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Me and ACA
I tried a bunch of times to get on NYS's health exchange last week. Dead end. The site went down for 'repairs' over the weekend, but as of 8 AM today it was up and running. Some thoughts.
The first step is to get a user ID. For those familiar with this type of registration process the Captchas etc. are not a big hurdle. But two 8 digit codes (no spaces please) are required on step one. My guess is that there are fair number of people who will struggle with this. The same could be said for the password requirements (eight digits, two numbers and one capital letter).
The NYS exchange wants more than the standard ID info of address and SS#. I was asked a series of questions to 'prove' my identity. I was asked to identify a financial institution that I had opened an account with in the past two years. Five banks were listed, and one of them was the bank I had in fact opened a new account.
Another question blew my mind. I have never purchased pet insurance, so this was a trick question that required the response "None of the above" to continue with registration.
These questions prove that the exchanges have access to a great deal of information about who is signing up. I suspect that the need for the servers to go out and gather the individual's data so that these questions can be posed, is the reason that the exchanges went down the first week. The plumbing for this can easily get clogged; the data bases for this type of info are huge. NYS has access to my IRS data, the pricing I got reflected the fact that my income was above the subsidy levels in the prior year.
Once you exist, the rest is straight forward. I'm single, 63; I'm a headache for ACA. Obamacare needs young healthy people to enroll. For every one of 'me' ACA will need a half-dozen twenty-year olds to balance the costs. I looked at the cheapest plan (Bronze - $360/mo) and the richest (Platinum - $620/mo). The difference between the two extremes is the annual deductible:
This pricing structure is flawed. For the Bronze plan I would pay $3,684 per year and face a$5,800 deductible. If I get sick, my all-in cost goes to $10,120. If I pay the high monthly premium I would pay $7,740 a year, but incur no deductibles. Therefore, in the event I need the insurance I would 'save' $2,380 by opting for the Platinum plan. At my age the Bronze plan is a bad bet.
I can easily envisage an age cohort of mine who opts for the Bronze plan, gets sick and then is stuck with a $5,800 bill that can't be paid. These very high deductibles are going to be a disaster for Obamacare. Who is going to eat the losses that will surely come from those with cheap plans and mega deductibles? The taxpayer will foot this bill....
I have medical insurance today that has similar features to the Platinum plan. It costs me $1,100 per month for the insurance. So I'm looking at a real savings of $5,760 per year! This is great news for me, and some will point to this and say that Obamacare is doing what it's supposed to do. The fact that I am now in a group that includes lots of younger people who will not need the insurance has brought down my costs.
This is going to fail. I should not be getting a subsidy from Obamacare. My investment income the past few years (thanks to ZIRP/QE) puts me in the top 2% (Income greater than $175k = top 2%). Why in hell should I be getting a subsidy? And if I'm getting a subsidy, who is going to pay it? Those twenty-somethings are going to save me $5,800 a year?? Why?
In spite of the large savings that I would realize from from signing up for Obamacare (a free one-month trip to Europe!) I did not hit the button. There is a catch in this for me. Can I keep the doctor that I have been seeing (and trust) for the past 25 years? There is no way to determine that. There is a field that allows you to check if your traditional doctor is covered by the plan. But when you ask, you get this:
Okay, this bug will get fixed someday, and when it does I will sign up for Obamacare (provided my Doc is in the group). When I do, I will save a bundle, but there is no way that this should be happening. Why is Obamacare putting big bucks in the pockets of geezers who are top 2%?
My conclusion is that the exchanges are setting the initial cost for insurance at rates that are artificially low. These are teaser rates that are designed to get folks to sign up. A year or two from now the insurance companies will be getting big increases. Whatever you think of Obamacare today, wait two years, you will come to hate it.
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thanks for your thoughts.
:)
Imagine the pent up demand of millions of people who lost their jobs and insurance and the millions of people who never had it. Suddenly all of these people who need knees scoped, colonoscopies, and every other delayable health issue- will descend onto health care providers in Jan. These are the fully subsidized non payers.
Now imagine all of us who can afford the newly cointed A.C.T. and who might pay into the system. Insurance at 500 a month is not affordable. I am not interested in paying someone else's premiums. So the payers, guys like me with the money in good health- are simply going to say fuck you. I'm not buying in. And plan B for me is Belize mf'ers.
Thus, the costs of Obamacare as Bruce has outlined will go supernova. These indeed are teaser rates..
no question lots of people who had no access to health care will now get it.
