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my collision with Obamacare

Threegoofs said:
Hmmm. So all this increased cost goes where?

The government? Nope.

Health care providers and hospitals? No- the cost of health care has actually risen at historically low rates.

Insurance companies? Yay! You're a big free market guy, so they will compete and lower prices!
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The health insurance market isn't remotely free
 
gdgyva said:
so lets budget for a MAJOR event?

he is 52, and other than a hernia...he didnt say any major issues

he might not have that major event happen for 10, 20, even 30 years

but he has to pay for it that entire time.....

yeah....doesnt seem fair to use the maximum as an example

makes the ACA seem reasonable when it isnt
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Yup. The analysis only works if you hit the max deductible yearly. In this you have to have in the ballpark of $8100 in out of pocket expenses for the new plan to be cheaper.
 
jaeger19 said:
Just to point out.. its all BS from the insurance company. Complete BS. Now Obamacare allows it..and encourages it.. but at the end of the day.. did you get dramatically sicker? Nope..

And if the insurance company was making money on you at their previous policy and rate.. they would making money on you NOW... There is no need for a higher rate... its simply that they CAN charge you more and you blame obamacare rather than the insurance companies.
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But thanks to the ACA, the insurers won't make more money by gouging you.

They need to pay out 80% of their premiums on care. If not, they must rebate the difference to the consumers directly.

Isn't it awesome?
 
buck said:
They may still be making money on him.. But they are now losing money on many of the rest insured through that plan. They need him to help pay for them.
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Bull. He was paying for the people before as well then.

Sorry buck but some 85% of americans had healthcare insurance prior to Obamacare. Obamacare added what? About 5%. And a good portion of those folks went to Medicaid expansion.
So now.. we are going to claim that adding just a few percentage points of people. People that were living and working WITHOUT healthcare insurance.. but were healthy enough to work enough to be above the line for Medicaid, but on the other hand were also so sick that they cost the insurance a lot of money when they went on insurance?

One would have to suspend all disbelief to believe that scenario. Sorry.. they did not HAVE to raise his rates. Its simply does not make sense. They raised his rates because they saw the opportunity to gouge him. Either for a subsidy.. or to raise the level of rates because now with the government on the hook.. demand has increased.
 
Threegoofs said:
But thanks to the ACA, the insurers won't make more money by gouging you.

They need to pay out 80% of their premiums on care. If not, they must rebate the difference to the consumers directly.

Isn't it awesome?
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No it isn't. What would be awesome is if you had complete freedom to purchase a plan that suits your particular circumstances from any provider in the country.
 
Threegoofs said:
But thanks to the ACA, the insurers won't make more money by gouging you.

They need to pay out 80% of their premiums on care. If not, they must rebate the difference to the consumers directly.

Isn't it awesome?
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Yeah.. that's a bunch of baloney on that one.

way to easy to manipulate the numbers on that one. Especially when its a percentage. It removes the desire of the insurance company to keep the costs down. The more money they spend on healthcare.. the more money they can keep in profit.
 
Gaius46 said:
No it isn't. What would be awesome is if you had complete freedom to purchase a plan that suits your particular circumstances from any provider in the country.
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Unfortunately, what suits many is to buy minimal coverage and if they have a medical condition that is expensive to treat, they default on the bill leaving everyone else to pick up the tab for their care
 
sangha said:
Unfortunately, what suits many is to buy minimal coverage and if they have a medical condition that is expensive to treat, they default on the bill leaving everyone else to pick up the tab for their care
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However.. the real question is just how much that matters. Defaulting on a 350,000 dollar bill? Sure.

But a 10,000 dollar bill? the number that;s going to happen isn't going to have that much effect.

the difference between a 10,000 limit and a person having a 6,000 isn't that big of a deal in the grand scheme of things.. but for a person trying to buy health insurance its is.
 
jaeger19 said:
However.. the real question is just how much that matters. Defaulting on a 350,000 dollar bill? Sure.

But a 10,000 dollar bill? the number that;s going to happen isn't going to have that much effect.
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That is a good question but I have no figures on how many people default on bills by size of debt so I can't say much on the issue.

the difference between a 10,000 limit and a person having a 6,000 isn't that big of a deal in the grand scheme of things.. but for a person trying to buy health insurance its is.
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If you're talking about deductibles, I agree. That's why I think all the poutrage over higher deductibles is besides the point. After all, health insurance isn't meant to pay for routine care or make health care cheaper. The elimination of lifetime maximums, OOP maximums, etc are more significant IMO. Health insurance is primarily meant to eliminate or reduce the risk of getting hit with a huge medical bill. A few thousand dollar difference in deductibles is not a big deal. Reducing the possibility of owing tens (or hundreds) of thousands of dollars is the important part
 
sangha said:
Unfortunately, what suits many is to buy minimal coverage and if they have a medical condition that is expensive to treat, they default on the bill leaving everyone else to pick up the tab for their care
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I don't disagree but there are legal remedies to that.

