Second installment on ACA for those that like to read tea leaves...

[explanade]

One thing I noticed going through open enrollment is that if you look at the provider networks of the insurance plans with the cheapest premiums, you see mostly doctors who got their medical degrees in China, India, or some Eastern European country or a lot of second tier schools in the US.

Not saying the training they got in these schools are poor or that they aren't good doctors but apparently they're willing to take lower rates and the carriers in turn can price their premiums lower.

It's similar to dentists who are in HMO networks also willing to take a lot less but some of them seem more interested in upselling discretionary procedures like various types of cosmetic dentistry.

I don't suppose doctors willing to take lower reimbursement rates are looking to convince patients to do more expensive procedures that you may not need.

 

[NW-Bound]

Allow patients to self prescribe medicine, and eliminate the Dr as the middleman. Then you need less Drs.

The malpractice lawsuits from all of this would end up being more than 20% GDP

Well, we will have to pass laws banning lawsuits.

If you take the wrong medicine, or suffer from side effects, tough luck. Better research the Web more carefully next time.

I guess it's the same thing as DIY home improvement projects or car repairs. YMMV.

 

[Texas Proud]

+1
I have repeatedly said the same thing over many threads, and quite a few posters agreed with me. As a nation we have beaten around the bush for too long already.

I think we are all to blame. To use my analogy earlier, we want to ride a taxi while paying only bus fare. It comes to a rude awakening that the cost catches up with us, and some of us now on ACA are paying limousine price for that taxi.

Just to throw more on this.... we also want to ride the bus but not pay the full rate... I cannot find the info for the bus, but for the rail system in Houston it is $4.75 subsidy per ride!!!

Houston’s Metro says it averages $4.75 in subsidies for every rail ride. Multiplied by projected ridership, that comes to $112,100,000 in taxpayer support this year.
​

 

[Fermion]

Well, we will have to pass laws banning lawsuits.

If you take the wrong medicine, or suffer from side effects, tough luck. Better research the Web more carefully next time.

I guess it's the same thing as DIY home improvement projects or car repairs. YMMV.

Except we don't even let you drink your own hot coffee in this country.

 

[NW-Bound]

Just to throw more on this.... we also want to ride the bus but not pay the full rate... I cannot find the info for the bus, but for the rail system in Houston it is $4.75 subsidy per ride!!!

Houston’s Metro says it averages $4.75 in subsidies for every rail ride. Multiplied by projected ridership, that comes to $112,100,000 in taxpayer support this year.
​

But perhaps car drivers do not mind paying somebody else to ride the bus to lessen the road traffic jam.

Except we don't even let you drink your own hot coffee in this country.

So, I guess we will not see DIY chemotherapy anytime soon?

 

[razztazz]

Well said. My question is why don't we have this information now and what does it take to get it? It seems like pleas to Congress have fallen mostly on deaf ears, for even something as simple as competitive bidding on Medicare drug prices.

The free market imperative of equal knowledge and equal power in the transaction is antithetical to profits. Read Adam Smith. Government policy is not made for consumers. It's made for the property owners. No business person really wants the customer to know what's happening. Transparency for the customer is defined as restrictions on property rights and interference with market mechanisms.

 

[GTFan]

Now there's a lot of folks who will be happy they don't have to have insurance anymore so maybe a percentage of people will be happier, till they're sick.

Well, there's your problem. Don't really understand folks who for some reason accept that being forced to carry insurance on your car is ok, but health insurance is not even though you're WAY more likely to need the health insurance to avoid a huge financial hit (and/or avoid putting burden on others).

People don't like being told what to do for the good of all (mandate), but it's already there for other risks.

 

[Fermion]

We are forced to pay for 911 services when we buy a prepaid cell phone even though I have never dialed 911 or used their service.

I have to pay for public schools in my property tax even though my parents and I went to private school.

A person is going to get treated by the ER in a hospital even if they have no insurance (this is required by law).

If a hospital is required to treat you, why can't you be required to carry insurance? If we change the law such that you can be refused even emergency treatment if you don't have insurance, then I think perhaps there could be some argument that you should have the freedom to choose.

 

[GTFan]

It comes to a rude awakening that the cost catches up with us, and some of us now on ACA are paying limousine price for that taxi.

Heh, and some of us managing MAGI down to less than 250% FPL are paying bus fare for that ACA limo. But now the limo is getting a lot smaller and will soon run into the same ditch as your taxi.

 

[ShokWaveRider]

The first thing we need to agree on is, you do not get anything you do not pay for. OK that said, in single payer countries (Canada, where I have experience), we pay it on our taxes and life is good, No deductibles, no Co-Insurance, No Co-Pays, JUST SERVICE FIRST (Not what is your Insurance). OK in some highly populated cities one has to wait, but I never did in Calgary. However, I wait 3 weeks for a cardiologist or Dermatologist appointment here in the US.

