Affordable Care Act and Ramifications Discussion

Parent Cafe
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<p>I lost my father to suicide and send understanding to all who have been through that or any tragedy. The loss is a whallop. Maybe, in some situations, where there is a terminal illness or our relatives are very infirm, we can wrap our minds around it. But it is always hard on the heart.</p>

<p>I think this EOL discussion is huge, bigger than huge. And it only starts with us or a few friends together starting to share, vent and support each other. No simple facts or obvious answers. Layered.</p>

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<p>As someone who has also been through the EOL process with a 89-year old father, I think the amount of medical resources devoted to the elderly via Medicare is nothing short of obscene, with no incentives by any party to make conservative judgments.</p>

<p>Again, this discussion has gotten into an area where I wonder if it is relevant to ACA concerns. The bulk of medical care goes to the elderly in this country. As depicted on the charts embedded below, our expenditures for the non-elderly are not too out of the norm of other similar countries, while our elderly expenses are off the charts:</p>

<p>[url=&lt;a href=“http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts/]2012”&gt;2012 - The Year In Healthcare Charts]2012</a> - The Year In Healthcare Charts - Forbes<a href=“scroll%20down%20to%20see%20chart”>/url</a></p>

<p>[url=&lt;a href=“http://www.post-gazette.com/stories/news/health/us-health-care-costs-for-the-aged-are-sky-high-371246/]U.S”&gt;http://www.post-gazette.com/stories/news/health/us-health-care-costs-for-the-aged-are-sky-high-371246/]U.S</a>. health care costs for the aged are sky high - Pittsburgh Post-Gazette<a href=“click%20on%20link%20to%20see%20graph”>/url</a></p>

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<p>“You can live on the street and still be happy if you have loving people around you, but your live will really suck if you’re sitting pretty while your family is dead so you wouldn’t have to go bankrupt.”</p>

<p>wisdom iluvbooks</p>

<p>zoosermom and lookingforward, sorry for your painful losses to suicide.</p>

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<p>Bay, </p>

<p>Great charts. </p>

<p>The elderly do cost more.</p>

<p>The bulk of healthcare costs does not go to the elderly because there are fewer elderly.</p>

<p>The charts before ages 55 and after are very interesting.</p>

<p>Vouchers are very regressive. </p>

<p>My grandfather and grandmother were put to death in hospitals. My grandmother made both decisions. It helped that she still had her mental capabilities. I guess It would have been cheaper if this was done in homes.
It was an ugly process.</p>

<p>ACA helps people 55-65. It also helps those that are uninsured.</p>

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<p>The idea of health insurance as we have now in this country seems so far stretched beyond what it was originally intended for, which was to help with the expensive things that could go wrong. </p>

<p>Not the basic preventitve stuff. </p>

<p>It kind of seems crazy to us now because some of us have plans (myself included) that didn’t cover the full cost of things so simple as vaccines, that our office visits were something wenpaid for and if we had blood work done, we paid for that, as well. </p>

<p>When my children were young, we paid for all of those things. If we hit our deductible and something else went wrong, then we used up our deductible and hoped for the best. Most times, we didn’t come close, and breathed a sigh of relief. </p>

<p>Our premiums were a whole lot lower, than, too. And quite frankly, costs for treatment were a little more obvious. We had a much better idea of the costs of these items - or maybe I did with our doctors because they were upfront about the costs. There were a lot of cash patients, too. With my first kid, no maternity insurance and so we set up a payment plan with doctors and hospitals. Yo do that today would scare me silly, because the costs are exponentially higher and not so transparent. </p>

<p>I remember about 15 years ago a dentist on our health plan that wanted my H to get a bite plate. He billed an e horbonant rate and when questioned, he said that if he did, than he would get the negotiated cost back from insurer. I was stunned. Since then, that is what I see for everything. If you are a cash patient and ask a doctor or dentist now what the cost would be without insurance, it can be much lower - if they even know what the true cost of service even is, nowadays. </p>

