Healthcare insurance and retirement - again!

[Senator]

In rest of the developed world Health Care is mandated just like income tax is mandated. And if you can not afford it (child, retiree, unemployed) you will get it for free.

I thought they had something like universal care, not a premium based insurance?

 

[samclem]

An area that troubles me on all these individual responsibility approaches is what about kids. I hate to see the sins of the parents visited upon the children. How can they be covered when parents choose not to be.

Yes, true. At some point, is it parental negligence to not have your children covered under a health insurance plan that has already been subsidized to the point the government has deemed it to be affordable?
Should civil courts use the health insurance status of parties in a divorce case as one factor in making decisions about child custody? I know of a case now where the husband and wife have been living separately for a year, are now divorcing. She has the kid with her, is barely making ends meet with a low-paying job, and yet is making a lot of sacrifices to get she and the child covered. He is not covered, and hasn't filed his taxes in years. I hope the court takes all that into account in deciding what is best for that child.

 

[Fermion]

Also requiring continuous coverage is problematic if someone loses their job and just can't quite make the COBRA or private insurer payments for a few months. A bit unfair yes to have coverage for 20 years, lose your job, miss coverage for a couple of months then have the law say pre existing condition applies in your case.

The whole thing is a big mess that ACA did actually try to address. It is very hard to predict how or if it can be fixed.

 

[eta2020]

I thought they had something like universal care, not a premium based insurance?

That usually means payroll deduction to cover national healthcare. No different from income taxes deduction.

If you emigrate as US expat into those countries by law you have to purchase private insurance. You are simply not allowed to reside in the country without health insurance.

 

[donheff]

We tried doing the HIPPA thing before and the insurance companies pulled every trick in the book to try to deny our application - never sending the info, not answering calls, just delay, delay delay hoping we'd give up. Then when we were finally approved it was over $2K a month in premiums with a large out of pocket max limit.

It was a very high stress time for us, we had kids at home that we needed to insure and we almost could not. I thought with the ACA all those kinds of shenanigans and sleepless nights were over - until I woke up Wednesday morning.

I went through something similar when my daughter aged out of my Federal family policy. BCBS refused to take her on with a single policy despite the fact that they had insured her from birth. Outrageous. We eventually found a DC program for high risk individuals dumped off their policies that forced another part of BCBS take her on for less money. Go figure. What a goofy system we have to put people through this.

My daughter's experience brings to mind another fear I have about systems that dump all responsibility on the individual and can capriciously leave someone without coverage (e.g. after job loss). How many of us would refuse to help out an uncovered child who is diagnosed with a curable but expensive cancer? Many of use would end up burning through our nest egg to help. That is why I jumped through hoops to make sure both of my kids were always covered and paid the premiums during periods they could not.

 

[bmcgonig]

I looked at it too, and if you are a disabled vet, you can get it. 100% free. I got out of the service in 1982, and was labeled with a 10% disability in November of 2013. 31 years later.

The only reason I looked into getting VA healthcare is so I could get a veteran's ID card, so that I could get 10% off at Home Depot and Lowes. I initially did not even consider I was disabled. The application was successful, and it got me my Home Depot discount and free healthcare. Plus a small monthly tax-free stipend.

If you worked in any type of noise environment in the service, see your county Veterans Affairs office. I have mentioned this to several people, and they all got 10% disability and VA care.

Senator, did they have your records after all that time? Or did you keep your medical records.

 

[daylatedollarshort]

Also requiring continuous coverage is problematic if someone loses their job and just can't quite make the COBRA or private insurer payments for a few months. A bit unfair yes to have coverage for 20 years, lose your job, miss coverage for a couple of months then have the law say pre existing condition applies in your case.

The whole thing is a big mess that ACA did actually try to address. It is very hard to predict how or if it can be fixed.

Exactly! Median household income in the U.S. is not much more than $50K before taxes. How many households can pay half that amount or more in health insurance premiums alone? The HIPPA laws were useless for most households anyway without any kind of price caps. And if the breadwinners are unemployed those kinds of premiums and out of pocket costs are out of the reach of most households. During unemployment, they would be using up their savings just to pay for basics like food and rent.

 

[Senator]

Senator, did they have your records after all that time? Or did you keep your medical records.

They had some records, but they mostly needed my job description. I was an aircraft mechanic. Their is no medical test for tinnitus. The disability standard was "more likely than not" caused by my service job title. Whether it was actually caused by rock concerts, shooting, aircraft engines, or something else, no one knows.

I applied with the Veteran's advocate at the county who knew what he was doing. Four months later received a check for a bit over $1600 as back pay. I get $133.17, tax free with COLA, every month for the rest of my life now. And free healthcare and lots of discounts at various places, including 10% off at Home Depot and Lowes.

