patrick.net

Call it Crazy says

Health marketplace sticker shock spreading

Have you ever bought health insurance on the individual market? It certainly doesn’t seem so. I have been in the individual market since 2005 and it has been terrible. High deductibles and co pays and rising premiums have in recent years (pre ACA) been the order of the day. Not to mention the preexisting condition exclusion or complete rejection. People who have employer supplied insurance or other group policies or are young and healthy have no idea how horrible the pre ACA individual market was. You seem to not have a clue or care. I would much prefer single payer to this hodge podge rehash of a republican plan from the 1990's but it’s better than what we had. What is your suggested alternative? Or do you think the old system was just fine? Better systems were considered but none could get through congress. Don’t think I have ever seen you offer an alternative. Correct me if I am wrong. but I only see only continual ACA bashing, gets old.

I'm willing to bet the patnet resident fanatical obamacare haters all have employer insurance anyway and are simply parroting crap from am radio. I object to ACA not because it's a bad law, but it's the wrong law that addresses the wrong problem.

It seems the long term strategy is to price most people out of everything but plans that cover catastrophic events.
On the surface, this doesn't look good. However, eventually it will force people to make choices in how they live and what they consume to protect their health, making short term user generated health care events a rarity. ( other than genetically initiated issues ).

How else are we to ween the lazy fat american public off of everything that drives their health down, and our costs up?
Hit them in the pocketbook, hard.
Cash is always the great equalizer.
rdm says

High deductibles and co pays and rising premiums have in recent years (pre ACA) been the order of the day.

What are the real problems that one is allowed to legitimately criticize ppaca for?

Call it Crazy says

It's a bad law

I disagree. It's a very, very good law if you are a health insurance company. Lobbying money well spent. It's a good law if you have prexisting conditions or you have develop an expensive illness that your insurer will dump you for. It's a good law for people who don't have much money but don't qualify for medicare. No none of this applies to me so don't be an anal orifice.

None of this does anything to lower the overall cost of health care.

errc says

What are the real problems that one is allowed to legitimately criticize ppaca for?

Not doing anything about the cost of health care. Huge amount of duplicate effort. Totally screwed up implementation would be a good start. Then go from there. There's certainly enough to citicize without having to make things up.

Homeboy says

So, how could it be possible for a person to sign up for insurance, and then, as Call it Crazy believes, be "surprised" that it has a deductible?

The whole mandatory high deductible thing is still kind of new, and to some people it might be completely new.

Are people that stupid?

Unfortunately, they are.

bob2356 says

I'm willing to bet the patnet resident fanatical obamacare haters all have employer insurance anyway

We do mostly have employer provided insurance, with the same extremely high deductible that practically guarantees that we pay for everything.

Call it Crazy says

Which the people in good health and with money get to pay for... Yep, it's great!!!

So you are saying if you got a serious cancer you would be ok with your health insurance dropping you and paying for it out of pocket? That kind of thing happened a lot pre ACA. It's an real issue that should have been addressed long before the ACA. There are a few parts of the ACA that are worth while. Even a blind squirrel finds a nut once and a while.

Your house must be real a interesting place since you only see black and white. Makes life easy for the painter I would think.

errc says

What are the real problems that one is allowed to legitimately criticize ppaca for?

The real ones.

The facts about Obamacare can, like the facts about the Carter, Clinton, and Obama administrations, be divided into two groups: actual facts and facts made up by the right-wing Wurlitzer.

True fact: Clinton got BJ in White House, signed the repeal of Glass-Steagal, and held coffee with wealthy donors at the White House.

Right-wing "facts": Obama born in Kenya, Clinton's presidency destroyed America's high moral tone, and Vince Foster was strangled by Hillary and Carville in a closet in the East Wing, then driven in an armored limousine and dumped in the park; Obama is entirely responsible for the entire national debt, and almost nobody has signed up for Obamacare because all the server rooms are in flames due to Michelle's connection to a Princeton classmate. Finally, Benghazi was a more massive disaster than 9-11, indicating willful negligence justifying imprisonment of Obama.

See, some of us have tired of right-wing "facts". "Make shit up" is not a political philosophy. Bundy grazed cattle on somebody else's land and failed to pay for it. Period.

zzyzzx says

Homeboy says

So, how could it be possible for a person to sign up for insurance, and then, as Call it Crazy believes, be "surprised" that it has a deductible?

The whole mandatory high deductible thing is still kind of new, and to some people it might be completely new.

Deductibles are NOT mandatory. Just like cloth seats are NOT mandatory. You get what you pay for!!!!!!

