<p>The return of the violins! :D</p>
<p>LF, it’s not going to change back; that worry doesn’t even cross my mind. That would require taking insurance away from millions of people. Political non-starter. ACA is here to stay, although we all agree it needs fixes. I don’t expect empathy from the likes of GP and I don’t much care. He can whine all he wants; we finally have good insurance that can’t be taken away. And he still has his Picasso hospital so I’m not even sure what he’s whining about. </p>
<p>Technically we have a network. And the network has providers. The issue is that this network seems to be bringing in non-network providers and a consumer has no way of knowing…</p>
<p>I did come up with a Post Merlot solution…</p>
<p>Everyone wears a medical ID bracelet. This has a chip encoded with the wearers’ health insurance policy information including a real time link to a data base which contains the names of all in network providers. Each and every provider - from the supplier of arm slings, hauler of bedpans, sticker of blood draws and up to neurosurgeons also wears micro chipped bracelet. Then, before any contact between provider and patient can be initiated an ‘okay to proceed’ code must be issued. If the bracelets don’t synch and give the appropriate go-ahead lawyers from the State - representing ACA interests, lawyers for the patient (which of course the patient needs to retain beforehand), lawyers from the provider and provider facility are dispatched and an agreement is reached. Of course, hopefully all this happens before the patient disperses with all of their arterially spurting blood.</p>
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GP has represented the position and difficulties those of us (yes, count me in that group) who have done the right thing all along. Those who have somehow, someway figured out how to be and stay insured through job losses, family changes, income changes, geographic changes, health changes and just plain the schitage life can dish out. Those of us that are now getting a huge whammy, who now get to pay EVEN more for less while being told how terribly insensitive and inhumane we are. So if the pain and difficulties of those who claim to have been unable to become insured counts, so does the pain and difficulties of those who now find themselves at a loss - after having DONE THE RIGHT THING all along. Congrats that what you have ‘can’t be taken away’. But at least acknowledge that it was given to you by taking something from someone else. And, be honest … you don’t care and have no empathy for 'that 'group of people.</p>
<p>You did the right thing: You didn’t get cancer. You didn’t get smashed by a random drunk driver. The business that employed you didn’t fail. Don’t mess it up now by straining your shoulder patting yourself on the back for being lucky.</p>
<p>dietz, there are plenty of other people who “did the right thing” and yet found themselves without insurance. For millions of people, personal virtue wasn’t enough. If you have a condition which makes you uninsurable, all the planning in the world isn’t going to help you.</p>
<p>But I understand what you’re saying. There have been losers. But please acknowledge that even with your “loss” you can still go to the doctor without fear of financial ruin. There may be inconveniences; there may be difficulties; your premium may be a bit higher (although ACA protects you too, from being overcharged for your insurance.) But try to put yourself in the position of someone who was rejected by the insurance industry because they had committed the sin of being sick, or someone who couldn’t pay for premiums which, even you must admit, were spiraling out of control. Please acknowledge that ACA is helping people who could never dream of going to the doctor at all, except the ER which would then bill them more than they could ever hope to pay. </p>
<p>CF: Luck follows the prepared mind. And my rotator cuff is quite capable of self back patting without damage…but thanks for your concern…I believe the response at this point is - Yawn.</p>
<p>LaMas: I know the ACA is helping some people and have seen the gyrations some have had to go through to try and get insurance in the past. The issue IMO, is that in order to solve one problem, the ACA has introduced a number of other problems. We do not seem to be at a point where the pros and cons can be discussed in a way which is productive.</p>
<p>Please tell me how my niece could have prepared her mind so she didn’t get Hodgkin’s lymphoma. I’m sure we’d all be grateful to know your wonderful plan to avoid getting cancer.</p>
<p>And you didn’t lose a spouse.
My family did all the right things, too.