 

[Senator]

Also requiring continuous coverage is problematic if someone loses their job and just can't quite make the COBRA or private insurer payments for a few months. A bit unfair yes to have coverage for 20 years, lose your job, miss coverage for a couple of months then have the law say pre existing condition applies in your case.

The whole thing is a big mess that ACA did actually try to address. It is very hard to predict how or if it can be fixed.

It is a mess. Before ACA I had job coverage. I left one job for another. I never had a gap in my insurance or my work.

I did have a broken arm in a cast when I left one job and went to another. There was a 30-day waiting period for coverage of pre-existing conditions or something like that. The new insurance would not pay for the cast and surgery for the pin removal until after the 30 days. I keep my cast on for an extra two weeks due to the 30-day clause.

It can be fixed (or repealed and replaced which is just a sound bite). Get rid of the stuff that doesn't work, and keep the stuff that does. Fund it with a different mechanism that is paid for by more people to spread the cost. A sales tax would be best, but a payroll tax (since I am not working) would be best for me.

 

[Fermion]

What will be bad is spending a ton of money replacing ACA with something that doesn't work, then going back to some patch job, eventually getting something like Romneycare again, or even something very similar to ACA. We are talking hundreds of billions that have been spent on setting up ACA, tons of money by states that set up exchanges too.

Why not just have everyone on something like the VA healthcare? Someone who worked 20 years in 110 degree heat shoveling molten asphalt on our road system doesn't deserve to be left out in the cold with cancer just as someone who defended the country doesn't deserve that.

 

[rodi]

So, perhaps if an individual can pledge some large amount of money in a bond to self-insure, he also does not have to buy health insurance at all. If he worries about exceeding his bond, he can buy supplemental insurance for beyond that amount.

Say hello to a plan with a deductible of $200K. I'd bet it's cheap. I want one.

PS. The deductible would not be annual, but rather lasts until you reach 65. So, the younger you are, the higher that deductible has to be, balanced with the higher risk of illness as you get older. Actuaries will have fun figuring this out.

But one of the things that comes with insurance is negotiated rates. What you describe would not get you that.

I pay (pretty expensive) premiums for a plan that is high deductible... Not $200k deductible - but $4500/person/year deductible, 6500 max OOP... and $9k family deductible/$13kMax OOP family. It hurts less to pay the bills while fulfilling the deductible when we see the knock down from outrageous billing to negotiated rates.

Last year - even with a hospitalization and several broken bones - we just hit the family deductible... It would have been 2-3x worse if we were on a 'self insurance' program that didn't give us the negotiated rates.

I'm expecting to hit the deductible for my son on Tuesday when he has an outpatient surgery... But it will be interesting to see what the difference between initial bill and negotiated rate is.

(FWIW - this is with Kaiser Permanente so I'm not even sure why there is a difference since they only serve Kaiser insureds.... why have the book rate at all - everyone pays the negotiated or less.)

 

[NW-Bound]

But one of the things that comes with insurance is negotiated rates. What you describe would not get you that...

No, it does not.

That "mysterious" billing practice has to stop. A poster was comparing paying for hospital services with buying a used car from a used car dealer; you don't know what the fair price is. I said it is worse than buying a used car. With a used car you look up the Blue Book, you kick the tire, open the hood to look, pull the dipstick, take a test drive. With hospitals, you don't know any info to do comparison shopping to see if you should spend more to get a deluxe operating room, gourmet meals while you recover at a fancy hospital or should save money to go to a more pedestrian hospital that's good enough, etc...

So, we need transparency in hospital billing, no matter what. It's about time.

 

[Senator]

But one of the things that comes with insurance is negotiated rates.

This is exactly what needs to happen on a larger level. Negotiated rates even lower than they are. Negotiations without having to cater to the companies that contributed to a campaign.

We are talking hundreds of billions that have been spent on setting up ACA, tons of money by states that set up exchanges too.

As someone that was involved in setting up a website for a major financial institution, and brought it in for ~$125M, do not get me started on the ACA website, that basically serves up pdf docs, and probably could have been set up on Wordpress for less than $100K...

 

[NW-Bound]

Also requiring continuous coverage is problematic if someone loses their job and just can't quite make the COBRA or private insurer payments for a few months...

There has to be a fallback for people who have financial hardship, like Medicaid now. One has to apply and qualify, then it is still counted as continuous coverage.

 

[eta2020]

How about this food for thought

Do you remember all the fuss about Martin Shrikeli raising price of Daraprim to 750 USD a SINGLE pill. At the very same time in tightly regulated EU market very same medicine cost few bucks.

Some things are better off regulated by government. The fact that drug companies rocketed up after election is telling me their profits are most likely going up.

 

[donheff]

No, it does not.

