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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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It does make sense (the perspective is slightly different, but the underlying financial mechanics match your example), raise the bar and make up for it on volume-- in network vs out of network, .gov vs private, insurance paid vs patient paid, sticker price vs final sale price. Hotel's rack rates would be a good analogy with the travel agencies block purchases and discounted rates.
of course it was zero for her. beyond what she and others paid in taxes and borrowed through the gov debt. I thought this was clear, and my emphasis was on the "simplicity" of the system, remember? and the fact that it currently works very well, to my own amazement
sure, that system is socialist (which reminds me that the current US system has neo-feudal parts. corporations allowed to provide healthcare? from my perspective an absurd situation unfit to a country of free people)
meanwhile according to the Financial Times the US spends 18% of it's GDP for healthcare, and the second highest spender is France, with 14%
at a certain point, a less expensive, simpler socialist model could even look better than what it's being used now - and ObamaCare looks like a complex liberal model to me
anyway, I agree with your assessment of "fraudolent cartel". but I don't agree with your Tyler-like assessment (as he does for Bismarkian pay-as-you-go pension models) of "every socialist experiment fails". it's the extreme liberal view that ensured the "tragedy of the commons" in the UK - after they provided sustenance for hundreds of years of paupers
it's easy to say that something "can't work" when enough interests are mired in destroying that something in order to gobble up the pieces
even modern militaries are fundamentally socialist institutions. and they do "work", it their sense of the meaning
all I'm trying to say is that ideology can be in the way of assessing systems
Not when you consider the human nature that has aways been with us throughout our history. A "system" cannot account for that. there has never been a "system" invented that was not corrupted and abused by humans. Its what we do. And the bigger and more complex it is, the more prone it is to abuse. Simplicity is our friend. The best plan is for people to accept they are on their own when it comes to financial security and we best plan a save for the worse case scenario. And doctors will have to know that if they want to get paid they have to offer market acceptable prices or they will go hungry like any of the rest of us.
i had a bicycle accident a couple years ago. i have my own insurance, but a large deductible. i went to emergency, where the doctor put a few stitches in my head, (no xrays) and sent me home. (with a warning to comeback if i had any head injury symptoms) A few weeks later a friend had a similar accident, and went to emergency, where they gave him MRIs and the whole gamut of tests. we compared injuries, and they were really the same, exactly same spot on the head
why did he get special treatment? he's indigent. you can draw your own conclusions, (1. the state was going to pay his bill, no questions asked. (2 doctors are really insurance saleman, and the emergency room mds are claims adjusters. that fender looks fine, we'll just rub the paint out and sned you on your way. two levels of care according to who's paying, and the indigent actually get better (more expensive) care.
the myth in this country is that the poor are starved and beaten and left for dead in the hallway. how do the indigent fare in HK?
I call BULLSHIT on your worthless Cock Brother lies! Your friend is INDIGENT? Then you are a worthless fuck of friend! My friend is indigent, really, tell a better bullshit story than that! MY friend is indigent really we aren't stupid here!
hah, he was riding one of my bicycles when he crashed. great guy, he did some construction work for us, and he could have been very successful, except for a meth problem.
Exactly how was 'the state going to pay his bills'?...your friend...
I know of no mechanism for the indigent to get their bills paid (unless he has mediCAID, a health care plan for the poor).
In fact he will probably be hounded for a huge bill and be drive to bankruptcy. If one has insurance then one is protect by the contract the insurance company has with the provider and a maximum charge for each type of service has been negotiated. With no insurance one is responsible for the entire outlandish original charge.
My personal experience (and I'm a physician) was to get a $14,000 hospital bill which insurance settled for $1,100. Without insurance I would have had to pay the entire 14k.
I do not think you have your facts correct.
i also had another friend deceased now, retired man (many years with the post office, ww2 vet) he had diabetes, and it came about that he needed a bypass. the operation went well, and they sent him home early, (knowing that diabetics are at greater risk postop) and he had a massive stroke the next day. he lived, somehow, in a nearly vegetative state, for ten more years. his government hc policy did not cover nursing home care, and he had to go on medicaid. (i suggested to his wife that she sue the hospital for the cost of the nursing home care, but these are very polite Japanese people)
the state then takes over his assets, and his wife has no more control over their savings, and must live on a stipend. (my neighbor is going through his right now, he could go on medicaid but they would attach his WIFES wages. if you have a high deductible and few assets, and a serious illness, this is where you are heading, with or without obamacase. obamacare plans to give the states more money, meanwhile you have to pay the premiums, whether you want to or not, but its not doing a damn thing for you i can see, except make money for them, and perpetuate the socialized economy, where business keeps the profits and gives government their losses.
I know of no mechanism for the indigent to get their bills paid (unless he has mediCAID, a health care plan for the poor).
