Obama Health Insurance

[Brat]

I did not intend to say that the treatment would be expected to return the person to their former level of function, only that treatment would be likely to be effective - not fruitless

My father had a brain tumor which was surgically removed. He did not have the expected result. Once he was medically stable he was sent to a skilled nursing facility where, if he continued to make progress (recover) the insurance would pay for a couple months nursing and physical therapy. If he stopped making progress the insurance payments stopped. He stayed, as I recall, 6 weeks - the point at which he stopped making progress.

As tough as that standard is, it makes sense. As anyone who has dealt with such matters, he was not the man he was before surgery... but then if he didn't have the surgery he would have been a paraplegic.

I have lived the standard I propose. My parents had long term care insurance, which helped.

 

[Independent]

Like others posted, I just need something more affordable.

Another bright side to retireing early, I would help create a job opening for someone else. Its all how you look at it.
Thanks to everyone,
Steve

One big issue to me is defining "affordable". Do you have any numbers for that?

I see a number of people agree with the "create a job opening" comment. I think the standard economist's response is that in the long run the number of jobs is flexible, it will expand to use all the productive workers. http://en.wikipedia.org/wiki/Lump_of_labour_fallacy The short term is different, and most of us probably think in the short term.

I didn't feel at all guilty about retiring at 59, but I didn't think I was doing a favor to some other worker.

 

[Alan]

I see a number of people agree with the "create a job opening" comment. I think the standard economist's response is that in the long run the number of jobs is flexible, it will expand to use all the productive workers. http://en.wikipedia.org/wiki/Lump_of_labour_fallacy The short term is different, and most of us probably think in the short term.

I didn't feel at all guilty about retiring at 59, but I didn't think I was doing a favor to some other worker.

I do think in the short term because that is what I can feel most emotionally. Over the years I have personally had to tell 4 good workers that they are being laid off simply because the company has to cut costs and their positions are being eliminated. I've finished a good few more for other reasons but laying good people off when the economy is bad and jobs are hard to find really sucks when you are the one giving them the news.

My megacorp is currently eliminating jobs. At my site alone we have 1/3 of our production units down for at least 6 months, one of them for at least a year, and the capital budget has been cut by 75%. If I was eligible to RE I would go in a heartbeat because I can afford it and want to RE, and with the added knowledge that someone else won't get laid off. My managers know this - I don't need a "package", just let me take retirement early - I'm leaving anyway in 13 months.

 

[Stevewc]

One big issue to me is defining "affordable". Do you have any numbers for that?

I want attempt to put exact numbers on this since the cost is different for each person/family depending on number of persons and locality in the present system. But I will say I would be more than happy to continue paying what I presently pay for my (group) family coverage. With my situation and employer, when a person retires you are basically thrown to the wolves. This is even after 30 years of service. I haven't got it down to exact numbers yet but will need to pretty soon. My best estimate to continue something close to the coverage I have would be over half my retirement check per month for private insurance. It would be almost impossible to live on whats left. Of course I will be doing some shopping when I'm a little closer to my retirement date. It sure would bring a smile to my face if something comes to the forefront in the next year or so. It will probably make the difference in my decision to continue working or give the job up to others.
Steve

 

[Rustic23]

When ever this subject comes up, I always think 'Be careful what you ask for'. We want a health care system that is timely, available, affordable, and high quality. In order to get this the insurance co., politicians, people, and health care providers will have to compromise. Someone in this mix is going to get screwed, and I can think of two that won't. The insurance co. will have the cash to lobby the politician, and therefore, I don't think either of these will have to compromise much. The people and the health care provider are a different story. There is already anecdotal stories of folks not being able to find a doctor that will take new Medicare patients.

So, I for one, am one of those that fears the change. I know the system we have. Lots of warts, but it works for DW and I. So I would like to see it tweaked some rather than a new 'Great Medical Society' or 'War on Health Care' started up.

 

[JOHNNIE36]

Hey, I was just thinking, didn't Mr. Obama propose or suggest the same health coverage or equivalent plan as those in congress? I don't know anything about their coverages and/or costs but I'll bet it's something to behold. Does anyone remember that subject coming up on the campaign trail? Why it that sticking in my mind? Refresh my memory.

 

[Stevewc]

Johnnie,
He does mention the same as congress type coverage at his web site. Just do a search on obama health plan. I don't remember many details about it though. That's probably because he's a politician, lots of promises but few details.
Makes you wonder?
Steve

 

[Stevewc]

When ever this subject comes up, I always think 'Be careful what you ask for'. We want a health care system that is timely, available, affordable, and high quality. In order to get this the insurance co., politicians, people, and health care providers will have to compromise. Someone in this mix is going to get screwed, and I can think of two that won't. The insurance co. will have the cash to lobby the politician, and therefore, I don't think either of these will have to compromise much. The people and the health care provider are a different story. There is already anecdotal stories of folks not being able to find a doctor that will take new Medicare patients.

