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Old 11-11-2013, 01:25 PM   #21
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When faced with myriad choices, whether it be clothes shopping, insurance shopping or anything else, I try to keep in mind the old adage that "perfect is the enemy of good enough". The young wife does not agree -- that's why she spends an hour looking for a new shirt at the department store and I spend five minutes.
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Old 11-11-2013, 01:28 PM   #22
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I just do not think healthcare should be compared with buying a car, TV, or other item, or even other insurance policies for that matter.

We ALL need and MUST HAVE it (No Option) at some point. I believe we just make it more complicated than it needs to be. 1 (One, OK 2 for those who MUST choose) Options for all would work just fine. I do not consider myself stupid (Although I was stupid enough to attend Uni for 6 years to get a masters degree that I rarely actually used in the real world), but I digress.

The high majority of folk are not that smart (Despite what we keep telling ourselves), I cannot imagine the problems (Web site Aside) they are having choosing a plan. I would not mind betting that most give up and solicit help of some sort to make the decision. I see more of a requirement for ACA store outlets to help the masses especially those over 55 (Again at a cost). Money that could be better spend on actual healthcare.

My point with the car analogy was to point out that what some of what you are describing as 'choices' are more like a choice of color as opposed to the make of the car....

I think that there are 4 providers in my county.... all do not provide every metal level.... there are a good number of bronze plans, but not a great many.... so first I would narrow it down to see if my docs take them (yes, I do want to keep my docs).... So if United Health does not have him, ALL of their choices are out... now look at BCBS, Humana and I believe Aetna...

Once I determine which ones have my docs, that probably has more than cut in half my choices... now I want to determine medal levels.... than go on to the deductibles etc...

I know there are a good number of BCBS that look pretty similar, but have a few tweeks here and there.... but the network is the same and the basics in the plans are the same....


And I will ask, why is this any different than any other purchase you make I just do not get it when people want to be told what is good for them and have one or two choices.... to me, that is not a choice...
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Old 11-11-2013, 01:42 PM   #23
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I just do not get it when people want to be told what is good for them and have one or two choices.... to me, that is not a choice...
This is actually my point. I feel everyone should get the same GOOD basic healthcare as anyone else regardless of income at the same costs. Then be able to choose a supplemental plan (or not) for items that they feel they need as extras such as private hospital rooms etc. But the BASICS to prevent personal bankruptcy and emergency room GP doctoring. (Which ends up effecting us all).

I guess I have just described Medicare for all.
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Old 11-11-2013, 01:48 PM   #24
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I just do not think healthcare should be compared with buying a car, TV, or other item, or even other insurance policies for that matter.
Not to pick on ShokWaveRider, but one of my pet peeves is that people conflate healthcare with healthcare insurance.

Healthcare is getting a flu shot, having surgery, or getting an MRI. Insurance is how we pay for it in some cases.

Shopping for healthcare insurance is a very different experience from shipping for a doctor or hospital or other healthcare provider.
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Old 11-11-2013, 02:17 PM   #25
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This is actually my point. I feel everyone should get the same GOOD basic healthcare as anyone else regardless of income at the same costs. Then be able to choose a supplemental plan (or not) for items that they feel they need as extras such as private hospital rooms etc. But the BASICS to prevent personal bankruptcy and emergency room GP doctoring. (Which ends up effecting us all).

I guess I have just described Medicare for all.

From everything that I read.... that is what the law says.... the 'BASICS' is covered by the bronze... or for younger the catastrophic.....


You must not be on medicare... there are PLENTY of choices out there and there are some that if you choose them you LOSE some of your BASICS (insurance that is, you actually might get the care but insurance will not pay for it)..... I am dealing with that right now with my mom... her insurance company is refusing to pay legit medical bills because they were not 'pre-approved'....
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Old 11-11-2013, 02:48 PM   #26
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I remember that when I first heard about the different "metal levels" and how only the Silver plans would include the cost-sharing options (lower deductibles, OOP max, co-pays, etc), I thought, "Why is that? What if I like a Bronze plan..." But when we finally got to see the choices, and I started comparing them, I started to feel differently! Comparing Blue Cross to Coventry, then Blue Select with Preferred Care Blue, then Blue Saver vs Blue Classic vs Blue First, then factoring in the Metal levels... Well, I'm pretty good with spreadsheets, but mine became a monster. But, turns out, focusing on the Silver options helped me get to the bottom line pretty quickly -- I think. Won't know the "real" answer till sometime next year, but that's the nature of insurance, and illness or health.

