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Jacob, an intellectually high-performing student in his senior year of college, experienced a seizure before class and was diagnosed with a low-grade oligodendroglioma, a malignant brain tumor in October 2009. These tumors, while having a relatively good prognosis in comparison to other malignant brain tumors, almost always recur, even after complete removal, and require at the minimum regular monitoring through MRI scans and in most cases seizure medication. Jacob worked part-time at his family's business and was on subsidized state health insurance at the time, as now. Following the operation, which partly removed his tumor, he had rehabilitation, graduated from university, and went through 12 cycles of a rather benign chemotherapy regimen. His family's business then closed for reasons unrelated to his health and Jacob was left without a job.
Jacob is considering working again; he has few, if any, noticeable adverse effects from the tumor. His seizures are well-controlled and he can drive. He indeed truly desires to be productive and have full-time employment. However, if he obtains a job, it will likely pay over the income limit fixed by his subsidized health insurance or have a health plan available to its employees, which would exclude Jacob from the state plan. The private health insurer will most likely enforce a pre-existing condition exclusion period; per state law this can be up to 12 months. Seizure medications and four-month MRIs will cost Jacob over $10,000 in out-of-pocket expenses, not to mention the possibility of an early tumor recurrence, making staying home and laying in his bed watching Youtube videos and posting on internet forums a more attractive option.
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How do you think the health care system should address Jacob and other patients like him?
People like Jacob are not a problem for the American Health Care system because a good HR department at most American businesses knows how to screen out people like Jacob and not to hire them in the first place! Also a good HR system knows what to do if a Jacob slips by and subsequently develops a chronic health condition. It is called a termination and in most of the nation "so called right to work states" they don't even have to give poor old Jacob a reason for his termination. In those that do require a justification for involutary termination, this has been developed to a fine art. Jacob will be out the door and the employer has an unwritten pact with the insurance provider to only have healthy employees who won't cost the insurance company much money so we have a win-win situation for both insurance company and employer.
Depending on the work Jacob finds, $10,000 may be unaffordable (and note that that is a minimum figure). As stated, he is currently on state health care; he possibly qualifies for SSI as well, although has not applied for it. He may judge employment's implications to be worse than his current quality of life, and therefore remain unemployed, apply for and get SSI, and be a materially unproductive member of society.
Maybe in a wealthy society such as ours, individuals like Jacob, who are just starting out in life and suffering from a chronic or terminal disease, have some claim on other, more fortunate peoples' money if they cannot pay for their own health care while fulfilling other necessities.
Our country's health care system, in terms of treatments and technologies, is the best in the world. However, our health care provision system is severely flawed.
Have a claim on others money? What type of insanity is that?
I'll give you a hint, hopefully you are able to grasp it. Here it is....Times have changed. There is no $50-200 a month employer provided health insurance anymore unless you work for a large business, State or Federal. Or the slim chance a small employer will pay most of the premium or the small business provides one crappy policy for its employees. Another words the **** is getting harder for people to pay each year, its become expensive. Why on earth do Americans put up with for-profit insurance akin to car coverage, including all the haggling that goes with it often times when one needs it the most, at a high cost at that? A sucker born every minute.
Now do you get it?
I pay around 300 bucks a month for full coverage for a family of five including dental and eyecare and I work at a casino. You must be the sucker around the time you came into the world.
I wonder how an exclusion period is allowed into the new law in regards to pre-existing conditions?
You're supposed to go without medical treatment for 1 year for serious illnesses?
Just another example of how owned the country is by corporate lobbyists.
And don't look to the right wing or libertarians or establishment Democrats to help you here.
The only faction in Government that would eliminate the "exclusion period" are progressive/liberal Democrats.
Then do it. High risk pools say you have to be uninsured for I believe it is six months or maybe a year before they pick you up as part of Obamacare. Do your homework before spouting off.
