<p>“Well but we are talking about the cost, not just what we pay right?”</p>
<p>I was just going off of Flossy’s $25 for a dental check-up and assuming that meant a cleaning and check-up, nothing else. I pay $90 for that. When they take x-rays it’s $175.</p>
<p>“I think that whether the parent of a minor is required to buy the pediatric dental is determined on a state-by-state basis.”</p>
<p>So it has to be offered but not necessarily be part of everyone’s plan?</p>
<p>You guys this is tricky and I’m not trying to make a huge point here. It’s very minor. But since you seem to be genuinely curious…</p>
<p>For example, when my son knocked out a front tooth at school falling over a hurdle in track and I took him to the dentist they did a big, long 2 hour deal on him to try to fix it and then found out we didn’t have insurance. The $2,000 bill became $200 the next day. They gave us some time to freak out and then nicely called to calm us down. My point is cash pay dental services are available at pretty good prices if you look and negotiate. And, yes, I have done those 25 dollar places with X-rays once or twice. They exist. Sometimes they cost a little more and throw in a coupon for free whitening if you refer a friend.</p>
<p>“So it has to be offered but not necessarily be part of everyone’s plan?”</p>
<p>I think that is correct. When I was on the NYS site for every plan offered there was the same plan but with dental added.</p>
<p>Flossy - If doctors and hospitals are all as generous as your dentist, no one would be losing their 401k or home when they incur huge bills and they have no insurance.</p>
<p>Medical bills is one of those rare areas where one’s assets have no protection and they can come after you for every penny.</p>
<p>We agree!..</p>
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My oldest daughter just got a filling - $87, we paid 20%, insurance paid the rest.</p>
<p>Calmom, I suppose these two friends could have received care locally, but, interestingly, in one case, the oncologist, and in the other case, the neurologist, advised both friends to get care from specialists in LA. They said if it was their own families, that’s what they would have done. Mind you, these were life threatening illnesses in both cases. </p>
<p>Calmom, if you were told this by a doctor you trust and if it was your life or your child’s life on the line, would you have done something different than what these people did? BTW, they are both fine today. I think most of us will do whatever is necessary to get the very best care if someone in our family has a serious illness.</p>
<p>If my kid wasn’t so darn vain and didn’t care if he had a mouth full of metal it wouldn’t have cost me anything. ;)</p>
<p>Goldenpooch, the question isn’t what I would do under certain circumstances, it is where the obligations of the insurance company end vs. where I am making a choice to buy something that goes beyond what the insurance company provides. </p>
<p>I’ll give you a relatively simple example. When my son was born, our insurance policy would pay only for a shared room at the hospital, but my husband wanted to be able to spend the night with me and the new baby in the room – so we agreed that we would ask for a private room if available. We knew that it would cost extra- we discussed the cost and agreed that we were willing to pay it. </p>
<p>I can think of a lot of things that my insurance can’t or won’t pay for. Some are things that go outside the bounds of traditional or accepted medicine (such as experimental procedures), and some are things that I would consider extra luxuries or frills, like that private room at the hospital. </p>
<p>That’s one reason I like having an HSA – I see it as a way that I can bank dollars that would otherwise have gone to higher premiums, to use if I want things that go beyond what insurance provides. I realize that in certain circumstances that could get very expensive – the private room might have cost us around $200 (I don’t remember, but we didn’t have much money in those days so we wouldn’t have gone with that option if the cost had seemed out of line). On the other hand, the cost to get surgery from a well-respected specialist at a top-of-the-line hospital as opposed to getting the same type of surgery from a less experienced surgeon at a less well-regarded hospital might be tens or hundreds of thousand of dollars.</p>
<p>I can see a reason to make that choice. I just can’t see any reason why I would expect my insurance company to pay for a <em>choice</em> I make. Another analogy: my kids were entitled to Cal grants, but only if they attended college in California. They both initially chose to attend schools out of state, so they lost their Cal grants. I wasn’t looking for ways to force the state to give us that money to take to the college of our choice - I understood that the system had rules and limits. </p>
<p>What I buy from the insurance company is a policy that will provide me medical care with doctors and facilities within the insurance network. They get to decide the network. I have a right to expect that there network will be comprehensive enough to meet my medical needs, and that there will be competent and qualified doctors within the network. But that’s it: if they can provide me with adequate medical care but I want better-than-adequate care, it may be on me to pay for it. </p>
