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Obamacare: Is a $2,000 deductible 'affordable?'

Boo Radley said:
I know quite a few in the field, and it's already happening. So the end game is it will increase access.
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I also know quite a few in the field, it is quite the opposite. Plus my brother is in the medical field, and he sees what's happening first hand.



Here, we might not be too far Apart. I have not argued this is the best plan, or the best approach. But it doesn't decrease access.
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Then we're going to have to agree to disagree. There is no way quality, educated medical personnel (GPs/NPs, mainly) are going to pop out fast enough to not only replace those retiring, those choosing to retire early because of the ACA, and service an inbound couple of million people.
 
GottaGo said:
I also know quite a few in the field, it is quite the opposite. Plus my brother is in the medical field, and he sees what's happening first hand.



Then we're going to have to agree to disagree. There is no way quality, educated medical personnel (GPs/NPs, mainly) are going to pop out fast enough to not only replace those retiring, those choosing to retire early because of the ACA, and service an inbound couple of million people.
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I have been, my wife is, my sister is, my brother is, my sister in law is and so is my brother in law. Not to mention we've been working with the hospitals here doing just what I said. You can also find articles on it happening, some having already been posted.

Professionals are not retiring for the first time. This is on going, and their replacements already on board. The small number retiring early is insignificant.
 
Boo Radley said:
Wring again. If we simply refused to treat those who can pay, there illnesses. And decaying health would bleed over in others. One way or another, the health of the community effects more than just the individual who can't pay.

Again, I ask you to define too much. I can't respond without knowing how you're defining too much.
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I don't know how else to explain it such that you and others understand the inherent theoretical flaw in health insurance which gives us nearly perfectly inelastic demand for medical care and hence runaway inflation in prices.

In a sense, you see the solution as the problem and vice versa.
 
Neomalthusian said:
I don't know how else to explain it such that you and others understand the inherent theoretical flaw in health insurance which gives us nearly perfectly inelastic demand for medical care and hence runaway inflation in prices.

In a sense, you see the solution as the problem and vice versa.
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I think you're trying to apply a theory that really doesn't play with medicine. Medicine is not a normal market service. A lot of our problem is trying to treat it like it is.
 
Boo Radley said:
As those retire, more come in. And while use of alternatives like nurse practitioners have been done before, they are seeing new attention. Creative approaches have gained new emphasis. And demand will assure adjustments. It's already begun. There is no likelihood access will be reduced. None at all.

But lets really look at your premise, for the few to have more, we have to leave some without. A bit like "let them eat cake" don't ya think?
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With 30 million new people expected to enter the health-care system in 2014 under the Patient Protection and Affordable Care Act, experts say a looming doctor shortage isn’t a chance—it’s a fact.
“These 30 million new patients have either not gone to the doctor or [have been] going to the emergency room so that is putting pressure into the system. You have a foundational supply and demand shift,” says Mitch Rothschild, CEO of Vitals, a consumer tool physician evaluation company.
He expects the shortage to hit the primary care physician (PCP) arena the hardest and explains that there is approximately one PCP for every 1,500 people in the U.S. but come 2020, there will be about 70,000 less doctors available to consumers as a direct result of the law, according to Deloitte.
In fact, a recent Deloitte 2013 survey of U.S. physicians found 57% doctors view changes in the industry under health-care reform as a threat, and six in 10 physicians report it’s likely that many will retire earlier than planned in the next two to three years, fueling the shortage.

Here’s the Doctor, You Have 6 Minutes
Here’s the problem: the number of people in the patient pool will increase 12% next year, but the supply of doctors will hold steady. Patients are already waiting longer to see their physicians and spending less time with them than they have in the past, according to Rothschild. On average, Vitals found patients are waiting 6% longer to see their doctors and spending only six minutes in the exam room.
“You’re going to wait longer and spend less time with doctors,” he says.


Read more: Obamacare Reality: Doctor Shortage on the Way | Fox Business
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Over half of physicians surveyed have reached a tipping point
and plan to make changes to their practices. Many intend to
take one or more steps likely to reduce patient access to their
services, limiting physician availability at a time when doctors
already are in short supply.

Over 60 percent of physicians would retire today if they had the means.

Over 52 percent of physicians have limited the access Medicare patients have to their practices or are
planning to do so.

Over 59 percent of physicians indicate passage of the Patient Protection and Affordable Care Act (i.e.,
“health reform”) has made them less positive about the future of healthcare in America.

Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it
three to five years from now.

http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf
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The Affordable Care Act isn’t scheduled to be fully implemented until next year, but some doctors already are viewing it as dead on arrival. The medical rumor mill is abuzz with stories about physicians girding for Mr. Obama’s signature domestic policy achievement by limiting their exposure to Medicare and Medicaid, selling their practices, converting to fee-for-service approaches, or even retiring from medicine altogether.
“Every single day, people are talking about retiring early, getting out of clinical medicine, or going into hospital administration, where you don’t have to think about patient care anymore,” said Dr. Richard Armstrong, a Michigan surgeon and chief operating officer of Docs 4 Patient Care, which opposes the Affordable Care Act.
Not all doctors agree. The American Medical Association endorsed the health care legislation at the time of its passage in 2010, although the group now is pushing for the elimination of the Independent Payment Advisory Board, the cost-control organization at the heart of the president’s plan that became known to critics as the “death panel.”


Read more: 'Obamacare' health care reform ALREADY forcing doctors to close practices - Washington Times
Follow us: @washtimes on Twitter
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Doctor Shortage Likely to Worsen With Health Law

http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?_r=0
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Joe, I think you are only seeing what you want to see. This is a disaster before it even gets fully off the ground...
 
ttwtt78640 said:
That "emergency" care cannot be denied whether you have insurance or not. If you are wealthy, only then is that major a concern, otherwise they write off the bad debt just as they now do and your credit rating still sucks. ;)
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And we can use the tax dollars collected from those that don't have insurance to foot the hospital bill. We could also, over time, raise the penalty for not buying insurance.
 
roughdraft274 said:
And we can use the tax dollars collected from those that don't have insurance to foot the hospital bill. We could also, over time, raise the penalty for not buying insurance.
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This idea sounds very good until you do the simple math involved. The PPACA law requires that low income workers (the majority of the uninsured) must spend 2% to 4% of their income on medical care insurance premiums (or as the tax penalty). Medical care insurance premiums now cost about $5,000/year for a single person and $20,000/year for a family. Even assuming that all low income folks ($20K/year) are single that means that their premiuim share is capped at about $600/year leaving a balance of $4,400/year to be picked up by the taxpayers for each of them even if they do not get sick but choose to have insurance.
 
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ttwtt78640 said:
This idea sounds very good until you do the simple math involved. The PPACA law requires that low income workers (the majority of the uninsured) must spend 2% to 4% of their income on medical care insurance premiums (or as the tax penalty). Medical care insurance premiums now cost about $5,000/year for a single person and $20,000/year for a family. Even assuming that all low income folks ($20K/year) are single that means that their premiuim share is capped at about $600/year leaving a balance of $4,400/year to be picked up by the taxpayers for each of them even if they do not get sick but choose to have insurance.
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You're math is completely made up. You're basically describing one person. But yes, at the end of the day, some tax money will have to go towards subsidizing low income peoples health insurance. I don't exactly think of that as a nightmare like some on your side do. I think it makes more sense to provide them health insurance which gives them access to preventative medicine and a higher quality of life rather than only footing the bill after major emergency situations. Either way it's going to happen.

I don't know exactly what the subsidies will be but your estimate of them only paying 600 seems low. If they make that little they'll probably be on Medicaid.

But the subsidies only make your the argument that people won't get insurance til they are sick look more ridiculous. If you're poor you'll be on medicaid, if your right above the poverty line, then the amount you'd be paying for health insurance isn't very different than your penalty for not having it, you'd be crazy not to get it. And so on and so on.
 
ttwtt78640 said:
This idea sounds very good until you do the simple math involved. The PPACA law requires that low income workers (the majority of the uninsured) must spend 2% to 4% of their income on medical care insurance premiums (or as the tax penalty). Medical care insurance premiums now cost about $5,000/year for a single person and $20,000/year for a family. Even assuming that all low income folks ($20K/year) are single that means that their premiuim share is capped at about $600/year leaving a balance of $4,400/year to be picked up by the taxpayers for each of them even if they do not get sick but choose to have insurance.
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Absolutely right...

But there also seems to be a naïve misunderstanding by many about the consequences of the state-by-state resistance. Regardless of who sets up the health insurance exchanges, the federal government will now define the details of coverage for the majority of health insurance policies. Massive taxpayer money will now be funneled into subsidizing health insurance, while medical care access will diminish with the reductions in payments to doctors and hospitals. More Americans will be shifted to Medicaid, even though some states will reject its expansion. More employers will reduce their health benefits or shift away from scenarios where they are required to offer the coverage. More employees will be forced to change their coverage and, necessarily, their doctors too. Many private health insurance options, including some of the most popular lower cost plans, will be eliminated by the actuarial and benefits-design dictates of the law.

