Obamacare: Obama just straight up lied to you, in your face (3 Viewers)

[matttyl]

The Congressional Budget Office estimates that ACA won't actually expand coverage and that the number of uninsured under Obamacare won't ever fall below 30 million.

A McKinsey report now estimates ACA will cost taxpayers at least an additional $400 billion more than originally proposed.

Been saying that for months to people saying I was crazy. Looks like economists and even now the CBO are agreeing with me.

 

[matttyl]

You live in 1 of the few areas in the US where the cost of insurance hasn't jumped substantially... It may not effect you. Don't assume the ACA isn't negatively impacting others based on the rates in your area..

My policy was canceled... My cost has gone up 110%... I was happy with the insurance I had...

But it wouldn't cover you if you got pregnant!!!

I think I am beyond my child bearing years...

Obama doesn't care, pay up or be fined.

 

[Dr Oadi]

I think that article makes sense, and it represents my own position. I didn't like Obamacare, didn't want it. But it's here, and not going away. So it needs to be fixed to make it better.

To me the most obvious solution is this: if your current insurance is cancelled due to Obamacare's new restrictions, and you find yourself forced to accept a new insurance which costs more money, then the federal government should provide you (or more likely the insurance company) a subsidy to take care of most or all of the difference. This will, of course, cause Obamacare to cost much more to the taxpayer than it does now. So be it.

Liberal mentality is destroying the US

 

[Bottomfeeder Sports]

You live in 1 of the few areas in the US where the cost of insurance hasn't jumped substantially... It may not effect you. Don't assume the ACA isn't negatively impacting others based on the rates in your area..

Well maybe the rest of you should look at Maryland to see why we get some of the best health care in the nation and health costs go up slower (with 1 recent exception) than the national average. But that is another discussion.But my point is that while health care cost overall are still growing faster than inflation like it has for quite a long time, those rates have slowed down and that trend is expected to continue. Not in Maryland, but nationally.

Factors affecting 2014 Medical Cost Trend

Four factors deflate medical cost trend in 2014

• Care continues to move outside costly settings such as hospitals to more affordable retail clinics and mobile health. Consumers value the convenience, and costs can be as little as one-third of the bill in a traditional healthcare site.
• Major employers such as Walmart, Boeing, and Lowes now contract directly with big-name health systems for costly, complicated procedures such as heart surgery and spinal fusion. The employers are making the move to high performance networks far away from the home office in the belief that even with travel costs, these networks still deliver overall savings.
• The federal governments new readmission penalties take direct aim at waste in the health system, estimated to be as high as 30%. According to government data, hospital readmissions dropped by nearly 70,000 in 2012, and this trend is expected to accelerate through 2014 as hospitals focus on discharge planning, compliance and the continuum of care.
• Seventeen percent of employers in PwCs 2013 Touchstone survey today offer a high deductible health plan as the only option for employees. And more than 44% are considering offering it as the only option. When consumers pay more for their healthcare, they often make more cost-conscious choices.

Two factors inflate medical cost trend in 2014

• Until recently, widespread adoption of generic medicines helped dampen overall medical inflation, but the rise of expensive complex biologics will nudge spending trends upward. Approvals of new biologics now outpace traditional therapies, and that pattern will continue in 2014 as research efforts target complex cases such as cancer.
• Health industry consolidation has increased more than 50% since 2009activity that is expected to continue through 2014. Higher prices are sure to follow in some markets. According to a recent report, hospital mergers can lead to price increases of up to 20.3% These price increases are especially acute in markets with one dominant system.

My policy was canceled... My cost has gone up 110%... I was happy with the insurance I had...

Sorry.

 

[Sand]

3 is a HUGE number (over half the individual market, actually), but the entire group is based on a lie that you could keep your coverage. So what if a single male doesn't have maternity or pediatric oral care, he has absolutely no need for either - same with a couple in their 50s or 60s. Shouldn't individuals be able to pick their own coverage? Why does the government think they know what people need better than those people themselves? Again, where is the choice here?

The government needs those unused portions of each policy to subsidize others. This is a basic tenet of the ACA to transfer the wealth where it is desired to go. On the other end, the limitation on cadillac plans is really nothing more than socialist egalitarianism.

The Congressional Budget Office estimates that ACA won't actually expand coverage and that the number of uninsured under Obamacare won't ever fall below 30 million.

A McKinsey report now estimates ACA will cost taxpayers at least an additional $400 billion more than originally proposed.

Been saying that for months to people saying I was crazy. Looks like economists and even now the CBO are agreeing with me.

Way, way low on the cost this will incur. Wait until year 1 stats come out showing how the pool is weighted way too lightly on young, healthy patsies (errr., policy holders). Then we'll see the CBO revise this number sky high.

 

[Mark Davis]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need.

Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach.

The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

 

[tommyGunZ]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need.

Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach.

The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

That's a fair point; undoubtedly some consumers were opting for plans with fewer benefits out of choice. I think there are lots more folks on the other side of the coin though. Folks who think they've got good coverage, yet still end up bankrupt when serious health issues arrive.

 

[DrJ]

I think that article makes sense, and it represents my own position. I didn't like Obamacare, didn't want it. But it's here, and not going away. So it needs to be fixed to make it better.

To me the most obvious solution is this: if your current insurance is cancelled due to Obamacare's new restrictions, and you find yourself forced to accept a new insurance which costs more money, then the federal government should provide you (or more likely the insurance company) a subsidy to take care of most or all of the difference. This will, of course, cause Obamacare to cost much more to the taxpayer than it does now. So be it.

And you call yourself conservative and suggest you care about the budget.

Being conservative is not the equivalent of being ideologically rigid. Given the current involvement of the government in health care, which is not going away, we cannot just rely on the old formula "more spending bad, less spending good." We need fluidity and thoughtfulness. This is something you and the rest of the Tea Party have never understood, which is the main reason I oppose you.

Yeah, just saying "oh, if you got cancelled and your insurance went up we'll just write a check and maybe tax some people and move along" is a really thoughtful solution to the problem.

Or: "I don't really like Obamacare. But since we're stuck with it, let's go ahead and double down." Do you have any idea how stupid that sounds?

Since we're just putting out stupid ideas, how about we just give every US citizen a trillion dollars? Hell, let's give every world creature a trillion dollars. We don't want to make this unfair. Then everyone in the world can afford health care, even the ####### squirrels. The economy is stimulated, all of our problems are solved. And it only takes one bill.

