Can I Say I Told You So?

[SPK145]

I wish it was from a more reliable source than the NY Times but:

Unable to Meet the Deductible or the DoctorBy ROBERT PEAR OCT. 17, 2014



Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.


But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year's brain scan and hoping for the best.

This post was edited on 10/18 10:30 AM by SPK145

Unable To Meet The Deductible

 

[HALL85]

We all knew the ACA was never meant to fix our healthcare system. It's wealth redistribution and nothing more.

 

[Section112]

My bro in law is a Gastrointerologist and he has lots of patients that are now foregoing their colonoscopies because of their higher deductibles in paying for both the procedure and the hospital.

 

[shu09]

Originally posted by Section112:
My bro in law is a Gastrointerologist and he has lots of patients that are now foregoing their colonoscopies because of their higher deductibles in paying for both the procedure and the hospital.

That isn't considered preventative care (which is supposed to be free)? Doesn't seem right to me.

 

[SPK145]

Originally posted by shu09:

Originally posted by Section112:
My bro in law is a Gastrointerologist and he has lots of patients that are now foregoing their colonoscopies because of their higher deductibles in paying for both the procedure and the hospital.

That isn't considered preventative care (which is supposed to be free)? Doesn't seem right to me.

Colonoscopies are preventative and therefore there can't be any sharing of costs, all paid by insurance. Just researched this as the Mrs. had one this past Thursday.

 

[Merge]

That article infuriates me. What did that woman do in 2012 and 2013? How much would the MRI cost after her insurance negotiated rate? Did she ask the hospital if they would offer a payment plan?

The girl with the ear infection could have gone to a minute clinic at cvs as would have paid maybe $100 with an Rx in hand.
Insurance is expensive and deductibles are difficult. Is it worse today than before the ACA? No, we just have A magnifying glass on the issue.

 

[HALL85]

The ACA created complicated solutions to a complex business and what you're seeing is how the insurance industry has taken advantage of the solution. Did anyone really think the public was going to win the cost shift game? Merge you're right about the woman that could have gotten cheaper care at the minute clinic but that's not the responsible American way that this country was known. Everyone wants cheaper but doesn't want to change or is too dumb to know their options. I work with hospital execs every day and they will tell you what a piece of garbage this legislation has been. It's confusing to them and they are administering it. They are also fed up with both parties and they're obstinate stances.

They are not addressing the real issues around cost, quality and even access. If you think the ACA guarantees reasonable access guess again. Look up the terms "Concierge Medicine" or "Retainer Based Medicine". Those that can pay get to the front of the line. Those that can't will have to make appointments three months out for wellness visits. Rationing of care due to the current and anticipated greater shortages of physicians. What good is free care if you can't get in to see your GP?

 

[SPK145]

Originally posted by HALL85:

What good is free care if you can't get in to see your GP?

As the hilarious PJ O'Rourke famously said "If you think healthcare is expensive now, wait until it's free!!!"

GP's do not make very much money BTW. Have a few GP's as clients and I am shocked at what they make. Got to get them in and get them out.

 

[HALL85]

I don't know why someone would choose a career as a GP these days. 12 years of school, huge loans to pay off, exhorbatent malpractice insurance for $140,000/year. This is why the shortage will get worse. General medicine is not attractive to the best and brightest. Also why most GP's will be employed by hospitals by 2020.

 

[Old_alum]

The kids and grandkids of friends who once would have been become MDs are now turning to dentistry or finance instead.

On Malpractice: As a doable small step, I would make any punitive-damages (above compensatory damages) payable only to the state and not subject to lawyers sharing therein.

I had earlier reported how an in-law was turned down for heart work because she was ''too old''.

Only two more years but will we last?

 

[donnie_baseball]

Originally posted by Merge:

The girl with the ear infection could have gone to a minute clinic at cvs as would have paid maybe $100 with an Rx in hand.
Insurance is expensive and deductibles are difficult. Is it worse today than before the ACA? No, we just have A magnifying glass on the issue.

$100 to see a nurse practitioner for five minutes? Great deal.

To answer your question: unequivocally yes. Why shouldn't there be a magnifying glass on this issue? This was going to be the crowning achievement of Obama's tenure (and still is, for the pathetic BHO apologists). I certainly started watching more critically when Nancy Pelosi issued the edict to "just sign it."