I feel for you.</p>
<p>We also did all the right things. And yet we were underinsured for a good 10 years. We were probably within a year or two of finally being priced out of the insurance market altogether.</p>
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<p>Increasingly, I think that’s only part of the problem, and in actual fact, a very gross oversimplification of what would bring down insurance premiums.</p>
<p>I’d be willing to bet Dstark’s park bench loot that a “healthy” proportion of the US health over-spend is from miguided treatment under the influence of flawed/skewed big pharma research and advertising that trickes down to doc and patient behavior. I think the new class of cholesterol drugs are a great example of this. Solid research shows they don’t actually extend life…particularly in middle aged women, where they increase the risk of cardiac event.</p>
<p>Another part is the administrative cost of for-profit finagling (compared to counties with single payer models.) Another part would be the cultural anathema here toward aging and death. (Eg. Viagra. Extending a poor quality of life at all cost with nonsensical procedures that line a pocket but protract misery.) Another part would be US exceptionalism where every single person believes whatever they’ve been told they want is what they have to have (a new knee, a factually ineffective heart stent, heroic measures to preserve life.)</p>
<p>And in fairness, because this is POSSIBLE (though I’d argue, unsustainable) here, well, of course its human nature to WANT all that. I’m guilty as charged. When the rubber hits the road, I’ll be right there in line for a bionic whatever 
And I’d sell the farm to keep my own kid’s brain cyst from exploding.</p>
<p>ACA is a comparatively small but philosophically strong first step toward sorting this mess out by virtue of the transparency of cost. But it’s a really long road. There are lots of fat smokers in other countries that spend a significantly smaller portion of GDP on healthcare and yet have better mortality rates. It’s almost inexplicable unless you entertain the notion that the premise of “first do no harm” has been lost in the exuberant free market pursuit of medical innovation :)</p>
<p>I did everything right yet still developed an autoimmune disease. So did a friend who has recently been diagnosed with MS and my cousin who has colon cancer, to name just a few. </p>
<p>I find it laughable that so many believe the “sick” did something wrong and you are somehow immune because you do everything right. </p>
<p>“I find it laughable that so many believe the “sick” did something wrong and you are somehow immune because you do everything right”</p>
<p>No-one said that. No-one. The comment was about insurance, not about health. Cueing violins for the ACA losers is a little insensitive imho. It is becoming increasingly impossible to take this thread seriously.</p>
<p>CF, LF, LM, Em: When I referred to doing ‘everything right’ I was referring to doing everything since the age of my first real job at 22 to make sure I maintained continuity of coverage. A 21 year old in the age of padded sleeves and Billy Idol figured that one out. I had parents who’d survived terrifying (yes DS - terrifying) experiences during WWII. I personally never thought I was invincible. My folks saw danger and possible financial ruin around every corner and structured their lives in an attempt to mitigate any potential damages. Heck, health insurance figured into college decisions.</p>
<p>There were many many things in the old system that did not work. And that needed to be fixed. The joy and rapture by which some support the ACA shows that they have little to any regard for the disarray it has brought upon a system the DID work for a large large number of people. Those of us that ‘did the right thing’ and kept paying the increasingly unaffordable premiums, managed our in/out of network issues, insured our kids from the moment of birth etc. are the ones who now get to DO MORE. And, it is positioned as being our moral obligation to do so…because…well…because we’ve identified as having been on some sort of gravy train. </p>
<p>BTW, it’s been years since you could simply be dumped from a company. (HIPAA has been around since 1996). So while some can dance the happy dance and revel in their FREE and affordable health insurance please note…that ‘free’ is added so some one else’s end of the month billing statement.</p>
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<p>The US does not have a particularly unhealthy population by first world standards. We’re younger than a lot of European countries. We’re fatter (although we were recently surpassed in fatness by Mexico, I believe) but we smoke less. And yet we spend twice as much per capita as many other countries.</p>
<p>The unhealthy behavior I’d like to cut on is paying too much for every procedure, treatment and drug.</p>
<p><a href=“ConsumerWatch: Some Covered California Patients Say They Can't See A Doctor - CBS San Francisco”>http://sanfrancisco.cbslocal.com/2014/04/18/consumerwatch-some-covered-california-patients-say-they-cant-see-a-doctor/</a></p>