 

[fantasycurse42]

I think that article makes sense, and it represents my own position. I didn't like Obamacare, didn't want it. But it's here, and not going away. So it needs to be fixed to make it better.

To me the most obvious solution is this: if your current insurance is cancelled due to Obamacare's new restrictions, and you find yourself forced to accept a new insurance which costs more money, then the federal government should provide you (or more likely the insurance company) a subsidy to take care of most or all of the difference. This will, of course, cause Obamacare to cost much more to the taxpayer than it does now. So be it.

And you call yourself conservative and suggest you care about the budget.

Being conservative is not the equivalent of being ideologically rigid. Given the current involvement of the government in health care, which is not going away, we cannot just rely on the old formula "more spending bad, less spending good." We need fluidity and thoughtfulness. This is something you and the rest of the Tea Party have never understood, which is the main reason I oppose you.

Yeah, just saying "oh, if you got cancelled and your insurance went up we'll just write a check and maybe tax some people and move along" is a really thoughtful solution to the problem.

Or: "I don't really like Obamacare. But since we're stuck with it, let's go ahead and double down." Do you have any idea how stupid that sounds?

Since we're just putting out stupid ideas, how about we just give every US citizen a trillion dollars? Hell, let's give every world creature a trillion dollars. We don't want to make this unfair. Then everyone in the world can afford health care, even the ####### squirrels. The economy is stimulated, all of our problems are solved. And it only takes one bill.

I want $1 Trillion Dollars... I like your platform!

Obamacare will cost a lot of democrats their seats and possibly the White House in the next election.

Removing Obamacare will be the war chant of the next Republican campaign and eventually it will be repealed.

 

[Mark Davis]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need.

Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach.

The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

That's a fair point; undoubtedly some consumers were opting for plans with fewer benefits out of choice. I think there are lots more folks on the other side of the coin though. Folks who think they've got good coverage, yet still end up bankrupt when serious health issues arrive.

I don't know. We can agree there are people on both sides of that, but I'd suspect there are more people who have that "non-compliant" plan due to their own choosing or means. Many small business owners for instance would choose to have this kind of plan. If my wife wasn't getting insurance through her employer, I'd have bought such a plan for us.

While I don't like government being big brother and deciding what plan I need, I don't actually believe that is the driving reason behind it. I don't think it's the government trying to "help" those people who could afford a more comprehensive plan but are ignorant to the risks. I still think it's driven by having to lump everyone in, including the young and healthy to subsidize the others they are now bringing in.

 

[matttyl]

Haha, TGunz thinks more people went bankrupt with medical insurance than had coverage without maternity cause they didn't want/need it. Keep spreading that......

There we're 1,181,000 bankruptcy filings by individuals in 2012.

http://www.bankruptcyaction.com/USbankstats.htm

62.1% of them we're from medical reasons, and 75% had health insurance.

http://m.dailykos.com/story/2012/01/05/1051848/-Medical-bills-cause-62-percent-of-nbsp-bankruptcies

So we're talking about a national total of about 550,000 people (and most filed bankruptcy to keep their homes, but that's a different topic).

And you think even fewer people picked more basic coverage to save money than that?! Then how come 11.4 million Americans hadHigh Deductible Health Plans (HDHPs) alone in 2011?!

http://ahip.org/HSA2011/

Just people with HDHPs outnumber those who filed medical bankruptcy 20 to 1!!!

 

[MaxThreshold]

Haha, TGunz thinks more people went bankrupt with medical insurance than had coverage without maternity cause they didn't want/need it. Keep spreading that......

There we're 1,181,000 bankruptcy filings by individuals in 2012.

http://www.bankruptcyaction.com/USbankstats.htm

62.1% of them we're from medical reasons, and 75% had health insurance.

http://m.dailykos.com/story/2012/01/05/1051848/-Medical-bills-cause-62-percent-of-nbsp-bankruptcies

So we're talking about a national total of about 550,000 people (and most filed bankruptcy to keep their homes, but that's a different topic).

And you think even fewer people picked more basic coverage to save money than that?! Then how come 11.4 million Americans hadHigh Deductible Health Plans (HDHPs) alone in 2011?!

http://ahip.org/HSA2011/

Just people with HDHPs outnumber those who filed medical bankruptcy 20 to 1!!!

You do realize you're talking to TGunz here, right? I mean, he's not really interested in facts and figures. He's a cheerleader for Team Left regardless of what they do. Obama is his Dear Leader and can do no wrong.

Just sayin'.

 

[jamny]

How many people here personally know someone who was dropped from their healthcare or didn't get coverage for an illness? I always hear about the evil insurance companies and how they fight tooth and nail to not pay for your illnesses. Both of my in-laws had serious heart procedures that cost over $100,000 each and they barely paid a dime. That's pretty good. They've both pretty much used up more than they've put into it already. The problem with Obamacare is that it isn't health care reform, which is much needed. It's health insurance reform. It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

 

[Bottomfeeder Sports]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need.

Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach.

The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

That's a fair point; undoubtedly some consumers were opting for plans with fewer benefits out of choice. I think there are lots more folks on the other side of the coin though. Folks who think they've got good coverage, yet still end up bankrupt when serious health issues arrive.

I don't know. We can agree there are people on both sides of that, but I'd suspect there are more people who have that "non-compliant" plan due to their own choosing or means. Many small business owners for instance would choose to have this kind of plan. If my wife wasn't getting insurance through her employer, I'd have bought such a plan for us. While I don't like government being big brother and deciding what plan I need, I don't actually believe that is the driving reason behind it. I don't think it's the government trying to "help" those people who could afford a more comprehensive plan but are ignorant to the risks. I still think it's driven by having to lump everyone in, including the young and healthy to subsidize the others they are now bringing in.

First I'm not a fan of ObamaCare. Second while I believe that the consumer protections of ACA is ultimately a good thing with this kind of system, you are correct that ACA works (assuming it does) by not allowing people to stand on the side of the "pool".But I'm also certainly glad that the plan of selling the crappiest of plans across state lines so most of us savvy health insurance consumers would have the cheapest of insurance that did not really cover much of anything lost out.

 

[tri-man 47]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need.

Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach.

The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

That's a fair point; undoubtedly some consumers were opting for plans with fewer benefits out of choice. I think there are lots more folks on the other side of the coin though. Folks who think they've got good coverage, yet still end up bankrupt when serious health issues arrive.

