<p>Sounds like another two tier. Those who can pay more and “Those that can’t are more solidly relegated to smaller networks and practitioners with long waits.” </p>
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<p>Schadenfreude is never pretty.</p>
<p>“But, those with standard insurance get the 4 week wait and perhaps limited access to practitioners, those on the concierge side get the 2 day wait and access to whomever they wish.”</p>
<p>Sign me up for the concierge service. Problem is that although some of the internists are converting their practices, it is difficult for a specialist to do this. </p>
<p>I know I have said this a million times but what really makes me angry, is that in Ca there are no wide networks in the individual market even if you’re willing to pay for it. I feel like I live in the old Soviet Union where the state decided what was good for you. All they ended up doing was severely lowering the standard of living for most of the population. </p>
<p>I agree, Dietz, the next shoe to drop is the small business group market. Next year, 20 to 30 million more people will be introduced to Obamacare. That should be quite a spectacle. Of course, our govt will cynically attempt to put it off until after the election.</p>
<p>Dietz,it’s not Schadenfreude -it’s just that I’m tired of hearing people whine and complain about problems that are relatively minor compared to issues that I and others around me have had to deal with in years past. I know people who have been literally waiting years to get medical treatment for chronic conditions because they couldn’t get any sort of insurance that they could afford. </p>
<p>I agree with you that the EPO network thing is confusing and a problem for many. But people in California have been opting for Kaiser or HMO’s with very limited networks for years, often because it was all they could get or afford. I don’t know what your friend’s son’s medical issues are – but if it is a potential, long-term problem-- well, before ACA the bills for the testing would have been the least of their problems. They would have faced having the son dropped from their policy as soon as he graduated from college, and possibly being uninsurable due to his pre-existing condition.</p>
<p>Your friends have choices – they can sign up the son for a separate plan in Davis, or they can shift to a plan with Anthem or HealthNet. They will probably have to wait until the next open enrollment period --but maybe not (under the circumstances) – and in any case next year is a lot better than never – which is the reality that many parents faced in the past when their kids developed serious medical problems. </p>
<p>So yes, you’ve raised an issue. But on the overall scale of things, it’s relatively minor – and probably more along the lines of a glitch that will be ironed out over time. Both you and I can come up with fairly simple, suggested fixes-- I’m sure the state regulators will also consider those issues.</p>
<p>We could have addressed the problem of providing insurance for people with preexisting conditions or the low income without putting the screws to millions of unsubsidized people in the individual market and soon the group market. Reform of our health care system which is around 20% of our economy should have been done incrementally, because no one is smart enough to reinvent our healthcare system, with a 30,000-page law (including regulations) that virtually no one read or even remotely understood, without having huge unintended consequences.</p>
<p>Some things can’t be done incrementally. You can’t give the chemotherapy today, and the anti-nausea meds next year. Similarly, if you insure 11 million new people now, and lower the premium cost for another four million or so, you can’t pay for it five years from now.</p>
<p>A lot of people who move from the small group market to the individual market are going to be better off with the individual insurance than they were with last year’s group insurance.</p>
<p>CF: You’re in the programming area IIRC…</p>
<p>There are a couple of very very different ways to introduce and implement a new system or a complete overhaul of an existing system. One is to to design and create the entire new/upgrade version, and on a designated day simply throw the ‘on’ switch. This makes the user/customer population the Alpha and Beta testers. The trouble shooting process for this type of implementation involves removing something proven to be ‘bad’ which of course is already now part of the functioning whole and it’s removal will affect more than just the one area.</p>
<p>Another way to implement a new/upgrade to a system is in functional modules. These modules are tested prior to introducing them to the customer by a large enough set of Alpha and Beta testers so that glaring issues tend to come to light and can be fixed. Smaller, self contained ideas and modules are introduced into the whole. If it’s clear the last thing introduced is not working, or worse yet, has broken previously working functions then you can pretty easily pull the newbie out and make repairs.</p>
<p>The ACA took the first approach. It is much harder to remove problems from a huge and multi intertwined live system than it is to remove the last faulty module. </p>
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True that. But you also can’t give untested chemo in combination with untested anti-nausea meds today to every cancer patient (removing some current patients from their previous, working protocol) and then sit back to see what potential problems arise. Then, after receiving problem reports, continue to keep the entire patient population on the exact same mix of drugs until the next possible correction is discussed, voted on, run past the share holders and finally implemented - piecemeal - to those yelling the loudest.</p>
<p>Calmom:
Things tend to be ‘minor’ when they do not apply to oneself. Arguably, since ‘only’ 20% of the population was uninsured (and a portion of this population voluntarily refused to insure themselves) this was a minor issue. Yet, it seems from your postings that your being unable to get insurance was a major issue for you. It is all perspective isn’t it.</p>
<p>The chemo test was Massachusetts’ Romneycare. And Switzerland.</p>
<p>This pretense that if we’d made tiny changes toward covering more people, that would have led in the fullness of time to even the 15 million or so newly insured we have now (counting the sub-26ers), let alone the 25-30 million we’ll have in five years-- that pretense, to me is so unbelievable as to be disingenuous. “Do something small now, and eventually the uninsured will become covered” sounds to me like code for “I’m happy with what I had and not particularly concerned with 15 million people who didn’t have insurance and now do.”</p>
<p>GP, are you talking about setting up high-risk pools? That’s been tried, you know. 35 states had them, and they did not work well, mostly because they were drastically underfunded. To set it up adequately would cost 25 billion or more, it’s been estimated. I doubt that the public would accept that. And even if they did, it would always be vulnerable every time politicians go on a budget-cutting spree. </p>
<p>High risk pools pose another problem: who’s in them? We’re right back to screening for preexisting conditions. Every single applicant would have to be underwritten, lest an insurer take on someone with an expensive illness… Who’s going to pay for that? How sick does someone have to be? What if you had cancer 20 years ago but have been the picture of health ever since? What if you have high blood pressure that’s very well controlled? If you’re healthy but then get sick, are you forced to leave the mainstream pool? </p>
<p>And how are they treated? Do they pay the same premiums as the mainstream pool people? Do they have the same copays, deductibles, OOPs? Are they eligible for the same subsidies? Do they have the same networks and formularies? The same ten essential benefits? </p>
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<p>Yes, Maine did this years ago. Insurers couldn’t exclude any pre-existing conditions, as long as you’d been continuously covered in the past.</p>
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<p>And if they get treated exactly the same, then why aren’t they just buying insurance with everyone else?</p>
<p>Exactly. But of course, separate but equal always falls short on the “equal” part. </p>
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<p>Unfortunately, without the individual mandate, this rule destroyed Maine’s individual insurance market, as it destroyed New York’s market. Community rating without an individual mandate means healthy people opt out.</p>
<p>And that plan is no help to someone who hasn’t been continuously covered. </p>
<p><a href=“http://www.latimes.com/local/lanow/la-me-ln-diabetes-hospital-report-20140515-story.html”>http://www.latimes.com/local/lanow/la-me-ln-diabetes-hospital-report-20140515-story.html</a></p>
<p>Meanwhile, diabetes costs are huge in California. 3/4 of hospitalized patients with diabetes are on Medicaid or Medicare. </p>
<p>This is why our healthcare costs are really rising. Diabetes Type II is up 35% in the last few years. </p>
<p>That is a sloppy article, TatinG. Not your fault, of course, but it’s sloppy. The author wants to use statistics, but does not seem to understand them. Particularly dopey is this part:</p>
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<p>But, is the number of diabetics disproportionate? The article gives us no way to know. Let’s say that we discovered that there were a disproportionate number of heart patients in hospitals, or cancer patients. It’s very likely we’d discover that. We’d conclude that sick people are more likely to be in the hospital! When we discover that diabetics are disproportionately represented in hospitals, we ought to conclude the same thing: sick people are more likely to be in the hospital than well people.</p>
<p>This is also egregious:</p>
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<p>That statistic is useless without being adjusted for age, race and population increase. How much of that increase is due to the increasing age of Californians? How much is due to population increase? How much to a difference in racial mix (Latinos are genetically more vulnerable to diabetes)?</p>
<p>In point of fact, diabetes is a serious problem nationwide. The author of that article could have written a good article with useful statistics. But she didn’t.</p>
<p>We can hope that increasing access to health care will lessen diabetes-related hospitalizations. Maybe, maybe not, we’ll see.</p>
<p><a href=“The Satisfied Unsubsidized: Obamacare’s Hidden Winners - The Atlantic”>The Satisfied Unsubsidized: Obamacare’s Hidden Winners - The Atlantic;
<p>Diabetes shouldn’t be discussed with any ultimate authority given to the common media. I’m not sure more than a few on this thread would pursue some real look-see. Yes, there are differences by state, age, race or ethnicity, gender- and one constant is its prevalence among low SES folks (oh, maybe we need to ensure they are insured.) The undiagnosed cases are seen as a severe threat, owing to the complications. They are starting to find education efforts and early detection improve stats. Oh, another reason to put these at-risk folks in front of med professionals.</p>
<p>This is an interesting start, for anyone wanting more than some easy headline. <a href=“http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf”>http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf</a></p>
<p>Maybe, we need food police since diabetes is very, very, very often linked to diet.</p>