Homeboy says

Here is an example of a plan you can find on Covered California, and what you would see when you click on "Plan Benefits":

An overview of the plans is listed here among the hyperlinks. Better plans are more expensive. Sticker shock?

https://www.blueshieldca.com/producer/ifp/products/medical/home.sp

Call it Crazy says

Maybe not mandatory, but many people don't understand how they factor into the plan, and just buy policies based on "monthly payment"...

Yes, that was an interesting post...disturbing.

I can't think of a health insurance plan I have had over the past decade with less than a $1000 deductible.

Given that auto insurance has a $500 deductible, for something which can be replaced (unlike my body), and given that we are all forced to have car insurance (COMMUNISM SOCIALISM FASCISM OHMAHGERD WHERE'S MAH GUN!), I don't get the fuss.

And, yes, I think it will modestly raise the cost of insurance for some - just like it was rising before ACA - but also lower the cost of treating many who were using the emergency room for health care.

Now let's open a debate on the merits of BenghaziCare vs. the Conservo-Libertoonian plan, the entire text of which I have provided here:

CaptainShuddup says

People are being taxed on everything, and still Liberals don't think it's enough

It isn't: we are running a deficit.

Even right wingers, controlling both houses and the presidency over a 5-year, were unable to end deficit spending during a period in which the economy expanded.

Taxes are not that high by the standards of the modern world. They need to go up.

JH says

Deductibles are NOT mandatory. Just like cloth seats are NOT mandatory. You get what you pay for!!!!!!

You obviously work for some sort of government agency. My choices are all high deductible plans, and I work for one of the biggest companies in the US.

Now let's open a debate on the merits of BenghizaCare vs. the Conservo-Libertoonian plan, the entire text of which I have provided here:

I'm confused. I mean, I thought we all knew that PPACA IS the right wing plan, being that it is heritage foundation legislation. And that it completely sucks ball bag. Or are some of you still so star gazed over the obamas name being prefixed to the tax, that you somehow forgot this important tidbit.

I mean, I thought we all knew that the private corporations were evil, gouging us all to death. Were supposed to hate the corporations, and lobbyists, right? Unless they're in bed with the dems, then they're good? It can be hard to follow along at times for us spectators with no rooting interest

Iosef V HydroCabron says

CaptainShuddup says

People are being taxed on everything, and still Liberals don't think it's enough

It isn't: we are running a deficit.

Even right wingers, controlling both houses and the presidency over a 5-year, were unable to end deficit spending during a period in which the economy expanded.

Taxes are not that high by the standards of the modern world. They need to go up.

Which taxes?

Where on Earth am I still able to afford more taxation? And, for what?

zzyzzx says

JH says

Deductibles are NOT mandatory. Just like cloth seats are NOT mandatory. You get what you pay for!!!!!!

You obviously work for some sort of government agency. My choices are all high deductible plans, and I work for one of the biggest companies in the US.

I can read...

JH says

Homeboy says

Here is an example of a plan you can find on Covered California, and what you would see when you click on "Plan Benefits":

An overview of the plans is listed here among the hyperlinks. Better plans are more expensive. Sticker shock?

https://www.blueshieldca.com/producer/ifp/products/medical/home.sp

Homeboy listed a silver plan with $2k ded. Not all plans available to the general public have ded.

Call it Crazy says

I never said coverage of pre-existing conditions was a bad idea... I said "WHO'S GOING TO PAY FOR IT"?????

Got to love libertarians. It's all about me. Who paid before? People who lost insurance or werent't able to get it went bankrupt, the hospitals passed the loss on to people with insurance. There was no savings in destroying peoples lives.

The question stands. You are ok with being dropped if you had a serious expensive illness then going bankrupt? Or do you want everyone to pay for your risk but you don't pay for everyone else's? The true libertarian answer is door #2 of course.

The deductibles are fraudulently presented.

I have insurance through my employer, with a 2500 per person, and a 5000 family deductible, and recently had a baby.

Now, the delivery and hospital stay cost about $50,000 (whether this is a ripoff is a topic for another day).

I have a 5,000 family deductible. How much did I have to pay out of pocket before insurance kicked in? $5,000? Nope, about $15,000. This is a PPO. so they covered 85% of the remaining $35,000, leaving with me paying about $20,000 total on an $50,000 bill with my $5k deductible plan that's supposed to cover 85% of medical costs.

The reason for this is buried in the fine print. The doctors, anesthesiologists, nurses, and pharmacy all bill separately. Despite being in the same hospital, some are in-network, some are out of network, and those have separate deductible schedules. The hospital doesn't use generics for some drugs, so those aren't covered at all.

My employer pays about $2,000/month and I chip in about $600/month for this wonderful policy, and for the privilege of having this policy, I have to pay e medical insurance tax.