I don't know. We can agree there are people on both sides of that, but I'd suspect there are more people who have that "non-compliant" plan due to their own choosing or means. Many small business owners for instance would choose to have this kind of plan. If my wife wasn't getting insurance through her employer, I'd have bought such a plan for us.

While I don't like government being big brother and deciding what plan I need, I don't actually believe that is the driving reason behind it. I don't think it's the government trying to "help" those people who could afford a more comprehensive plan but are ignorant to the risks. I still think it's driven by having to lump everyone in, including the young and healthy to subsidize the others they are now bringing in.

s Mark

As the Wall Street Journal summarized it a day or two ago: Forced equity is trumping individual choice.

It really ticks me off that the President's 'read my lips' moment ("if you like your health care plan, you can keep it") was a lie that he continued to repeat. A basic premise of the ACA was that many policyholders would need to be driven to ACA to create the necessary pool. The President, et al. knew this would happen, but a different, and false, picture was painted. It's insulting to many, I'm sure, to hear claims that their insurance was inadequate. As you point out, people chose varying types of coverage for a number of reasons. That's their choice. They don't need the government stepping in and forcing them to change.

 

[The Commish]

I just got my open enrollment at work which is a very large company.

The short of it? My options have been dropped from 4 to 3 now. The cost to keep the same insurance as I had last year will be another $600 on top of what I paid last year.

Of course, I am sure this is just a coincidence and has nothing to do with Obamacare. Oh and there was a nice message basically saying that if I don't sign up for one of these insurance options that I am pretty much screwed if I don't with the higher costs through Obamacare sans any subsidy (which I would not qualify for because I turned town the coverage from work).

very large company - self insured?

keep the same insurance - so no new mandated benefits?

Of course, I am sure this is just a coincidence and has nothing to do with Obamacare. - I don't think has that much to do with ObamaCare, but the rate of growth for health care has slowed down. So ObamaCare is not adding cost (at least yet) to the overall health care market.

So while I'm not a big fan of ObamaCare, I don't see how ObamaCare is the driver for your particular increase in cost. Unless the company is paying a smaller share to avoid cadillac plan tax. But since these plans don't really cover much more that doesn't seem like the best approach to avoid that tax.

There is lots of change happening in health care today because every one knows that the rate of growth of cost from the recent past is unsustainable. Most of this change has very little to do with the ACA and is happening with or without. For one thing, ACA is not even the biggest government mandated change for 2014, That would be ICD-10.

Like I said, I am sure it is all just a happy coincidence as there is nothing in the documents that say "Hey, because Obamcare is screwing everything up- you are screwed in these areas."

Well, that is except for the part that specifically informs me that if I don't get coverage through their much less generous terms than previously offered that I am pretty much screwed as I would not be able to get a cheaper plan that may better fit my needs and since I declined this coverage would not qualify for any assistance regardless of otherwise qualifying.

And of course, Obamacare has no impact on insurance unless you buy in the single serve marketplaces.

So as of yet "ObamaCare must be responsible" because of :whoosh:

I am willing to concede that I could be overlooking/"conveniently forgetting" a driver of cost that could come from changes caused by the ACA, but without one - or without one of the premises above being wrong then your rates are simply going up because health care cost increases continue (even though it has gotten better) to outpace the rest of the economy,

But while acknowledging that makes for a good conversation it does makes for poor right wing nonsense.

Do you buy the argument that because ACA hasn't really done anything to address the obvious cost issues, that it's part of the problem?

The rate of the growth of healthcare has slowed since the passage of ACA. I don't believe that ACA is all that responsible - it is normal market mechanism including the industry trying to fix itself before a government solution (ACA fits within the industry solution). So maybe the slowing down in the rate of growth would be greater without the ACA, maybe the ACA will cause this change in the near future, but even if so health care costs are going up at a slower rate than in the recent past. So how can that be part of the here and now problem? Since insurance companies are (or soon will be) required to spend a certain percentage on actual healthcare they don't really have the option of "banking" expected future costs, can they?

So while I understand that those with crappy plans because either they didn't cover anything, they had large built it in profit margins in the high risk-high rewards market, or the plans looked good on paper but were designed to quickly shed anyone that actually put in claims are facing having to find new plans. With two of the three of these groups needing to spend more to now have real coverage and to absorb the costs of the third group. Those are legitimate gripes, but I'm not sure I agree that any of these people are really losing with the resulting changes. It is a hard sell that I'm not willing to attempt to argue that the lifelong consumer protections are worth the higher costs. None of this however applies to Chad's situation as he presented it.

I still don't like the ACA, but where is it driving up costs?

I'm not suggesting it's driving up costs. It's clear there's nothing in it to reduce costs though. I have a problem with that given the fact that our costs are so out of whack.

 

[Ballstein]

Insurers Gave U.S. Chamber $86 Million Used to Oppose Obama's Health Law

http://www.bloomberg.com/news/2010-11-17/insurers-gave-u-s-chamber-86-million-used-to-oppose-obama-s-health-law.html

 

[Bottomfeeder Sports]

... It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

Not yet. I'm not sure I believe that FFS is going away, but everyone (including the ACA experiments) is working as if it will be different this time.

 

[Bottomfeeder Sports]

I'm not suggesting it's driving up costs. It's clear there's nothing in it to reduce costs though. I have a problem with that given the fact that our costs are so out of whack.

Look up one post. This is simply false.

 

[tommyGunZ]

The Congressional Budget Office estimates that ACA won't actually expand coverage and that the number of uninsured under Obamacare won't ever fall below 30 million.

A McKinsey report now estimates ACA will cost taxpayers at least an additional $400 billion more than originally proposed.

Been saying that for months to people saying I was crazy. Looks like economists and even now the CBO are agreeing with me.

Link?

 

[matttyl]

Insurers Gave U.S. Chamber $86 Million Used to Oppose Obama's Health Law

http://www.bloomberg.com/news/2010-11-17/insurers-gave-u-s-chamber-86-million-used-to-oppose-obama-s-health-law.html

I'm surprised it wasn't more. The government spent 10 times as much on the website alone,and it didn't work either.