<p>I find it somewhat inconsistent that you express very expensive medical “tastes” (you want Cedars Sinai and UCLA medical center) – but at the same time you are very concerned about premium levels. If the insurance companies are going to pay out $X in claims, they need to collect $X+ 25% in premium dollars to cover their administrative costs. So let’s say that a company expects to pay out $2 million in claims and has 30,000 subscribers. So the insurance company will want to collect $2.5 million in premium dollars – and to make that all work, they will need an average of $8,333 per subscriber. (Obviously these are made up numbers- I have no idea what any company really pays or how many customers they have). Every decision they make which increases their costs is something that will necessarily be passed to the subscribers in premiums. </p>
<p>I understand why you want to be able to go to Cedars if you get sick. I just don’t understand why you expect me to pay for that over a less-expensive hospital.</p>
<p>You wrote:
Most of us don’t have the financial ability get the “very best” of anything. Many, many people are very grateful if they can just be afforded the basics. That isn’t to say the “very best” is a bad thing-- but it generally is something that people of means pay extra for.</p>
<p>I do think that if GP is going to be forced to pay for things for other people that he would never need, such as pediatric dental care, maternity and birth control services, etc…and his premiums (and taxes) are getting raised accordingly, I certainly wouldn’t begrudge him the possibility of medical care at the best possible facility to save his life. Whether he is interested in lower premiums or not.</p>
<p>There’s a difference between paying for other people’s needs (like ordinary maternity care) and paying for other people’s wants and desires (like the “very best care”, instead of ordinary standard care). I’m willing to pay for needs, but if someone wants the best oncologist in the world, that’s on them. GP doesn’t want to pay for filling some kid’s cavities, but he wants to force all the other subscribers to pay for his expensive tastes in hospitals, oncologists and heart surgeons.</p>
<p>We could go around in circles about this but I have had insurance for my entire life that allowed me to go to healthcare providers that are now considered too expensive. Now I know Calmom and CF think this only happened because people with preexisting conditions were not allowed to have the same insurance as me, although they were if they had group insurance. What is even more interesting is that I am not even given the choice of a policy with an expanded network (or maybe a two tier network) at some price.</p>
<p>For now these changes are primarily confined to the individual market, but next year these narrow networks will work there way into the employer-provided plans and then we will see what the reaction will be.</p>
<p>Edit: BTW, it will be interesting to see how this all goes down when people who live in the LA area are told they have to go to St Vincents instead of Cedar Sinai.</p>
<p>Yes they will, but the problem lies in the cost of medical care. In the context of group insurance, the insurance companies always amortized the premium costs over the particular employer group. That’s why small employers would see a huge hit in premiums if a single employee suffered a catastrophic illness. Those sort of costs had less of an impact with large employers – if you have 1,000 employees and one employee has $500,000 in medical bills, that $500 per employee, which works out to $42 per month premium increase (and of course in real life it is offset by all the employees who spent less than anticipated on health care). That same sick employee working for a small business with only 20 employees essentially destroys the viability of the plan. </p>
<p>The impact of rising costs and group plans has simply made things tougher over the years for smaller companies to provide insurance for their employees, forcing more people onto the individual market. </p>
<p>Insurance companies kept costs low on the individual market by excluding people who actually needed the product that was being sold. Now they can’t do that any more, so the pricing on the individual market is starting to look more like the pricing on the employer market. </p>
<p>You described the problems you had buying LTC insurance because your wife had been taking anxiety pills – how would you feel if you had been turned down for regular health insurance for that reason? Or if the only insurer willing to take you on did so with a 75% increase in premium rates to compensate for that?</p>
<p>Calmom, I only had to be underwritten for health insurance twice in my life. The first time was 25 years ago when I left the company where I worked and started my own business. My wife and I were fairly young then and, like most people in that age group, pretty healthy. The second time was around ten years ago when I left Anthem and went to Blue Shield at the urging of an agent, which I have regretted because I think Anthem is more responsive (marginally) to their customers than Blue Shield. If I had had a preexisting condition then, I would have stayed at Anthem. So I only really had to be underwritten for health insurance once in my life. </p>
<p>I wonder how many people go without insurance at a younger age because of different priorities and then try to get insurance after they get sick. Some people make bad choices in their lives, although I know there are others who are unable to get insurance due to no fault of their own. </p>
<p>I am not defending the old system because it was too expensive and too many people were not adequately insured, but I think there were other alternatives that could have been tried.</p>