This is somewhat OT but it would be nice to be able to comparison shop. When you're being rushed to the ER you have no control whatsoever over what the final cost is going to be. The hospital puts a number on a piece of paper the insurance company pays part and you the pay the rest. There's no way to argue to it, no way to tell whether the charges are reasonable or the services rendered necessary. They bill you and you pay.
 
Gaius46 said:
I don't disagree but there are legal remedies to that.
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And those are?

This is somewhat OT but it would be nice to be able to comparison shop. When you're being rushed to the ER you have no control whatsoever over what the final cost is going to be. The hospital puts a number on a piece of paper the insurance company pays part and you the pay the rest. There's no way to argue to it, no way to tell whether the charges are reasonable or the services rendered necessary. They bill you and you pay.
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Yeah, next time I'm bleeding out, I'll go comparison shopping. :roll:
 
sangha said:
And those are?



Yeah, next time I'm bleeding out, I'll go comparison shopping. :roll:
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Same as any other creditor. Courts, judgments, liens etc.

As far as bleeding out - that's exactly my point. You can't comparison shop. End result is you can be changed ANYTHING and have no recourse. Insurance companies typically only pay reasonable and customary which puts you on the hook for anything they don't deem reasonable. And there ain't a thing you can do about it.
 
jaeger19 said:
Yeah.. that's a bunch of baloney on that one.

way to easy to manipulate the numbers on that one. Especially when its a percentage. It removes the desire of the insurance company to keep the costs down. The more money they spend on healthcare.. the more money they can keep in profit.
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This is true. In my experience with the ACA, office/ED visits have gone up dramatically.

Have you noticed a bump?
 
Gaius46 said:
Same as any other creditor. Courts, judgments, liens etc.
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Ever hear the saying "You can't squeeze blood out of a stone"?

Some penniless guy who is too sick to work can be taken to court, but you can't take money from him that he doesn't have.


As far as bleeding out - that's exactly my point. You can't comparison shop. End result is you can be changed ANYTHING and have no recourse. Insurance companies typically only pay reasonable and customary which puts you on the hook for anything they don't deem reasonable. And there ain't a thing you can do about it.
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Fair enough. I was responding to the notion that comparison shopping might be a practical means of avoiding huge medical bills. I must have misread you on that point.
 
sangha said:
Ever hear the saying "You can't squeeze blood out of a stone"?

Some penniless guy who is too sick to work can be taken to court, but you can't take money from him that he doesn't have.




Fair enough. I was responding to the notion that comparison shopping might be a practical means of avoiding huge medical bills. I must have misread you on that point.
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Eh I was probably less than clear on the point.

Understood on the other. Not a 100% solution but I'd assume there are a good number of people who can pay - perhaps in installments - but choose not to.
 
Gaius46 said:
Eh I was probably less than clear on the point.

Understood on the other. Not a 100% solution but I'd assume there are a good number of people who can pay - perhaps in installments - but choose not to.
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I doubt it.

There's nothing stopping hospitals, doctors, etc from taking people to court for money they are owed. In fact, they take people to court all the time. There's no reason to think there are many who can pay their bill but choose not to.
 
sangha said:
I doubt it.

There's nothing stopping hospitals, doctors, etc from taking people to court for money they are owed. In fact, they take people to court all the time. There's no reason to think there are many who can pay their bill but choose not to.
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Yes... its called medical bankruptcy.. the easy way out of your debt. And the funny thing.. it not medical debt that causes it.. its other debts.. but if you have medical debt... then its easy to get a medical bankruptcy.

At any one time.. we have hundreds of thousands of dollars in unpaid bills that are delinquent. and the cost of suing someone just means in many cases that it just costs us more.
 
jaeger19 said:
Yes... its called medical bankruptcy.. the easy way out of your debt. And the funny thing.. it not medical debt that causes it.. its other debts.. but if you have medical debt... then its easy to get a medical bankruptcy.

At any one time.. we have hundreds of thousands of dollars in unpaid bills that are delinquent. and the cost of suing someone just means in many cases that it just costs us more.
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I don't think you've done a good job of following this. Plenty of people don't pay their medicals bill but we were talking about people who *CAN* pay but don't. You can't declare bankruptcy if you have the money to pay. And though I imagine there are some people who manage to hide their assets, I doubt that's a large number.