(and they will vote demo.)
as to the health care expenditures, i have no doubt that the way the aca has been written that not only will the health care industry will use it as a profit center, but also they will force rates up. (single pay, i believe, would have been the least expensive approach. in fact i thought just change the medicare age downward over time and not have to create another system. but hey, that's just me...
as for belize, a postcard from you will be as close as i can get to it.
:)
Obama started this whole thing by demonizing insurance companies. They saw the light and eventually jumped on board after concessions that they knew would benefit their short term interests (like there are any other). The people who run these insurance companies could give a shit if they are still in business five years from now. Corporations are a cash machine that when empty they move on to the next. Everything in this bill is designed to force an escallation in costs that insurance companies will pass along to their mandated customers. At some point, as it was in the beginning, our glorious leaders will begin ringing the hands publically at the plight of us poor victims of insurance profiteering and step in to save us. That means nationalization. Remember Maxine Waters commenting that she would nationalize oil companies due to their excess profits? Anyway, these insurance companies will still exist but come under full government control, pasturized into disctinctions without a difference and a defacto single payer plan. Costs can be folded back into general revenues and we will live happily ever after. I want to puke but it only makes sense as our government is already the largest insurance company in the world. They push fear and sell protection for the small cost of your wealth and freedom.
Interesting you mention the teaser rate concept. I wonder what will happen to the penalties in 2 years -- if the plan costs go up, but the penalties for not signing-up don't rise at an equivalent rate, we should see more "opt outs".
This looks like just another program developed with short-term thinking and long-term consequences.
"...if the plan costs go up but the penalties for not signing-up don't rise at an equivalent rate, we should see more "opt outs".
The penalties rise VERY rapidly, to onerous levels. They were kept low initially so the ACA could pass.
Looking at my state's exchange, "catastrophic" insurance is about 1/4 of the price/mo. as the highest deductible bronze plan (minimum that qualifies for avoiding the penalty)[even though the "cat" insurance covers a lot more than I thought]. If you want to get a real, bona fide insurance plan (something worth a shit at a deductible that normal people have come to expect), then you're probably looking at an upper tier silver or gold package... Generic pricing is as follows: Catastrophic: $50/mo.; Bronze: $200/mo.; Silver: $250/mo.; Gold: $300/mo. [didn't even see platinum].
Last time I looked, the penalties are $300/person (or 1% AGI) for the first year and $700/person (or 2.5% AGI) the second with COL increases after that... I think the insurance credits (subsidized premiums) top out at a ~$40k/household level. This is a fairly brutal tax that's going to smack the hell out of anyone who actually has to pay for insurance and hasn't reached monetary escape velocity. Throw this on top: http://www.irs.gov/Individuals/2013-changes-to-itemized-deduction-for-me... and we're getting nailed with a pretty brutal raping. The fact that the rates can increase for insurance policies at any time, can decrease in benefits provided at any time, and the penalties can increase for some vague metric the government controls anyway... then this sucks. Essentially I get to pay more for the same healthcare, at best... if it ever becomes too much, then I get to eat a big fat penalty. How this isn't viewed as a bailout for the insurance companies (and a tax levied by the insurance companies upon the american people and collected by the government) is beyond me...
I guess we need to provide more insurance to people who already have it... or, if they don't have it because they can't afford it now, then we can just make them pay for it?
People who don't have a pot to piss in aren't going to give a flying fuck about "deductibles". And those who can pay will be further burdened with the general ignarance in this country.
"ignarance"
Good joke there!
You did do that on purpose, didn't you?
You mean it's not a derivative of "ignant"
From St. Ignace.
Thanks for this post. It contains a lot of personal information that most of us would be leery about disclosing, but without which the significance of your experience would be less meaningful. I hope you're wrong about your conclusion, but I wouldn't bet against it.
Yes, but you just wait until the uninsured are insured under Obamacare! Then, everyone's rates should come down as we are no longer paying for the uninsured. Oh boy!, What will I do with that extra $2,000 a year? Oh boy!
."just wait until the uninsured are insured under Obamacare"
Not gonna happen, never was the intent.
You may be missing one additional "cost". If the govt runs this like any other govt office that serves the public, the pain of dealing with this ins when you are sick will not make up for the difference in cost. You'll be begging for your private plan's shitty service. Even if they have contracted to private providers, it won't be the same.