The Democrats' Fallback Plan For When Obamacare Inevitably Fails - Forbes
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If Obamacare's stated goal was to broaden the health insurance market, give more options to consumers, and generally lower the cost of health insurance, courtesy of the IRS' flawless execution of yet another unprecedented government expansion, it may be in for a tough time. Because while on paper every statist plan of centrally-planned ambitions looks good, in reality things usually don't work out quite as expected. Case in point the news that Aetna will stop selling health insurance to individual consumers in California at the end of 2013, in advance of Obamacare's complete transformation of the insurance market: a transformation which just incidentally may see most private health insurance firms follow in Aetna's steps and the emergence of a single-payer system along the lines of the British National Health Service. A government-mandated and funded system which, needless to say, crushes private enterprise, and ends up costing far more for all involved than an efficient market based on individual wants, needs and capabilities constantly in flux.

Aetna Pulls Out Of California Individual Insurance Market In Response To Obamacare | Zero Hedge
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Well, ain't that great?!!!! I wonder how long we will have to keep accurately predicting what is going to happen before people will sit up and listen?
 
roughdraft274 said:
You're math is completely made up. You're basically describing one person. But yes, at the end of the day, some tax money will have to go towards subsidizing low income peoples health insurance. I don't exactly think of that as a nightmare like some on your side do. I think it makes more sense to provide them health insurance which gives them access to preventative medicine and a higher quality of life rather than only footing the bill after major emergency situations. Either way it's going to happen.

I don't know exactly what the subsidies will be but your estimate of them only paying 600 seems low. If they make that little they'll probably be on Medicaid.

But the subsidies only make your the argument that people won't get insurance til they are sick look more ridiculous. If you're poor you'll be on medicaid, if your right above the poverty line, then the amount you'd be paying for health insurance isn't very different than your penalty for not having it, you'd be crazy not to get it. And so on and so on.
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Mecidaid is available only if you are disabled or have dependents it is not an option for other single low income workers (like myself). Examine the sample CA plans under PPACA and you will see that most doctor/clinic/hospital visits (beyond your annual preventive "check-up") still require co-pays or costs that are incurred before you reach your deductable or "maximum out of pocket" that still averages about $6,000/year.

http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf
 
ttwtt78640 said:
Mecidaid is available only if you are disabled or have dependents it is not an option for other single low income workers (like myself).
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Yes it is.

What the Self-Employed Don't Know About Obamacare Subsidies - Businessweek
If your annual income is at or below 138 percent of the federal poverty level, you should qualify for Medicaid, the government’s health coverage for low-income Americans. For 2013, the poverty guideline is $11,490 for one person and $23,550 for a four-person household.
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I'm not sure of your situation, but if you make below 138% of the poverty line, and your employer doesn't offer health insurance as a benefit, then you will qualify when the bill goes into full effect. If you can find a source that says differently please show it to me cause I haven't heard what you're saying anywhere.
 
roughdraft274 said:
Yes it is.

What the Self-Employed Don't Know About Obamacare Subsidies - Businessweek


I'm not sure of your situation, but if you make below 138% of the poverty line, and your employer doesn't offer health insurance as a benefit, then you will qualify when the bill goes into full effect. If you can find a source that says differently please show it to me cause I haven't heard what you're saying anywhere.
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I don't know about your state but in Texas low income alone is not getting you on Medicaid.

Edit: PPACA never addressed any single adult person making below 100% (133% in some states) of the federal poverty line. Show me any PPACA rate structure addressing single adult folks in that income group.

Basic Requirements
Regardless of income, Medicaid covers only certain groups. Generally, to qualify for coverage, you must be pregnant, the parent or guardian of a child 18 years old or under, disabled or at least 65 years old.
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Texas Medicaid Eligibility Requirements | eHow

General Program Requirements
In order to qualify for this benefit program, you must be a resident of the state of Texas, a US national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older.
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Benefits.gov - Texas Medicaid
 
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ttwtt78640 said:
I don't know about your state but in Texas low income alone is not getting you on Medicaid.



Texas Medicaid Eligibility Requirements | eHow



Benefits.gov - Texas Medicaid
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That's why you have medicaid expansion that passed with the Health Care Bill. Every source I can find says that individuals that have low enough income will qualify for medicaid. Worst comes to worst you get a good subsidy to pay for the majority of your premiums.

