Please Help Me Understand Your Suffering

Sorry, ridksi. You're in a tough spot.

"Until people start dying because they're too
poor to afford doctors, nothing will change."

It was called, "The Affordable Care Act," it was the change (and hope) that we voted for because:

People were dying because they were too poor to afford doctors.

jersey_boy said:


It was called, "The Affordable Care Act," it was the change (and hope) that we voted for because:


People were dying because they were too poor to afford doctors.

Affordable?

https://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html

http://www.nytimes.com/2015/02/08/sunday-review/insured-but-not-covered.html

http://www.nydailynews.com/opinion/dr-marc-siegel-doctor-hates-obamacare-article-1.2846378

When a patient comes to me smiling with their new Obamacare coverage, it is difficult for me to smile back. That’s because I immediately envision a test or a referral that may not be covered by their plan or an essential service they will have to reluctantly pay for out of pocket because of their deductible.

why are you laughing?

how many more people have coverage? 20 some odd million?

You think that happened because it was unaffordable?

Do you think a NYT "many say" article is worth it's weight in dog poop?

BG9 said:

jersey_boy said:


It was called, "The Affordable Care Act," it was the change (and hope) that we voted for because:


People were dying because they were too poor to afford doctors.

Affordable?

https://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html


http://www.nytimes.com/2015/02/08/sunday-review/insured-but-not-covered.html


http://www.nydailynews.com/opinion/dr-marc-siegel-doctor-hates-obamacare-article-1.2846378

When a patient comes to me smiling with their new Obamacare coverage, it is difficult for me to smile back. That’s because I immediately envision a test or a referral that may not be covered by their plan or an essential service they will have to reluctantly pay for out of pocket because of their deductible.

ridski said:

Tom_Reingold said:

ridski said:

If you can't afford to pay, you shouldn't get the care.

I disagree.

I don't walk into other places and demand things I can't afford.

Lucky for you that you haven't needed to beg. If I need to eat, I'll eat, even if I have to steal food. We all deserve to eat and to have reasonable healthcare. Coming from the UK, I'm surprised you disagree. Or maybe that's why you left?

drummerboy said:

why are you laughing?

how many more people have coverage? 20 some odd million?

You think that happened because it was unaffordable?

Do you think it would have happened without the mandate?

Let's put it another way. Coverage itself isn't too pricey, right? You can get a Bronze package for around $150-200 a month with subsidies. But your deductible is high.

Let's say you're married and both of you are making minimum wage with no kids yet, you're living in Newark in an apartment and you sign up for the Horizon BCBS Omnia Bronze package. You've got a combined take home pay of around $30,500, you're paying $2400 a year in insurance (assuming a subsidized $200 a month) but insurance doesn't pay for anything until you've paid $6000 first. If anything happens to the two of you, say one has an asthma attack and the other contracts lyme disease in the same year, you're paying up to $8400 or 27.5% of your take home wages before your insurance policy even kicks in for anything.

Even if that doesn't happen, that's what you are facing every year. You are hedging 27.5% of your after-tax wages against getting sick, and there's no guarantee that your minimum wage will rise or that the premiums will not.

It is not affordable at all. It could have been if the initial public option was part of the bill, that was the part that was supposed to keep prices down, but the public option isn't there.

Let me be clear. I have no doubt whatsoever in my mind that whatever the Republicans come up with when they repeal or repair the ACA is going to be a much bigger bucket of **** than the ACA ever was. None at all. I'm in favor of Medicare for all, with those who can afford it buying secondary insurance. At this point, however, I believe you need to destroy the system you currently have and build a whole new one.

Tom_Reingold said:


Lucky for you that you haven't needed to beg. If I need to eat, I'll eat, even if I have to steal food. We all deserve to eat and to have reasonable healthcare. Coming from the UK, I'm surprised you disagree. Or maybe that's why you left?

All these years on this board and you post this. You don't know me at all, Tom.

This is a classic argument - "It's not perfect, so get rid of it."

That response ignores what the situation would be, if the person had no health coverage at all.

Some people think that a better response is, "So make it better."