So, I for one, am one of those that fears the change. I know the system we have. Lots of warts, but it works for DW and I. So I would like to see it tweaked some rather than a new 'Great Medical Society' or 'War on Health Care' started up.

Rustic,
I must admit I'm somewhat fearful my self.
The fact that it could make or break my retirement plans has me very interested though. I figure I'll make the best of what comes my way.
I am self centered on this one for sure (lol) !!!
Nothing like being honest,
Steve

 

[Brat]

I really think this will be bitten off in chewable chunks. The first coverage will be for children and prenatal care. One that universe is covered the actuaries will adjust private health care insurance product costs.

If I ran the world... for adults the next would be a basic product that covers preventative care and major medical expenses. If people want to insure themselves beyond that then they can buy a separate policy (akin to medigap insurance). I think we will re-visit "donut hole" coverage (such as that in Medicare Part D) where the citizens have the option of buying insurance to fill the hole.

 

[OAG]

The current system is, for younger folks, based on "optional" purchase of insurance. IMHO that will never work - look at the numbers of people that do not have insurance for which it would be economical to purchase (20-50 year old). Also look at the Auto Insurance situation - you have to buy insurance to cover the folks that are driving around without auto insurance. Unless it can be figured out how to make it "mandatory" to purchase medical insurance it is going to be difficult. Of course we could make it Universal and Free and then after about 10 years just have a "bailout" - which is exactly what may be coming. It is early and I am somewhat of a cynic when it comes to "welfare" programs and "handouts" especially to those that can but won't.

 

[Independent]

Hey, I was just thinking, didn't Mr. Obama propose or suggest the same health coverage or equivalent plan as those in congress? I don't know anything about their coverages and/or costs but I'll bet it's something to behold. Does anyone remember that subject coming up on the campaign trail? Why it that sticking in my mind? Refresh my memory.

I recall Edwards using the "same as Congress" line.

This seems like a good 2-page overview of Obama's statements from an independent source. I see voluntary enrollment in "a new public plan". I also notice a real shortage of numbers. http://www.kff.org/uninsured/upload/Obama_Health_Care_Reform_Proposal.pdf

 

[Independent]

One big issue to me is defining "affordable". Do you have any numbers for that?

I want attempt to put exact numbers on this since the cost is different for each person/family depending on number of persons and locality in the present system. But I will say I would be more than happy to continue paying what I presently pay for my (group) family coverage. With my situation and employer, when a person retires you are basically thrown to the wolves. This is even after 30 years of service. I haven't got it down to exact numbers yet but will need to pretty soon. My best estimate to continue something close to the coverage I have would be over half my retirement check per month for private insurance. It would be almost impossible to live on whats left. Of course I will be doing some shopping when I'm a little closer to my retirement date. It sure would bring a smile to my face if something comes to the forefront in the next year or so. It will probably make the difference in my decision to continue working or give the job up to others.
Steve

Yes, I'd be happy to just continue with my group coverage, too. My employer said that it paid about 90% of the premium on my health insurance, leaving me with only 10%. According to this source, the average worker is paying about 25%. Yearly Premiums For Family Health Coverage Rise To $12,680 In 2008, Up 5 Percent As Many Workers Also Face Higher Deductibles - Kaiser Family Foundation

I think that those of us with "good" group coverage tend to underestimate the actual cost of medical care while we're working. We can be shocked to find out how expensive it is when we have to get it on our own. As I mentioned above, we hear that the US spends 16% of GDP on health care, but have trouble converting that number into 20% of gross income, every year of our lives.

 

[ziggy29]

Yes, I'd be happy to just continue with my group coverage, too. My employer said that it paid about 90% of the premium on my health insurance, leaving me with only 10%. According to this source, the average worker is paying about 25%. Yearly Premiums For Family Health Coverage Rise To $12,680 In 2008, Up 5 Percent As Many Workers Also Face Higher Deductibles - Kaiser Family Foundation

I think that those of us with "good" group coverage tend to underestimate the actual cost of medical care while we're working. We can be shocked to find out how expensive it is when we have to get it on our own. As I mentioned above, we hear that the US spends 16% of GDP on health care, but have trouble converting that number into 20% of gross income, every year of our lives.

As a data point, I'm in an HSA-eligible HDHP plan with a $2500 family deductible. According to our open enrollment materials, the company pays about $600 a month for it (employee + spouse coverage level) and our share of the premium cost is about $93. That includes an employer match into the HSA which, for us, is $1000 for 2009.

 

[barker]

I am optimistic that sincere health care improvements will be made. There are more and more stories being published about people either dieing prematurely or going bankrupt trying to pay for health care.

It seems that Congress and the President are both "of a mind" that improvements need to be made.