As a libertarian what exactly do you think would be the solution to all of this? Do you think that we should just deny emergency medical care to poor people that can't pay it off?
 
roughdraft274 said:
That's why you have medicaid expansion that passed with the Health Care Bill. Every source I can find says that individuals that have low enough income will qualify for medicaid. Worst comes to worst you get a good subsidy to pay for the majority of your premiums.

As a libertarian what exactly do you think would be the solution to all of this? Do you think that we should just deny emergency medical care to poor people that can't pay it off?
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That mandate for state Medicaid expansion was struck down by the SCOTUS. That is exactly why 27 states have refused to play the PPACA exchange game.

Edit: Please cite one of your "everybody now gets Medicaid" sources.

Texas resists PPACA insurance exchanges, Medicaid expansion - Articles - Employee Benefit News
 
ttwtt78640 said:
That mandate for state Medicaid expansion was struck down by the SCOTUS. That is exactly why 27 states have refused to play the PPACA exchange game.

Edit: Please cite one of your "everybody now gets Medicaid" sources.

Texas resists PPACA insurance exchanges, Medicaid expansion - Articles - Employee Benefit News
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If that's the case, then you should be mad at anyone then you should be mad at your legislature. All the democrats in Congress or Obama can do is offer it. If Texas wants to remain the state with the most uninsured then that's their choice.

I wish you the best of health for the rest of your life, but if you do ever get sick and need costly services, or ever have uninsured friends that need costly services, I hope you keep in mind who the people were that turned it down and don't just blame democrats.

And again, what's your solution? Let people die? Deny them emergency care? If your a true libertarian then that's your only answer correct?
 
roughdraft274 said:
If that's the case, then you should be mad at anyone then you should be mad at your legislature. All the democrats in Congress or Obama can do is offer it. If Texas wants to remain the state with the most uninsured then that's their choice.

I wish you the best of health for the rest of your life, but if you do ever get sick and need costly services, or ever have uninsured friends that need costly services, I hope you keep in mind who the people were that turned it down and don't just blame democrats.

And again, what's your solution? Let people die? Deny them emergency care? If your a true libertarian then that's your only answer correct?
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We all need food, clothing and shelter yet are expected to provide those, even more essential, things for both ourselves and for our dependents. The "answer" is not to simply say that any non-diabled adult (U.S. citizen?) that does not earn/produce enough to sustain their own needs and those of their dependents is now "entitled" to their "fair share" of that earned/produced by others.
 
ttwtt78640 said:
We all need food, clothing and shelter yet are expected to provide those, even more essential, things for both ourselves and for our dependents. The "answer" is not to simply say that any non-diabled adult (U.S. citizen?) that does not earn/produce enough to sustain their own needs and those of their dependents is now "entitled" to their "fair share" of that earned/produced by others.
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That sounds like a very long winded way of saying "let them die". If that's your position the least you could do is own up to it. I have a friend with no insurance and low income that just had an aneurysm (he was one of those young and healthy people that Republicans and conservatives are always saying really don't need insurance). They managed to rush him to the hospital, ive him emergency surgery, monitor him in the ICU and saved his life. Total cost around 300,000 dollars. He'll never be able to pay that back. But I'm glad you have such a simple solution. Should have just let him die. And you have the gall to criticize Obamacare, lol. It's not perfect by any means, but it's miles ahead of your solution.
 
roughdraft274 said:
That sounds like a very long winded way of saying "let them die". If that's your position the least you could do is own up to it. I have a friend with no insurance and low income that just had an aneurysm (he was one of those young and healthy people that Republicans and conservatives are always saying really don't need insurance). They managed to rush him to the hospital, ive him emergency surgery, monitor him in the ICU and saved his life. Total cost around 300,000 dollars. He'll never be able to pay that back. But I'm glad you have such a simple solution. Should have just let him die. And you have the gall to criticize Obamacare, lol. It's not perfect by any means, but it's miles ahead of your solution.
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OK Skippy, but if that same "young friend" had paid $600 to $1,000/year for their $5,000/year medical insurance policy (with the balance being paid by other taxpayers) then the situation would largely be the same. Note that he did not die, got his needed medical care and will possibly suffer a credit rating hit (only if the treatment facility sells that debt to a collection agency). I am not calling for no more writing off of charity care, or mandating that actual life saving care be denied, that is not going to happen no matter how many get insured and you know it.
 
ttwtt78640 said:
OK Skippy, but if that same "young friend" had paid $600 to $1,000/year for their $5,000/year medical insurance policy (with the balance being paid by other taxpayers) then the situation would largely be the same. Note that he did not die, got his needed medical care and will possibly suffer a credit rating hit (only if the treatment facility sells that debt to a collection agency). I am not calling for no more writing off of charity care, or mandating that actual life saving care be denied, that is not going to happen no matter how many get insured and you know it.
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1. It wouldn't largely be the same. If he had health insurance maybe he would have actually gone to the doctor for his headaches and dizziness that he had for a week leading up to the aneurysm. They could have then told him his blood pressure was through the roof and get that fixed for a fraction of the cost of the surgery and hospital stay.