Thank you, Obama.

bob2356 says

Call it Crazy says

I never said coverage of pre-existing conditions was a bad idea... I said "WHO'S GOING TO PAY FOR IT"?????

Got to love libertarians. It's all about me. Who paid before? People who lost insurance or werent't able to get it went bankrupt, the hospitals passed the loss on to people with insurance. There was no savings in destroying peoples lives.

The question stands. You are ok with being dropped if you had a serious expensive illness then going bankrupt? Or do you want everyone to pay for your risk but you don't pay for everyone else's? The true libertarian answer is door #2 of course.

Who paid before?

What changed?

Who pays now?

zzyzzx says

The whole mandatory high deductible thing is still kind of new, and to some people it might be completely new.

Deductibles are not new, and they are not mandatory.

myob says

I have insurance through my employer, with a 2500 per person, and a 5000 family deductible, and recently had a baby.

A vasectomy probably would have cost you $1000 or less.

Homeboy says

Deductibles are not mandatory.

They are at all or almost all private employers. All my plan choices were high deductible plans. Even Kaiser was!!! Since it's not open enrollment I probably can't give you exact figures, but I remember that all of them were, without exception. You must be on some sort of government plan.

zzyzzx says

A vasectomy probably would have cost you $1000 or less.

Sometimes, people have kids on purpose.

errc says

What are the real problems that one is allowed to legitimately criticize ppaca for?

Probably the biggest problem is people not being able to find a primary care doctor, as apparently a lot of doctors are refusing to accept insurance that was purchased on the exchanges. Another problem is that there seem to be a lot of glitches in the implementation of the insurance, mainly by the private insurance companies, but also by some of the administrators of the state exchanges. I'll give you just one small example - I keep getting letters from my insurance company saying I haven't paid my bill. So I called them and asked if my account was paid up, and they said it was. I asked why I was getting those letters, and the CS rep said they were "required by law" to send them. No, you're not required by law to send letters to people telling them they haven't paid their bill when they HAVE paid their bill.

myob says

Sometimes, people have kids on purpose.

The problem with covering childbirth as part of health insurance, is that you are then obligated to cover other optional stuff as well. That makes health insurance extra expensive.

zzyzzx says

They are at all or almost all private employers. All my plan choices were high deductible plans. Even Kaiser was!!! Since it's not open enrollment I probably can't give you exact figures, but I remember that all of them were, without exception. You must be on some sort of government plan.

So then you don't even understand that insurance you get through your employer has nothing to do with the ACA state exchanges? You don't know that whether or not your employer-sponsored insurance has a deductible is in absolutely no way related to ACA? Hmmm...don't know that there's much point talking to you until you educate yourself as to what the law does and does not do. Might as well blame ACA for sunspots.

myob says

I have a 5,000 family deductible. How much did I have to pay out of pocket before insurance kicked in? $5,000? Nope, about $15,000. This is a PPO. so they covered 85% of the remaining $35,000, leaving with me paying about $20,000 total on an $50,000 bill with my $5k deductible plan that's supposed to cover 85% of medical costs.

The reason for this is buried in the fine print. The doctors, anesthesiologists, nurses, and pharmacy all bill separately. Despite being in the same hospital, some are in-network, some are out of network, and those have separate deductible schedules. The hospital doesn't use generics for some drugs, so those aren't covered at all.

Thank you, Obama.

How is that Obama's fault?

zzyzzx says

You obviously work for some sort of government agency. My choices are all high deductible plans, and I work for one of the biggest companies in the US.

Then maybe in the future you won't be so quick to take the side of huge corporations that cut their budgets at the expense of their employees, like you did in this thread:

http://patrick.net/?p=1236325

Not so glib about it when it happens to you, eh?

High-deductible plans are not mandatory. They are just cheaper. If your employer only offers you a high-deductible plan, it is because your employer CHOSE to do so.

Homeboy says

How is that Obama's fault?

He either did not understand the giant economic scam in so called "free market" healthcare industry, or did not care about it. He thought mandatory insurance would be the ultimate panacea.

You cannot give away cheap bus tickets to everyone without increasing the number of seats.

zzyzzx says

myob says

Sometimes, people have kids on purpose.

The problem with covering childbirth as part of health insurance, is that you are then obligated to cover other optional stuff as well. That makes health insurance extra expensive.

When you start covering optionals, you are not using insurance, you are using a benefit. It is much like vision "insurance" provided by some employers. It is not insurance at all. It is a benefit that entitles you to an annual visit and maybe $100 toward glasses every 2 years.

Insuring against bankruptcy or serious financial loss is insurance.

sbh says

Apropos deductibles, I've never had an employer based coverage so I wouldn't know what the rest of y'all are used to, but I found a platinum plan for me in TX on healthcare.gov with no deductible.