BG9 said:

jersey_boy said:


It was called, "The Affordable Care Act," it was the change (and hope) that we voted for because:


People were dying because they were too poor to afford doctors.

Affordable?

https://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html


http://www.nytimes.com/2015/02/08/sunday-review/insured-but-not-covered.html


http://www.nydailynews.com/opinion/dr-marc-siegel-doctor-hates-obamacare-article-1.2846378

When a patient comes to me smiling with their new Obamacare coverage, it is difficult for me to smile back. That’s because I immediately envision a test or a referral that may not be covered by their plan or an essential service they will have to reluctantly pay for out of pocket because of their deductible.

South_Mountaineer said:

This is a classic argument - "It's not perfect, so get rid of it."

That response ignores what the situation would be, if the person had no health coverage at all.

Some people think that a better response is, "So make it better."

A $70k a month plan with a $2mm p.a. deductible is "better" than no health coverage at all.

Not sure what ridski's point is.

Nobody would buy that plan, they'd pay the fine.

There are other plans, with other numbers, which aren't perfect but which would help people who need them.

I think my point is still valid.

If I misunderstood the point of the post I'm responding to, I'll revise my response.

ridski said:

South_Mountaineer said:

This is a classic argument - "It's not perfect, so get rid of it."

That response ignores what the situation would be, if the person had no health coverage at all.

Some people think that a better response is, "So make it better."

A $70k a month plan with a $2mm p.a. deductible is "better" than no health coverage at all.

I think ridski's point is that the ACA is valuable but it also has built in negatives that need to be addressed. his point that medicare for all is far better than what the ACA offers is valid and most of the posters here would agree with that.

If you are not poor enough to be covered by medicaid, not covered via your employer sponsored plan and have to choose an ACA plan than you are liable for certain costs if you get sick which you still may not be able to afford.

However, given those costs they are still preferable to having no insurance and losing everything via bankruptcy.

the 20 million who are now receiving yearly checkups and have a doctor to call when they are ill are far better off than they were before.

you know, I don't think anyone's arguing that the ACA is close to the best way to do this.

But it moved the ball significantly forward, and should be looked at in that light. Problems that need to be fixed would normally be fixed if we had Congresspeople who were interested in good government. Unfortunately, we don't have that.

hoops said:

I think ridski's point is that the ACA is valuable but it also has built in negatives that need to be addressed. his point that medicare for all is far better than what the ACA offers is valid and most of the posters here would agree with that.

If you are not poor enough to be covered by medicaid, not covered via your employer sponsored plan and have to choose an ACA plan than you are liable for certain costs if you get sick which you still may not be able to afford.

However, given those costs they are still preferable to having no insurance and losing everything via bankruptcy.

the 20 million who are now receiving yearly checkups and have a doctor to call when they are ill are far better off than they were before.

Thanks, hoops. It was patently obvious I was failing to get my point across and I was trying to come up with a better way (mind not quite in it this week) but you have done a marvelous job reframing my point perfectly.

I was never a fan of the ACA, though I'm happy that some (including myself this year) have managed to get coverage they wouldn't have had without it. I think it's a couple of really good regulations wrapped in a ton of unnecessary legislation.

And in case no one has noticed, we're talking about this because no one who believes they have suffered under Obama has the nuts to answer the initial thread question.

even employer based plans now have pretty high deductibles. It's not specifically a drawback of only ACA mandated plans

Thanks. That's what I was hoping for.

ridski said:

hoops said:

I think ridski's point is that the ACA is valuable but it also has built in negatives that need to be addressed. his point that medicare for all is far better than what the ACA offers is valid and most of the posters here would agree with that.

If you are not poor enough to be covered by medicaid, not covered via your employer sponsored plan and have to choose an ACA plan than you are liable for certain costs if you get sick which you still may not be able to afford.

However, given those costs they are still preferable to having no insurance and losing everything via bankruptcy.

the 20 million who are now receiving yearly checkups and have a doctor to call when they are ill are far better off than they were before.

