Speaking of ACA

[ziggy29]

Clearly we can't afford an unlimited, all-you-can-eat system without any incremental cost to anyone.

And just as clearly, IMO, I can't morally justify a system where people can die, or get a lot more sick than need be, because they lack basic coverage or, even if they have insurance, have a deductible so high that going to the doctor would pose a significant financial hardship.

So there are a couple of "limit lines", so to speak. We can't afford the former of these two statements, and a compassionate and affluent society needs to be better than the latter. At that point, the debate, so to speak, is coloring within those lines.

 

[Breedlove]

This is a highly political string and should be cancelled or deleted .

 

[MichaelB]

It is never that simple. I do not have an answer, and just tried to raise the point.

Same here. We agree.

 

[MichaelB]

This is a highly political string and should be cancelled or deleted .

To me it looks like a civil conversation among respectful forum members.

 

[NW-Bound]

For lack of better things to do while hiding from the outdoor heat, I spent a bit of time reading about Germany healthcare system.

Why Germany? Because as Wikipedia says, "Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek almost any type of care they wish whenever they want it".

Also, "Germany has the world's oldest national social health insurance system, with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889."

But I found something a bit disturbing to me.

Insurers have to accept people with income below 60750€ per year, who pay a premium of 7.3-8.3% of their income but with a cap at about 400€ a month. The employers pay another 7.3%. This is "compulsive insurance".

If you make more than the above threshold, or if you are a freelancer, or if you have a "minijob", plus some other categories, then you have "voluntary insurance". It is not really voluntary on your part, because everyone must have insurance. Rather, the insurers can refuse you, or demand underwriting, and raise premium based on existing conditions.

The "voluntary" or private insurance is really cheap for young persons even when they get no employer matching, but becomes more expensive when people get older. And when they get to 55 when the premium gets to about 1500€/month, it is said that going back to compulsive insurance is virtually impossible.

Hey, no "minijob" means no goofing off. No ER. You are deadmeat. It appears that to fit in the system, you have to do your part, meaning pay more as you are young and healthy so that you can get subsidized when you are old. And work till your retirement age. No cheating allowed!


PS. Readers of this forum will remember what FIREd said about trying to get health insurance in France when he moved back from the US. There was no such thing as ER in France, so he had to create a "minijob" to qualify. It seems the same here with Germany.

I could not help smiling when I realized that if I were not in the US, I would be working my butt off right now instead of doing ER and studying healthcare systems in other countries.

 

[jimandthom]

A lot of the problem with lifetime caps is not because of the craziness that can happen with end of life care, but the start.

Imagine having a child who is born with a defect, that's fixed in surgeries and premie care, who finally leaves hospital at say 3 months old... and they've already burned off their lifetime cap?

I was the recipient of a surgical error decades ago that left my insurance covering above $300k. So, before 30, having burned off a quarter of my cap, wasn't a fun prospect. I always looked for employer plans with providers that didn't have a cap. I'm personally glad they all have to, now.

Obviously anecdotes shouldn't drive policy, but there is something to envy in the idea that, in some countries, no one has to ever worry that a catastrophic illness could result in financial devastation.

This is a coworker/child at my last employer. If you count the 4ish months mom was in the hospital prior to birth and the 6 months the baby was in neonatal care, isolation, IC the whole nine yards, it was 9-10 months in the hospital. Now add in the last 5 years or so of Drs., surgeries, special assistance etc.

Mom relayed the conversation she had in the ER the night her waterbrok/started into labor at around 4-5 months. She was told, that it was a good thing she had such good insurance. For the underinsured, she was told, they would have stopped the labor then sent them home.

 

[Rianne]

I mentioned this case awhile ago regarding bankruptcy b/c of HC costs.
Parishioners in my church-before ACA

Wife, Phd, MD taught graduated med students at university. Great HI.
Husband, MD, had his own practice, very popular, many patients.
4 children, first 3 very healthy active kids.
Last child had rare illness. I think you know where I'm going here.
After years of struggle, adorable little boy, so loved in the community, passed.
Parents way over $1M limit, bankruptcy.
Wife quit teaching and let medical license lapse due to depression.
I do not know their present day situation. Community had numerous fund raising activities, did not come close to saving their financial situation.


I lost my religion after moving back to Illinois.

 

[NW-Bound]

Modern medicine is wonderful, but can also be a curse.

In the old days there was no cure for some diseases, hence healthcare costs stayed low.

Now, if there are some iffy treatments for a disease, if I am among the afflicted of course I will want it, even if the chance is slim.

How do we decide when a treatment is worthwhile, and when the money is better spent elsewhere?

It's not easy. I am sure other countries grapple with this dilemma too. They all try to contain healthcare costs.

 

[CardsFan]

For lack of better things to do while hiding from the outdoor heat, I spent a bit of time reading about Germany healthcare system....