The key is I get more stress in the long run by dealing with insurance companies than I ever get from the ailment I may have, and I have a Pacemaker, we do not want to even go there with the hoops I had to jump though to get the insurance to pay that when it was all supposed to be covered. Removing that part of the equation is priceless. JMHO.

I am lucky, If I do not like the outcome of any of these proposed/speculated changes, I will simply go back to Canada stay for 183 days when the weather is good, and come back here (FLA) in the winter. Now, do I want to do that, no. But I also do not want to give all my hard earned retirement money to an insurance company.

 

[DUFUS]

My philosophy on the health care delivery "systems" (or lack thereof) in this country boil down to three words. Whether you find the INDUSTRY to be an example of American exceptionalism or exasperationilism, one can unequivocally state...:

ONLY IN AMERICA

Before Obamacare, as things stand currently, or with whatever is to follow, you can be sure...

ONLY IN AMERICA.

But thankfully reasoned debate hasn't gone out of style, and we won't just have a bunch of self serving lawmakers fear mongering, ginning up the citizenry (against each other), and lining their buddies' pockets and padding their resumes for a future gig as a lobbyist in the so-called private sector that benefited immeasurably from public subsidies under their governance to begin with.

That does NOT happen in America.


Personally, ACA works for me. Yeah, it's crappy insurance for cheap (I guess that's a "value" of sorts), but that's all I ever wanted after retiring early anyway. If it is repealed and replaced and the rates go up substantially for me (age 53, modest pension, may or may not have a pre-existing condition; after all that's for insurance companies to define), then I'll reassess whether I want what's offered at all.
I don't have a god I have to make peace with or a family to support. It's liberating to say I just don't give a sh!t. I'll continue to do what I can to keep the odds in my favor wrt maintaining the good health I have now. If somewhere down the line I draw a catastrophic/terminal short straw, oh well. I'd rather leave my one niece a healthy inheritance, than throw good money at bad health/luck that can't be reversed. I choose not to go bankrupt for a health condition I didn't choose. Do I still have THAT liberty?

Lest anyone get the wrong impression though, to paraphrase Mose Allison (R.I.P.): I'm not a cynic, I'm a realist with a sense of humor. It's a survival technique.

ONLY IN AMERICA, do I need that now more than ever.

 

[samclem]

The free market imperative of equal knowledge and equal power in the transaction is antithetical to profits. Read Adam Smith.

That does not mean that profit can't be made even with total parity of knowledge and power, it's just that asymetric knowledge can increase profits. Something closer to knowledge parity (along with other steps that improve market efficiency) does tend to reduce profits, but not necessarily to the extent that capital finds a better use elsewhere. We're spending a lot of money on health care in the US, there will still be lots of money to me made if the margins are lower.

 

[LARS]

Personally, ACA works for me. Yeah, it's crappy insurance for cheap (I guess that's a "value" of sorts), but that's all I ever wanted after retiring early anyway. If it is repealed and replaced and the rates go up substantially for me (age 53, modest pension, may or may not have a pre-existing condition; after all that's for insurance companies to define), then I'll reassess whether I want what's offered at all.
I don't have a god I have to make peace with or a family to support. It's liberating to say I just don't give a sh!t. I'll continue to do what I can to keep the odds in my favor wrt maintaining the good health I have now. If somewhere down the line I draw a catastrophic/terminal short straw, oh well. I'd rather leave my one niece a healthy inheritance, than throw good money at bad health/luck that can't be reversed. I choose not to go bankrupt for a health condition I didn't choose. Do I still have THAT liberty?

Lest anyone get the wrong impression though, to paraphrase Mose Allison (R.I.P.): I'm not a cynic, I'm a realist with a sense of humor. It's a survival technique.

Eminently reasonable position. One I generally agree with; however, the potential fly in the ointment is the proverbial there are no atheists in a foxhole. So when/if confronted with a life threatening/life shortening event will you be able to remain the "one atheist in the foxhole" so to speak and remain stoic...

 

[MRG]

Well, there's your problem. Don't really understand folks who for some reason accept that being forced to carry insurance on your car is ok, but health insurance is not even though you're WAY more likely to need the health insurance to avoid a huge financial hit (and/or avoid putting burden on others).

People don't like being told what to do for the good of all (mandate), but it's already there for other risks.

Are we related?

 

[NW-Bound]

Here in AZ, one can avoid the mandatory vehicle liability insurance if he posts a bond of $40K to show financial responsibility. The $40K may be too low, but there's that concept.