<p>That being said and getting back to the idea of bankrupting our families over medicalmcosts for those with a low qualitynof life, most of us have seen it firsthand or know someone who has endured it. I have seen it withna friend’s young son and now see what is happening with my MIL who has Alzheimer’s. </p>

<p>Personally, I do not want to live a life when I do not recognize my children’s faces, when my personality becames angry and physically dangerous to others around me. It is heartbreaking. I probably would choose to end it. For her, the costs are not financially painful, yet. The emotional costs are far more devastating. </p>

<p>EOL costs are almost always going to be that elephant in the room (as previously posted) and as our boomer generation gets older and lives longer, will be financially draining on families and our country. It is an emotional issue but something that we will have to get a handle on. </p>

<p>Mortality is not infinite. Neither is our ability to pay for it.</p>

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<p>How much of our insurance premiums go to preventive care?</p>

<p>We seem to be going in the direction of insuring more preventive care. I would like to think there has been a cost benefit analysis done and insuring for preventive care saves money.</p>

<p>[Why</a> Obamacare’s State Rate Changes Are Misleading (AET, CI, UNH)](<a href=“http://www.fool.com/how-to-invest/personal-finance/2013/07/20/why-obamacares-state-rate-changes-are-misleading.aspx]Why”>Why Obamacare's State Rate Changes Are Misleading | The Motley Fool)</p>

<p>“The problem that objective analysts face in assessing Obamacare is that everything depends on the baseline from which you start. Every state’s insurance environment is different, and so in judging savings under Obamacare, you’re inherently judging not only how well Obamacare does in establishing a health-insurance framework but also how well the pre-Obamacare framework did in providing low-cost care to those seeking coverage.”</p>

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<p>"The idea of health insurance as we have now in this country seems so far stretched beyond what it was originally intended for, which was to help with the expensive things that could go wrong.</p>

<p>Not the basic preventitve stuff."</p>

<p>Who told you that? From its very beginnings, when large corporations began offering workers insurance as part of their pay/benefit packages, the idea was that the corporations could gain significantly by finding ways to keep their workers out of the hospital, and productive. Now, much of what we now know as preventative health measures (as well as occupational heatlh) was still in its infancy, but the idea of prevention was at the very birth of health insurance in this country, and was NEVER conceived of as only catastrophic care.</p>

<p>It is also true that, until Reagan, there were county health clinics all across the country that also offered preventative health services. The Republicans thought that would be better provided through private health insurance (and the Democrats sort of went along, with sometimes-successful attempts to expand Medicaid.)</p>

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<p>It is a good question, dstark. </p>

<p>I am not sure. Flu shots are cheap, Gardasil vaccines, not so much. </p>

<p>Blood work can be expensive, depending upon what is being screened. Pap exams used to be suggested for women after 18, now they do not do those until years later (said our Kaiser doc). </p>

<p>Maternity care can also be expensive - which actually probably falls in the preventative category. If you take care of mom during pregnancy, baby has better, healthier outcome. </p>

<p>An MRI would not be preventative, but it is often ordered to rule out big things. And the last one I had about 10 years ago cost 2300. I have no idea what It would cost now.</p>

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<p>I dont think mris cost much more today. Reading the news reports, prices seem to vary.</p>

<p>I find mini’s post interesting. He is older so he has probably seen more in many areas. :)</p>

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<p>Staying out of the hospital would be the “what could go wrong” part. The expensive part. </p>

<p>I guess if everyone always worked for big companies and had complete coverage that paid for everything, I would see your point. Growing up, my family owned a bsuiness and the insurance they had did not cover eveything. When a parent passed away, huge medical bills were there. When i needed my tonsils out when in high school, I was shocked at the cost my father paid for his portion of care. He paid a huge chunk, but an even bigger chunk was picked up by insurance company. </p>

<p>I do not think this was that unusual for health insurance, either. </p>

<p>Vaccines were never free on any insurance I had until I got to Kaiser. We always paid a chunk of fee on every other health plan when my kids were small.</p>

