<p>“There is a lot of misinformation out there. One of the things that we hear often is that I have to go buy a government plan on the marketplace,” Allen said. "We spend a lot of time explaining to people, ‘You’re going to buy a private insurance plan. There is no government plan.’ " </p>
<p>This makes me sigh and shake my head - that after 3 or so years since ACA passed and all the media attention about the law, that so many people still believe it’s government run health insurance.</p>
<p>The misinformation is annoying, but with businesses like Blue Cross informing the public , the information is going to get out.</p>
<p>“Across the country, Blue Cross companies are among the health insurers most aggressive in reaching out to build consumer trust and capture their spending on policies. Spots for a broad new print, television and online advertising campaign are multiplying. Meetings with civic organizations community groups, and religious institutions are taking place from Vermont to Texas. The North Carolina company has rented movie theaters and invited guests to watch first-run films, with the addition of a 15-minute ad explaining the Affordable Care Act and laptop-ready staffers in the lobby offering individual guidance on the law.”</p>
<p>There was a lot of media talk about states setting up the exchanges, or else the federal government would do it for them. That makes it sounds like government-run health care. Plus, a lot of people are going to get their health care coverage heavily subsidized by the government, and that sounds like government run health care, too. Finally, the government has mandated what must be covered by insurance plans, so that sounds like government-run health care as well. It is understandable to me that people don’t understand it very well.</p>
<p>I agree with you there, Bay. The government has not done a very good job of knocking down the misinformation that detractors and obstructors have been putting out there since Day 1, nor of explaining what ACA actually is. </p>
<p>I think another problem is that this is a state-by-state program (albeit governed by certain federal rules), so each state is handling the roll-out in its own way. Some states have already begun campaigns to educate their people, and some never will. There’s even one state in which local officials are actually forbidden to cooperate with the federal exchange. </p>
<p>Part of the success of the Massachusetts program was that during the run-up to the program going live, they had an aggressive media presence telling people what it was, how it would benefit them, and how to sign up. Massachusetts now has 2% uninsured.</p>
<p>One of the problems I’m encountering is that when I try to find information online, so much of it is outdated. And still (since it’s not October yet) even the most up-to-date information is very vague.</p>
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<p><a href=“https://www.healthcare.gov/[/url]”>https://www.healthcare.gov/</a></p>
<p>[Home</a> | HHS.gov/healthcare](<a href=“http://www.hhs.gov/healthcare/]Home”>Health Care | HHS.gov)</p>
<p><a href=“http://kff.org/health-reform/[/url]”>http://kff.org/health-reform/</a></p>
<p>It is also helpful to check your state’s information page - and know that calculators are not necessarily accurate, yet.</p>
<p>Exactly…</p>
<p>I am really late to the party here and as such have only begun to skim this thread.</p>
<p>Healthcare in the US is the messiest possible problem I’ve seen and coming as I do from a single-payer system (Canada) ten years ago, I am increasingly perplexed about humane solutions to what appears to me to be a barbaric problem with vast socioeconomic variances. So there is a lot that I don’t understand about what’s going on now, though I do feel that an attempt, however controversial, to address the problem is possibly better than nothing.</p>
<p>The very small company my husband and I own now has a blue cross blue shields plan which costs approximately ten percent of our hard “overhead” and which periodically jumps in premiums by as much as 20 percent a year. As a result, it is our single most variable cost of doing business – since we’re service oriented and other than equipment and lease, do not have a lot of overhead. </p>
<p>In my case, since the plan also covers ME, I know from direct experience that I would be paying this on the front end or the back end, so I was a proponent of the coverage. By this, I mean, in Canada, I would be paying more tax than in the US comparatively, so when my aghast family carries on about the obscene amount we pay in premiums that far exceeds what they pay in a mortgage, I ask them how much tax they paid last year :)</p>
<p>So to my mind, I only have a small dog in the race at the moment. But my observations in my time here are nonetheless unsettling to me when I expand my consideration to embrace my son, his future offspring, and the woes and suffering I see around me.</p>
<p>For example, the bureaucratic waste of private insurers (which will be exacerbated under anything other than single payer…which is a place I don’t believe the US will ever go) inflates medical service cost by at least 20% according to most research. So that’s 20 cents on the dollar committed to fighting or managing a claim instead of being spent on service delivery. Very inefficient.</p>
<p>Bankruptcy due to medical expense is a very real phenom however much folks not currently facing that phenom would like to deny the possible and probable future personal pragmatics of that equation. To me, it is heartbreaking that any individual has to think that way when faced with so many other stressors when a loved one is ill. That reality is what is to some “barbaric” about the US health system. Pragmatically speaking, I suspect i would be unwilling to exhaust my spouses solvency to extend my own life given the choice…but who knows until they’ve walked that path.</p>
<p>I watched my helpless employee throughout his mother’s death to cancer in her late 50s. She had been employed and covered, but was conveniently “fired” when diagnosed with cancer and left with cobra that ran out. Every day there was some “fight” to get his mother adequate care, comfort, eventually hospice. Nobody could afford extended treatment.</p>
<p>The year prior, my own father in Canada was on his 13th year of cancer survival, in his 70s, when it returned and went mestastic. At some point, the focus of coordinated care shifted to comfort and a viable ending at home, where we were able to instead have in-home care and the services of a pain specialist for a comparatively gentle end-of-life. My mother was able to actually spend quality time with him, had professional support, and was not indebted any way in the process. And in truth, though it may sound expensive, his decision to not further treat probably saved the government a good deal more than the home care cost it. I’m not sure this scenario would have been possible in the US.</p>
<p>The other advantage of “socialist” healthcare, or baseline healthcare that covers all citizens, is not obvious until you start looking closely at preventative health statistics. The more difficult and costly medical consultation is to navigate, the less likely the chance of preventative intervention, particularly among those not socialized to a maintenance lifestyle. One way or the other, the system will end up paying, which is likely why we’re not actually getting better longevity ratings for the medical expenditure compared to some of the single payer systems.</p>
<p>Several years ago, before moving to the US, I’d been at a meeting with the owner of a Boston IT company (about 100 employees) who’d surprised me by saying he wished the US had Canada’s healthcare system.
