<p>Well, you know how laws are lately, romani. Anything can be overturned, anything can be changed, voted in, voted out. It’s hard to know what is certain anymore, except as they say, death and taxes (and I think there’s some guy out in CA that claims to have cured death).</p>
<p>It was ruled unconstitutional. Isn’t that kind of a big deal? Couldn’t someone have seen that coming? Maybe not. Anyway the Florida idea looks interesting.</p>
<p>This is very interesting interview of Robert Laszewski, a health care expert, by Ezra Klein (ACA supporter).</p>
<p>When asked if there was anything that could be done to fix the law, he said the following:</p>
<p>“If an entrepreneur had crafted Obamacare he would’ve gone to a middle class family. A family of four make $54,000 a year has to pay $400 in premiums net of subsidy and for that the standard silver plan has an average deductible around $2,500 and a narrow network. They’re going to pay almost $5,000 for that?”</p>
<p>“So the entrepreneur would say I’ve got $5,000 in premium and all this deductible, what do they want for that? And they probably would’ve said we want office visits and lab tests because the kids need to go in occasionally and then we want catastrophic care. The problem with Obamacare is it’s product driven and not market driven. They didn’t ask the customer what they wanted. And I think that’s the fundamental problem with Obamacare. It meets the needs of very poor people because you’re giving them health insurance for free. But it doesn’t really meet the needs of healthy people and middle-class people.”</p>
<p><a href=“http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/09/a-health-industry-expert-on-the-fundamental-problem-with-obamacare/[/url]”>http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/09/a-health-industry-expert-on-the-fundamental-problem-with-obamacare/</a></p>
<p>Interesting article. Small pools of sick people.</p>
<p>The Laszewski numbers don’t add up.</p>
<p>He is saying that the middle-class family is paying too much for health care because they have to pay for all these mandated benefits, and if we only got rid of the mandated benefits premium costs would go way down, everything would be hunky-dory, and Goldenpooch would be happy.</p>
<p>But that’s not what is driving up the costs. The costs are high because of care for sick people. That’s where the big money is. And nobody is in favor of health insurance that doesn’t pay for the big-ticket items like cancer and heart attacks. The only way to make Goldenpooch happy is to allow health insurers not to insure sick people.</p>
<p>Also, Laszewski doesn’t propose a fix. He talks about not enough people coming in, the irrelevance of the individual mandate, lack of value for the middle class, etc etc etc. But like every critic of ACA, when pinned down about a solution, he has none. The best he can come up with is a vague reference to “some pretty significant things” which could happen in 2015. I’d be interested to know what those “things” are. He hints at cutting back on the mandated benefits. I wonder which of the [10</a> Essential Benefits](<a href=“http://www.forbes.com/sites/investopedia/2013/10/11/essential-health-benefits-under-the-affordable-care-act/]10”>http://www.forbes.com/sites/investopedia/2013/10/11/essential-health-benefits-under-the-affordable-care-act/) he considers expendable? Prenatal care? Physical therapy? Prescription drugs? Or perhaps he’d like to go back to the good old days when benefits were capped? Or maybe we could do away with that pesky 80% medical loss ratio. Or gosh, how about we just start keeping some of those sickies out the pool altogether; that sure would make life better for everyone (except the sickies, of course). </p>
<p>And then premiums would go down for those allowed in the pool, and providers networks would blossom again, and people would be able to go back to their ridiculously expensive hospitals, and all would be well (except for the sickies). Funny how “reforms” to ACA sound a whole lot like how things were before ACA.</p>
<p>Not going to get in a debate about this but I don’t think diet counseling, adult depression screening, alcohol misuse screening and counseling or any other preventative service should be provided for free. Family planning, maternity and addiction services don’t need to be mandatory. </p>
<p>I don’t see why we are providing plans with anything more than basic services to people who are paying very little for the insurance. Finally, we could set up separate pools for people with preexisting conditions, and to the extent that the costs exceed the premiums, then tax the population to defray the expense. Instead, under Obamacare, you have a small subset of the individual market shouldering the burden of these costs.</p>
<p>There are alternatives to ACA. It is absurd to say it is either Obamacare or single-payer.</p>
<p>Diet counseling, depression screening, etc. may be no big deal to you, but they are a VERY big deal to those who need them. You should count your blessings that you are able to pay for preventive care; you seem blissfully unaware that not everyone is so fortunate. What should they do? Remember that it’s a lot cheaper to prevent a disease than it is to treat it. And family planning and pre-natal care are among the most cost-effective services there are. Putting in a few bucks on the front end of those medical issues saves big money on the back end. </p>