This post was edited on 10/21 8:51 AM by donnie_baseball

 

[HALL85]

Originally posted by donnie_baseball:

Originally posted by Merge:

Insurance is expensive and deductibles are difficult. Is it worse today than before the ACA? No, we just have A magnifying glass on the issue.



It is worse. No doubt about it. Our rates with insurers for 1,100 employees went up 8% this year along with increases in deductables across the board.

 

[Section112]

I can tell you my small business rates are still increasing rapidly. Very little choice as well. ACA sucks the big one.

And to clarify my statement above my bro-in-law said people aren't getting procedures done like they used to due to the higher deductibles. I'm no expert but I had to have a procedure after my colonoscopy and it ended up costing $2,200 out of pocket for the stuff not covered (all in plan too) and deductibles and it was a same day 45 min procedure. That is with insurance costing $1800+ per month for my family. Many folks cannot afford that. And speaking of aholes, it's gonna get worse before these aholes fix anything.

 

[Pirate6711]

The biggest issue is that the ACA doesn't address the root cause of the rapidly rising costs of healthcare. The politicians who oppose the ACA also don't address those costs. Until those costs are addressed, prices will continue to rise, regardless of how the coverage is presented. The insurance, medical, pharma, and other associated lobbies will make sure that costs are not controlled and politicians from both sides of the aisle will gladly listen to them over their constituents.

 

[shu09]

I tend to agree with Pirate6711.

IMO, the main problems with the healthcare system in this country are for-profit insurance companies, big pharma and hospitals that charge outrageous prices for often simple procedures.

To me, it is borderline criminal that people like Section112 have to pay thousands of dollars a month for insurance, only to have a procedure not be covered and then shell out a couple thousand more. What is the insurance for then? The problem is greedy, for-profit insurance companies. Until we get rid of companies who make money off of sick people, healthcare in this country will never be affordable. If I had it my way, healthcare would be 100% guaranteed for all and every insurance company would cease to exist. In a nation such as ours, with so much medical talent and wealth, no person should have to pay thousands of dollars a year (some going bankrupt) for medical care. It should be guaranteed.
This post was edited on 10/21 9:47 PM by shu09

 

[SPK145]

Originally posted by shu09:

Until we get rid of companies who make money off of sick people, healthcare in this country will never be affordable.

Where would innovation come from and the ability to bring said innovation to the masses? The profit motive is the engine that drives that bus. Socialism certainly hasn't and won't do that.

 

[HALL85]

Without any insurance how exactly would you guarantee any and all healthcare to everyone. That would likely cost more than the current system. Don't get me wrong...the system needs major reform. The ACA has just made it worse.

 

[shu09]

Originally posted by HALL85:
Without any insurance how exactly would you guarantee any and all healthcare to everyone. That would likely cost more than the current system. Don't get me wrong...the system needs major reform. The ACA has just made it worse.

I'd have a third-party non-profit agency coordinate all of the healthcare coverage in this nation. People would pay an affordable premium to get into the system and it would also be subsidized by the government. When people go to a doctor, they will pay a co-pay depending on the type of visit (primary care, specialist, ER, or extended hospital stay). All other costs will be covered by the agency so the citizen does not pay another dime, outside of the annual premium and co-pay for the procedure. The process would be the same whether you break your leg, have surgery, or have an extended hospital stay. Costs would be capped so that the doctors make enough money to make a good living, but not where it runs the system bankrupt.

Unfortunately, this could never happen until the government gets its spending under control, which we all know won't happen.

 

[Merge]

Originally posted by donnie_baseball:

$100 to see a nurse practitioner for five minutes? Great deal.

To answer your question: unequivocally yes. Why shouldn't there be a magnifying glass on this issue? This was going to be the crowning achievement of Obama's tenure (and still is, for the pathetic BHO apologists). I certainly started watching more critically when Nancy Pelosi issued the edict to "just sign it."


This post was edited on 10/21 8:51 AM by donnie_baseball

I changed my primary care physician about 8 years ago because I kept seeing nurse practitioners.
Not that they are useless but sometimes you need to speak to a PHD.

For some things though that are easy to diagnose ( like ear infections as noted in the article or a strep strip test) a doc in the box... minute clinic or whatever is a great option that reduces cost as well as over crowding of a primary care office.

 

[Merge]

Originally posted by HALL85:

Originally posted by donnie_baseball:

Originally posted by Merge:

Insurance is expensive and deductibles are difficult. Is it worse today than before the ACA? No, we just have A magnifying glass on the issue.