15 or 20 years ago I was working on project in Israel, and stayed in a hotel on the Dead Sea. I noticed there were quite a few Germans staying there and swimming in the Dead Sea. Come to find out the German Health Care system was paying for this as therapy for skin conditions.

 

[joeea]

Modern medicine is wonderful, but can also be a curse.

In the old days there was no cure for some diseases, hence healthcare costs stayed low.

I hope this isn't meant as some sort of argument for "the [good?] old days"?

 

[NW-Bound]

^^^ I did not say the old days were good.

But they were certainly simpler. You get sick, you die.

My paternal grandparents whom I never knew died of simple dysentery during WWII, leaving my father alone to fend for himself at the age of 17.

And I was told that from first having symptom to death was just a couple of days for them. Zero healthcare cost.

PS. My late father also told me of how his older brother died. A tree fell on him while he was clearing the farmland, breaking a leg. He died.

PPS. I recently watched an old French movie set in WWII: "Forbidden Games". A peasant's eldest son got kicked by a horse. After he died in bed a couple of days later, his mother cried and said she should have given him some castor oil. The peasant scolded his wife, saying that it would not help. The wife said "but that would not hurt either".

 

[zinger1457]

15 or 20 years ago I was working on project in Israel, and stayed in a hotel on the Dead Sea. I noticed there were quite a few Germans staying there and swimming in the Dead Sea. Come to find out the German Health Care system was paying for this as therapy for skin conditions.

And they spend only about half of what we (US) do on healthcare.

 

[ShokWaveRider]

Just a little anecdote I just experienced today with our health care availability here in NEFLA.

I just got back from visiting an Imaging Center, Blood Testing Facility and Dermatology Office.

The Objective was to only book appointments not get any service. I prefer to do this in person on nice days as it is an excuse to ride the bike around, all are within 3 miles of our home. Each facility had appointments on the same day, either immediately in one case or later today.

The Imaging Center appointment was for me to get a CT Scan and Ultrasound.

Blood Testing was for Regular testing

Dermatology was for our annual checkup.

I had to explain that I only wanted to make an appointment at this time and give them our new Healthcare info, this is the first trip this year. All appointments were made and confirmed for Friday this week.

DW is on a highly subsidized ACA plan with Florida Blue, I have Medicare with an AARP Plan G.

 

[jimandthom]

Modern medicine is wonderful, but can also be a curse.

In the old days there was no cure for some diseases, hence healthcare costs stayed low.

Now, if there are some iffy treatments for a disease, if I am among the afflicted of course I will want it, even if the chance is slim.

How do we decide when a treatment is worthwhile, and when the money is better spent elsewhere?

It's not easy. I am sure other countries grapple with this dilemma too. They all try to contain healthcare costs.

Great points.

Should a 5 year old child, whose family is on the dole, receive the same treatment as a 5 year old child whose family make 300K per year? I personally think yes.

Not necessarily saying that the child should go to Mayo clinic but should at least be given the same level of care within the same hospital as the one whose family has the best insurance and extra dollars would receive at the same facility.

 

[samclem]

Bold is mine:

Should a 5 year old child, whose family is on the dole, receive the same treatment as a 5 year old child whose family make 300K per year? I personally think yes.

Not necessarily saying that the child should go to Mayo clinic but should at least be given the same level of care within the same hospital as the one whose family has the best insurance and extra dollars would receive at the same facility.

I understand the sentiment. But the passive voice in bold may be helping us to avoid considering very important issues: Who has the assets needed to make this possible, who decides if the assets will be used for this, and what other opportunities are lost if the assets are used for this care?


We don't have to (and can't) answer these questions here, but these questions (and other like them) need to be grappled with to ultimately develop (or evolve, stumble into) a system that is in accordance with our values (individually, and as a society).

 

[joeea]

But they were certainly simpler. You get sick, you die.

Even simpler - sometimes you die and you weren't even sick.

My paternal grandparents whom I never knew died of simple dysentery during WWII, leaving my father alone to fend for himself at the age of 17.

And I was told that from first having symptom to death was just a couple of days for them. Zero healthcare cost.

Yup, that was indeed simple as far as your grandparent. Not so simple for your father.

PS. My late father also told me of how his older brother died. A tree fell on him while he was clearing the farmland, breaking a leg. He died.

Even simpler!

If simpler is what you want, the old days were often better, but not always.

My uncle was a victim of polio as a child. He lived, but was physically handicapped his entire adult life. I don't think he felt that was simple.

 

[NW-Bound]

Great points.

Should a 5 year old child, whose family is on the dole, receive the same treatment as a 5 year old child whose family make 300K per year? I personally think yes.

Not necessarily saying that the child should go to Mayo clinic but should at least be given the same level of care within the same hospital as the one whose family has the best insurance and extra dollars would receive at the same facility.

From what I read, the above is not guaranteed, even in countries like Germany.

