do you support repeal & replace obamacare? 🚫🔀🤵🏿💉❓

NO!!!!!!!!!!!!!!!!!!!!!!!
I am self employed (I own the law firm). I buy our health coverage through the CT State Exchange.
My policy is issued by Connecticare, just as my plan was before ACA became law. It is the same level of coverage.
Big Changes with ACA (incorrectly called Obamacare):
No more lifetime or annual caps on coverage. In 2016, Mrs. CTL was on life support for 27 days and had 10 surgeries with 5 additional hospital admissions. Bill was more than $2.5 Million. Before ACA the policy had a $1 Million cap.
I now can use any hospital in the state. 4 medical specialist we now use did not accept Connecticare prior to ACA.
Single children can stay on parents’ policy until they are 26 years old. We made use of this for youngest Miss CTL. When the next older child was still in school and turned 21 she was forced off our policy.
NO rejection for preexisting conditions. Mrs. CTL would not be able to get coverage under the different proposed ‘Trump’ Non-Care plans.

BTW: It’s 4 years that I’ve had the plan and even with annual increases and my age in an older bracket, my monthly premium is $600 less than I paid before ACA.

CTLawyer – you have a fringe case. I am on the verge of letting my NY insurance lapse, because I simply can’t afford 15k+/year (+ 400/month+ subsidy) for what essentially is a catastrophic coverage couple’s silver plan. A normal healthy couple does not usually use over 6k/year in doctor’s bills – the deductible until insurance kicks in.

The ACA helps in some ways and hurts in others. The real conversation needs to be – how to get the government out of health care and allow the free market to work. When the fees are undisclosed, actually unknown, due to insurance generally covering the exorbitant fees charged by doctors and hospitals, there is never any negotiation. People negotiate with builders, plumbers, mechanics – everyone, except their doctor. A doctor’s visit with a blood test should not cost $500+. The prices are all fake, and it’s mostly due to lack of competition. Ask a hospital “how much is this procedure?”, and they will not know. It all gets billed later on, with an entire team of people who specialize in “medical billing”. It’s insane, and it needs to be fixed.

Single-payer healthcare is the best route to go, bar none.

kollelman,

Your plan does sound terrible, I’m sorry. There is still a long way to go to improve health care and coverage in the U.S.

I agree that the fees that medical providers charge are often exhorbitant. I do not believe this is due to insurance companies blindly paying out, however. When I receive explanations of benefits from my insurance company, they pay out only a pre-negotiated amount to the provider, and I am responsible for a pre-negotiated co-pay, either a fixed dollar amount, or a percentage of the pre-negotiated amount. The excess amounts (sometimes crazy!) charged by the provider is disallowed, and the provider is forced by the agreement with the insurance company to accept the amounts negotiated. Patients who are uninsured do not have this protection, and are at the mercy of whatever the provider bills.

In your free market vision of health care, what is the role of insurance? Even if there is cutthroat competition among providers, the cost of care during a catastrophic event or prolonged illness is still going to be very high.

@ubiquitin – that is the exact problem. Currently, there is no free market. It’s the government and the insurance companies that own healthcare. An individual almost never has the ability to negotiate. The Christian healthcare groups that some have joined have some negotiating power, but that’s only because they are large enough to actually have some leverage.

@Avram – I agree that insurance companies don’t blindly pay out, but as you mentioned, normal people don’t have that option. Insurance should be just like any other insurance, protection against catastrophe – calculated risk. Also, if a person doesn’t want coverage for X, Y, Z – why pay for it? For car insurance, you may affect others, so the state forces a minimum coverage. You want rent-a-car coverage, collision, fire, glass, you pay for those. This is not possible in healthcare with today’s laws. Additionally, due to the government being a guaranteed payer, rates are artificially high, since there is really no competition. Insurance companies often base their payout rates off of government negotiated prices.

@zahavasdad – There can be a pool for high risk people – just like car insurance. Also, the prices would need to come down – (I propose aided by limits on medical malpractice lawsuits). People used to pay their doctor for pregnancy visits, and 200, 500, whatever to deliver a baby. Today’s rates are insane, probably due to the fact that OB/GYN doctors are probably paying 200k/year just for malpractice insurance.