Thanks, hoops. It was patently obvious I was failing to get my point across and I was trying to come up with a better way (mind not quite in it this week) but you have done a marvelous job reframing my point perfectly.

I was never a fan of the ACA, though I'm happy that some (including myself this year) have managed to get coverage they wouldn't have had without it. I think it's a couple of really good regulations wrapped in a ton of unnecessary legislation.

ridski said:

And in case no one has noticed, we're talking about this because no one who believes they have suffered under Obama has the nuts to answer the initial thread question.

Yup. A nice and pretty civil detour, but a detour nonetheless. Does anyone else think we are on the fasttrack to Constitutional Crisis? And there's nary a peep from the Republicans about it. This is how coups are engineered. Quietly at first. And then with a bang. We just skipped the quiet part, I think.

ridski said:

And in case no one has noticed, we're talking about this because no one who believes they have suffered under Obama has the nuts to answer the initial thread question.

I'd like to agree but I think the reason is that none of them are reading this thread. They are watching cartoons on REALLY big televisions.

@ridkski, I thought I knew you well enough to believe you favored UK- or Canada-style health insurance. And now it seems that I've been right. (Right?) So what is this you're saying about not being entitled to stuff you can't afford? Can you resolve this apparent conflict?

I'm not sure if you've explained earlier, are you saying that pre-ACA your insurance situation was better - and that the ACA caused you to go from good to bad?

ridski said:

And in case no one has noticed, we're talking about this because no one who believes they have suffered under Obama has the nuts to answer the initial thread question.

Anyone who recalls, please refresh my memory.

Given that the ACA passed with not a single Republican vote in support and that the Dems held both houses of Congress, why did the Dems not push through single-payer?

Were there Democrats who did not support single-payer who would have allied with the Republicans and killed the whole thing?

I'm confused about deductibles. In 2015, I was covered by a BC/BS plan through healthcare.gov (the ACA). I had a busy year medically -- expensive meds, quarterly checks with my PCP, four skin cancer procedures, and two unrelated visits to minor emergency. I spent about $2,000 out of pocket, nowhere near my deductible ($6,000). All I paid was the copay -- $30 for GP, $50 for minor emergency, $60 for specialist, about $300 each for the procedures (which cost thousands each), and some minor amounts for meds and labs.

I hear people saying that you have to pay for everything out-of-pocket until the deductible is met before you get any coverage for anything, but that wasn't my experience.

jimmurphy said:

Anyone who recalls, please refresh my memory.

Given that the ACA passed with not a single Republican vote in support and that the Dems held both houses of Congress, why did the Dems not push through single-payer?

Were there Democrats who did not support single-payer who would have allied with the Republicans and killed the whole thing?

As I recall, that was back when Obama was trying to come up with compromise solutions that would get support from both sides of the aisle.

Tom_Reingold said:

@ridkski, I thought I knew you well enough to believe you favored UK- or Canada-style health insurance. And now it seems that I've been right. (Right?) So what is this you're saying about not being entitled to stuff you can't afford? Can you resolve this apparent conflict?

As I said, my analogy went a little too far so I'm re-calibrating my argument. Hoops explained my position.

drummerboy said:

I'm not sure if you've explained earlier, are you saying that pre-ACA your insurance situation was better - and that the ACA caused you to go from good to bad?

ridski said:

And in case no one has noticed, we're talking about this because no one who believes they have suffered under Obama has the nuts to answer the initial thread question.

I'm currently on a silver plan because the math works out. You pay $100 more a month up front to avoid the massive deductible and lower your co-pays. I sketched it out that with two people on 2 doctor visits a year each, it's cheaper overall than paying less for a crappy bronze plan. Most of these bronze plans are worthless if you discover on your well visit that you actually have anything wrong with you, but yes they're better than no coverage at all.

Here's a question: What happens to the money the government gets from the fines they collect from those who don't have coverage?

kthnry said:

I'm confused about deductibles. In 2015, I was covered by a BC/BS plan through healthcare.gov (the ACA). I had a busy year medically -- expensive meds, quarterly checks with my PCP, four skin cancer procedures, and two unrelated visits to minor emergency. I spent about $2,000 out of pocket, nowhere near my deductible ($6,000). All I paid was the copay -- $30 for GP, $50 for minor emergency, $60 for specialist, about $300 each for the procedures (which cost thousands each), and some minor amounts for meds and labs.