 

[Zegras11]

How many people here personally know someone who was dropped from their healthcare or didn't get coverage for an illness? I always hear about the evil insurance companies and how they fight tooth and nail to not pay for your illnesses. Both of my in-laws had serious heart procedures that cost over $100,000 each and they barely paid a dime. That's pretty good. They've both pretty much used up more than they've put into it already. The problem with Obamacare is that it isn't health care reform, which is much needed. It's health insurance reform. It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

A week before my son was born, my wife switched from BCross of CA (20% co pay on everything) to Kaiser. I was self employed. That was 16 1/2 years ago. At the age of 51 weeks, he had 3 open heart surgeries, was in the ICU for 4 months, and has had quarterly check ups since then.

We estimate his total bill to be around $2million now. We never saw a bill. We never had to pay an extra dime, but did get normal premium raises.

In July 2010, we moved to Boise, where Idaho had a LAW on the books that pre existing could not be denied. (3 other states at time had this also). Our premiums for same coverage were actually a little lower in ID than CA, and I was nine months into a recovery also for a PE I had four years ago tomorrow.

My wife now works at Boise St and we've been covered for the first time in our lives by work the past two years.

 

[matttyl]

The Congressional Budget Office estimates that ACA won't actually expand coverage and that the number of uninsured under Obamacare won't ever fall below 30 million.

A McKinsey report now estimates ACA will cost taxpayers at least an additional $400 billion more than originally proposed.

Been saying that for months to people saying I was crazy. Looks like economists and even now the CBO are agreeing with me.

Link?

Link to what? Me claiming months ago that Obamacare would increase the number of uninsured or links to the media finally catching up and agreeing with me? Or link to the CBO report (released prior to final ACA high rates being released or the millions of people being thrown off their current coverage) saying that the number of uninsured would still top 30 million?

 

[Ballstein]

Insurers Gave U.S. Chamber $86 Million Used to Oppose Obama's Health Law

http://www.bloomberg.com/news/2010-11-17/insurers-gave-u-s-chamber-86-million-used-to-oppose-obama-s-health-law.html

I'm surprised it wasn't more. The government spent 10 times as much on the website alone,and it didn't work either.

It was, this was 2010...imagine the millions more.

 

[jamny]

How many people here personally know someone who was dropped from their healthcare or didn't get coverage for an illness? I always hear about the evil insurance companies and how they fight tooth and nail to not pay for your illnesses. Both of my in-laws had serious heart procedures that cost over $100,000 each and they barely paid a dime. That's pretty good. They've both pretty much used up more than they've put into it already. The problem with Obamacare is that it isn't health care reform, which is much needed. It's health insurance reform. It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

A week before my son was born, my wife switched from BCross of CA (20% co pay on everything) to Kaiser. I was self employed. That was 16 1/2 years ago. At the age of 51 weeks, he had 3 open heart surgeries, was in the ICU for 4 months, and has had quarterly check ups since then.

We estimate his total bill to be around $2million now. We never saw a bill. We never had to pay an extra dime, but did get normal premium raises.

In July 2010, we moved to Boise, where Idaho had a LAW on the books that pre existing could not be denied. (3 other states at time had this also). Our premiums for same coverage were actually a little lower in ID than CA, and I was nine months into a recovery also for a PE I had four years ago tomorrow.

My wife now works at Boise St and we've been covered for the first time in our lives by work the past two years.

So had you stayed with BC, you would have had to pay 20% of nearly 2 mill? What made you switch? And why is kaiser so much better?

 

[Carolina Hustler]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need.

Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach.

The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

That's a fair point; undoubtedly some consumers were opting for plans with fewer benefits out of choice. I think there are lots more folks on the other side of the coin though. Folks who think they've got good coverage, yet still end up bankrupt when serious health issues arrive.

I think when someone has a catastrophic illness or injury their medical bills aren't the main reason they go bankrupt. Typically they are unable to work, that will still be the case, and they will still lose their houses etc..

 

[Zegras11]

How many people here personally know someone who was dropped from their healthcare or didn't get coverage for an illness? I always hear about the evil insurance companies and how they fight tooth and nail to not pay for your illnesses. Both of my in-laws had serious heart procedures that cost over $100,000 each and they barely paid a dime. That's pretty good. They've both pretty much used up more than they've put into it already. The problem with Obamacare is that it isn't health care reform, which is much needed. It's health insurance reform. It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

A week before my son was born, my wife switched from BCross of CA (20% co pay on everything) to Kaiser. I was self employed. That was 16 1/2 years ago. At the age of 51 weeks, he had 3 open heart surgeries, was in the ICU for 4 months, and has had quarterly check ups since then.

We estimate his total bill to be around $2million now. We never saw a bill. We never had to pay an extra dime, but did get normal premium raises.

In July 2010, we moved to Boise, where Idaho had a LAW on the books that pre existing could not be denied. (3 other states at time had this also). Our premiums for same coverage were actually a little lower in ID than CA, and I was nine months into a recovery also for a PE I had four years ago tomorrow.

My wife now works at Boise St and we've been covered for the first time in our lives by work the past two years.

So had you stayed with BC, you would have had to pay 20% of nearly 2 mill? What made you switch? And why is kaiser so much better?

Yep, we would have had to pay that 20%. We switched to Kaiser because the premiums were only $30 higher per month and it was $20/visit. We also had 7yr old twins at the time and were spending quite a bit out of pocket on them. Kaiser's care turned out to be much better than what we got a BC.

 

[matttyl]

I highly doubt that your 20% co insurance had no out of pocket max at all. That said even coverage that "only covers" 80% would still be considered "gold coverage" by the ACA!! Their are two tiers (3 if you count "castistropic") that on average would cover even less.

 

[Zegras11]

I highly doubt that your 20% co insurance had no out of pocket max at all. That said even coverage that "only covers" 80% would still be considered "gold coverage" by the ACA!! Their are two tiers (3 if you count "castistropic") that on average would cover even less.

I don't recall what it was now, but I do remember that the cap was very high. Does a $100K per year sound right? Maybe it was a million for life. I'm just so glad she did the homework and we switched.

Wow... I haven't had a need to see any of the plans. Are you ####ting me on how bad those plans are?

 

[StrikeS2k]

How many people here personally know someone who was dropped from their healthcare or didn't get coverage for an illness? I always hear about the evil insurance companies and how they fight tooth and nail to not pay for your illnesses. Both of my in-laws had serious heart procedures that cost over $100,000 each and they barely paid a dime. That's pretty good. They've both pretty much used up more than they've put into it already. The problem with Obamacare is that it isn't health care reform, which is much needed. It's health insurance reform. It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

A week before my son was born, my wife switched from BCross of CA (20% co pay on everything) to Kaiser. I was self employed. That was 16 1/2 years ago. At the age of 51 weeks, he had 3 open heart surgeries, was in the ICU for 4 months, and has had quarterly check ups since then.