You have no idea what you're talking about... there is a bifurcated medical system already. If the medical professional knows that insurance will cover the tests, then they're done without question "as a matter of policy." The justification for running the extra tests is to CYA for med mal. However, the med mal tends to happen from the extra hospital stays where minimum wage workers are interacting with patients (increased in duration due to the very tests that are claimed to prevent med mal)... or during serious medical procedures... not for a "failure to diagnose." (those cases are really, really difficult to prove, at best).
Anyone interacting with a patient KNOWS the payer source... and, if you're an indigent, then there's no excuse not to be signed up for free healthcare, hence the incredibly large participation rate. There are governmental (and private) workers whose sole jobs are to get poor people signed up for governmental services... everyone also knows they're available...
I can say without a doubt that I've heard directly from people who are in the trenches every day that this happens... routinely... patients are just pinballs that are bounced around the bumpers to rack up the score (money) as much as possible.
PS, if you think the bill you receive from the hospital (anyone for that matter) is the amount they'll take to settle the debt, then you're crazy... You would have been asked to pay it, but if you're the kind of guy that pays the sticker price for a new car, then best of luck to you in this world... it's going to eat you alive as we're required to negotiate for more and more.
The trick is to catch them at fraud, with witnesses - you have to go in knowing that. When presented with undeniable proof of fraud (I've got some great true stories on that) - they often will let you settle for insurance co rates - or less. Yes, it's blackmail. Who was guilty first? The nurses stealing the pain meds to sell, that my friend caught them doing on his vidphone (back before those were common and anyone thought to look at what was sticking out of his shirt pocket)? Or me and witnesses catching them at the fraud, and instead of trying to get it prosecuted, simply telling them I wouldn't put it all online if they didn't charge me?
Again, fuck them running. Not the average physician, who tend to be good guys. It's the big companies, like Carrillion who buy them all up and add a layer of fraud even Wall Street or London would blush in shame if caught at it.
Some tort reform wouldn't hurt. My mother, a psycholgist (can't prescribe drugs, only talk) - paid on the close order of $35/patient hour for malpractice, and passed it through to those who could pay. When she treated the indigent and got paid in, say, chickens, the IRS declared those chickens the most valuable birds on the planet, as obviously they were pay for tens of thousands of dollars worth of treatment (my mom was nice to the patients).
Stated ad nauseum, but tort reform happened decades ago... The insurance companies are lying to doctors about the reasons for malpractice premiums. The reasons doctors have to pay outrageous premiums is because they can... simple as that... the whole thing is a shakedown... it's one big negotiation. Doctors just don't understand that they're the suckers in the game (narcissism will do that).
Bingo. Word on the street is droves of young single women are waiting to become moms on Obamacare. Think Widowmaker is joking??
US medicine is really incorporated fellatio by the "medical professionals." It sure as hell has nothing to do with health care or providing anything but a conduit for money.
Ask the AMA why the fuck they don't allow more into medical schools and why the medical monopoly is untouchable??
Fuck doctors. If you are reading this message I hope you get sick.
I hear ACA funds are to be used to build and staff the new J. Mengele School of Medicine at Columbia. Soon to be followed by the M. Sanger Health Planners University at Harvard.
Motherfuckers have successfully compromised the professions of apothecaries and healers, knowledgable about the balances of the body and the plants and herbs that heal it. Natural and homeopathic treatments were left in the dark with the formation of the AMA. Mind-numbing opiate and synthetic drugs since. No more healers, no more getting well. Only sickness and the doctors to perpetuate it.
You can't sell harmful, largely untested drugs to people if they're actually healthy. Healing doesn't pay, which is why so little of it comes out of allopathic medicine.
Right on.
When my kid was 2 or something she went through the ear infection cycle thing: Take her to the doc, get a prescription for Amoxycillin (pink goo), take it for a week and 3 weeks, or so, another ear infection. That amoxycillin is iatragenic was well known at the time--in fact I remember reading it in the WSJ one day (that means the medication causes the cycle of recurrence). Anyway, my wife got sick of this after about 3 rounds and dug out an old German home remedy book. She sat up one night with the kid putting a drop of warm, garlic infused oil in the ear now and then. Result: last ear infection, ever.
Two friends at work had kids the same age and were going through the same stuff -- they stayed with the medical system and a year or two later their kids had to have drains put it. Adds up to lots of doctors visits, medications, a surgery with anesthesia and follow-up medication and checkups.
I used to get into trouble as a young lad for not taking my pills and anti biotics and look at me now.... A chronic masterbating world of warcraft champion. I can't wait till I get to stand next to you at the doctor.