<p>“Basic services” for people who get subsidies? You want a two-tiered health care system in this country, one for the haves like yourself, and one for the have-nots. Which health services should be denied to the poor? And who pays for the bill for medical problems which are therefore not treated at an early stage?</p>
<p>What would be the point of a separate pool for pre-existing conditions? The taxpayers or insured people pay for their health services either way.</p>
<p>There are alternatives to ACA? Such as?</p>
<p>“Putting in a few bucks on the front end of those medical issues saves big money on the back end.” </p>
<p>This statement not been backed up by scientific data. Check out this New England Journal of Medicine article or some of the other studies.</p>
<p>[MMS:</a> Error](<a href=“http://www.nejm.org/doi/full/10.1056/NEJMp0708558]MMS:”>http://www.nejm.org/doi/full/10.1056/NEJMp0708558) </p>
<p>[Think</a> preventive medicine will save money? Think again | Reuters](<a href=“http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129]Think”>http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129)</p>
<p>“You want a two-tiered health care system in this country, one for the haves like yourself, and one for the have-nots.”</p>
<p>Regardless of Obamacare or any other system you devise, not everyone is going to get the same level of care. There will continue to be disparate levels of care based on what you can afford. The rich will get their care from concierge services and the best hospitals. That won’t change. </p>
<p>If you pay virtually nothing for your insurance, you shouldn’t receive everything but the kitchen sink. This will prove to be unaffordable.</p>
<p>“What would be the point of a separate pool for pre-existing conditions?”</p>
<p>So the cost could be shared equitably by everyone in the population.</p>
<p>“There are alternatives to ACA?”</p>
<p>Yes [An</a> Alternative to Obamacare | RealClearPolitics](<a href=“http://www.realclearpolitics.com/articles/2009/05/20/an_alternative_to_obamacare_96575.html]An”>An Alternative to Obamacare | RealClearPolitics)</p>
<p>GP, have you ever seen the bill for a NIC unit? If you can counsel a pregnant woman to eat right, improve lifestyle, and take folic acid for pennies a day, you’re literally saving the public hundreds of thousands on the front end alone, never mind the later societal cost. </p>
<p>Since we’re playing what-if though, if I wanted to make healthcare affordable in the US, health insurance would not cover pharma 
You’d have to buy a separate policy to cover pharma, and it would be re-imbursement only. Pharma ads would be banned, and there’d be oversight in the medical research community with government funded research, not pharma sponsored research.</p>
<p>I’m guessing insurance would cost half as much, fewer people would die from contraindications, and the generic market would soar ;)</p>
<p>I think he was advocating Plans that primarily cover catastrophic events, with a few primary care visits thrown in. Insurance is for catastrophes, not routine care.</p>
<p>My head is still spinning from how expensive health care is today. If you have a subsidy, good for you…but it is still costing us. </p>
<p>From DStark’s previous projections that it will likely increase about 2.5% a year, basically forever, we are in for a bumpy ride and over the next decade and beyond. The question that keeps me up nights is wondering how we will pay, individually and as a society, for these increasing costs that will continue to increase?</p>
<p>There are many things which are neither routine or considered catastrophic which can easily put a world of hurt on someone who doesn’t have comprehensive insurance. For the last 6 weeks I have been dealing with what originally was thought to be a UTI, then possibly Interstitial Cystitis, then possibly a rare bacteria in my urine and then possibly bladder cancer. During this time I have been to the doctors (primary, gyno, urologist) at least 10 times, had 11 urine tests, blood tests for diabetes, a bladder and kidney ultrasound, one trip to the ER - where I had a cat scan and an pelvic ultrasound, and IV pain killer and an IV saline flush. I have been on 4 different antibiotics - one which made me sicker and my symptoms worse than I was before, anti-spasmatics, pain meds and anti-anxiety meds. Finally at the urologist, who I wouldn’t have been able to see as quickly if not for my gyno making the appointment, a urine test to test for abnormal cells and one to test for blood and infection of any kind, and a csytoscopy to examine my bladder. </p>
<p>The good news is I don’t have bladder cancer, no abnormal cells, no IC, and the weird bacteria, according to my uro, is found in 40 % of all women and I should never have been put on the antibiotic that is used to treat it which likely gutted whatever good bacteria I had (it’s the same one they give to people before going to a country where there is malaria.) But I had terrible bladder pain and other very painful symptoms which that could not be ignored, so had to go to the doctors. I am likely well over $10K in medical expenses by now and I am only one person. Something similar could happen to anyone else in my family and without comprehensive insurance the bills would certainly put a world of hurt on my budget - especially now that we are paying college tuition. At least my expenses would have already maxed out deductible of most plans, at the very least and my OOP - and it’s only January! </p>