We estimate his total bill to be around $2million now. We never saw a bill. We never had to pay an extra dime, but did get normal premium raises.

In July 2010, we moved to Boise, where Idaho had a LAW on the books that pre existing could not be denied. (3 other states at time had this also). Our premiums for same coverage were actually a little lower in ID than CA, and I was nine months into a recovery also for a PE I had four years ago tomorrow.

My wife now works at Boise St and we've been covered for the first time in our lives by work the past two years.

So had you stayed with BC, you would have had to pay 20% of nearly 2 mill? What made you switch? And why is kaiser so much better?

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

 

[Zegras11]

How many people here personally know someone who was dropped from their healthcare or didn't get coverage for an illness? I always hear about the evil insurance companies and how they fight tooth and nail to not pay for your illnesses. Both of my in-laws had serious heart procedures that cost over $100,000 each and they barely paid a dime. That's pretty good. They've both pretty much used up more than they've put into it already. The problem with Obamacare is that it isn't health care reform, which is much needed. It's health insurance reform. It doesn't address the high cost of health care itself. If we can somehow bring down the insanely high cost of medical procedures, the cost of insurance will follow.

A week before my son was born, my wife switched from BCross of CA (20% co pay on everything) to Kaiser. I was self employed. That was 16 1/2 years ago. At the age of 51 weeks, he had 3 open heart surgeries, was in the ICU for 4 months, and has had quarterly check ups since then.

We estimate his total bill to be around $2million now. We never saw a bill. We never had to pay an extra dime, but did get normal premium raises.

In July 2010, we moved to Boise, where Idaho had a LAW on the books that pre existing could not be denied. (3 other states at time had this also). Our premiums for same coverage were actually a little lower in ID than CA, and I was nine months into a recovery also for a PE I had four years ago tomorrow.

My wife now works at Boise St and we've been covered for the first time in our lives by work the past two years.

So had you stayed with BC, you would have had to pay 20% of nearly 2 mill? What made you switch? And why is kaiser so much better?

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

We remember him saying that and wondered why also.

 

[matttyl]

I highly doubt that your 20% co insurance had no out of pocket max at all. That said even coverage that "only covers" 80% would still be considered "gold coverage" by the ACA!! Their are two tiers (3 if you count "castistropic") that on average would cover even less.

I don't recall what it was now, but I do remember that the cap was very high. Does a $100K per year sound right? Maybe it was a million for life. I'm just so glad she did the homework and we switched.

Wow... I haven't had a need to see any of the plans. Are you ####ting me on how bad those plans are?

The $1m likely was your lifetime maximum benefit (and that's per person, not per policy). You mentioned that this was 16.5 years ago I think, and back then it was extremely rare for people to hit those kinds of numbers as "open heart surgery" and things like the NICU and other high cost medical procedures weren't as prevalent and available as they are today. Years ago policies had these "lifetime caps", but because of competition among carries and the changing medical care landscape they typically went from $1m to $2m and them to $5m and many to $10m before the new law was passed saying that there could be no lifetime cap. This is a really big reason why policy premiums have gone up so much in the past 10-15 years - the amount the policy could potential pay has gone up greatly, and a person's ability to actually hit those numbers has gone up with new and more readily available medical procedures. In reality (and I've been a health insurance agent for about 10 years now) I've only seen one policy hit a lifetime cap and it was a heart replacement with very expensive drugs afterwards so that the new heart would "take", so he just went from one policy to another after he came close to the cap on the first (the second was a guaranteed issue plan).

And yes, sortof on your second question. The new ACA plans are built so that on average for a very large group of people "bronze plans" would cover 60% of your medical expenses, silver would cover 70%, gold 80%, and platinum (which are ridiculously expensive) would cover 90%. That's not per person, though, it's per large group and many people go though a year without any claims at all or very few claims and the plan would cover 0% for them (as they didn't hit deductibles or anything), while someone else with very large claims (like your example) might actually get 90% of their claims covered as they hit their maximum out of pockets and such. The new plans would likely have a max out of pocket for a family that had your situation at $12k excluding prescriptions, which could take your OOP up towards $20k potentially.

 

[Rich Conway]

My attitude toward this is exactly the same as it was to the sequester: I am not in favor of suddenn changes to the system which hurt people. Change is inevitable, but in our day and age there should be ways to make it less painful by doing things more thoughtfully.

The same problem exists here that exists with the budget, with the farm bill, and with every other policy. "Thoughtful" policies don't make for good sound bites. "Thoughtful" policies don't get politicians reelected. "Thoughtful" policies don't make campaign donors happy. Because of these things, and particularly the last one, "thoughtful" policies can't get the votes.

Therefore, your choices are A) Nothing, B) policies that harm some people but that do some good, or C) policies that are bad all around. You seem to be arguing against B, but fail to recognize that A and C aren't better choices.

 

[Dr Oadi]

I find it interesting that one of the main arguments of the ACA supporters is that these people losing their plans because those plans didn't meet ACA standards is a good thing. You know, some people may want a really high deductible to only cover a truly catastrophic event because they have the means to cover themselves for lesser issues. A forty year old single woman may not want maternity coverage and therefore wants to save her premium dollars instead of paying for coverage she simply doesn't need. Anytime the government takes choices away from people and the argument is basically that the government knows better than individuals do as to what is best for them, that is concerning. I'm not someone who is far right and believes government can't serve good purposes but this is an overreach. The salespeople for this plan politically can't just level with the public and say "You're going to have to pay more so that we can cover everyone who didn't have coverage before". There's an economic reason that the insurance companies weren't covering those folks, so someone has to pay the balance.

That's a fair point; undoubtedly some consumers were opting for plans with fewer benefits out of choice. I think there are lots more folks on the other side of the coin though. Folks who think they've got good coverage, yet still end up bankrupt when serious health issues arrive.

I don't know. We can agree there are people on both sides of that, but I'd suspect there are more people who have that "non-compliant" plan due to their own choosing or means. Many small business owners for instance would choose to have this kind of plan. If my wife wasn't getting insurance through her employer, I'd have bought such a plan for us. While I don't like government being big brother and deciding what plan I need, I don't actually believe that is the driving reason behind it. I don't think it's the government trying to "help" those people who could afford a more comprehensive plan but are ignorant to the risks. I still think it's driven by having to lump everyone in, including the young and healthy to subsidize the others they are now bringing in.