My wife is a hospital administrator in Dallas. Says they are not going to sign these Obamacare insurances. You're not going to get an appointment. They'll just push you to Parkland hospital (the safety net hospital). Parkland is backed up that you cant get appointment now for 8 months because they already take the Medicaid patients. Says there is no way in hell they're taking these patients with the reimbursement rates so low.
If you're poor, it pays to not get the Obamacare and just pay the $99 penalty for the free clinic.
Bruce, call the hospital that clinicians work and ask to speak to their administrator if they're going to be taking on the Obamacare insurances.
YUPPER! pay the penalty , type up a single sheet with all the necessary enrollment information for ACA and keep it in your wallet ,, F the insurance companies , they're complicit in enabling this monstrosity... When you have an emergency someone at the hospital will sign you up on the spot....
This is the inevitable conclusion of socialized medicine, bifurcated health care.
Puhlease. Banks got TARP. Insurance got ACA and real estate got ZIRP.
Its a fucking handout after handout to incorporated personhood and fraud from top to Fascist bottom.
Love it, hate it, you can't be both, Krasting.
^^^This - Bruce Kasting is yet another paper-pushing middle man. Remove all the fucking middlemen and things like healthcare fix themselves.
Hmm. Doesn't it go: You --- Doctor --- Insurance Company
If you take out the middle man, i.e. your doctor, healthcare does indeed fix itself, just like you'll be fixing that torn ACL or doing that colonoscopy yourself.
Maybe we should come up with a plan B?
Funny, and all this time I thought I was a writer....
You seem to have issues with ACA. One can't help but wonder why you have supported those politicians on the left who have doggedly supported it with your substantial cash donations. A change of heart? Its a free world but I question motivations and have learned that what people say is not neccessarily what they do.
You write for the 1% you pompous prick! You hate working people, every sentence you write smells of hate. WE can't even understand the complicated username/password ha! FUCK YOU!
Krasting - I think it's actually a good bet exchange rates WILL GO DOWN in a year or two.
Insurance companies don't want to go bankrupt. I think rates are currently set for mostly sick people to sign up quickly -- they need it and have been locked out. In time, young people will be mostly forced in. They think they don't need or want it, and will wait until they have families/etc.
It doesn't really matter if the insurance companies WANT TO go bk or not ,,, the old people and people with pre-existing conditions , who now cannot be turned down or charged more will get policies , single young people will pay the penalty and stiff the insurers... with uncontrolled costs the insurers will dry up in a year or two... GUARANTEED.. then we have single payer...
After a couple years of taxpayer subsidy they'll just wither away huh? LOL
Don't worry about him, Bruce. It's okay to push paper, if the paper pushes you first.
you are a consumer and nothing more
get used to it
You did just fine on Wall Street. Don't be ashamed of your past, unless you are of course. Good pict of Grandma and Grandpa.
the states are going to get additional fed assistance to help your friend when he can't meet the deductible. medicaid is a roach motel, you hand them your assets, and you are never solvent again. this raises issues, singulary, what happens after you go over to medicaid? you no longer pay your premiums? my neighbor is already there, before he even had a chance to sign up for obamacare, he ran up some med bills last month he can't possibly pay. the state is working with him..
if obamacare turns out in the end to be nothing more than a policy of turning the hc problem over to the states, that is probably a good thing. (just because they can adjust their own cost structures) in the meantime the insurance companies suck you dry before the states get their share of your miserable carcass. (obama the corporatist). medicaid was always there, providing more federal funds is hardly an orginal idea, or hc reform.
and as legislation goes this is just as bad as Bushes Medicare D plan. just rip off the mask Barry we know who you are
I will just state for the record what the medical situation is in Hong Kong.
Anyone who holds a Hong Kong ID Card (including a residence visa) is entitled to medical care in government hospitals (which are fine institutions based upon upon what I have experienced) for $100 HKD a day. That is about $12 US.
Private medical insurance is freely available at very reasonable cost and is used primarily to upgrade into a private hospital, which presumably is important for the status minded.
General practitioners and specialists have walk in offices through out the city.
My father, who lives in NYC just received an ambulance bill for $10,000 USD. This would cost $100 HKD.
There is no Obamacare.
You will find a similar situation in Bangkok and Singapore.
No wonder we have fallen down on the list of competitive economies.
