Why are we so paranoid about having choices?

[Malcolm2]

Quote:

Originally Posted by samclem That is a false dilemma. Instead we need to consider the full range of options, not just "this or that." It goes to the very subject of this thread. It's not made right by "listening to them sympathetically." These people just want what they had before this ACA became law: the contract they had between themselves and their insurer (two private parties that both deemed the arrangement to be mutually beneficial).

+1

They should be able to _keep_ their policies, not just be listened to which is telling them someone else knows better -typically false. Having 50 million lose policies is not what was promised, but perhaps was what was intended.
Washington Post today:

http://m.washingtonpost.com/national...6d4_print.html

[MichaelB]

The reaction to the cancellations is understandable and even reasonable. Under the previous system, however, consumers had no choice or say in the matter. The insurer unilaterally chose whether nor not to renew a policy and so informed the policyholder. Every year countless policies were cancelled, the primary reason being because they were were needed. Consumers then found themselves without any policy option and newly uninsurable.

Since I retired 14 years ago I've had 4 policies cancelled.

[Gatordoc50]

All that is happening with the exception of the website malfunction was completely predictable. There was only one person in the country that was saying this would be seamless and that premiums were going to go down and that you could keep your doctor. Only one. Shame on anyone who relied on this one source. They have no right to complain.

[Mulligan]

Quote:

Originally Posted by MichaelB The reaction to the cancellations is understandable and even reasonable. Under the previous system, however, consumers had no choice or say in the matter. The insurer unilaterally chose whether nor not to renew a policy and so informed the policyholder. Every year countless policies were cancelled, the primary reason being because they were were needed. Consumers then found themselves without any policy option and newly uninsurable. Since I retired 14 years ago I've had 4 policies cancelled.

That scenario you faced Michael would be very problematic for someone who develops an ongoing health issue after getting a policy then getting cancelled. I get a one year reprieve then I am thrown into the pot, so status quo would obviously benefit me. But looking forward, while it sounds nice for legislation to allow you to keep current policy, I think it would eventually be counter productive to most of us in the end. Exchange would start out as a glorified high risk pool and rates would sky rocket. Then when the insurance company does get a chance to drop you they will. What incentive would there be to keep you on a cheaper plan? My rates are going up 3X current amount. But I would rather pay that than 6X if I get dumped into a national high risk pool exchange.

[MRG]

Quote:

Originally Posted by Gatordoc50 All that is happening with the exception of the website malfunction was completely predictable.

Not to disagree, but the website issues were totally predictable, IMHO mostly preventable. Sure it would have some issues the first week, but this is silly. If Megacorp had ever dropped the ball like this, they would have been bankrupted.

MRG

[Gatordoc50]

Quote:

Originally Posted by Mulligan That scenario you faced Michael would be very problematic for someone who develops an ongoing health issue after getting a policy then getting cancelled. I get a one year reprieve then I am thrown into the pot, so status quo would obviously benefit me. But looking forward, while it sounds nice for legislation to allow you to keep current policy, I think it would eventually be counter productive to most of us in the end. Exchange would start out as a glorified high risk pool and rates would sky rocket. Then when the insurance company does get a chance to drop you they will. What incentive would there be to keep you on a cheaper plan? My rates are going up 3X current amount. But I would rather pay that than 6X if I get dumped into a national high risk pool exchange.

+1
You can't go backwards and distort the risk pools. That would be a huge mistake.

[Mulligan]

Quote:

Originally Posted by Gatordoc50 +1 You can't go backwards and distort the risk pools. That would be a huge mistake.

Yes, we don't need to make it worse as we are already counting on 20 something's to buy health insurance which will be problematic enough already....I was watching a program that was interviewing random people about Obamacare. They interviewed this mid 20 something lady. She knew very little about it, and then they asked her if she even had insurance, and she said she "didn't know if she did". I hope I am not counting on many of those type to keep my rates down!

[Gatordoc50]

Quote:

Originally Posted by MRG Not to disagree, but the website issues were totally predictable, IMHO mostly preventable. Sure it would have some issues the first week, but this is silly. If Megacorp had ever dropped the ball like this, they would have been bankrupted. MRG

Ya, a couple of computer geeks threw one together at I would guess little or no cost. But the real site is being used for much more than insurance choices. It reminds me of a SNL skit. It's an insurance exchange AND an espionage tool AND a wealth transfer device AND a dessert topping!

[travelover]

Quote:

Originally Posted by samclem .......... It's not made right by "listening to them sympathetically." These people just want what they had before this ACA became law: the contract they had between themselves and their insurer (two private parties that both deemed the arrangement to be mutually beneficial).

The part I have a problem with is that we (all Americans) have a societal contract to pay for any medical care that the patient can't afford themselves. So, if you can afford a policy with no caps, but choose to buy an inexpensive capped policy, you are in effect pushing the risk off on the rest of society - the hospital and the other patients that must pay higher premiums to cover the uncompensated care.