First I'm not a fan of ObamaCare. Second while I believe that the consumer protections of ACA is ultimately a good thing with this kind of system, you are correct that ACA works (assuming it does) by not allowing people to stand on the side of the "pool".But I'm also certainly glad that the plan of selling the crappiest of plans across state lines so most of us savvy health insurance consumers would have the cheapest of insurance that did not really cover much of anything maternity care and drug abuse treatment lost out.

Fixed that for you.

 

[Bottomfeeder Sports]

...so most of us savvy health insurance consumers would have the cheapest of insurance that did not really cover much of anything maternity care and drug abuse treatment lost out.

Fixed that for you.

Only in the world of sound bites.

 

[Dr Oadi]

...so most of us savvy health insurance consumers would have the cheapest of insurance that did not really cover much of anything maternity care and drug abuse treatment lost out.

Fixed that for you.

Only in the world of sound bites reality.

Lots of mess ups today but that is to be expected defending the mess up known as ACA.

 

[Sarnoff]

Haha, TGunz thinks more people went bankrupt with medical insurance than had coverage without maternity cause they didn't want/need it. Keep spreading that......

There we're 1,181,000 bankruptcy filings by individuals in 2012.

http://www.bankruptcyaction.com/USbankstats.htm

62.1% of them we're from medical reasons, and 75% had health insurance.

http://m.dailykos.com/story/2012/01/05/1051848/-Medical-bills-cause-62-percent-of-nbsp-bankruptcies

So we're talking about a national total of about 550,000 people (and most filed bankruptcy to keep their homes, but that's a different topic).

And you think even fewer people picked more basic coverage to save money than that?! Then how come 11.4 million Americans hadHigh Deductible Health Plans (HDHPs) alone in 2011?!

http://ahip.org/HSA2011/

Just people with HDHPs outnumber those who filed medical bankruptcy 20 to 1!!!

That's a bit of a BS stat, though, to say medical bills were the "cause" of the bankruptcy. They were just one factor of many. A person with massive student loan debt, an underwater mortgage, who then loses their job, has all their investments go sour and is living on their spare change who then gets pregnant and is charged more than $5000 for the delivery counts as a "medical" bankruptcy in the way they skewed that statistic. Even though the other factors were a much greater contribution to their overall loss of money. That person could have easily paid their medical bills had they not gone through all the other stuff first.

 

[Bottomfeeder Sports]

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

And this is the model that US healthcare is embracing-Today your primary care doctor's job is to up sell you to other services. If they are a small independent practice (a dying breed) they push you towards the stuff they sell directly to you. If they are part of a drug store then they send you out to the store with list of stuff. If they are part of a larger health care system they push you to the specialists and the hospitals in that system.

In the Kaiser model the system already has all of your premiums and the job is to instead of pushing you towards other services to keep you healthy enough to not need any of them. And if you do need something to take care of it quickly before the cost get out of hand. At the same time when you need multiple providers they are all communicating with one another via electronic records.

So ultimately the change that the entire industry has been moving towards (prior to ACA) is away from the traditional FFS model and towards a model where providers are paid per patient and get rewarded based on how well they keep you healthy so you don't need more care. The Kaiser model that Obama speaks of when he is talking about his grandmother's care.

Problem is that while there are numerous places where this works moving the whole system to "managed care" and "capitation" payments has failed spectacularly just over a decade ago. Replace those terms with "patient-centered medical home" and "accountable care organization" among others and it is 1998 all over again. Maybe this time will be different. It pretty much has to be.

And the answer to how does the ACA attempt to deal with cost is that the ACA attempts to align Medicare and Medicaid into the new delivery model however it may turn out.

 

[timschochet]

My attitude toward this is exactly the same as it was to the sequester: I am not in favor of suddenn changes to the system which hurt people. Change is inevitable, but in our day and age there should be ways to make it less painful by doing things more thoughtfully.

The same problem exists here that exists with the budget, with the farm bill, and with every other policy. "Thoughtful" policies don't make for good sound bites. "Thoughtful" policies don't get politicians reelected. "Thoughtful" policies don't make campaign donors happy. Because of these things, and particularly the last one, "thoughtful" policies can't get the votes.

Therefore, your choices are A) Nothing, B) policies that harm some people but that do some good, or C) policies that are bad all around. You seem to be arguing against B, but fail to recognize that A and C aren't better choices.

Oftentimes there are realistic alternatives which are more thoughtful. For example, in the case of the sequester, there were the Simpson/Bowles proposals- also quite painful, but at a slower pace and more thoughtful.

But in the event that you're correct that thoughtful approaches are not going to happen, then IMO, in most instances, the best result is to do nothing. That sector of our society which is still a free market may solve several of our most pressing issues all by itself- it normally does over time.

 

[datonn]

My attitude toward this is exactly the same as it was to the sequester: I am not in favor of suddenn changes to the system which hurt people. Change is inevitable, but in our day and age there should be ways to make it less painful by doing things more thoughtfully.

The same problem exists here that exists with the budget, with the farm bill, and with every other policy. "Thoughtful" policies don't make for good sound bites. "Thoughtful" policies don't get politicians reelected. "Thoughtful" policies don't make campaign donors happy. Because of these things, and particularly the last one, "thoughtful" policies can't get the votes.

Therefore, your choices are A) Nothing, B) policies that harm some people but that do some good, or C) policies that are bad all around. You seem to be arguing against B, but fail to recognize that A and C aren't better choices.

Oftentimes there are realistic alternatives which are more thoughtful. For example, in the case of the sequester, there were the Simpson/Bowles proposals- also quite painful, but at a slower pace and more thoughtful.

But in the event that you're correct that thoughtful approaches are not going to happen, then IMO, in most instances, the best result is to do nothing. That sector of our society which is still a free market may solve several of our most pressing issues all by itself- it normally does over time.

Tim, I think your initial train of thought here was naive. If you are not in favor of sudden changes which hurt people, then you are in-favor of never passing another law/budget, ever again. If you're for eliminating government waste? You're "for" having tens of thousands losing their jobs. If you're for meaningful tax reform? You're "for" countless numbers of tax accountants and probably lawyers losing large chunks of their income (or losing their jobs altogether). Etc, etc.

