurance. In other cases, the doctor is looking for the rich people who want premium care.
When the medical office does full "capitation", they drive costs down fast.