I pay around 300 bucks a month for full coverage for a family of five including dental and eyecare and I work at a casino. You must be the sucker around the time you came into the world.
I came in the world 54 years ago. Now keep in mind, narrow one, that 300 bucks a month is either independent coverage which pays out about nothing when a serious health issue crops up because there is less protection using independent coverage than group, or your employer is contributing to your premium. So, which do you have, group coverage or independent coverage?
Jacob can apply for high risk insurance coverage due to his pre-existing condition that will cover him until he is eligible for EGHP coverage for his pre existing condition.
Insurance provided by employers are group policies and there are no restirctions on pre existing conditions. Some employers impose a waiting period before becoming eligible. There is the only drawback that I can see at this point. When going on an interview these questions can be addressed.
Jacob, an intellectually high-performing student in his senior year of college, experienced a seizure before class and was diagnosed with a low-grade oligodendroglioma, a malignant brain tumor in October 2009. These tumors, while having a relatively good prognosis in comparison to other malignant brain tumors, almost always recur, even after complete removal, and require at the minimum regular monitoring through MRI scans and in most cases seizure medication. Jacob worked part-time at his family's business and was on subsidized state health insurance at the time, as now. Following the operation, which partly removed his tumor, he had rehabilitation, graduated from university, and went through 12 cycles of a rather benign chemotherapy regimen. His family's business then closed for reasons unrelated to his health and Jacob was left without a job.
Jacob is considering working again; he has few, if any, noticeable adverse effects from the tumor. His seizures are well-controlled and he can drive. He indeed truly desires to be productive and have full-time employment. However, if he obtains a job, it will likely pay over the income limit fixed by his subsidized health insurance or have a health plan available to its employees, which would exclude Jacob from the state plan. The private health insurer will most likely enforce a pre-existing condition exclusion period; per state law this can be up to 12 months. Seizure medications and four-month MRIs will cost Jacob over $10,000 in out-of-pocket expenses, not to mention the possibility of an early tumor recurrence, making staying home and laying in his bed watching Youtube videos and posting on internet forums a more attractive option.
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How do you think the health care system should address Jacob and other patients like him?
1. wait twelve months and get any job he wants with good health insurance
2. work with a larger buisness, in which the contracts with health insurance companies preclude pre-existing conditions for new hires (volume of patients has more clout).
3. There are many meds and treatments that are limited by medicaid (US version of Canadian plan). It is impossible to get some medicines that we would otherwise use for private insurance patients. Additionally, imaging ,which would involve MRIs and potentially PET scans(typically not for a CNS tumor), are very limited for medicaid patients.
That was pretty easy. This is coming from a physician who is uninsureable if I attempted to purchase a private insurance plan on my own (due to cancer). However, I have excellent coverage, as I am a part of a multi-specialty clinic with over 1,000 employees.
People like Jacob are not a problem for the American Health Care system because a good HR department at most American businesses knows how to screen out people like Jacob and not to hire them in the first place! Also a good HR system knows what to do if a Jacob slips by and subsequently develops a chronic health condition. It is called a termination and in most of the nation "so called right to work states" they don't even have to give poor old Jacob a reason for his termination. In those that do require a justification for involutary termination, this has been developed to a fine art. Jacob will be out the door and the employer has an unwritten pact with the insurance provider to only have healthy employees who won't cost the insurance company much money so we have a win-win situation for both insurance company and employer.
This is absolute true, I've witnessed it, seen it happen to someone close to me. I've had law firms confirm pretty close to what you are stating.
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Also a good HR system knows what to do if a Jacob slips by and subsequently develops a chronic health condition. It is called a termination and in most of the nation "so called right to work states" they don't even have to give poor old Jacob a reason for his termination. In those that do require a justification for involutary termination, this has been developed to a fine art.
Jacob will be out the door and the employer has an unwritten pact with the insurance provider to only have healthy employees who won't cost the insurance company much money so we have a win-win situation for both insurance company and employer
