Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
In my medical office we excluded my wife from our medical plan. With her disease she would have DOUBLED the premiums of all our 40 or so employees! Her medical bills are up to $170K so far this year. About every 4 years new and expensive medical technologies save her.
I'm so sorry for your wife's illness and hope that she continues to do well. My brother has multiple sclerosis. Fortunately, the course of his illness has been relatively mild and his employer has been able to accommodate him. For example, he has a couch in his office and can shut his door to nap when needed. They pay for him to fly business not coach. (Exhaustion is a side effect of both the illness and the drugs.) But he is a highly credentialed scientist not easily replaced; not every employer can do that.
Without employment ... or the ACA, well the MS drugs are thousands each month. His wife was in a bad car accident and has permanent injuries. She cannot work to qualify for insurance.
I'm so sorry for your wife's illness and hope that she continues to do well. My brother has multiple sclerosis. Fortunately, the course of his illness has been relatively mild and his employer has been able to accommodate him. For example, he has a couch in his office and can shut his door to nap when needed. They pay for him to fly business not coach. (Exhaustion is a side effect of both the illness and the drugs.) But he is a highly credentialed scientist not easily replaced; not every employer can do that.
Without employment ... or the ACA, well the MS drugs are thousands each month. His wife was in a bad car accident and has permanent injuries. She cannot work to qualify for insurance.
Employer based certainly CAN be part of HC coverage, I just don't think that it should have such a broad application. It certainly can be offered as a group perk. But for many if not most workers, it would make more sense to have the added wage and then have them get insurance aside from an employer. An insurance that is more portable and individually customized and centered.
I just did a study for my state on this very issue. Interviewed some very smart people on the subject. This is what I learned:
There are two different types of 'pre-existing conditions.' The first category includes someone with a chronic, long-term condition - perhaps even from birth. His/her costs are relatively well known, both in amount and over time. Some can be very expensive. These are the people Obama originally wanted to help with his ACA.
The second is the person who wrecked his Camaro last Friday night, broke 14 bones and popped a lung, and is looking at $50,000 in immediate surgical costs. He (or his nearest relation) signed himself up for health care the following Saturday morning. As soon as he is better, he will drop his coverage.
Medical insurance is based on the principle that the costs (risk) of many can be spread over a static population - like the employees at a company. What Obamacare proved over the short time it was in effect was that the general population is not static enough over which to spread risk because of the people in the second category.
I still hold out hope that the risk presented by the first category can be covered, but the 'mandate' was clearly insufficient to make the people in the second category participate until their need was dire. And then, they only participated as long as they needed the help. Then they quit the program.
In conducting my study, I was astounded at how many hundreds of millions of dollars the health insurance companies lost in their brief experimentation with Obamacare. I don't even know how some of them are still in business. No wonder they are running for the exits. (Personally, I cannot take a $600 million loss, but I know an insurance company that did.)
Medicaid used to be the safety net for the people in the first category. Collection agencies and civil judgements used to be the future for people in the second category. I have no argument with returning people in the second category to collection agencies and civil judgements - their irresponsibility caused them to not be able to pay medical bills they incur.
But people in the first category - maybe there is some way Medicaid can expand to cover them. Don't know - didn't examine that because Obama was still president when I did the study. But it might be worth a re-look.
I am sure the insurance companies will rip Trump a new one about the pre-existing conditions. The only way it would work is if everyone must buy insurance (mandate) or else everyone would go without health insurance and buy only when they become ill. Did Trump think this through?
But, another process is to get rid of the requirements of what constitutes 'insurance'.
"Major Medical" policies are a thing of the past which 'eliminating' Obamacare can bring back. Many people bought and liked those policies. They don't cover your day-to-day medical needs.. Prescriptions, physicals, sick visits to the doctor.. But, they do cover you in the event of a Major Medical event.
And they are SIGNIFICANTLY cheaper than any Obamacare plan.
Yes they do, but don't many of those still have high deductibles? Again who has $5k-10K just laying around. But if you can swing it, go for it
I am sure the insurance companies will rip Trump a new one about the pre-existing conditions. The only way it would work is if everyone must buy insurance (mandate) or else everyone would go without health insurance and buy only when they become ill. Did Trump think this through?
Trump already said pre-existing and 26 are staying.
Thinking back, I wouldn't have leaned toward taking certain jobs
when I was 18-26, took them because they had health insurance,
but they weren't very good jobs otherwise. I'm a little bitter about that,
these extended children still on their parents health care at 26 years old,
they won't have to sweat it like we did.
Part of HC reforms have been to push, support and financially augment primary care and the medical home. In specific terms as a primary care doc, I would (and should) be the one to send a patient to the surgeon. And typically after cheaper, easier and less painful modalities have failed. Like Chiro, PT, pain management and/or injections. In my practice it is more common sense than evidence based.
As a back patient myself for 25 years, this comes easier for me.
We're overlapping here for the first time I too have had back issues. My primary did recommend PT - it was very effective. I needed a script from her before I could see the therapist. An evaluation has to be done every 30 days to monitor progress but fortunately I've already graduated. I will, though, need to maintain the exercise program for the rest of my life.
BUT under my insurance plan (BC/BS) I could have skipped my primary and gone directly to the orthopedist. (I did initially skip her to see a chiro, which only exacerbated the issue.) Having reached advanced middle age, I have a lot of friends with joint issues and I am amazed how many simply see a surgeon and want to be fixed. Immediately. This is their first brush with infirmity and they want no part of it. Our medical system allows it.
Location: Live:Downtown Phoenix, AZ/Work:Greater Los Angeles, CA
27,606 posts, read 14,615,202 times
Reputation: 9169
Quote:
Originally Posted by Hoonose
Employer based certainly CAN be part of HC coverage, I just don't think that it should have such a broad application. It certainly can be offered as a group perk. But for many if not most workers, it would make more sense to have the added wage and then have them get insurance aside from an employer. An insurance that is more portable and individually customized and centered.
Thank you for the kind thoughts.
Employers get discounted rates that individuals do not, so you would have to pay employees massively more money for them to purchase their own policies without having to cut back elsewhere
The problem with this is, if insurance companies start denying everyone for pre-existing conditions no matter what the condition is, people will be paying huge premiums like they are now. Allergies and thyroid issues aren't the same as diabetes or cancer.
People keep saying they're afraid of what changes will be made, and I get that, but what difference does it make when so many people can't afford Obamacare?
And really, if you're relatively healthy like I am, I'll rarely meet my deductible or max out of pocket. I'd prefer a major med (catastrophic) plan.
When I was stuck in 'Murica, even though I took the Almighty Personal Responsibility and took care of myself, and was cured of Ulcerative Colitis- I STILL was declined for all coverage due to pre-existing. I bet is insurance companies declined for lack of soul and conscience, these TRumpers wouldn;t be wetting themselves with glee
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