Medicare/Medicaid are basically guaranteed. Hospitals, nursing homes, etc. bill the government and expect to get paid. eg. Drugs can cost $500/dose from the manufacturer and the government will pay that + a fee to the hospital for administering, etc… If the government was not footing the bill for millions of patients, there would be no way to effectively charge those rates for many drugs/services.

I agree the rates would be high. It is definitely not anything like a 16yr old “needing” to drive. I argue more towards overall lowering of the costs through free market and lessening the artificially inflated jury awards for silly lawsuits. The current costs are not normal. No need for every pregnancy to cost 20k+. Also, people should be able to form their own groups and pool the risk, to prevent throwing individuals off the plan for high usage. This should not be tied to employment, and should rather be any group of people, yet allow the insurance company to bill them individually.

Its about $5000 for a normal baby delivery and about $15,000 for a c-section

Both are assuming mother and baby are healthy. If there are complications, the payments can sky-rocket. A Premie in NICU can cost in the MILLIONS if the baby has to be there for a significant amount of time (Like months)

Kollelman

“there is no free market.”
nor can there be. People dont decide to have heart attacks. and when they do happen they cant go bargain hunting.

“An individual almost never has the ability to negotiate”

Its far worse than that. Say a hospital wants $100 for an Xray. The insurance with their bargaining power says ok we will give you $70 take it or lose our patients. The hospital then raises the bill to $150 The insurance company says ok we will give you $100 (which is what the hospital wanted.) Hospital is happy they get what they want , insurance company is happy since they are gettign a bargain
The ones who realy lose are individuals without insurance who are now stuck with a bill for $150 that is more than the hospital even wants.

Insurance for childbirth doesnt realy make sense. Try gettign car insurance and telling the insurance company yo plan on having a car accident r”l every year or few years.
Similarly for preexisting conditions, some of which people are born with. trying buying homeowner’s insurance once a home is on fire

Folks, why don’t we make this very simple. Repeal the ACA and reinstate the laws and healthcare system that were in effect until the ACA came into law.

How do hospitals and other medical providers get away with setting different prices for the same service, based on whether the customer has insurance? Why is that legal?

They probably have a significantly better rate of collection from insurance companies than from private people.

Health care providers have no choice but to demand full payment of their inflated list prices from the uninsured due to the federal law governing Medicaid. They couldn’t legally bill the uninsured less even if they wanted to.

I don’t know the intricacies, but federal law governing Medicaid and/or Medicare place severe restrictions on Medicaid or Medicare (it’s one or the other) accepting facilities from discounting the list rate for the uninsured.

Most advanced industrialized nations have gone with some form of single-payer plan. The costs are generally about half of what the US spends on healthcare, and the care is just as good. Some products and services, e.g., healthcare, don’t work in so-called free-market systems. Stop worrying about nonsense and myths about the “miracle” of free markets. Look at what works and do it that way.

@Joseph
You can wait a long time for a specialist in the USA, as well

MIL needs a complete evaluation by a gerontologist. Wife tried to arrange the appointment in early May. The soonest she could get an appointment within 50 miles (New Haven, Bridgeport, Stamford, Waterbury, Greenwich) was September 25

“Single payer countries have notably longer waits for specialists than the US.”

Again, longer than whom? certainly not longer than the uninsured.

Of course, your data isnt completely accurate. See the recently released “commonwealth fund international survey on health” Both Germany and France had lower wait times than the US (Though the US was better than other countries in this regard (though neither are true single payer systems, but there are very few in the world so I assumed you were using the term more liberally)
Of cours ethe US DOES have single payer health insurance for those over 65, and I am not aware of any delays in treatment in that group
And besides, what is the harm in waiting a bit longer for a non emergent visit

However, if the thought of waiting really distresses you, the (main) reason waits are so long is to keep down costs. We can spend more than Canada does have extra specialists, likely stil spend less than we do and have shorter wait times than Canada does.

huju
” and the care is just as good”
that should read “The care is better”

@ubiquitin
I gave an example of a wait for a specialist by my MIL…she’s in her late 80s, on Medicare…that single payer system
The Gerontologists only serve senior citizens, so they all are single payer (Medicare) patients. Again in a 50 mile in-state radius, the earliest appointment available was 4 months out.