WB, that's what I heard from my Dad's spine surgeon who visited HK about 4 years ago on some sort of exchange. He said thier spine surgeons and facilities were top notch. I don't know what hospitals he visited but I was impressed.
I also know my Dad's surgery almost bankrupted him; not the doctors' bills which he was able to negotiate down quite a bit with them but the hospital bill where they refused to budge one centimeter.
Hong Kong also has very long wait times compared to the US for things like CT's and MRI's. Mortality for things like cancer generally are far lower in socialized medical systems like Hong Kong and Europe, since more effective, expensive therapies are either rationed or not offered. Yes, medicine in the US is a mess, but not because it isn't socialized. One of the reasons care is so expensive in the US is that Americans bear the r&d cost of medical advances for the rest of the world.
An afterthought, I'll bet there are more malpractice attorneys in, say, Pine Bluffs, Wyoming (pop. 1,100) than in Hong Kong.
Your implication is obvious; however, without much basis in reality. I live in Texas and we heard for years the "ambulance chasing" lawyers were the reason our HC costs were astronomical. Guess what that lobby succeeded in doing? You guessed it.....passed Tort Reform to limit your damages to $250k even if Dr./Hospital kills your a$$ from Gross Negligence. Want to guess how that fixed our annual increases in HC Costs & Insurance? They continued to rise at or above the pre-Tort Reform rates. FYI: this situation continues today and tort reform was passed over 10 years ago in TX.
It is all BS. Same as other Crony Capitalists of the DC persuasion. Another Example: Our bought and paid for legislators argued the Free Market would reduce Electricity Rates in TX so they gutted all Consumer Protection Regulations of the Utilities. Now, 5 years later TX has amongst the highest Electiricity rates in the nation - from one of the lower to mid-pack pre-De-regulation. Electricity Costs are always and forever a function of fuel inputs and transportation distances. TX provides the most accomodative environment for the Utilities one can imagine. We produce and supply the fuel to generate electricity locally (NG and Coal), generate electricity locally so very short transport distances, and everyone knows we are very pro-biz state so the utilities can basically take your land (condemnation) to install pipes, power lines, stations, etc, and pay you just enough to buy a sandwich and be "all square" insofar as our legislators are concerned! Oh, and we give them a tax break to do it all for we dumbarses.
I would expect that Mortality for disease like cancer is elevated in socialized Health Care systems since diagnostic testing is limited and "effective" therapies are rationed, if offered at all.
I would expect that whereEarly Diagnostics are initiated and therapies are not rationed, as in a competitive Health Care system, that Morality is decreased and Life Span enjoys an increase.
What type of Socialiast bullshit are you selling here? We do not want that Socialist bullshit as we are antisocial-ist.
I have to agree, every country I have worked in has better medical plans than the U.S. Fuck the insurance companies and return their profits to the patients and medical staff, win, win! Fuck Krasting WE are to stupid to understand passwords, what a pompous prick!
CEO Compensation 2012
Drugs & Biotechnology
1. John H Hammergren, McKesson, $131.19 mil
2. John C Martin, Gilead Sciences, $43.19 mil
3. David E I Pyott, Allergan, $33.82 mil
Health Care Equipment & Services
1. George Paz, Express Scripts, $51.52 mil (2011)
2. Stephen J Hemsley, UnitedHealth Group, $48.83 mil (2011)
3. David B Snow Jr, Medco Health, $22.19 mil (2011)
Not that CEO compensation generally isn't ridiculous, but it's stupid to think it's the problem with the medical system. For example, United Health's revenue was $110 billion, so you could zero out the CEO's salary and use the cash to lower your premium by the huge sum of, drum roll....., 0.05%. So if you were paying $500 per month, that would drop to the low, low price of $499.75. Wow. Don't spend the savings all in one place.
If the number one guy makes a hundred million then the number two guy makes? Ditto all the way down. The whole system sucks (except for the top people) Limit the top guy and everything else falls into place.
The best bet for elder Americans, unless you are broke, is to sell everything and leave. Go live in a place without guns, rent if you must, and enjoy health care without red tape.
Red Tape is what makes USA healthcare predatory, and predatory is the best word to describe it. It's got nothing to do with health or healing. Welcome to the USA Medical Industrial Complex.
Predictions are difficult, especially about the future; however, thunderchief's comment about retiring to a locale with a less predatory culture of Big Pharma, Big Insurance, Big Tort and Big Government holds water.
http://gonzalolira.blogspot.com/2013/07/if-you-are-baby-boomer-you-will-...