[47]

Quote:

Originally Posted by Mulligan That scenario you faced Michael would be very problematic for someone who develops an ongoing health issue after getting a policy then getting cancelled. I get a one year reprieve then I am thrown into the pot, so status quo would obviously benefit me. But looking forward, while it sounds nice for legislation to allow you to keep current policy, I think it would eventually be counter productive to most of us in the end. Exchange would start out as a glorified high risk pool and rates would sky rocket. Then when the insurance company does get a chance to drop you they will. What incentive would there be to keep you on a cheaper plan? My rates are going up 3X current amount. But I would rather pay that than 6X if I get dumped into a national high risk pool exchange.

The status quo you mention is the insurer just collecting your premium.. not providing you a usable service. That would be continuing the insurance when you actually need it.

What people don't understand.. or refuse to understand.. is that most of the junk policies were not insurance at all. They were just one-way payment arrangements. Every year, the insurance companies would decide whether the next year they would rather take your money or pay for your medical services. In the mean time you are older by a year with all the ailments that come with steadily marching steadily towards your body's use-by date, and the insurance companies are that much richer.

Unless you received a rejection notice from an insurance company.. NOT an insurance premium increase mind you.. just outright rejection saying "no can do" -- you cannot really comprehend what the old situation was under the surface. Needless to say I did, and that completely changed my perspective.
We were financially doing okay, and all I wanted was some kind of catastrophic insurance to protect the assets in the worst case.

We had no chronic diseases, and our claim history in the past two years were close to zero. The reason for rejection.. My wife having had a C-section delivery (no other complications) with the past 5 years was considered a pre-existing condition, and that was that. It was not by our choice. In the US one third of the deliveries are through c-section.

Arguing about a $100/month premium increment sounds downright petty to me when weighed against guaranteed insurance for *life*, as you also concluded.

The following is an interesting read and parallals my own experience. It appeared well before ACA was okayed by the courts.
http://www.nytimes.com/2011/02/20/op...0Dubinsky.html

[Hamlet]

Yup, the old system for individual health insurance was incredibly bad, probably as bad a system as could be devised if you were trying to make it bad. People who never had any health issues liked it okay (who wouldn't), but anyone who actually needed care over the long term would be screwed eventually.

The new system has a lot of stupid things in it, but I think it is going to be a major improvement over the current system. Of course, just about anything would be.

Quote:

Originally Posted by MichaelB The reaction to the cancellations is understandable and even reasonable. Under the previous system, however, consumers had no choice or say in the matter. The insurer unilaterally chose whether nor not to renew a policy and so informed the policyholder. Every year countless policies were cancelled, the primary reason being because they were were needed. Consumers then found themselves without any policy option and newly uninsurable. Since I retired 14 years ago I've had 4 policies cancelled.

[NW-Bound]

Quote:

Originally Posted by 47Percent ... Here is a more representative link. http://transform.childbirthconnectio...omparison1.pdf

Wow! The cost for natural childbirth with no complications varies from $6K in Maryland to $10K in Arizona, and tops out at $18.5K in New Jersey. What's going on here? A variation of 3X between states? The $6K looks more than enough to pay for the staff in the delivery room, and the 1 or 2-day hospital stay.

It was many years ago that we had to deal with child delivery, and then everything was covered by megacorp insurance so we had no idea what it cost back then.

[Gatordoc50]

Quote:

Originally Posted by NW-Bound Wow! The cost for natural childbirth with no complications varies from $6K in Maryland to $10K in Arizona, and tops out at $18.5K in New Jersey. What's going on here? A variation of 3X between states? The $6K looks more than enough to pay for the staff in the delivery room, and the 1 or 2-day hospital stay. It was many years ago that we had to deal with child delivery, and then everything was covered by megacorp insurance so we had no idea what it cost back then.

That is quite a disparity. There will still be disparities between areas due to population, physical access to care, and even whether or not you are in a right to work state. I would guess that if you're in an area that won't let you pump your own gas, your colonoscopy is going to be more expensive. To be c

[sailor]

Quote:

Originally Posted by 47Percent I am not arguing your premise that to each their own in terms of health care cost. But I think your $3,500 figure is missing a zero at the end. Here is a more representative link. http://transform.childbirthconnectio...omparison1.pdf Note that these graphs DO NOT include anesthesia charges and newborn care charges as per the footnote. Ouch!! Just cut her up and pull it out, then pack it up all to go! These are 2010 figures, and you may have to add 30-40% to those numbers now. I have had various women go through pregnancies in my family over past few decades and I don't know what a "birth center" is. The birth center costs seem quite tempting and are somewhat in line with your $3,500 number. Maybe they just have one midwife with some vaseline.. not sure how it works. But hospital deliveries in Metro areas are definitely in the five figures. Prenatal care is not included in these figures.

I went to the source of the data ( HCUPNet project).
And I think you are both right - where the disagreement is, that the charge is not the cost.
If I got it right - "charge" is the "sticker price" hospital puts on your bill, and the "cost" is whatever insurance+patient paid.


As a side note I enthusiastically support birthing centers (but did not have access to one with our kids) and midwifes (Kaiser midwifes helped with deliveries all 3 of little sailors).