It is worse. No doubt about it. Our rates with insurers for 1,100 employees went up 8% this year along with increases in deductables across the board.

and... Is 8% unusual? In the 8 years before Obama took office the average premium for an employer sponsored family plan was increasing about 9% per year.

See page 28.

http://files.kff.org/attachment/2014-employer-health-benefits-survey-full-report

 

[HALL85]

Merge, it was 8% AND the deductibles increased. That never happened before.

 

[Merge]

Originally posted by HALL85:
Merge, it was 8% AND the deductibles increased. That never happened before.

See that same link that I provided starting on page 136.
There has been a trend of increased deductibles and an increase of plans which have a deductible which started before Obama took office.

The average premium increase for employers with more than 200 employees increased more than 11% per year from 2000-2004.

The average premium increase from 2010 to 2014 has been less than 5%.

Premium increases, increased deductibles and reduction of benefits was all happening prior to the ACA.

 

[HALL85]

Originally posted by Merge:

Originally posted by HALL85:
Merge, it was 8% AND the deductibles increased. That never happened before.

Premium increases, increased deductibles and reduction of benefits was all happening prior to the ACA.

Deductibles have never increased at the rate they have over the past two years.

 

[HALL85]

Originally posted by shu09:

Originally posted by HALL85:
Without any insurance how exactly would you guarantee any and all healthcare to everyone. That would likely cost more than the current system. Don't get me wrong...the system needs major reform. The ACA has just made it worse.

I'd have a third-party non-profit agency coordinate all of the healthcare coverage in this nation. People would pay an affordable premium to get into the system and it would also be subsidized by the government. When people go to a doctor, they will pay a co-pay depending on the type of visit (primary care, specialist, ER, or extended hospital stay). All other costs will be covered by the agency so the citizen does not pay another dime, outside of the annual premium and co-pay for the procedure. The process would be the same whether you break your leg, have surgery, or have an extended hospital stay. Costs would be capped so that the doctors make enough money to make a good living, but not where it runs the system bankrupt.

Unfortunately, this could never happen until the government gets its spending under control, which we all know won't happen.

That's a noble plan, but who is the third-party non-profit agency that is going to do that? Most of those greedy hospitals you mentioned earlier are all "non-profits" that are building some of the most expensive offices to house their executives. The federal government? Just look at the VA fiasco and history of rampant Medicare fraud...do you really having Washington run the agency will ensure cost containment? When has any Federal agency accomplished that? Finally, who determines how much a doctor can make to "make a good living"....sounds Socialist to me.

System needs fixing and the key IMO is to simplify it and get government out of the delivery of healthcare. It's only adding yet another layer of cost which is driving the price to consumers up.

 

[donnie_baseball]

Originally posted by shu09:

Originally posted by HALL85:
Without any insurance how exactly would you guarantee any and all healthcare to everyone. That would likely cost more than the current system. Don't get me wrong...the system needs major reform. The ACA has just made it worse.

I'd have a third-party non-profit agency coordinate all of the healthcare coverage in this nation. People would pay an affordable premium to get into the system and it would also be subsidized by the government. When people go to a doctor, they will pay a co-pay depending on the type of visit (primary care, specialist, ER, or extended hospital stay). All other costs will be covered by the agency so the citizen does not pay another dime, outside of the annual premium and co-pay for the procedure. The process would be the same whether you break your leg, have surgery, or have an extended hospital stay. Costs would be capped so that the doctors make enough money to make a good living, but not where it runs the system bankrupt.

Unfortunately, this could never happen until the government gets its spending under control, which we all know won't happen.

Neat make-believe world. What "non-profit" is going to take on that Herculean task, and then "cover...all other costs?" What is the premium based on? Ability to pay? Risk status? And what would the co-pay(s) be? Capping costs cuts out half of your specialists, who would walk away from the system, and you'd be left with the best of the worst. In the end, it will fall back to a pay-to-play system.

Health insurance needs to be regulated on a state-to-state basis, like auto insurance; those of us who have been around long enough can actually appreciate that NJ has finally gotten a handle on that.

 

[SPK145]

Originally posted by shu09:

Until we get rid of companies who make money off of sick people, healthcare in this country will never be affordable.

What about those greedy, profit-seeking pharmaceutical companies? What about those greedy, profit-seeking medical device companies? What about those greedy, profit-seeking medical diagnostic companies?

Why did you single out insurance companies?