I hear people saying that you have to pay for everything out-of-pocket until the deductible is met before you get any coverage for anything, but that wasn't my experience.

Hard to say without knowing specifics. The current BC/BS Bronze plan has a $3000 individual and $6000 family deductible. On my old Aetna plan, I had a $500 deductible and my wife had a separate $500 deductible, and the first time I saw a doctor each year, I'd be paying for that visit, depending on coverage. It sounds to me like you had a $2000 personal deductible. According to the Horizon site:

"A deductible is the amount you must pay for covered health care services before your Horizon BCBSNJ plan begins to pay. If your deductible is $1,000, for example, your plan won’t pay anything for covered health care services that are subject to the deductible until you have paid $1,000 out of your pocket for covered expenses. The deductible may not apply to all services. Generally, the deductible resets at the start of your plan year. In addition to collecting your copayment amounts, participating practices may make arrangements with you at the time services are provided for the payment of amounts that will be applied towards your deductible."

When I spoke of a $6000 deductible, I was talking about a married couple, each with a $3000 deductible. Preventative visits are often covered without having to use up your deductible. And at this point, I have no more will to write the word deductible ever again.

kthnry said:

jimmurphy said:

Anyone who recalls, please refresh my memory.

Given that the ACA passed with not a single Republican vote in support and that the Dems held both houses of Congress, why did the Dems not push through single-payer?

Were there Democrats who did not support single-payer who would have allied with the Republicans and killed the whole thing?

As I recall, that was back when Obama was trying to come up with compromise solutions that would get support from both sides of the aisle.

Yeah, that's my general recollection too. Would have been better to just jam through single-payer given the cooperation he got.

yes, they needed 60 votes, and Democrats were basically held hostage by conservative members of their own party.

Remember Max Baucus? He basically had the final say on what the ACA would look like.

jimmurphy said:

Anyone who recalls, please refresh my memory.

Given that the ACA passed with not a single Republican vote in support and that the Dems held both houses of Congress, why did the Dems not push through single-payer?

Were there Democrats who did not support single-payer who would have allied with the Republicans and killed the whole thing?

I asked you kind of a specific question, which you overlooked. Here it is again.

are you saying that pre-ACA your insurance situation was better - and that the ACA caused you to go from good to bad?

My point is that if you went from good to bad because of the ACA, then you can claim you suffered from it. But if that didn't happen, then the claim of suffering can't be that strong.

ridski said:

drummerboy said:

I'm not sure if you've explained earlier, are you saying that pre-ACA your insurance situation was better - and that the ACA caused you to go from good to bad?

ridski said:

And in case no one has noticed, we're talking about this because no one who believes they have suffered under Obama has the nuts to answer the initial thread question.

I'm currently on a silver plan because the math works out. You pay $100 more a month up front to avoid the massive deductible and lower your co-pays. I sketched it out that with two people on 2 doctor visits a year each, it's cheaper overall than paying less for a crappy bronze plan. Most of these bronze plans are worthless if you discover on your well visit that you actually have anything wrong with you, but yes they're better than no coverage at all.

Here's a question: What happens to the money the government gets from the fines they collect from those who don't have coverage?

The $146M that insurance companies spent on political contributions and lobbying also explains why dems did not support a single payer plan.

https://www.opensecrets.org/lobby/indusclient.php?id=F09

drummerboy said:

yes, they needed 60 votes, and Democrats were basically held hostage by conservative members of their own party.

Remember Max Baucus? He basically had the final say on what the ACA would look like.

jimmurphy said:

Anyone who recalls, please refresh my memory.

Given that the ACA passed with not a single Republican vote in support and that the Dems held both houses of Congress, why did the Dems not push through single-payer?

Were there Democrats who did not support single-payer who would have allied with the Republicans and killed the whole thing?