Something like the above can be required by the Federal government. If someone gets in an accident, the hospital can treat him to a stable condition or to stop bleeding, then gets reimbursement out of his bonded account. For long-term treatments or chronic conditions, of course he is on his own.

 

[samclem]

Buying auto liability insurance is not mandatory anywhere for anybody. It is only mandatory if person want to exercise a >privilege< (driving on a public road). OTOH, having the government compel every citizen to buy a private product (health insurance) was new territory, and not clearly within the constitution. The Supreme Court apparently agreed, which is why the penalties for not purchasing insurance were instead deemed by SCOTUS to be "taxes" rather than "penalties" or "fines" (despite the wording of the actual law). The federal government's power to tax is on solid ground.

None of this has anything to do with future proposals, but apparently people want to discuss it here (again) for some reason.

 

[ShokWaveRider]

Originally Posted by GTFan
Well, there's your problem. Don't really understand folks who for some reason accept that being forced to carry insurance on your car is ok, but health insurance is not even though you're WAY more likely to need the health insurance to avoid a huge financial hit (and/or avoid putting burden on others).

People don't like being told what to do for the good of all (mandate), but it's already there for other risks.

+ A Gazillion!!! Makes Perfect Sense.

 

[brucethebroker]

Seems like much worry about things that may or may not happen.

Keep your powder dry until congress is seriously debating the changes......fewer ulcers that way.

 

[Mulligan]

+1
I have repeatedly said the same thing over many threads, and quite a few posters agreed with me. As a nation we have beaten around the bush for too long already.

I think we are all to blame. To use my analogy earlier, we want to ride a taxi while paying only bus fare. It comes to a rude awakening that the cost catches up with us, and some of us now on ACA are paying limousine price for that taxi.

While I agree with you and Texas, I am more cynical. I have given up hope near term anything changing. So all I am hoping for is the pig I am forced to kiss has a lot of lipstick on it. Give me that 3k tax credit for being old and double my HSA contribution deduction while I continue to complain about healthcare costs.

 

[ShokWaveRider]

Seems like much worry about things that may or may not happen.

Keep your powder dry until congress is seriously debating the changes......fewer ulcers that way.

We (I) worry because it is the single most important item that affects everyone who early Retired or is on Medicare at 65+.

All the other items are just noise compared to healthcare (for our demographic) and potentially the largest drain on our hard earned retirement funds.

 

[travelover]

Here in AZ, one can avoid the mandatory vehicle liability insurance if he posts a bond of $40K to show financial responsibility. The $40K may be too low, but there's that concept.

Something like the above can be required by the Federal government. If someone gets in an accident, the hospital can treat him to a stable condition or to stop bleeding, then gets reimbursement out of his bonded account. For long-term treatments or chronic conditions, of course he is on his own.

Didn't we have a thread, not too long ago, about what a large percentage of the population couldn't come up with $1000 if they had to?

People with an extra $40K are not the problem.

 

[explanade]

+1
I have repeatedly said the same thing over many threads, and quite a few posters agreed with me. As a nation we have beaten around the bush for too long already.

I think we are all to blame. To use my analogy earlier, we want to ride a taxi while paying only bus fare. It comes to a rude awakening that the cost catches up with us, and some of us now on ACA are paying limousine price for that taxi.

The other analogy is that there are free riders, people who don't pay for insurance, rack up medical bills and don't pay or have no assets to pay.

People with assets have to get health insurance, as much to protect their wealth as well as their health.

 

[pb4uski]

+1 For us that is the main reason... to protect our wealth... and secondarily, to gain access to negotiated rates (but from what I understand you can often do better paying cash).

That "protect the wealth" logic also extends to our kids... I would not want to be put in the position where they have a health event and can't get the care that they need without us writing a big check... so I insist that they both carry health insurance... if they didn't then I would probably pay for it (to protect me), but please don't tell them that.

 

[daylatedollarshort]

Seems like much worry about things that may or may not happen.

Keep your powder dry until congress is seriously debating the changes......fewer ulcers that way.

The issue is that our worst case alternatives are not actions we can implement overnight or even in a few months. Go back to work and and get a job? My tech skills are getting out of date and I'm probably overqualified for Starbucks, so getting a job if I go that path for me probably means taking classes and getting some current certifications. Moving abroad? That is a possibility but a lot of work in itself and mutually exclusive with taking classes to get a full-time job here. If we can get insurance but it is much more expensive we would probably up our hobby income, but again that takes time and time away from pursuing the other alternatives.

 

[explanade]

They were saying the replacement plan would need at least 8 senators from the minority, unless the majority is willing to get rid of the filibuster for good.

It's going to be a long period of uncertainty but another scenario is if they impair the ACA with budgetary moves or executive orders which do not require 60 votes in the Senate, a lot of insurers may choose to bail long before a full repeal.