Get rid of them all and what do you have?

 

[SPK145]

Originally posted by shu09:

I'd have a third-party non-profit agency coordinate all of the healthcare coverage in this nation. People would pay an affordable premium to get into the system and it would also be subsidized by the government.

So pay a premium and also pay to subsidize as there is no government subsidy as it has no money of its own, only what it can confiscate from others.

Why would you limit this to healthcare coverage? People have to eat, people have to have clothes, people have to have shelter.

Isn't that communism? And has it ever worked anywhere before?

 

[Merge]

Originally posted by HALL85:

Deductibles have never increased at the rate they have over the past two years.

Maybe the $ amount but the average deductible per policy increased 34% in 2 years between 2007 and 2009. I doubt we have seen the same % increase in the last 2 years.

2006-2007 is when we had the shift to increase deductibles instead of continuing 10% + per year premium increases to closer to 5%.

Tying that shift to the ACA just doesn't appear to stand up when looking back at the last 10 years.

 

[Section112]

Merge I can tell you our small business copay went from $30 to $50 to now $75 in the last two years. I'd have to look at the deductibles but those went up too.

So you can't measure straight premium increases and say its better because there are many other factors involved.

I must congratulate you though. You and maybe one other senator might be the only ones that actually read the ACA.

 

[Merge]

Originally posted by Section112:
Merge I can tell you our small business copay went from $30 to $50 to now $75 in the last two years. I'd have to look at the deductibles but those went up too.

So you can't measure straight premium increases and say its better because there are many other factors involved.

I must congratulate you though. You and maybe one other senator might be the only ones that actually read the ACA.

Absolutely, I agree. All I am saying is that these trends of rising costs and increasing premiums started well before the ACA.

To keep premiums from having 10%+ increases every year(like in the early 2000's) we are seeing higher deductibles and higher copays. If we look at trend lines of the last 15 years of premiums, deductibles and copays the changes since the implementation of the ACA would not be statistically significant.

fwiw, I have always been in favor of higher copays. It discourages overuse and promotes a healthier lifestyle since people are more afraid at the costs associated with getting sick... though I don't want the costs to be so high that people avoid getting the care when they really need it.


This post was edited on 10/22 3:59 PM by Merge

 

[HALL85]

The statistical data that is being collected still does not reflect the most recent years and we've not seen the overall impact of the ACA. Early returns (at least on the granular level-seeing how rates have increased in the company examples that have been shared) are showing that the overall cost born by the consumer is much higher.

The other interesting thing I find is that the rhetoric from BO was that the ACA was supposed to attack healthcare at the heart of the big, bad insurance industry, yet that sector has performed at a record pace from a profit and stock price standpoint since the implementation of ACA. For-profit hospital chains have also done extremely well. So who got punished???

 

[shu09]

Donnie, my auto insurance has gone up every single year. I've never had an accident and never had a ticket in 10 years of driving. That makes no sense. My rates should be going down because I've proven to be a low risk driver.

 

[shu09]

Originally posted by SPK145:

Originally posted by shu09:

Until we get rid of companies who make money off of sick people, healthcare in this country will never be affordable.

What about those greedy, profit-seeking pharmaceutical companies? What about those greedy, profit-seeking medical device companies? What about those greedy, profit-seeking medical diagnostic companies?

Why did you single out insurance companies?

Get rid of them all and what do you have?

You're right, they also share blame. I mentioned big pharma in my post.

 

[Old_alum]

I am no expert in health care or in insurance.

That said, you get what you pay for, as long as the consumer is paying.

Let's face it, labor in the US in general is way higher than the ROW. And the highly educated medical pros have (or had) been near the top.

Also, technology is expensive. Want a high-tech diagnosis and a miracle cure? Then you need R&D. Without profit incentive no one will spend on R&D!

Other countries medical costs are lower for many reasons but they now can still get miracle cures ONLY IF the US is doing the R&D. Take away the profit incentive and the whole world loses.

In every instance, history has shown that a free market is the only effective and efficient way to allocate resources.

You get what you pay for, as long as the consumer is paying. In that way, people order only what they really need. When health care seems to be "free" then everyone wants the best of "everything".

That said, catastrophic-medical is a big problem. ALL health insurance companies should pay into one catastrophic-medical "wholesale insurance pool", so that when the roulette wheel stops, it does not bankrupt the unlucky last insurer of record.

A VERY big problem is the last year of life. What percentage is it? 30% 40% 50% of total??