And, there's always another open enrollment in twelve months (said the optimist?)
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Old 11-11-2013, 02:55 PM   #27
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I am dealing with that right now with my mom... her insurance company is refusing to pay legit medical bills because they were not 'pre-approved'....
I know people that have been in that. Had insurance on paper then had fight to get them to pay for what they were supposed to. You never really know if you have insurance till you try to use it.
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Old 11-11-2013, 03:12 PM   #28
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I guess I have just described Medicare for all.
I do wonder why the shorthand is always "Medicare for all" instead of "Medicaid for all." Medicare is paid for with premiums collected from a payroll tax, and to be qualified a person/family needs to have been employed and paid in. Medicaid is paid for from the general fund (state and fed), and there are no requirements to have been employed. And, now there are no asset tests (in some states), though income tests remain.

Dispensing "free" money from the government's general fund to pay for the health care of all citizens bears a lot more similarities to Medicaid than to Medicare. I'm guessing "Medicare" is viewed more favorably, so that's the handle that is used. In practice, I think the jury is still out on whether the level of care, availability, etc would more resemble Medicaid or Medicare.

Choices: (Most) people like them because they want to have some input into what happens to them. Who among us has fewest choices? Infants, the institutionalized, the infirm/dependent. They are not "free" to the extent they must rely on others to provide for them. Next comes the poor, who have some options, but they are limited. In general, most people want to be independent, they resent dependency. Even at the feet of a benevolent benefactor who "knows what is best." We're just funny that way.
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Old 11-11-2013, 03:18 PM   #29
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I do wonder why the shorthand is always "Medicare for all" instead of "Medicaid for all."
Nope. Medicaid would Go away. Base Medicare would be funded via the tax roles like most other developed countries (and YES we may have to pay more). No different to other insurance premiums but paid directly from taxes. That way everyone who pays taxes contributes.
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Old 11-11-2013, 03:27 PM   #30
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Nope. Medicaid would Go away. Base Medicare would be funded via the tax roles like most other developed countries (and YES we may have to pay more). No different to other insurance premiums but paid directly from taxes. That way everyone who pays taxes contributes.
But less than 45% of people pay Federal Income taxes, yet you want everyone to get this "free" health care. You are describing something much closer to Medicaid, not Medicare (if we must use an American program name). There's nothing wrong with that--is there?
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Old 11-11-2013, 04:09 PM   #31
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Works for Canada and everyone else. Would you rather they went without?
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Old 11-11-2013, 04:09 PM   #32
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I do wonder why the shorthand is always "Medicare for all" instead of "Medicaid for all."
The reason I use Medicare for All is not because Medicare is viewed more favorably than Medicare. It is because I am more familiar with Medicare and how it works since I've had family and friends on Medicare, including my husband. I just don't have the personal experience with Medicaid. I've found Medicare generally works well.
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Old 11-11-2013, 04:58 PM   #33
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But less than 45% of people pay Federal Income taxes, yet you want everyone to get this "free" health care.
Excellent point. None of my damn kids paid me one red cent while growing up, but I was still expected to provide them with medical insurance, health care, AND the moochers even expected me to clothe and feed them. Buncha looters and moochers, ya ask me! Shoulda left them all out on the hillside...

Hint: About 46% of US Households owed no federal income tax for 2011. A significant majority of these still paid federal payroll taxes, as well as federal excise taxes, state, and local taxes of various sorts. TPC estimates that 61% of households paying no federal income tax are working households.[1] Further, most of these working households do pay taxes in other years. (Income and tax bracket may vary from year to year.)[2]

Removing services from people in years when they don't have sufficient income, and may be in greatest need of those services strikes me as being less than optimal.

1. Tax Policy Center, “Who Doesn’t Pay Federal Taxes,” TPC Tax Topics | Who Doesn't Pay Federal Taxes?

2. Tim Dowd and John B. Horowitz, “Income Mobility and the Earned Income Tax Credit: Short-Term Safety Net or Long-Term Income Support,” Public Finance Review (April 11 2011), p.p 619-652
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Old 11-11-2013, 05:03 PM   #34
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I remember that when I first heard about the different "metal levels" and how only the Silver plans would include the cost-sharing options (lower deductibles, OOP max, co-pays, etc), I thought, "Why is that? What if I like a Bronze plan..." But when we finally got to see the choices, and I started comparing them, I started to feel differently! Comparing Blue Cross to Coventry, then Blue Select with Preferred Care Blue, then Blue Saver vs Blue Classic vs Blue First, then factoring in the Metal levels... Well, I'm pretty good with spreadsheets, but mine became a monster. But, turns out, focusing on the Silver options helped me get to the bottom line pretty quickly -- I think. Won't know the "real" answer till sometime next year, but that's the nature of insurance, and illness or health.

And, there's always another open enrollment in twelve months (said the optimist?)
On the other hand - I discarded Silver really quick when I realized I could save big on premiums and apply the savings toward the deductible instead - if needed.