For my family personally, we've exhausted my work health insurance benefits, and also exhausted the cobra benefits. We are currently on an expensive high deductible private health insurance plan that unfortunately has some existing conditions excluded. So we are hoping for improvements in our own situation through any number of possible changes(medicare for 55+ age people, etc.). Even just moving toward mandatory health insurance for all and eliminating pre-existing conditions would be an improvement for us.

It's not that we're not willing to pay a fair price for health insurance. We've paid all our lives for it already and used it very little. It just needs to be accessible to all and not over-priced so much to make it impossible to pay for.

 

[Independent]

As a data point, I'm in an HSA-eligible HDHP plan with a $2500 family deductible. According to our open enrollment materials, the company pays about $600 a month for it (employee + spouse coverage level) and our share of the premium cost is about $93. That includes an employer match into the HSA which, for us, is $1000 for 2009.

If I understand this correctly, the premium for this plan is $693 per month or $8,316 per year. In addition, there can be $2,500 of out-of-pocket expense for the deductible (I'm not sure it that includes a co-pay). That's a little less than the Kaiser average for a "family", but it appears that you don't have children in this plan.

My comment on "affordable" is about the total cost of health care. It's especially eye-opening for seniors because costs go up with age. I've been doing a little digging, and ended up with this estimate of U.S. per capita spending for 2008:

00-18 $3,383
19-44 $4,302
45-54 $6,650
55-64 $9,940
65 + $18,888

I expect that most ERs in the 55-64 age group aren't expecting to pay nearly $10,000 per person for health care.

(This is total spending, which can be paid by private insurance, out-of-pocket, Medicare, Medicaid, etc. It includes long term care, but excludes insurance administration expenses.)

 

[OAG]

If I understand this correctly, the premium for this plan is $693 per month or $8,316 per year. In addition, there can be $2,500 of out-of-pocket expense for the deductible (I'm not sure it that includes a co-pay). That's a little less than the Kaiser average for a "family", but it appears that you don't have children in this plan.

My comment on "affordable" is about the total cost of health care. It's especially eye-opening for seniors because costs go up with age. I've been doing a little digging, and ended up with this estimate of U.S. per capita spending for 2008:

00-18 $3,383
19-44 $4,302
45-54 $6,650
55-64 $9,940
65 + $18,888

I expect that most ERs in the 55-64 age group aren't expecting to pay nearly $10,000 per person for health care.

(This is total spending, which can be paid by private insurance, out-of-pocket, Medicare, Medicaid, etc. It includes long term care, but excludes insurance administration expenses.)

From this chart, which I do not question, I wonder what the actual "out of pocket" expenses to a couple (or per person) actually averages. If one has Medicare, a low cost (or third party payer policy) supplemental policy without co-pays (or alternatively with reasonable co-pays) I would think the "out of pocket" expenses may be just a smallish fraction of the chart figure.

Personally, we pay only MEDICARE premiums ($1,156.80 per person) and have no other "out of pocket" expenses and we are 70/68 years of age. I wonder how the chart makers came up with the almost double cost as one moves into MEDICARE eligibility.

 

[barker]

Right now we are paying $6, 532/year for a 57yo/55/23(college student) family of three. This is from Golden Rule(United Health Care private insurer) for a $5,000 deductible/person(100% coverage after meeting deductible) health insurance policy with an exclusion for a condition I had when we started the insurance.

So add in our personal costs pre-deductible and it's not hard to see spending $11,532/yr, $16,532/yr or more if one/two people needed any care at all involving hospitalization in the same year.

Of course, any costs for the excluded condition I have or any "related complications" are not covered at all, and increase this cost.

I do not think these costs are horribly outrageous, however, I hope the new administration and congress will help out to some degree. Even just eliminating the exclusion would help us.

After all, all of us retirees have paid huge amounts of money over the 25-30 years of working and probably taken very little back in health care costs. At least that was the case for my family. That's the way insurance is supposed to work - you don't bankrupt the people whose house burns down, you shouldn't bankrupt the people who need health care.

 

[ziggy29]

From this chart, which I do not question, I wonder what the actual "out of pocket" expenses to a couple (or per person) actually averages. If one has Medicare, a low cost (or third party payer policy) supplemental policy without co-pays (or alternatively with reasonable co-pays) I would think the "out of pocket" expenses may be just a smallish fraction of the chart figure.

One could chart out a best/average/worst case, I suppose.

For anyone with employer-subsidized insurance, "worst case" would have to include not only health issues causing you to hit the plan's out of pocket maximum, but also losing the employer subsidy and finding your own or going the COBRA route.