This is a non-emergency room type visit. The delay is devastating. Without the evaluation, the secondary insurers will not authorize coverage by in-home health aides, durable medical equipment (walker, wheel chair, commode, etc). She can’t gain admittance to certain care facilities or day programs. Event the Town Senior Citizen transportation won’t serve her without the evaluation. Unfortunately, we watch her slide downhill every day. We have offered to pay for a number of these services/programs, but without the gerontologists evaluation there is no entry. (In terms of durable medical equipment, she is currently using items that belonged to my late mother A”H. They sat in our garage, because Goodwill won’t accept used DME.

CT Lawyer

Im sorry for the distress you are going through.
there arent many geriatricians, and even less gerontologists. which is likely why you are having trouble. if R”L she needed an orthopedist I doubt the wait would be that long. And more to my point, if a medicare patient needs an orthopedist I dotn think the wait is longer than for a privately insured patient

Your example highlights just how broken our system is. Obviously I dont know the specifics of your situation. But Seeing a gerontologist is (almost) never medically urgent. I understand that there are bureaucratic hurdles to get equipment that she needs for which she needs to be evaluated. But that just highlights how fractured our system is. why does a pateitn need a physician to determine she needs a walker or commode, a Physical therapist should be able to make that detemriniation?

At any rate, why not have her see an internist who certainly can make that detemriniation. while you wait for appointment with geriatrician?

“The US has the best doctors, the best hospitals with the best doctors and medical equipment.”

Again what does that mean? What is the point of the “best doctors..” If we arent living longer.

IF I tried to market to you a new cure for colon cancer.” ITs the absolute best !” I insist
The first thing you would ask me, ok are patients living longer? ” oh well no,”
you might go on to ask ok less side effects? “Nope, just the opposite”

Is it cheaper?
“No, But it is the best! ”
You would rightly decline to stock that drug.

You say “The best doctors”
in what way best bedside manner?
In this regard we actually do pretty good (see the report I referenced) though still not the best
Of course if by “best doctor” you mean the most in dept this is correct though not usually considered a marker of “best doctor”

“The best hospitals?”
again in what way? Least preventable errors? no in that regard we among the worst

@Ubiquitin
Anthem Bluecare which is her Medicare and wraparound refused the order for DME made by #1 Internist, #2 Oncologist #3 Physical Therapist (paid for by Anthem Bluecare. They insist on the evaluation by the Gerentologist.
A wheelchair require specific face to face notes from the evaluating doctor, not just an Rx.

None of the insurance pays for things such as shower chairs. The insurers will pay for 6 weeks of 1 hour per visit twice weekly home health aides. Once she is evaluated, she’ll get 9 hours oper day 7 days per week

CTL, can’t you pay for the services privately until it is approved?

On August 2nd I posted about the delay in seeing a specialist experienced by my MIL. There was a FIVE MONTH wait to see a gerontologist. Her Blue Cross/ Blue Shield Medicare combination would not ok durable medical equipment until prescribed by the specialist. They had rejected orders from her Oncologist and Internist.
The EARLIEST appointment she could get was for September 25th.

Joseph asked if I could pay for the equipment from my own pocket while I was waiting for the approvals. The answer is that I went to our garage and brought in walker, wheelchair and commode that had belonged to my late mother. They were collapsible and we held on to them.

On August 16th while at Chemotheraphy, she was sent to the hospital for a week’s stay. She was released to a rehab facility and was there 23 days. Medicare and Blue Cross decided she was not making enough rehab progress to warrant the cost of care and we were give one night’s notice to bring her home. There were no private pay beds available.

MIL was brought home last Sunday morning and we arranged care in our home.

On Wednesday morning Sept. 20 the Gerontologists office called to cancel the appointment. He had decided to take a long weekend including Yuntif and we were told to call on the 26th to attempt to book a new appointment.

It didn’t matter……………………………
10:32 that night while our family was at the Rosh HaShanah dinner table, my wife and I and a private duty nurse were in my wonderful MIL’s room as she drew her last breath.

The levayah is this morning……………………..all of her family was already here for Yuntif anyway. This will be forever etched in our memories as the worst RH of our lives.

CTL
Baruch Dayan Haemes
Im sorry for your family’s loss