Agree with you totally Bastiat. Also, iatrogenic medicine is one thing, but there's also the kind that kills you:
Compare deaths from medicines, vitamins, and all US wars
http://jonrappoport.wordpress.com/2013/10/07/shock-comparing-deaths-from-medical-drugs-vitamins-and-all-us-wars/
What's the ACA?
A Cunt's Answer to healthcare issues...
When all one wants is power over people, the debt for this means nothing.
FORWARD ASS NAPKIN!
"Assholes Capturing America"
But but but...PrezBo said, it'll be easier to sign up than Amazon! And and and...save everyone $2,500 per year! And and and monthly payments around the same as my cell phone bill and I could keep my doctor!
(Sound of bubble gum snapping)
And and and Pelosi said it would reduce the federal deficit, put people back to work and cure my acne & genital herpes just by The Light shining on my face from their website!
WTF man!!! ;-)
Doctor says he commin, but you got to pay him cash.
According to a now popular video, a competitor to Obamacare.
But the ACA has a real easy to remember helpline number , no doubt picked by Bath-House Barry Soetero himself , 1-800 FUCK YO (this is not a joke ,, that's the number..)
Bruce as far as my dog is concerned...
I would NEVER Snifferdoodle.
This:
https://www.youtube.com/watch?v=sx2scvIFGjE
Which one in the photo is the pompous prick Krasting? The guy that thinks no worker should have the health care of the 1%. My brother had brain cancer. Without access to a state funded plan no one would take him. He lives today.
Tell the truth Landrew- how many meds does it take every day for you to maintain your clearly tenuous hold on reality? You can't get through a single day without a few happy pills, can you?
I will concede the possibility that you are just deeply stupid, but I'm betting on foaming-at-the-mouth bipolar.
You're welcome.
On a long enough timeline the survival rate for everyone drops to zero.
That's embarassing!
This was nothing but a test to see where the average citizen stood, so as to TAKE full advantage of the new money lining up at the doorstep of the administration.
This is only a test, pay no attention to the fellow who took down your credit card #, and don't check your daily statements from the bank for we are innocent of all charges cause we have more money. I applaud the effort BK.
NSA is track name of domesticated animal own by citizenry!? AMERIKA. IS. SCREW.
Boris, is it true you fled the USSR because your dog was called Solzhenytsin?
Nyet, Boris not to have pet, have dander allergy, but maybe famous Russian author is have dog name Boris?
Yes, correct. His dog was named after Boris Yeltsin because the dog had a strange affection for Vodka and he also thought the gesture might help avoid another long skiing holiday in Siberia.
It gets better..
http://www.youtube.com/watch?v=O0azojPPRhw
Is excrement improve with age? No, do not thinking so.
The FSA pay nothing. Young people won't pay and will pay the "Fine" instead. If they increase the "Fine" up to the levels of the premium, young people simply can't afford to pay. Then what, millions of personal bankruptcies (Excepting discharge of student loans) or more private sector jails? At least once inside, healthcare is free. And the 0.01% benefit nicely.
The old, sick and those with serious pre-existing conditions will predominate and, without contributions from the FSA and the young, costs will go through the roof to the point that NOBODY will be able to afford it, except those who already have private insurance, whose premiums will also rocket higher.
Next step: Single payer system, For the good of the American people. Government then controls 60%+ of GDP. Similar to France. Back in the USSA, land of the free.
Wasn't there an article showing more then 50% of people do not pay ANY income tax? If so, how are they going to enforce this law?
@Son of Loki
See above. Yes, 50% of the population pays no Federal Income tax. They also use Food Stamps, Disability payments, Obama phones etc. This is the "Free Shit Army" or FSA.
The Government (That is the tax mules, aka the "Middle Class" taxpayer) will pay for their Healthcare, so there is no need for concern for them. Now re-read my earlier comments.
This is called "Wealth re-distribution", aka "Socialism" America is truly fucked.
Oh, and by the way, who do you suppose the FSA vote for? This has been described as "The tyranny of the majority", aka "Democracy", which the founding Fathers recognised in creating a Constitutional Republic. Now long dead. Until America goes completely bankrupt, I suspect the same party might remain in power. Not that the other lot would make much difference unless forced to actually do something. Pathetic really.
Amusing that you twinkies always focus on the insignificant byline items (like a kid jealous of another kid's lollipop) while ignoring the real FSA: old people.
AmeriKa citizenry is should be grateful... Obama is fundamental transformation of AmeriCa in bloodless coup through disaster-r-us economic program. Except for utter destruction of wealth and trust, decimation of world great healthcare system of innovation and advancement, no one is get hurt!
Horse manure improves with age but I agree with your statement in general.
Dear Mr. Spoilsport,
You are connoisseur of Horse manure!? Are you cook first or eat raw?
Troubled,
Boris
I would prepare it the same way they prepare Yak manure in the Urine mountains.