 

[barker]

here's some excerpts from a pretty good cnn article talking about the prospects for health care insurance improvements:

The cost of providing health insurance to employees continued to skyrocket, jumping by an average of 5.7% per employee after a 6.1% hike in 2007...

health care was the number-one concern of small business owners....

the recent "Call to Action" issued by Sen. Max Baucus (D-Mont.) echoes Obama's plan, but with the added wrinkle that coverage would be mandatory. That's a controversial measure, but one that health experts say is key to keeping premiums low - and it could help get insurance companies on board. Most observers expect health-care reform to wait until after an economic stimulus package is dealt with, but not too long after. The forecast: Smaller reforms are likely in 2009, followed by a full-on throwdown over a major health insurance overhaul in 2010.

 

[Independent]

From this chart, which I do not question, I wonder what the actual "out of pocket" expenses to a couple (or per person) actually averages. If one has Medicare, a low cost (or third party payer policy) supplemental policy without co-pays (or alternatively with reasonable co-pays) I would think the "out of pocket" expenses may be just a smallish fraction of the chart figure.

Personally, we pay only MEDICARE premiums ($1,156.80 per person) and have no other "out of pocket" expenses and we are 70/68 years of age. I wonder how the chart makers came up with the almost double cost as one moves into MEDICARE eligibility.

I certainly agree with the comment that out-of-pocket costs are just a fraction of the total cost of health care for most people. Most of the costs are picked up by the employer share of group insurance or by the taxpayers. This source gives OOP share as somewhere in the teens for all age groups http://www.cms.hhs.gov/NationalHealthExpendData/downloads/2004-age-tables.pdf page 3. (Note that the employee share of premiums is not included in their definition of "out of pocket".)

I think that's part of the political problem with "health care reform". Lots of people underestimate the actual spending. And, many people think the "solution" is shifting the cost to "someone else".

I also have to agree with Barker that it seems like if you've been paying into "the system" all your life, and you know you've been overpaying because premiums don't vary by age, it seems wrong to find that you don't get any benefit for all those years of premium payments when you get older. (I thought HIPAA was supposed to deal with the pre-existing condition problem, but I'm willing to believe there are problems with that, too.)

 

[ziggy29]

(I thought HIPAA was supposed to deal with the pre-existing condition problem, but I'm willing to believe there are problems with that, too.)

The problem with HIPAA is that even if you jump through all the hoops, at the end of the day it says nothing about the affordability of a policy offered with no exclusions for preexisting conditions.

There's nothing at the federal level that requires insurers to price these policies affordably, so there's really little protection for people with preexisting conditions. (Some state laws may help, though, that vary from state to state.) So ultimately, in many states, for all intents and purposes all that's left is the state high risk pool.

 

[samclem]

There's nothing at the federal level that requires insurers to price these policies affordably, so there's really little protection for people with preexisting conditions.

To the degree that the marketplace is efficient, we would expect insurers are charging based on the costs they expect to incur for people with pre-existing conditions. I think when people say "affordable insurance for people with pre-existing conditions" we know they really mean "insurance premiums that will not cover the costs of care that is likely to occur. These costs are shifted to someone else."

"Affordable" housing, "affordable" health care--"affordable" is the current codeword for "below market rate, provided under mandate and paid for by others."

 

[Martha]

To the degree that the marketplace is efficient, we would expect insurers are charging based on the costs they expect to incur for people with pre-existing conditions. I think when people say "affordable insurance for people with pre-existing conditions" we know they really mean "insurance premiums that will not cover the costs of care that is likely to occur. These costs are shifted to someone else."

This is why we need to make sure that everyone has insurance. Pay in while young and healthy, maybe take more out later.

If it was true insurance preexisting conditions would never be covered. What we are after is a way to pay for medical care which doesn't break the bank for both individuals and us all.

 

[Zoocat]

This is why we need to make sure that everyone has insurance. Pay in while young and healthy, maybe take more out later.

If it was true insurance preexisting conditions would never be covered. What we are after is a way to pay for medical care which doesn't break the bank for both individuals and us all.

I wonder if there's any way to do this without breaking the federal bank and without rationing in some form or another. This "rationing" could be a very different kind of medical care system than we have now, for example a system of walk-in minor injury care clinics, like they have at some Walmarts which are very inexpensive.

But I wonder if in the year 2020 for example if elderly people will still be receiving heart bypass operations and elaborate cancer treatments that cost several hundred thousand dollars and paid for by Medicare?

When looking at our federal budget and current deficit it's hard for me to see how our country going forward can afford to pay for the same standard of care for the elderly.

 

[barker]

When looking at our federal budget and current deficit it's hard for me to see how our country going forward can afford to pay for the same standard of care for the elderly.

In today's system we expect our private companies to pay the majority of health care costs. I've read that both GM and Chrysler would be profitable today if they were not having to pay for employees and retirees health care. Companies in Japan, China, India, Europe, etc., don't have this expense.

So we pay it one way or the other... might as well pay it the cheapest and lowest overhead way possible - "Medicare for all" for instance.