National stats from 2011 from HCUPNet:

2011 National statistics - principal diagnosis only
Outcomes by Normal pregnancy and/or delivery
Normal pregnancy and/or delivery Standard errors
Total number of discharges 225,214 11,484
Charges, $ (mean) 10,644 377
Costs, $ (mean) 3,039 65

[Hamlet]

I think the big issue is that many of the pre-ACA policies wouldn't have covered the unusual pregnancy, or the sick child after it was born. It isn't that rare to have a premature birth, and severe cases can result in six figure medical bills.

That needs to be covered, or the policy doesn't really function as insurance.

Remember, under the ACA, pregnancy has to be covered in the plan, but as far as I know it still has to reach the deductible before the insurance company has to pay out, so the cost of the run of the mill variety birth is likely to be mostly born by the consumer if they have one of the higher deductible options.

Quote:

Originally Posted by clifp So I am fine for having unusual/life threatening pregnancy being covered but not the run of the mill variety. If people want to protect against those type of risks they should pay for it.

[M Paquette]

Quote:

Originally Posted by 47Percent What people don't understand.. or refuse to understand.. is that most of the junk policies were not insurance at all. They were just one-way payment arrangements. Every year, the insurance companies would decide whether the next year they would rather take your money or pay for your medical services. In the mean time you are older by a year with all the ailments that come with steadily marching steadily towards your body's use-by date, and the insurance companies are that much richer.

Yup.

I've mentioned the Mega-Life and similar 'medical policies' sold on college campuses before. Many private schools required the students to buy one of their plans, even if the student was covered by a parent's plan, giving reasons like 'it's the only plan the campus clinic takes'. These were offered at a huge range of schools, from the local community college to Ivy League institutions. The plans had a payout rate (the portion of premiums spent to cover medical expenses of the insured) of under 15%. Yes, 85% of the premiums went to 'operating expenses' and profit. The plans had awesome coverage. No coverage for cancer. No coverage for treatment of chronic illness. No coverage for prescriptions. Hospitalization and emergency room expenses had a lifetime cap of $2,500.

Great stuff. DD was required to buy one of these plans. And the rates were pretty low, around $80 a month. Such a deal.

[Mulligan]

Quote:

Originally Posted by M Paquette Yup. I've mentioned the Mega-Life and similar 'medical policies' sold on college campuses before. Many private schools required the students to buy one of their plans, even if the student was covered by a parent's plan, giving reasons like 'it's the only plan the campus clinic takes'. These were offered at a huge range of schools, from the local community college to Ivy League institutions. The plans had a payout rate (the portion of premiums spent to cover medical expenses of the insured) of under 15%. Yes, 85% of the premiums went to 'operating expenses' and profit. The plans had awesome coverage. No coverage for cancer. No coverage for treatment of chronic illness. No coverage for prescriptions. Hospitalization and emergency room expenses had a lifetime cap of $2,500. Great stuff. DD was required to buy one of these plans. And the rates were pretty low, around $80 a month. Such a deal.

I would be willing take make a bet that the college got some kind of kick back out of that monthly premium, too. What a ripoff.

[47]

Quote:

Originally Posted by Mulligan I would be willing take make a bet that the college got some kind of kick back out of that monthly premium, too. What a ripoff.

The only one who PAYS is the end user. Everyone else is on the take. It is not uncommon for even doctors to get questionable incentives (kickbacks) from pharmaceutical companies for preferentially prescribing certain Rx and procedures.

The entire machinery of the healthcare industry revolves around the $'s the end user pays. But the way the whole thing is organized would lead you to think everyone thought the patients themselves are just a nuisance to be dispensed away with if at all possible. Your wallet is welcome. Direct deposit is even better.

The technical term for insurance company lingo for the actual payment it makes for your healthcare is MLR, short for "Medical LOSS Ratio" -- with not even a hint of irony. Every dollar they pay on behalf of you is a loss for them.

People who say they *love" their current insurance (company) should keep that in mind.

[NW-Bound]

Quote:

Originally Posted by M Paquette ... Hospitalization and emergency room expenses had a lifetime cap of $2,500... Great stuff. DD was required to buy one of these plans. And the rates were pretty low, around $80 a month. Such a deal.

What a scam! One must have a very short life stay in the ER. Perhaps for 1 hour? It costs more than $2.5K before you get admitted and transferred from the ER to a hospital room.

When we had our young adult children in our insurance policy, it was around $50 each per month. Of course there has always been that $10K annual deductible for the entire family.

While on our policy, my perfectly healthy son got to spend 9 days in the hospital because of a weird and rare liver bacteria infection which could cost him his life. Total cost was $34K (my part $10K, insurance $24K), which included 30 days of outpatient treatments. Now, that's to me is real health insurance.

PS. Several contagious disease specialists conferred, and never knew what caused the infection. One never knows when he is hit with something.

[Gatordoc50]

A lot of pent up anger towards healthcare providers here. I do find it somewhat interesting that people who retire early complain of being ripped off by other people. I'm not saying you aren't getting ripped off, just that you're ripping someone else off even better. Well played.