Find us something other than proclamations declaring November 3, 2013 as "timschochet Day" in the FFA, and you're basically talking about passing laws that will have an immediate and negative impact on some group of other individuals.

 

[jonessed]

The reason Kaiser is an efficient model is because they put the onus of making medical decisions on the patient. They prescribe tests and care based on probability. It's a good model for the 90% of people that are the norm, but if your symptoms are a result of a lower probability illness/problem you will either have to push for a test or wait until the issue gets worse.

They don't have the best specialists either, but that follows the same line of thinking. They are good enough for the majority of issues.

This is a much better national model than the current system or ACA (which is really just an expanded version of our current system). For whatever reason Obama chose not to go in this direction. I believe we should model it more like the French system however and keep the options for better, private insurance add-ons for those that can afford it.

 

[StrikeS2k]

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

And this is the model that US healthcare is embracing-Today your primary care doctor's job is to up sell you to other services. If they are a small independent practice (a dying breed) they push you towards the stuff they sell directly to you. If they are part of a drug store then they send you out to the store with list of stuff. If they are part of a larger health care system they push you to the specialists and the hospitals in that system.

In the Kaiser model the system already has all of your premiums and the job is to instead of pushing you towards other services to keep you healthy enough to not need any of them. And if you do need something to take care of it quickly before the cost get out of hand. At the same time when you need multiple providers they are all communicating with one another via electronic records.

So ultimately the change that the entire industry has been moving towards (prior to ACA) is away from the traditional FFS model and towards a model where providers are paid per patient and get rewarded based on how well they keep you healthy so you don't need more care. The Kaiser model that Obama speaks of when he is talking about his grandmother's care.

Problem is that while there are numerous places where this works moving the whole system to "managed care" and "capitation" payments has failed spectacularly just over a decade ago. Replace those terms with "patient-centered medical home" and "accountable care organization" among others and it is 1998 all over again. Maybe this time will be different. It pretty much has to be.

And the answer to how does the ACA attempt to deal with cost is that the ACA attempts to align Medicare and Medicaid into the new delivery model however it may turn out.

If the entire industry was moving towards Kaiser's model Obama wouldn't have had to do anything. By his own admission, if the entire industry were as efficient as Kaiser "we actually would have solved our problems"

 

[datonn]

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

And this is the model that US healthcare is embracing-Today your primary care doctor's job is to up sell you to other services. If they are a small independent practice (a dying breed) they push you towards the stuff they sell directly to you. If they are part of a drug store then they send you out to the store with list of stuff. If they are part of a larger health care system they push you to the specialists and the hospitals in that system.

In the Kaiser model the system already has all of your premiums and the job is to instead of pushing you towards other services to keep you healthy enough to not need any of them. And if you do need something to take care of it quickly before the cost get out of hand. At the same time when you need multiple providers they are all communicating with one another via electronic records.

So ultimately the change that the entire industry has been moving towards (prior to ACA) is away from the traditional FFS model and towards a model where providers are paid per patient and get rewarded based on how well they keep you healthy so you don't need more care. The Kaiser model that Obama speaks of when he is talking about his grandmother's care.

Problem is that while there are numerous places where this works moving the whole system to "managed care" and "capitation" payments has failed spectacularly just over a decade ago. Replace those terms with "patient-centered medical home" and "accountable care organization" among others and it is 1998 all over again. Maybe this time will be different. It pretty much has to be.

And the answer to how does the ACA attempt to deal with cost is that the ACA attempts to align Medicare and Medicaid into the new delivery model however it may turn out.

If the entire industry was moving towards Kaiser's model Obama wouldn't have had to do anything. By his own admission, if the entire industry were as efficient as Kaiser "we actually would have solved our problems"

Yep. And if we had a cure for cancer, people stopped abusing alcohol/drugs (had a cure for dumb###), people stopped smoking (see alcohol/drugs), stopped serving their kids Big Macs and a Coke for dinner...we actually would have solved our problems too.

Talk about rainbows and unicorns. Anyone who actually thinks that "the marketplace" would get us to that point is either "special," or their brainwashing is complete. Not directed at StrikeS2k...just sayin'.

 

[StrikeS2k]

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

And this is the model that US healthcare is embracing-Today your primary care doctor's job is to up sell you to other services. If they are a small independent practice (a dying breed) they push you towards the stuff they sell directly to you. If they are part of a drug store then they send you out to the store with list of stuff. If they are part of a larger health care system they push you to the specialists and the hospitals in that system.

In the Kaiser model the system already has all of your premiums and the job is to instead of pushing you towards other services to keep you healthy enough to not need any of them. And if you do need something to take care of it quickly before the cost get out of hand. At the same time when you need multiple providers they are all communicating with one another via electronic records.

So ultimately the change that the entire industry has been moving towards (prior to ACA) is away from the traditional FFS model and towards a model where providers are paid per patient and get rewarded based on how well they keep you healthy so you don't need more care. The Kaiser model that Obama speaks of when he is talking about his grandmother's care.

Problem is that while there are numerous places where this works moving the whole system to "managed care" and "capitation" payments has failed spectacularly just over a decade ago. Replace those terms with "patient-centered medical home" and "accountable care organization" among others and it is 1998 all over again. Maybe this time will be different. It pretty much has to be.

And the answer to how does the ACA attempt to deal with cost is that the ACA attempts to align Medicare and Medicaid into the new delivery model however it may turn out.

If the entire industry was moving towards Kaiser's model Obama wouldn't have had to do anything. By his own admission, if the entire industry were as efficient as Kaiser "we actually would have solved our problems"

Yep. And if we had a cure for cancer, people stopped abusing alcohol/drugs (had a cure for dumb###), people stopped smoking (see alcohol/drugs), stopped serving their kids Big Macs and a Coke for dinner...we actually would have solved our problems too.

Talk about rainbows and unicorns. Anyone who actually thinks that "the marketplace" would get us to that point is either "special," or their brainwashing is complete. Not directed at StrikeS2k...just sayin'.

The question I've been asking literally FOR YEARS is WHY didn't Obama gear his changes towards pushing the market that way if he believes that it would solve all our problems? I've yet to get ONE single response answering that question.

 

[jonessed]

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

And this is the model that US healthcare is embracing-Today your primary care doctor's job is to up sell you to other services. If they are a small independent practice (a dying breed) they push you towards the stuff they sell directly to you. If they are part of a drug store then they send you out to the store with list of stuff. If they are part of a larger health care system they push you to the specialists and the hospitals in that system.