<p>“The unhealthy behavior I’d like to cut on is paying too much for every procedure, treatment and drug.” </p>
<p>The government has a long history of paying to much for everything so I’m failing to see how ACA will help with this. Look what they spent of a dilapidated website. </p>
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<p>You weren’t paying healthy-person insurance rates because you maintained continuity of coverage. You were paying healthy-person insurance rates because you were healthy. </p>
<p>Do you not understand that for people who got sick, the insurance companies would do everything they could to make sure they didn’t maintain continuity of coverage? Do you not get it that insurance companies would deliberately try to entice healthy people to a different plan, leave the sick people on the old plan, not sell the old plan to any new subscribers and jack prices every year? Do you not get it that maintaining continuity of coverage is easy when you are healthy and insurers want to keep selling to you, and almost impossible when you get sick and the insurers want to get rid of you?</p>
<p>You’re congratulating yourself for doing what your insurers wanted you to do. But if you were sick, your insurers would no longer have been your friend. People who maintained continuity of coverage just like you, but who got sick, were paying way way more than you were, not because of any personal virtue of yours. You insist that because you were lucky enough to be healthy and pay healthy-person health insurance rates, you deserve to continue to pay healthy-person insurance rates. And that means you think that sick people deserve to pay much higher rates because they got sick, even though they did everything right and maintained continuity of coverage. That may look like justice to you, but to me it looks like kicking someone while they’re down.</p>
<p>CF: Really? Obesity is a huge driver of health care costs. Chronic conditions like diabetes Type II, heart disease, some forms of cancer, joint problems, back problems. A huge percentage of people in this country are morbidly obese and have these conditions. These are entirely preventable. Smoking, drinking to excess, eating to excess, drug abuse…all entirely preventable by exercising some personal responsibility. </p>
<p>Dietz, health insurance was inexpensive 25 years ago. 16 million people more people have insurance in 2014 than pre ACA. The uninsured rate is the lowest since Gallup started tracking. Many people that had insurance are now paying less. I am paying more. $800 a month more right now. There are people that were better off in 2013 than in 2014. </p>
<p>The insurance companies admitted they prevented people from buying insurance. Preventing people with pre conditions from buying insurance did occur. Raising premiums on those that the insurance companies did not want did occur. Health care cost increases have exceeded inflation for a long time. 50 percent of the uninsured said they could not afford healty insurance. </p>
<p>Wages as a percentage of gdp are around 75 year lows. Corporate profits are at the highest levels in 75 years. (75 years are approximate numbers). One tenth of one percent of the population owns 20 percent of the wealth. That is double what it was 30 years ago. Most of the people in this country are becoming poorer. if your income is in the top 5 percent of the country you aren’t wealthy. If your net worth is $1 million you are not wealthy. And as time goes on fewer and fewer people are wealthy. Eventually, the way things are going, the top 1 percent aren’t going to be wealthy. This country’s wealth is getting very concentrated in a few hands. That is not good for the country.</p>
<p>ACA helps 80 percent of the people in the individual insurance market by lowering costs or expanding medicaid. I would argue that getting rid of preconditions helps everybody, but at a higher cost for some. Luck can change. We can do the right things and still get screwed. Over time, ACA will be improved. Already it looks like we are going to have more insurance companies competing in several states in 2015. If there is demand, networks will be expanded. </p>
<p>Those who can’t find a doctor are supposed to lodge a complaint with state regulators, who have been denying the existence of a doctor shortage for months.</p>
<p>Meanwhile, the sick and insured can’t get appointments.</p>
<p>“What good is coverage if you can’t use it?” Nguyen said.</p>
<p>Experts said the magnitude of the problem is growing, and will soon be felt by all Californians. But those on the front lines, like the free clinic, are feeling it first.</p>
<p>More than 3 million Californians are newly insured. At the same time, a third of our primary care doctors are set to retire. </p>
<p>The above quote is from Flossy’s link, CBS San Francisco. </p>
<p>One-Third of primary care doctors are set to retire. State authorities are denying there is a doctor shortage. They have their heads in the sand. </p>