But your post does hint at one thing I mistated - hospitals and other providers don't often take people to court to collect debts. What they do is sell the acct receivable to a collection agency.
 
sangha said:
That is a good question but I have no figures on how many people default on bills by size of debt so I can't say much on the issue.



If you're talking about deductibles, I agree. That's why I think all the poutrage over higher deductibles is besides the point. After all, health insurance isn't meant to pay for routine care or make health care cheaper. The elimination of lifetime maximums, OOP maximums, etc are more significant IMO. Health insurance is primarily meant to eliminate or reduce the risk of getting hit with a huge medical bill. A few thousand dollar difference in deductibles is not a big deal. Reducing the possibility of owing tens (or hundreds) of thousands of dollars is the important part
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Very true.. its one of the faults of Obamacare.. What people need is catastrophic policies that reduce the possibility of owing tens or hundreds of thousands of dollars. What they should have done and should do.. is increase the out of pocket limits.. so making the insurance cheaper (so more will be able to buy it)... but mandate that the insurance must pay for say four visits to the doctor a year.. so that people will at least go to the doctor when they get sick rather than wait..
 
sangha said:
I don't think you've done a good job of following this. Plenty of people don't pay their medicals bill but we were talking about people who *CAN* pay but don't. You can't declare bankruptcy if you have the money to pay. And though I imagine there are some people who manage to hide their assets, I doubt that's a large number.

But your post does hint at one thing I mistated - hospitals and other providers don't often take people to court to collect debts. What they do is sell the acct receivable to a collection agency.
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yes you can declare bankruptcy if you have the ability to pay.. especially medical bankruptcy because its relatively easy. Caveat.. "having the ability to pay" is a relative term. What generally happens is that other debt gets renegotiated and you pay THAT debt.. and the medical debt gets wiped out.

And yes.. we take people to collections.. which generally means that we are lucky to get pennies on the dollar..
 
Gaius46 said:
Same as any other creditor. Courts, judgments, liens etc.

As far as bleeding out - that's exactly my point. You can't comparison shop. End result is you can be changed ANYTHING and have no recourse. Insurance companies typically only pay reasonable and customary which puts you on the hook for anything they don't deem reasonable. And there ain't a thing you can do about it.
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Actually the customer is not on the hook for any charges not deemed necessary and reasonable... its one of the big advantages of having insurance.. even if you have a high deductible which means that you will be paying out of pocket. you get the contracted rate (which is generally lower) and you aren't responsible beyond what the insurance company calls reasonable and necessary.. (UNLESS your providers has explicitly pointed out that insurance will not pay for this and the cost will be borne by you)
 
US Conservative said:
This is true. In my experience with the ACA, office/ED visits have gone up dramatically.

Have you noticed a bump?
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Office visits definitely. Not so much emergency department.. actually a decrease there but that's because now they can go to the office rather than the ED.. and we have done a lot to try and encourage folks to go the clinics rather than the ED for things not really emergency.

Of course the reimbursement is terrible.. (at least in 2 states we have business, ones not so bad.. better than medicare)... you know medicine.. work harder for less money...
 
jaeger19 said:
Actually the customer is not on the hook for any charges not deemed necessary and reasonable... its one of the big advantages of having insurance.. even if you have a high deductible which means that you will be paying out of pocket. you get the contracted rate (which is generally lower) and you aren't responsible beyond what the insurance company calls reasonable and necessary.. (UNLESS your providers has explicitly pointed out that insurance will not pay for this and the cost will be borne by you)
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I need to go back a recheck some claims that were filed in the past couple of years but I'll take your word on it. So that basically means no matter what hospital you go to you're going to pay basically the same thing - or do contracted rates vary from hospital to hospital? Thanks.
 
Gaius46 said:
I need to go back a recheck some claims that were filed in the past couple of years but I'll take your word on it. So that basically means no matter what hospital you go to you're going to pay basically the same thing - or do contracted rates vary from hospital to hospital? Thanks.
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No.. it means what the insurance company deems reasonable and necessary.

there still can be individual variation in the rates to each hospital.. or provider. For a variety of reasons.. costs, negotiation power.. etc.
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jaeger19 said:
No.. it means what the insurance company deems reasonable and necessary.

there still can be individual variation in the rates to each hospital.. or provider. For a variety of reasons.. costs, negotiation power.. etc.
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Okay so then my basic premise is still valid though possibly not to the extent that I originally thought.
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