In the Kaiser model the system already has all of your premiums and the job is to instead of pushing you towards other services to keep you healthy enough to not need any of them. And if you do need something to take care of it quickly before the cost get out of hand. At the same time when you need multiple providers they are all communicating with one another via electronic records.

So ultimately the change that the entire industry has been moving towards (prior to ACA) is away from the traditional FFS model and towards a model where providers are paid per patient and get rewarded based on how well they keep you healthy so you don't need more care. The Kaiser model that Obama speaks of when he is talking about his grandmother's care.

Problem is that while there are numerous places where this works moving the whole system to "managed care" and "capitation" payments has failed spectacularly just over a decade ago. Replace those terms with "patient-centered medical home" and "accountable care organization" among others and it is 1998 all over again. Maybe this time will be different. It pretty much has to be.

And the answer to how does the ACA attempt to deal with cost is that the ACA attempts to align Medicare and Medicaid into the new delivery model however it may turn out.

If the entire industry was moving towards Kaiser's model Obama wouldn't have had to do anything. By his own admission, if the entire industry were as efficient as Kaiser "we actually would have solved our problems"

Yep. And if we had a cure for cancer, people stopped abusing alcohol/drugs (had a cure for dumb###), people stopped smoking (see alcohol/drugs), stopped serving their kids Big Macs and a Coke for dinner...we actually would have solved our problems too. Talk about rainbows and unicorns. Anyone who actually thinks that "the marketplace" would get us to that point is either "special," or their brainwashing is complete. Not directed at StrikeS2k...just sayin'.

Kaiser is very profitable (they are technically a non-profit but they throw excess earnings all over the place). I see no reason why the ACA couldn't have opted to force the industry into this direction instead of into the mess we have now.

Kaiser operates the way they do simply because they are the insurer and the medical provider wrapped into one. Their efficiency model is simply a natural progression from there.

 

[jonessed]

Kaiser is one of those hated HMO's. You use their facilities and doctors for everything. They already do a lot of the things the new health care law is supposed to be pushing, such as sharing your health care records between all their specialists so they all know your history. I've had Kaiser for probably 35 of my 47 years on this earth and wish my current employer offered them so I would still be with them. Oh, and Obama's grandmother had Kaiser. He said that if other insurance carriers were as efficient as Kaiser we'd already have solved our health care problem. But, instead of crafting his bill towards that goal he went another direction. I wonder why.......

And this is the model that US healthcare is embracing-Today your primary care doctor's job is to up sell you to other services. If they are a small independent practice (a dying breed) they push you towards the stuff they sell directly to you. If they are part of a drug store then they send you out to the store with list of stuff. If they are part of a larger health care system they push you to the specialists and the hospitals in that system.

In the Kaiser model the system already has all of your premiums and the job is to instead of pushing you towards other services to keep you healthy enough to not need any of them. And if you do need something to take care of it quickly before the cost get out of hand. At the same time when you need multiple providers they are all communicating with one another via electronic records.

So ultimately the change that the entire industry has been moving towards (prior to ACA) is away from the traditional FFS model and towards a model where providers are paid per patient and get rewarded based on how well they keep you healthy so you don't need more care. The Kaiser model that Obama speaks of when he is talking about his grandmother's care.

Problem is that while there are numerous places where this works moving the whole system to "managed care" and "capitation" payments has failed spectacularly just over a decade ago. Replace those terms with "patient-centered medical home" and "accountable care organization" among others and it is 1998 all over again. Maybe this time will be different. It pretty much has to be.

And the answer to how does the ACA attempt to deal with cost is that the ACA attempts to align Medicare and Medicaid into the new delivery model however it may turn out.

If the entire industry was moving towards Kaiser's model Obama wouldn't have had to do anything. By his own admission, if the entire industry were as efficient as Kaiser "we actually would have solved our problems"

Yep. And if we had a cure for cancer, people stopped abusing alcohol/drugs (had a cure for dumb###), people stopped smoking (see alcohol/drugs), stopped serving their kids Big Macs and a Coke for dinner...we actually would have solved our problems too. Talk about rainbows and unicorns. Anyone who actually thinks that "the marketplace" would get us to that point is either "special," or their brainwashing is complete. Not directed at StrikeS2k...just sayin'.

The question I've been asking literally FOR YEARS is WHY didn't Obama gear his changes towards pushing the market that way if he believes that it would solve all our problems? I've yet to get ONE single response answering that question.

The obvious answer is single-payer. The method he chose is the more obvious stepping stone to single-payer. Luckily, if the ACA continues to struggle it will likely step us back into something more privatized instead of something like single- payer.

 

[datonn]

jonessed,

Can I ask who the original architect was for a majority of the skeleton/scaffolding that is now known as Obamacare or the ACA? I'll give you a hint: It wasn't the Obama administration.

 

[StrikeS2k]

jonessed,

Can I ask who the original architect was for a majority of the skeleton/scaffolding that is now known as Obamacare or the ACA? I'll give you a hint: It wasn't the Obama administration.

No matter who thought it was a good idea, they were wrong. So, not sure what your point is.

 

[datonn]

jonessed,

Can I ask who the original architect was for a majority of the skeleton/scaffolding that is now known as Obamacare or the ACA? I'll give you a hint: It wasn't the Obama administration.

No matter who thought it was a good idea, they were wrong. So, not sure what your point is.

You know what the point is. People play-off Obamacare as some communist/socialist takeover of our nation. Vilifying Obama and the Democrats for daring to destroy the very democracy that our Founding Fathers created and attempted to enact laws/rules to ensure (their essential message, not mine).

If we could just have an H-O-N-E-S-T discussion/debate around these types of issues, there might be hope for America. But as it is, we're basically Sunnis and Shias...living inside of the same political boundary, but NOT "one nation, under God, indivisible...with liberty and justice for all."

 

[Courtjester]

Put me in the "Like Kaiser" camp.

I have their HMO through my employer. $450 a month premium. Zero deductible. $30.00 co-pays on most everything. Good choice of doctors and hospitals

I don't know what I would do on a $10,000 deductible plan. I am a Type 1 diabetic and if I had to pay out of pocket the first 10k, it would be rough. My insulin a month costs me $60 now. It would normally be $600.00 without insurance.