WTF do guns have to do with it? Well, besides gratuitous bullshit?
well written, WB7. I visited an aged cousin in Italy, this summer. she had a knee replacement, for which she had to travel to a specialized clinic across the country, which is also a rehab center
cost: zero (except for the travel). results: brilliant. though if you ask Italians, their national health care system sucks, badly, and they moan only more about the taxes they have to pay for it. yet it works
note: I thought I would have had to pay for a clinic further north
if your only parameter is simplicity, then "Single Payer" NHS beats the rest. how much does a titanium knee replacement cost elsewhere?
Mine was 50 G's. At least that was the bill I saw. Don't know if Aetna negotiated. Excellent care and results at Good Samaritan. Minimum wage care givers were few and far between. One nurse said he used to be a plumber.
Cost: zero? Really? Everyone just worked for free? The replacement piece was just fabricated out of thin air?
I think not. What you meant to write was PRICE: free. That is a very different thing.
Results? Brilliant I'm sure in that Italy like most of Europe has fine doctors and rehab specialists. BUt I would remind you that Italy as a nation is broke. And they don't lay out the huge sums we do for our Empire. And they're still fucking broke and there economy is a shit mess.
Why? Because like every socialist experiment EVER FUCKING TRIED Italy's "free" healthcare is an economic failure> Just like in Canada. Just like in Sweden. Great Britain, Germany, France and every other single payer set up otu there. They are not sustainable over the long run.
The "system" in the US is the problem. We do not need a "system" much like we do not have a system for the procurement of the countless other far more immediate neccessities of life like food, clothing, shelter. What has occured in the US is that "healthcare" has become a fraudulent cartel that rapes the consumer with the good graces of government to back it up with huge market distortions and massive regulation and restriction that allows for the inflated pricing of otherwise inexpensive care.
I spent 6 days in a shared room in a New York City hospital in 1999. They charged me $1500/night just for the room. The total bill was over $18,000. And that did not include the surgeon $5500 or the anestesia $2500. And that was 1999. When I asked the surgeon how much the operation would be he said $11,000. When I told him I was paying cash he said it was then $5500. When I inquired as to why that was he said because $5500 is my price. When I submit to an insurance carrier I have to write it as $11,000 or so to actually be paid the $5500 that I need to cover MY COSTS.
And that in a nut shell is the complete load of bullshit that is the medical cartel in the US.
ACA will fail. It ws built to fail and it will bankrupt the nation as HAS ALREADY Medicare. Single payer is the end game goal of the fascist pricks who run our government. Because then they have TOTAL control from cradle to grave. Single payer is the wet dream of the totalitarians because it is the easiest path to complete societal control.
And that's the path we've been on for many, many years now. And now it's here.
Your local hospital has a pow-wow every year where the administrators decide what to charge for services (as does every professional medical group)... the basis for their costs for the upcoming year is a fairly simple formula: figure out the highest paying insurance rate and add 10%+. The point is to never let any insurance money go to waste...
What the Doc told you doesn't really fit though... typically all those procedures have "allowable amounts" set by the insurance provider (adhesion contracts for all but the largest sick care providers). In other words, he's going to get $5,500 for the service regardless of whether he charges $5,500 or $1,000,000... The rate is set to cover ALL insurance providers the medical professional is contracted with... he's likely set it that high because another insurance provider pays him more for the same service.
Sorry Macho, this isn't how it works in the US. I own a medical facility, employ 3 Dr.s, and several other mid-level providers. We work with insurance providers all the time, as well as two state Medicaid programs.
I can assure you that we never meet with other doctors and talk about what we charge. We negotiate with the insurance companies for the best deal we can reach and go with that for those patients covered by them. Yes, we certainly can and do get data about average charges for procedures in our state and more locally and I won't say that I am above calling another office to get some pricing information for direct comparing, but that’s down without them knowing who I am.
There are plenty of things wrong with the current system – and certainly the ACA – but this isn’t one of them.
I didn't say that doctors price fix with anyone outside their own medical group... this would be... illegal. However, without a doubt, medical groups DO meet together and fix their prices routinely (how else do you know what to charge patients). The basis for pricing is typically the highest amount the medical group can negotiate with an insurance company. Again, never leave any money out there. This has been present as long as insurance has played an intricate part in the equation... and it isn't wrong per se, but it's definitely a symptom of a broken system.