IMHO a part of this is doctors and hospitals doing "all they can" in fear of malpractice suits. I had an in-law who passed away hours before the hospital staff stopped treating him because they could not reach the next-of-kin and were afraid of being sued.

I am not for BO's death squads who refuse every procedure to the old. But insurance should offer options on most every procedure with proportionate co-pays so that the family can "get by" but still pay a fair share for extreme measures.

As an aside, IMHO most insurance companies should be mutual companies.

In any event, the government has ALWAYS been the least efficient and least effective provider of anything. The government does not trust professional judgment so they have amateurs try to anticipate EVERY possible outcome and then legislatures mandate every step that must and may be taken and these are the ONLY ones they will pay for---even if no one actually reads said legislation.

 

[donnie_baseball]

Originally posted by SPK145:

Originally posted by shu09:

I'd have a third-party non-profit agency coordinate all of the healthcare coverage in this nation. People would pay an affordable premium to get into the system and it would also be subsidized by the government.

So pay a premium and also pay to subsidize as there is no government subsidy as it has no money of its own, only what it can confiscate from others.

Why would you limit this to healthcare coverage? People have to eat, people have to have clothes, people have to have shelter.

Isn't that communism? And has it ever worked anywhere before?

LOL. Perfect.

"The government" should just pay for all the necessities of life.

Merge mentions incentivizing people to not use the system by raising copays. In theory, that should be true, and for reasonable people like you and I, absolutely. Having been in the business for 15 years now, I can tell you that it's not reality.

Maybe I'm becoming callous in my old age (but my car insurance is really cheap), but the average idiot is still just that. I spend some time in a clinic, once a week, and all of the patients are SSDI, Medicaid, or Charity Care. Just about everyone there is incurable -- many because they don't want to be. Everyone has a mystery illness/pain, and all the free consults, MRI's, courses of therapy just can't fix them. Come spend a day or two in this clinic, and see what medicine on the front line is about. And this is in the suburbs of NJ!

 

[Merge]

Originally posted by Old_alum:

I am not for BO's death squads who refuse every procedure to the old.

That is not a real thing and has been debunked MANY times, even by me on this board to one of your previous posts.

 

[Merge]

Originally posted by donnie_baseball:

Merge mentions incentivizing people to not use the system by raising copays. In theory, that should be true, and for reasonable people like you and I, absolutely. Having been in the business for 15 years now, I can tell you that it's not reality.

Obviously I don't know what you have seen in your career but I have ready several studies that suggest otherwise.

Copays go up - Usage goes down. That was even the point of the article posted.

http://www.cbpp.org/cms/index.cfm?fa=view&id=1398

http://www.cfah.org/hbns/2012/even-small-increases-in-copays-affect-use-of-childrens-healthcare

http://www.namcp.org/journals/jmcm/articles/13-1/copayment.pdf

If you are concerned with price, you should love the trends of copays and deductibles.

 

[donnie_baseball]

Originally posted by Merge:

Originally posted by donnie_baseball:

Merge mentions incentivizing people to not use the system by raising copays. In theory, that should be true, and for reasonable people like you and I, absolutely. Having been in the business for 15 years now, I can tell you that it's not reality.

Obviously I don't know what you have seen in your career but I have ready several studies that suggest otherwise.

Copays go up - Usage goes down. That was even the point of the article posted.

http://www.cbpp.org/cms/index.cfm?fa=view&id=1398

http://www.cfah.org/hbns/2012/even-small-increases-in-copays-affect-use-of-childrens-healthcare

http://www.namcp.org/journals/jmcm/articles/13-1/copayment.pdf

If you are concerned with price, you should love the trends of copays and deductibles.

None of those studies are 15 years, longitudinal, and ongoing, so yeah, I'm going to go with what I know.

 

[Merge]

Donnie, you can't just ignore the data. The first link was testing what was found in the RAND study on cost sharing.

http://www.rand.org/content/dam/rand/pubs/reprints/2005/RP1114.pdf

And pretty much every study I have seen suggests the same thing.

 

[Old_alum]

Originally posted by Merge:

Originally posted by Old_alum:

I am not for BO's death squads who refuse every procedure to the old.

That is not a real thing and has been debunked MANY times, even by me on this board to one of your previous posts.

Tell that to my in-laws!

I don't care what you call them, under ACA physicians are discouraged from providing expensive care to citizens of a certain age.