2. Why aren't you calling for hospitals to be able to deny emergency medical care? Are you not a libertarian? It seems as though your solution to the problem is to stick our thumbs up our asses alittle bit more. Skippy, lol.
 
roughdraft274 said:
1. It wouldn't largely be the same. If he had health insurance maybe he would have actually gone to the doctor for his headaches and dizziness that he had for a week leading up to the aneurysm. They could have then told him his blood pressure was through the roof and get that fixed for a fraction of the cost of the surgery and hospital stay.

2. Why aren't you calling for hospitals to be able to deny emergency medical care? Are you not a libertarian? It seems as though your solution to the problem is to stick our thumbs up our asses alittle bit more. Skippy, lol.
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Are you implying that the annual cost of medical care insurance is less than that for a single doctor visit? I pay cash for my medical treatment (and have no insurance) and must go once per month for blood work, pay for my prescription medication and see the doctor every three months.

If you think that medical care costs will go down as the percentage of insured go up then simply look at MA; this did not occur under RomneyCare.

https://en.wikipedia.org/wiki/Massachusetts_health_care_reform#Outcomes
 
j-mac said:
Joe, I think you are only seeing what you want to see. This is a disaster before it even gets fully off the ground...
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I didn't say there was going to be one. I said we'd adjust. The retirements are not that huge a problem as they are too few. But with moves towards using other providers and encouraging more doctors, we will adjust. I think your mistake is thinking it is static. Instead, it is a fluid situation.
 
roughdraft274 said:
I think they won't grow as fast. Nothing will just magically make the costs go down.
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That was not your assertion earlier. You implied that costs would go down as more folks received "preventive" care, as in the case of "your friend" that could have avoided expensive surgery. My point is that someone that cannot (or will not) spend $100 to see a doctor now is not any more likely to spend even $25 to see a doctor after being forced to pay $600 just for insurance (or the uninsured fine).
 
ttwtt78640 said:
That was not your assertion earlier. You implied that costs would go down as more folks received "preventive" care, as in the case of "your friend" that could have avoided expensive surgery. My point is that someone that cannot (or will not) spend $100 to see a doctor now is not any more likely to spend even $25 to see a doctor after being forced to pay $600 just for insurance (or the uninsured fine).
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Many uninsured don't go to the doctor out of fear that they have no idea the cost of just a general exam. When you have a 25$ copay, you know the cost going in. I go to the doctor and he has to do a blood test or something, I'm still out only 25$, where as the uninsured might have to shell out another 200-300 for that. I grew up til I was 21 with no insurance. I know the feeling of it, I know what it's like to have parents ask "do you think it's bad enough to actually see a doctor". I also know what it's like to have good insurance and to not have to be scared of going to the doctor for fear of emptying my back account or going bankrupt.
 
roughdraft274 said:
Many uninsured don't go to the doctor out of fear that they have no idea the cost of just a general exam. When you have a 25$ copay, you know the cost going in. I go to the doctor and he has to do a blood test or something, I'm still out only 25$, where as the uninsured might have to shell out another 200-300 for that. I grew up til I was 21 with no insurance. I know the feeling of it, I know what it's like to have parents ask "do you think it's bad enough to actually see a doctor". I also know what it's like to have good insurance and to not have to be scared of going to the doctor for fear of emptying my back account or going bankrupt.
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True enough. That being said, the bottom line remains the same; someome living in fear of the high cost of medical care (low income - like myself) is better off (financially) paying for their needed medical care out of pocket, and doing all in their power to stay healthy, rather than being forced to pay 2% of their income (off the top) plus up to $6K in added out of pocket costs. I spend about $15 for my monthly blood work and medicine and about $50 every three months for a doctor visit, or $380/year, much less than the cost of what any PPACA insurance plan would cost me even if my added out of pocket costs were then slightly reduced for the doctor visits.
 
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