That "mysterious" billing practice has to stop. A poster was comparing paying for hospital services with buying a used car from a used car dealer; you don't know what the fair price is. I said it is worse than buying a used car. With a used car you look up the Blue Book, you kick the tire, open the hood to look, pull the dipstick, take a test drive. With hospitals, you don't know any info to do comparison shopping to see if you should spend more to get a deluxe operating room, gourmet meals while you recover at a fancy hospital or should save money to go to a more pedestrian hospital that's good enough, etc...

So, we need transparency in hospital billing, no matter what. It's about time.

+10000 This is not even vaguely partisan. Everyone reacts with horror to the insane obscure pricing policies of our system.

 

[pb4uski]

I have wondered/speculated about some of these things as part of a replacement/modification of the ACA without mandates. More draconian approaches might include waiving the pre-existing condition exemption for a year or two for people who drop coverage. An area that troubles me on all these individual responsibility approaches is what about kids. I hate to see the sins of the parents visited upon the children. How can they be covered when parents choose not to be.

Also requiring continuous coverage is problematic if someone loses their job and just can't quite make the COBRA or private insurer payments for a few months. ....

Children would be covered under CHIP if their parents were ignorant enough to forgo health insurance.

If someone is unemployed then it is likely that their lack of income would qualify them for continued coverage on Medicaid... they would just need to take the responsibility to sign up for Medicaid. Also, the solution that I envision would include some mechanism to make health insurance affordable low income people do not qualify for Medicaid similar to ACA subsidies.

Just like today:

If you're unemployed you may be able to get an affordable health insurance plan through the Marketplace, with savings based on your income and household size. You may also qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP).

 

[NW-Bound]

+10000 This is not even vaguely partisan. Everyone reacts with horror to the insane obscure pricing policies of our system.

My friend got a knee replacement while under megacorp insurance. The hospital was in the network, same as the surgeon whom he saw for consultation beforehand.

Later, the insurance cried foul. It turned out that the assistant surgeon was not on the network, and he charged 2x what the main surgeon got. So, the insurance said it was my friend's responsibility, and he had to pay the difference. My friend said "What the hell? I never saw him before. Who let that guy into the operating room? Hell no, I won't pay".

The assistant surgeon eventually accepted what the insurance offered: same pay as the surgeon.

This is the kind of shenanigan that they have been pulling. Amazing! I am surprised that nothing has been done about that.

 

[ivinsfan]

I looked at it briefly. It seems to have income limits way lower then ACA Cliff.

I don't know how practical it is for most people who are FI.

Not always, type and duration and date of service can come into play..any boots on the ground Vietnam era will not be subject to income or asset limits.

 

[travelover]

.............This is the kind of shenanigan that they have been pulling. I am surprised that nothing has been done about that.

That's really the crux of it. Who is supposed to protect the public against being ripped off by medical providers and pharmaceutical companies? I think we all know and we also know that these entities contribute huge amounts of money to campaigns.

 

[NW-Bound]

How about this food for thought

Do you remember all the fuss about Martin Shrikeli raising price of Daraprim to 750 USD a SINGLE pill. At the very same time in tightly regulated EU market very same medicine cost few bucks.

Some things are better off regulated by government. The fact that drug companies rocketed up after election is telling me their profits are most likely going up.

I thought it was government regulations that prevented the cheaper drugs from getting imported.

 

[Senator]

How about this food for thought

Do you remember all the fuss about Martin Shrikeli raising price of Daraprim to 750 USD a SINGLE pill. At the very same time in tightly regulated EU market very same medicine cost few bucks.

Some things are better off regulated by government. The fact that drug companies rocketed up after election is telling me their profits are most likely going up.

I am not even sure why you should need a doctors prescription for most drugs. I went to a pharmacy in Mexico, and the pharmacist looked at me and gave me an antibiotic. It was like $3.

If I see a drug advertised on the internet or TV, I should be able to buy them from anywhere in the world. I may be taking a risk, or not. It would create more competition. The drugs advertised on TV are not nearly as harmful as alcohol or cigarettes and those I can buy easily.

Controlling drug expenses goes a long way to controlling healthcare costs.

 

[eta2020]

I thought it was government regulations that prevented the cheaper drugs from getting imported.

That is sarcastic

But you will pay numerous times more for your medicine as compared to rest of world. That is on average 2-6 times more.

http://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/

 

[Tadpole]

That is sarcastic

But you will pay numerous times more for your medicine as compared to rest of world. That is on average 2-6 times more.

http://www.cnn.com/2015/09/28/health/us-pays-more-for-drugs/

Which gives other countries more wiggle room to negotiate downward wouldn't you think?

 

[youbet]

If you emigrate as US expat into those countries by law you have to purchase private insurance. You are simply not allowed to reside in the country without health insurance.

We need that here!