Thank you for posting this. I have posted this link twice already for California:

JH says

An overview of the plans is listed here among the hyperlinks. Better plans are more expensive. Sticker shock?

https://www.blueshieldca.com/producer/ifp/products/medical/home.sp

Homeboy listed a silver plan with $2k ded. Not all plans available to the general public have ded.

If people continue bitching about the cost of such low or no ded. health coverage, they are bitching up the wrong tree. The costs have been increasing by near double digit percentages for over 10 years now.

myob says

I have a 5,000 family deductible. How much did I have to pay out of pocket before insurance kicked in? $5,000? Nope, about $15,000. This is a PPO. so they covered 85% of the remaining $35,000, leaving with me paying about $20,000 total on an $50,000 bill with my $5k deductible plan that's supposed to cover 85% of medical costs.

What is your out of pocket maximum? I'm not completely buying your explanation on this, without a lot more information, having gone through the same thing -- the hospital is required to coordinate network benefits, and generally speaking an in-network hospital should have in-network doctors. I definitely didn't pay more than the out of pocket maximum.

Homeboy says

High-deductible plans are not mandatory. They are just cheaper. If your employer only offers you a high-deductible plan, it is because your employer CHOSE to do so.

And in addition, many employers give you HSAs to offset some of the deductible. I've seen some high deductible plans where the HSA amount they gave you was so high, that you almost got paid to have insurance.

gsr says

He either did not understand the giant economic scam in so called "free market" healthcare industry, or did not care about it. He thought mandatory insurance would be the ultimate panacea.

I don't know that I agree. He most likely would have liked to regulate the industry, but the republicans would NEVER have allowed that. Maybe you've already forgotten, but ACA barely squeaked through as a law, and that's the conservative version that we have. I think he correctly realized that a private insurance solution was the ONLY way to get any kind of reform at all.

gsr says

You cannot give away cheap bus tickets to everyone without increasing the number of seats.

Not sure what this is supposed to mean. Deductibles and insurance over-billing existed long before ACA was even being debated. Surely you aren't suggesting these problems are Obama's fault.

JH says

When you start covering optionals, you are not using insurance, you are using a benefit. It is much like vision "insurance" provided by some employers. It is not insurance at all. It is a benefit that entitles you to an annual visit and maybe $100 toward glasses every 2 years.

Insuring against bankruptcy or serious financial loss is insurance.

Oh, I'm 100% with you, and I would love to see the medical system be competitive, but "insurance", which is actually pre-paid pooled service, hides prices from people and so, there is no price competition. I fully realize that I was using a benefit, albeit one which I pay for and want to use. If medical pricing wasn't such a racket, going uninsured and negotiating prices ahead of time would have worked great.

Google "Oklahoma Surgical Center". This is a place that doesn't take insurance at all, and charges so much less as a result, that paying full price there is often less than the 20% medicare copay that people end up paying. Between these guys, and non-insurance networks like SimpleCare, I hope that we have alternatives to Obamacare in the future.

The reason I said "Thanks Obama" is that I was dropped from my original health insurance because it didn't comply with the law (which, I liked, by the way! It was cheaper, had better coverage, but didn't cover some now mandatory things). I would have loved to keep that insurance, but I was forced into this annoying plan that costs me more.

errc said: What are the real problems that one is allowed to legitimately criticize ppaca for?
Homeboy already said it, but I'll add a little more. In CA the biggest disaster appears to be limited to the Anthem Blue Cross plans and also the not for profit Blue Shield insurance. In their infinite wisdom, these insurers decided not to force doctors who accept their other plans to also accept ACA plans. As a result, it appears that many folks are having trouble finding a PCP. I'll make two predictions:
1. (And this one is a bit out there). There will be a small end of year ObamaCare rebate for folks who bought the Blue Cross and Blue Shield plans (because few services where actually used).
2. Kaiser will be the big winner next year as people flee BC and BS plans. Why? Because we now have an open and transparent marketplace where people can make choices based on how well they are served by their plans. Capitalism's finest hour.

Homeboy says

So then you don't even understand that insurance you get through your employer has nothing to do with the ACA state exchanges? You don't know that whether or not your employer-sponsored insurance has a deductible is in absolutely no way related to ACA?

I wasn't blaming Obamacare for high deductible policies offered at employers.

corntrollio says

And in addition, many employers give you HSAs to offset some of the deductible. I've seen some high deductible plans where the HSA amount they gave you was so high, that you almost got paid to have insurance.

HSA annual limit contribution is actually pretty small. I can only put $3300 into it this year. My employer does not contribute anything to it. Wells Fargo used to contribute a little to it, like $350 per year, but that was years ago and I would assume that's been done away with by now.