After you reach the yearly benefit cap of what insurance pays out, you are on the hook for the rest. Ok, but do you get to continue benefiting from their negotiated reimbursement rates? For example, if a doc visit is priced at $550 but the insurance company’s rate is $200, are you charged $200 or $550?
DH was in a very bad accident. He was sent to a trauma hospital via Lifestar. I’m pretty sure he would,have exhausted $75,000 in coverage in the ER.
One other good thing about ACA is that limits went away.
My heart attack was $250k. My chemo is $100k/year (and may not be covered in 2017). It’s one of those newer, molecularly targeted drugs that everyone complains about, until they need it. I’ve been uninsurable since age 41, but too healthy to get SS disability.
Lifting lifetime limits has been essential for me. I’ve racked up $2M easily in the past 14 years. ACA rules have enabled S2 to stay on our plan, though he has a little over a year left on that front.
^^^Your experiences are the reason we will buy insurance regardless of the cost. Anyone could be wiped out financially by a single hospital stay or acute illness.
I wish the off-exchange plans in my state cost the same as the exchange plans. We won’t qualify for subsidies, so don’t need the exchange plans for that reason, but for 2017 the off-exchange plans are $250 and up more per month for similar benefits. I can’t see paying that just to avoid the exchange.
For most people, it doesn’t matter. $50,000, or $100,000? Who cares, if you’ve already exhausted your savings.
We’re the only first world industrialized nation that allows people to be bankrupted when they have a medical situation…
It is heart rendering reading some of the stories here, but do you really think the health care systems in most single-payer nations would cover some of the expensive treatments described? Health care in single-payor countries is heavily rationed, and frequently expensive treatments are not offered or are carefully restricted.
I suspect that if some of the people on this thread were in single-payer countries, they would not be bankrupt, they would be dead.
Provide documentation that single payer countries like Canada DON’T cover severe accidents, lupus, cancer, asthma and heart attacks, Zinhead. Which countries are we talking about that don’t cover these things?
@Cardinal Fang - Of course they cover severe accidents, lupus, cancer, asthma and heart attacks, but they don’t offer the high priced care and cutting edge drugs people expect in the US. European style single-payer systems keep costs down by several ways, including:
1 - Rationing health based on cost and mortality rates
2 - Drastically curtaining legal liability of the medical system.
3 - Limiting the price of drugs to cover production costs only and shifting the research and development cost of new drugs to the United States.
The ACA does none of these things which is why it is failing.
The best US medical care is better than anywhere else in the world. And so for those people who have access to it, US medical care will save some people that will not be saved elsewhere in the world.
However, for the population as a whole, medical care in the US produces worse outcomes than most other industrialized nations. It is clearly not working for many people.
I fear single-payor (not that it will pass anytime soon) will dilute the real strengths of US medical care. Is there a way to make medical care available to everyone while still preserving its strengths?
If we can figure a way to keep pre-existing conditions in, without exploding the premium rates, I would be very satisfied.
I don’t mind healthcare plans staying private, just as long as they work for people. I also agree with @Zinhead with regards to pharmaceutical R&D costs/profit, and medical malpractice costs being large drivers in the price of insurance plans. These issues need to be tackled head on if we are to see reasonable insurance rates and good coverage for everyone.
@zinhead:
That is a myth that the health insurance companies have been spreading for years about single pay systems, that they don’t cover needed treatments, and also leaves out something the blatter heads don’t talk about, how our own insurance companies hande things.
-First of all, insurers in the US routinely deny payment for treatments they claim are ‘experimental’ or ‘unproven’. Go ask oncologists and cardiologists about what happens with their patients with insurance, where they have something the oncologist or cardiologist knows will require treatment X, but the insurance won’t pay for it, claiming they should use Y. Often they use Y, it doesn’t work, then the patient is in such bad shape that when they finally get approval for X, it is often too late or actually costs more. One thing to ask yourself, who has more reason to deny care, a for profit health insurance company with shareholders and executives expecting huge paydays or a single payer system that is non profit? This goes on all the time, when life saving drugs, like the new immunotherapy for cancer paitents, for example, come out, insurance companies can exclude them as being ‘unproven’ or ‘experimental’ without any real recourse other than suing them.
-As far as single payer goes, where people complain is not life saving medicine, but rather is in elective surgery, things like hip replacements and the like, in systems like Canada’s those can often take a long time to get into the queue.
-One thing single payer does differently than our current system from what I know is that after a certain point, they put a limit of extraordinary care to resuscitate a patient who has coded. It is a hard decision, but they are a lot less likely to try and extend the life of someone with stage IV cancer and rather focus on making them comfortable, in a sense they have a DNR on a patient.
And while I haven’t looked at the stats, I would bet a lot more people in this country die for lack of lifesaving treatment, because they cannot afford it, lacked health insurance before ACA and/or had it denied by their health insurer, than died becuse single payer wouldn’t cover needed treatment…
One thing those who decry single payer health insurance don’t talk about, the amount of people filing for bankruptcy because of medical bills is a teeny fraction of what it is in the US, and those who do the last I read are people who decided to get treatment in the US and then end up sandbagged by bills.
“The best US medical care is better than anywhere else in the world. And so for those people who have access to it, US medical care will save some people that will not be saved elsewhere in the world.”
True, but most Americans insurance isn’t going to cover treatment by specialists at the Cleveland Clinic,
Mass General, Dana Farber, Mayo Clinic, insert your top notch regional medieval center here, because those facilities aren’t in their network.
Of course, it is rationed in the US as well. Medical insurance companies (whether government or private) restrict what treatments that they cover in various ways, and many plans (HMOs, traditional Medicare) do not cover every provider, and others (PPOs) do not cover many providers at their highest coverage levels. However, such rationing appears to be ineffective at controlling costs in the US.
How do doctors feel about ACA?
I know quite a few MDs, between my own and ones living in town. All wish for universal healthcare.
Read the comments about the future of medicine on some of the student doctor websites. They are very afraid of not being able to pay back the student loans, working themselves to death and not making the kind of income that is commensurate with their education and work hours.
From the link, “46% of physicians give the Affordable Care Act a D or F grade, while 25% give it an A or B.”
That mirrors the Gallop Poll numbers cited earlier.
Until they find their salaries slashed by national healthcare.
@TatinG makes an important point.
While you don’t want students entering medicine primarily for the money, you certainly don’t want students primarily interested in helping people to be deterred by the lack of money.
Medical school is nearly free in some European countries, and the flip side to that is that doctors make civil servant wages. In contrast, medical school in the US can cost more than a house in some areas.
I’ve had insurance deny a procedure that would have been approved had I been covered by Medicare.
And I have what is considered one of the best plans for fed govt employees