<p>One reason why private insurance is so expensive is because of the tremendous cost shifting that takes place in our hospitals and the system generally. Medicare and Medicaid reimburse at very low rates, so hospitals have to recoup these costs from private insurers. Maybe the govt should collect more money from Medicare recipients or at least means test them. That would provide some relief to policyholders of private insurance.</p>
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That’s a secondary issue, somewhat down the ladder from the #1 biggest problem: the people who are uninsured- or those who thought they were insured but whose insurance benefits topped out or whose insurers found reasons to cancel them – leaving hospitals with -0-. Those are people who arrive critically ill to emergency rooms and can’t be turned away. The insurers’ exclusion of those with pre-existing conditions applied at both ends – usually as screen preventing insurance in the first place, but often as a pretext to cancel coverage after the patient became sick, triggering the insurance company to dig through the past medical records – for example: [Cancer</a> patient tells of rips in health insurance safety net - CNN.com](<a href=“http://www.cnn.com/2009/POLITICS/06/16/health.care.hearing/]Cancer”>Cancer patient tells of rips in health insurance safety net - CNN.com)</p>
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<p>Somehow I don’t think you will be all that happy about means-testing Medicare recipients if they started doing that the year you become eligible for Medicare. If you have to wonder how I could possibly make ends meet with an income hovering around 400% of the poverty line, I have a sense that whatever sort of income level was set for Medicare, you would probably be above it. </p>
<p>The reason that Medicare and Social Security are deemed “entitlements” and not means-tested is that they are financed from payroll deductions. The people who have higher end incomes have also been paying more into the system over the years – that is especially true for Medicare, where the actual benefits paid out have no particular connection with the amount paid in. </p>
<p>FWIW, there is an upward adjustment in the Medicare Part B premium for people with higher incomes. It’s not a whole lot of money, but it is something: - [Part</a> B costs | Medicare.gov](<a href=“http://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html]Part”>http://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html)</p>
<p>
GP, the average buyer of insurance on the individual market is insured for 2 years or less – I think the most common situation is likely someone who has a job that provides insurance, then loses that job. Job loss can often be tied to health issues. COBRA partially addresses that issue, but COBRA rates are typically very high, and there is a time-limit on COBRA. </p>
<p>I’d also point out that for many people, the pre-existing condition was acquired in childhood – it might even be something they were born with. So it may be that at the first point that the individual was even old enough to be thinking about buying insurance, the health record already stood as a barrier.</p>
<p>ACA solves the problem of the uninsured. They can now buy individual insurance. Some with subsidies, some without. </p>
<p>It creates a tiered system where those that can afford the best, get the best. So nothing really new, there. </p>
<p>[Obama</a> Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare - Forbes](<a href=“http://www.forbes.com/sites/theapothecary/2013/10/31/obama-officials-in-2010-93-million-americans-will-be-unable-to-keep-their-health-plans-under-obamacare/]Obama”>Obama Officials In 2010: 93 Million Americans Will Be Unable To Keep Their Health Plans Under Obamacare)</p>
<p>If you purchased a individual health plan on your own and had it since March 2010, and that plan did not change by more than $5.00 in cost, you are good. </p>
<p>But what if it did? Or say, you were in COBRA in March 2010, as my family was. We had a good plan. Then our eligibility ran out through COBRA, had to purchase a new plan. </p>
<p>Remember, at that time in 2009 and 2010, there was quite a staggering amount of unemployment? They even had a short term premium reduced COBRA program? </p>
<p>Lots of people lost grandfathered status because they couldn’t afford health insurance as they were losing their homes in record numbers in those years. They lost their unemployment eligibility, like my husband when he was foolishly starting his own company in 2009 after losing his job and then ineligible for continued unemployment benefits - only eligible for 5 weeks of benefits because of this, even though out of wirk nearly 24 months. If only he had worked “under the table”, we would have had the extended benefits, but nope. Too honest and wanted to do our part to help a struggling economy by creating employment and new business and paying our taxes! </p>
<p>ACA works well for those who were lacking insurance, but t created a new subset of people who will lose what they had. they might be able to get a similar or better plan, but the premium just bumped for many into the unaffordable range. </p>
<p>I know, Jay Carney said it is just 5% of the population…but what was the number of peopke that previously was uninsurable, in the first place? </p>
<p>I am still wondering how people like me - above subsidy range, but now with much larger potential premiums, co-pays and possible out of pocket costs will manage to pay our kid’s tuition bills. What happens to our EFC, then? Does the burden shift to finaid offices reassessing their aid programs? Will tuition skyrocket to help cover those that now have greater need than before?</p>
<p>To me simple solutions are always best. But to get to simple in our system you need cooperation. We do not have that.</p>