When I asked him why, he responded that it would level the playing field for companies like his against the huge multinationals in terms of attracting talent. He said the resources allocated to finagling with healthcare were ridiculous for employers his size.</p>
<p>I often think back to that conversation, and it makes me wonder just who it is that benefits from the status quo. Or why looking at alternative models is so controversial. I hope whatever comes from the wrangling, propaganda, exploitation and inefficient execution of ACA, that it is at the very least a baby step toward a more sensible system, but it is so very difficult to steer this MSS US in any single direction, I fear foundering ahead ;)</p>
<p>kmcmom- thanks for the post.</p>
<p>I would really like to hear from any other posters that lived in a country that had a different health care system than the US.</p>
<p>Which country, what did you like about it, what did you dislike, what was the basic model used. Anything that really worked or anything that was really a problem.</p>
<p>Moderator’s Note</p>
<p>This is mainly a help CC member with the new laws and insurance thread and what other countries did or did not quickly KILLS a thread since it leads to political rants and “why can’t we be more like country XXXXX”.</p>
<p>If someone can get treatment in other countries with their insurance it is allowed but anything beyond that won’t stay up unless it is within boundaries.</p>
<p>Sorry did not mean to get it political. Just wanted to find out others experience.</p>
<p>I’m rooting for your small dog, kmc.</p>
<p>This will be very interesting to see how the exchanges play out in a few months. There is some consternation in my state because they turned down requests from five insurers, and only accepted four, so very low competition.</p>
<p>I appreciate your thoughtful and insightful post, kmc. One thing I’d quibble with, though:</p>
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<p>I agree with the basic premise that the 20% of our health care dollar that goes to insurance-related bureaucratic overhead is wasteful, inefficient, and unnecessarily costly. But the ACA has a provision to address that, the “85/15 rule” which requires that at least 85 cents of every dollar in health care premiums must go to providing actual medical care, i.e., doctor’s fees, hospital costs, lab costs, preventive care, etc. If an insurance company is spending less than 85% of its premiums on actual medical care, it must rebate the difference to its customers. Some people are already getting rebate checks.</p>
<p>Granted, 15% administrative overhead is still high. Most single-payer systems and Medicare spend a much smaller fraction on these sorts of expenses. But it’s at least an effort to address the problem.</p>
<p>Interesting article with early speculation on possible health insurance rates on Minnesota’s exchange. Key point, in my opinion: the rates posted this fall will just be the insurers’ “opening bids” on a market that does not yet exist, akin to an IPO when a company goes public. Ultimately rates will be dictated by a competitive market and could go up or down from the initial offerings.</p>
<p>[Prices</a> pose critical question for Minnesota’s health insurance exchange | Star Tribune](<a href=“http://www.startribune.com/business/219138281.html]Prices”>http://www.startribune.com/business/219138281.html)</p>
<p>I was reading some stories recently about insurance companies staying out of exchanges (one I read said Aetna (?) did not want to participate in CA exchange as an example). </p>
<p>Should we consider that an opening bid? 
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<p>I am curious to understand how they attract or detract insurers to these exchanges.</p>
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<p>I agree. Trying something is better than doing nothing. I know that ACA has a lot of issues. What I hope is over the next several years, ACA will be improved based on real implementation and work out some of the issues.</p>
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<p>Part of that overhead, is state taxes on insurance. On average, ~2% goes right back to support the state overhead/regulations of health insurers. (Indeed, one reason companies self-insure is to avoid state premium taxes.) And of course, xx % of that total is also in the form of corporate income taxes, both federal and state. Thus, while a nonprofit single payor may reduce expenses in some areas, it will result in some less revenue to the states.</p>
<p>Since governments are the biggest spenders on health care driving the cost down will negate the slight loss of revenue.</p>
<p>^Of course, but to me it is improper to claim that 20% of all premiums is “wasteful, inefficient, and unnecessarily costly…” Someone’s waste is another’s tax payment. :)</p>