<p>Fortunately for me, since I have employer subsidized insurance and everything is covered except for co-pay and also not subject to the deductible, since I stayed in network, the total cost of everything for me so far will likely be $500, if that. I haven’t gotten all the EOB’s but my OOP right now is about $200.</p>
<p>Emilyee, ACA plans have huge deductibles. This is a problem. It just is. Many people can’t afford the premium hikes. What if they actually have to use the insurance?</p>
<p>Lucky for you that you have employer covered insurance. </p>
<p>Otherwise you would have sucked up paying your max OOP cost for this months bills alone on an ACA plan. </p>
<p>This would be that year you get nailed health-wise and get the full benefit of comprehensive insurance. Most of us will not, on a yearly basis, need to use what we or our employers have paid out in premiums. It adds up. </p>
<p>I am starting to see the benefits of catastrophic vs. comprehensive coverage. I guess I am a little late to the game. </p>
<p>Emilybee, Hope you feel better, soon. :)</p>
<p>Most I have seen are at most $5000K per person and many less than that. I am one person and just this one thing already is over $10K in expenses. Next month my H could get something, equally as crazy, or my kid. Or maybe a family all stays pretty healthy (the most likely scenario) and they don’t have medical bills anywhere close to the cost of their deductible or OOP max. </p>
<p>But, having a catastrophic illness is not the only way one might accrue huge medical expensive (my case in point) and if you don’t have comprehensive it can be very, very bad for someone financially. </p>
<p>If people don’t like the insurance which is being offered under ACA, then they should pay the fine and self insure.</p>
<p>"Otherwise you would have sucked up paying your max OOP cost for this months bills alone on an ACA plan. "</p>
<p>I don’t see that as a bad thing. I would be done for the next 12 months.</p>
<p>“Emilybee, Hope you feel better, soon.”</p>
<p>Thanks, I am feeling better but not 100%. I’m on probiotics now replacing all the good bacteria in my gut the antibiotics destroyed and my anxiety is less now that I don’t have the worry of bladder cancer freaking me out.</p>
<p>Can you explain what you mean by “self insure”? You have said this numerous times, and yet, I am still admitting that the term confuses me. </p>
<p>If you are an individual sole proprietor, one employee, it does not seem possible to self insure in conventional sense of what that term means. </p>
<p>If you mean setting aside money and hoping your dollars out are less than you have saved, that isn’t insurance. It’s being uninsured and paying cash or setting up a payment system with doctors, hospitals, etc. </p>
<p>You can buy self insurance if an employer with a certain number if employees, and a large amount if employers do this. </p>
<p>Most people looking to be insured are not trying to be uninsured. I am concerned about premiums for the same reason I am concerned about being uninsured. Setting aside money on the what if scenario scares me, too, like it would most people. </p>
<p>I am not against affordable care or health insurance. It isn’t a statement of principle. It is about seeing how I can afford this system in the years ahead. Isn’t that a concern for most of us?</p>
<p>emilybee,</p>
<p>If you had not had the resources to see a doctor about your condition, wouldn’t you be in the same position you are in now? (Or better, because you would not have had to remedy a doctor’s error). Or did I misunderstand and you have a diagnosis?</p>
<p>SamuraiLandshark, The 2.5 percent increase a year is just because of age. A 50 year old will pay more than a 49 year old in most states including ours.
Health insurance costs will also rise along with health care cost increases.</p>
<p>Some people who dont get subsidies now will receive subsidies in the future if their income doesnt increase much or drops. </p>
<p>Also, most parents arent going to take care of our kids health care needs forever. Families that cover 2 parents and 3 kids will hopefully see their kids grow up and take care of themselves.</p>
<p>“If you mean setting aside money and hoping your dollars out are less than you have saved, that isn’t insurance. It’s being uninsured and paying cash or setting up a payment system with doctors, hospitals, etc.”</p>
<p>Well, that is sort of what I mean. To self insure you just need to be able to set aside a boat load of cash (at least several million but that is up to the individual how much they would think they might need) that is only for the event of a medical catastrophe. </p>
<p>Regular medical expenses you would pay out of your normal income. </p>
<p>IMO, if one cannot afford to do that - then they need, imo, comprehensive coverage. </p>
<p>Of course, one can always be foolish and reject getting comp. coverage and hope they or a family member will never need expensive medical care.</p>