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<p>deleted…</p>

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<p>^^I think he’s just saying that when people start talking about EOL, that is the way that the conversation starts to turn, as an exaggeration of talking points.</p>

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<p>When I was young, vaccines were free. As a child, I remember lining up for the polio vaccine and the rubella vaccine. No payment involved. </p>

<p>The cost for my uncomplicated delivery. $200. My sister was delivered by a resident when the main OB couldn’t get there in time. The cost: Free. This was in the 50’s before insurance plans.</p>

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<p>American medicine is oriented toward saving lives, without regard to context. Unless the patient specifically requests otherwise, the default is to throw every resource at the illness (for the insured, at any rate; for the uninsured, it’s a different story). I don’t fault the doctors; they merely carry out an American trait, a belief that every problem can be solved if we just work hard enough and put enough resources into it.</p>

<p>European end-of-life care is more often aimed toward comfort, not squeezing out every last moment of life no matter the patient’s quality of life or the financial cost.</p>

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<p>“The cost for my uncomplicated delivery. $200. My sister was delivered by a resident when the main OB couldn’t get there in time. The cost: Free. This was in the 50’s before insurance plans.”</p>

<p>Well, can’t beat free. I thought my oldest son was the record. Born in a military hospital, only cost was $8 for a box lunch. Of course, the service we received wasn’t worth much more than that. Youngest son (with supposedly good insurance), 3K.</p>

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<p>Bay, for your father, who made the decision to take his medical care to obscene levels? Your mother, you and any siblings? Because:</p>

<p>the default is to throw every resource at the illness [More or less, depending; look into medical ethics.] The premise in the arguments of many posters is that they have NO control. They do. It can be the default in absence of other instructions. Individuals and families can make decisions, make their wishes known. You don’t want that chemo, she does not want that operation. He does not want a breathing tube. Take a look, because if affects us all. </p>

<p>Same applies to any age group.</p>

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<p>Bay’s charts are fantastic. </p>

<p>When we look at insurance costs compared to pay, it is obvious why many of those that dont have employer based healthcare are struggling.</p>

<p>A similar chart from what Bay posted…
My opinion is doctor pay is not extravagant although I doubt these numbers include ownership stakes in some businesses.</p>

<p>[2011</a> - 2012 Physician Salary Survey - Profiles - ProfilesDatabase.com](<a href=“http://www.profilesdatabase.com/resources/2011-2012-physician-salary-survey]2011”>Resources | Profiles Database)</p>

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<p>Based upon bay’s charts, I also don’t think physicians are overpaid, certainly not considering the responsibility and the high level of education and training required. I’m sure most people don’t even make those kinds of salaries until well into their thirties.</p>

<p>It was interesting to see that we actually spend about the same amount of money on healthcare as Western European countries. You don’t see that in the news, you read about how we are spending SO much more money than others. What this chart shows it that we spend about the same until age 55, then it starts increasing, at age 60, health care costs skyrocket. I’m not sure how the ACA is going to change that.</p>

<p>These charts also showed me that health care insurance is cheaper than I thought it was. Still crazy expensive, but not as bad as I’d expected.</p>

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<p>No, my father made all his own decisions. He was conscious, coherent and intelligent. My mother had predeceased him. He had worked hard his entire life, paid his taxes, served his country, raised his children, and felt entitled to cash in on everything offered to him in terms of medical care.</p>

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<p>Yes, this was our experience. My father was finally killed by hospice, where he agreed to go after spending weeks in the hospital, rather than undergo dialysis. They drugged him up 24/7 so that he was asleep and pain-free all the time, and he ultimately dehydrated/starved to death because he was never awake to ask for food/drink. That is my impression of what happened anyway, and as shocking as the realization was to me at the time, now I feel it was okay.</p>

<p>.</p>

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<p>I understand and think our thoughts intersect on much of this. Sorry, for what you went through then and now.</p>