Germany allows certain people, mostly high income types, to chose "voluntary" insurance over "compulsory" insurance. With voluntary private insurance, there's underwriting and the premium gets very high for older people, typically 1500 euros/month for a 55-year-old, and there's also high deductible. If you have preexisting conditions, the premium will be higher, and the deductible will also be higher. And the insurance may not accept you at all. And you cannot go back to compulsory insurance for the masses when you are old. That's cheating.

In exchange for paying more for "voluntary" insurance, you can get more experimental treatments. And you get better service. Basically, you pay more to get more.

Back to my joke earlier that some may consider to be in poor taste, RobbieB has to pay extra to get caviar and wagyu beef, something that most people do not want to pay. Or they can afford it, but have to forego vacations, or rather drive a fancier car. There's some freedom of choice, even in Germany universal healthcare.

 

[NW-Bound]

... If simpler is what you want, the old days were often better, but not always...

I did not say I want simple either. I myself would be dead already, if modern medical care were so simple.

But because it is more complicated now, we have the dilemma we now have to solve. Namely, how to pay for all this complication.

I am just leery of people who have a "simple" solution to this complex problem. And reading about how other nations deal with it has opened my eyes.

15 or 20 years ago I was working on project in Israel, and stayed in a hotel on the Dead Sea. I noticed there were quite a few Germans staying there and swimming in the Dead Sea. Come to find out the German Health Care system was paying for this as therapy for skin conditions.

Maybe they were covered by a fancy "Voluntary" insurance plan, and not the "Compulsory" plan for the masses?

Or it could be cheaper than some even more expensive treatments we have here in the US?

Or it could be a pilot program to see if it can cure the eczema or psoriasis that is impossible to treat because we still do not understand, let alone having a cure?

 

[BeachOrCity]

I know Germans get massages as part of their healthcare!

 

[NW-Bound]

It is probably cheaper and more helpful than all the fancy new drugs Americans spend money on.

 

[LimaPop]

I have had very good luck with health sharing; it's not for everyone but I do wish more people look seriously at this option. I also use a DPC with a local doctor to take care of the routine and small stuff. I am very pleased and don't have the high ACA costs and deductibles. I tend to front the money instead of having the providers bill directly, I like understanding what services I'm getting and how much they cost. I suspect if I could protect my income and get an ACA subsidy I would revisit.

 

[joeea]

But because it is more complicated now, we have the dilemma we now have to solve. Namely, how to pay for all this complication.

Sorry, but "more complicated" and "how to pay for it" aren't connected.

It was difficult to pay for simpler care back in "the old days". Sometimes people did without care. Sometimes they suffered. Sometimes they died.

I am just leery of people who have a "simple" solution to this complex problem. And reading about how other nations deal with it has opened my eyes.

I agree on both counts!

 

[NW-Bound]

A friend of mine who is 10 year my senior used to tell me how things were simpler when he grew up. His father was a milkman, back when they still delivered jugs of milk to people's doorsteps in the morning. His family had no insurance, the same as most Americans then. My friend said that when he and his siblings were sick, his father took him to the doctor and paid with cash. That was it.

When I first heard his story, I nodded that, indeed things were a lot simpler then. Well, there was no cure for cancer or any fancy surgery, so you just died if you were among the unlucky ones, and that was that. Simpler stuff that was available, people just paid out of pocket.

Before I forgot, my friend also talked about how his father paid for child delivery for his younger sister. The hospital had an installment program, and his father paid it in a year or two.

And though I was 10 years younger, it was the same with my family, although we were not in the US. There was no million-dollar treatment, so there was not a lot of chance to bankrupt yourself seeking treatment.

And that was what I meant by saying things were simpler, the same way there were no computers, Internet, smartphones for people to spend money on. You had a radio, not even a BW TV, and that was it.

 

[jimandthom]

Bold is mine:




I understand the sentiment. But the passive voice in bold may be helping us to avoid considering very important issues: Who has the assets needed to make this possible, who decides if the assets will be used for this, and what other opportunities are lost if the assets are used for this care?


We don't have to (and can't) answer these questions here, but these questions (and other like them) need to be grappled with to ultimately develop (or evolve, stumble into) a system that is in accordance with our values (individually, and as a society).

Mostly because the civil tone this thread has taken, could end and Porky show up.

should the child receive the same care---- in a perfect world yes---- in our world, hopefully they can receive the previous level of top rated care.

Massage is a wonderful thing.

 

[NW-Bound]

Qualitatively, most people would agree that spending $1M to save a newborn is more worthwhile than spending the same to extend the life of a 70-year-old by 1 year? Heck, even a 40-year-old for that matter.

But how do we set a formula? What if the chance of saving the baby is only 5%, but the chance of 1 more year of life for the geezer is 95%?

Qualitatively, things are simple. Quantitatively, many things become very difficult.

And, even without data, I would bet that cases involving $1M babies are fewer than $1M or $500K geezers.