Silver is like the plans we used to have, with high premiums because we had low doctor visit copays and low prescription copyays. I never had the bronze option before, and it's better for DH and me.
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Old 11-11-2013, 05:04 PM   #35
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I do wonder why the shorthand is always "Medicare for all" instead of "Medicaid for all." Medicare is paid for with premiums collected from a payroll tax, and to be qualified a person/family needs to have been employed and paid in. Medicaid is paid for from the general fund (state and fed), and there are no requirements to have been employed. And, now there are no asset tests (in some states), though income tests remain. Dispensing "free" money from the government's general fund to pay for the health care of all citizens bears a lot more similarities to Medicaid than to Medicare. I'm guessing "Medicare" is viewed more favorably, so that's the handle that is used. In practice, I think the jury is still out on whether the level of care, availability, etc would more resemble Medicaid or Medicare. Choices: (Most) people like them because they want to have some input into what happens to them. Who among us has fewest choices? Infants, the institutionalized, the infirm/dependent. They are not "free" to the extent they must rely on others to provide for them. Next comes the poor, who have some options, but they are limited. In general, most people want to be independent, they resent dependency. Even at the feet of a benevolent benefactor who "knows what is best." We're just funny that way.
Sam, I think being able to distinguish the difference between those two terms as a middle class commoner such as myself, is a sign of becoming old. In my 20s and 30s I didn't know the difference between Medicare and Medicaid and used them interchangeably. Now, I clearly know the difference.
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Old 11-11-2013, 05:04 PM   #36
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But less than 45% of people pay Federal Income taxes, yet you want everyone to get this "free" health care. You are describing something much closer to Medicaid, not Medicare (if we must use an American program name). There's nothing wrong with that--is there?
Medicare is funded with payroll taxes, not federal income tax. And a heck of lot more than 45% of the people pay the payroll taxes. And even those who haven't usually have for quite a few years.
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Old 11-11-2013, 05:12 PM   #37
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But less than 45% of people pay Federal Income taxes, yet you want everyone to get this "free" health care.
I agree with the comments on way more people paying payroll taxes. Regardless, when I said I favored Medicare for all I never said that I viewed it as free. I am well aware that it is not free. I also know that if it covered more people that there would need to be more money to pay for it. I am not one of those who believes that universal health care is free. Personally I am OK with raising taxes to pay for the things that I think should be provided through government.
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Old 11-11-2013, 05:16 PM   #38
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I am not sure what my exactly options are. I have been able to look at the plan on HawaiiHealthConnect.com for more than month.

Still it seems in many ways I have less choices than before. My old plan (which I can keep and probably will despite a $40/month premium hike average last 10 years $20) didn't cover maternity, birth control, prescription drugs, and was very limited on mental health coverage. On the other hand 3 nights in the hospital would have probably cost me a $1000 or so and my max out of pocket was $3,000 . Even with the new ACA Gold plan 3 nights in the hospital is almost certainly going to cost me $2,000+ and $6,350 max out of pocket is a lot of money on top of $4500 worth of annual premiums. I'd gladly trade all of the other coverage I get from ACA for keeping my out of pocket at $3k vs 6,350.

Now we all have the same type of coverage and the only differences are premiums vs copays. I don't understand why we can't have a system where you have basic catastrophic insurance, and then add on additional coverage for additions, like maternity, prescription drugs etc.

I can do this with car insurance. I generally only keep collision on a car a couple of years. I also don't have road assistance, rental cars or any of the other things. What I do have is max out liability. I have relatively deep pockets and I'm not judgement proof. Being out hundreds of dollars isn't go to change my life being out hundreds of thousands will. Other people are different than can go with minimum liability, but carry collision, road side, because for them being out a couple thousand is big deal. But no one is going to sue them for a $1 million, cause they don't have it.
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Old 11-11-2013, 05:58 PM   #39
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We are having an interesting dinner conversation right now. As you consider the need for health care, perhaps this is worth considering. The mortality rate of black men is higher than white men who live outside of prison. That is, black men die at a younger age than white men. However, when you look at mortality rates of incarcerated white and black men, their mortality rate is the same. So what is difference? The conclusion is the access to health care. "These findings suggest that firearms and motor vehicle accidents do not sufficiently explain the higher death rates of black males, and they indicate that a lack of basic healthcare may be implicated in the death rates of black males not incarcerated." http://link.springer.com/article/10.1353/dem.0.0123
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Old 11-11-2013, 06:00 PM   #40
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I don't understand why we can't have a system where you have basic catastrophic insurance, and then add on additional coverage for additions, like maternity, prescription drugs etc.
Maternity might not be your best example. Though there is no question that maternity coverage is very expensive and used to be optional. I think it is difficult to get a fetus to opt-in for insurance, regardless of how much they might need the coverage. I also don't think having a mother unable or unwilling to pay for maternity coverage is a good reason to deprive the fetus of such coverage.

Actually, based on a PBS program a few years back comparing the health systems in different countries, I think you want something similar to the Swiss system. As I recall it was described as mandatory insurance providing mandatory minimum coverage, with insurance companies competing by offering different "extras."
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