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Yup.
You could get them through college, you could get through work what the employer offered, you could even opt out if you didn't want health insurance and that's when you would get the 105k dollar bill for services rendered...
What we have now is pathetic. I called it in college. I remember having this argument with a professor.
This will benefit the insurance companies the big ones at least.
This will hamstring my generation stuck with student loan debts and raise the costs and make things much more complicated. I even offered to bet 50 dollars on it.
Sure enough.
I went from paying 35 dollars per week through an MVP provider I acquired on my own.
I had 10 dollar Co pays to see a PCP
25 dollar for a specialist.
Prescriptions were a sliding scale 10 bucks for anti biotics, 25 bucks for say allergy or blood pressure or migraines. 35-50 for your hardcore pain killers and your life sustaining meds/radiation chemo etc
50 dollar copay for vision care. Another 50 for prescription glasses 65 for contacts.
Dental was a separate carrier.
90 dollar copay for emergency room visit. For any reason. The only thing it did not cover was an ambulance ride.
How was health insurance not affordable? what was wrong with it?
I had to use it 3 times 2 times for emergencies. Both times were for tick bites and getting sick with ehrlichiosis.
Everything was covered with a small copay at 35 dollars per week.
Post ACA.
Health insurance premiums were 90 dollars a week for empire blue EPO.
2,000 dollar yearly deductible which needed to be met every calender year.
Or face the fine.
A "Silver plan".
I had to travel either an hour north or an hour south to see a PCP.
My doctor was out of network. I could pay to see him, but it did not count towards the deductible.
Oh and the best part. 80/20 coverage. Meaning... insurance would pick up the tab for 80% of the bill, after your deductible was met for the year of course. And you were responsible for 20%.
Then came the "pre existing coverages" clause to protect insurance companies. So if you switched jobs and say you were injured at the previous employer say a torn rotator cuff or herniated disc in your back. Yes workman's comp covered the initial costs and insurance would pick up what's left over after you've met your deductible of course... providing the treatments medicines doctors and such were "in network".
Essentially.
My health insurance costs went up 200% for 45% the coverage I once had.
This is what happens when you invite the government to meddle in health care in the name of more affordable health insurance.
I want to know who the ACA benefitted. Had to be unemployed bums welfare recipients etc.
I know exactly who this benefitted. Health insurance companies. Why?
That health plan provider was bought out a year after ACA went through by Empire Blue... (NY state subsidy of Blue Cross Blue shield)
How?
They were responsible for only 80% of your fees.
They required you to have a 2k per year deductible for health insurance.
Get the government out of health insurance and health care. Period.
The one and only thing I would even consider the government meddling with would be a consumer protection act that denies a health insurance company to drop a patient for any reason what so ever or fail to pay out on a claim.
ACA benefited the poor and lower middle class with Medicaid expansions and subsidies. And it also benefited older patients and those with pre-exisiting medical conditions. The young and healthy had to take it on the chin. But remember no one stays young and healthy...
Medical malpractice is a relatively tiny portion of healthcare costs.
Medical malpractice is a serious state issue.
States are free to impose caps on settlements/ awards and some do a very good job of of it. Other states, not so much.
And tort reform hasn't lowered overall HC costs anywhere. It makes it easier/cheaper for docs to practice. So more docs are attracted to those states, and then more gets done. Hospitals always try and recruit more docs because they know that more docs means more medical business going on locally.
While I understand that an emergency and imminent event preclude doing research at that time, and I sympathize with this teacher, he should have done his research beforehand.
He knew, or should have known, that his insurance plan requires that services AND doctors be "in network." If they're not, expect a bill.
He also should have known that his was not a state which legislated comprehensive protection against this sort of billing.
I'm thankful that the insurance DH and I have chosen has no network requirement for care OR physicians. Everyone needs to do their homework. Even teachers.
Even if he knew that, how would that information help him when he's in an ambulance fighting for his life?
Thank ACA for that...
Pre ACA there was not one thing considered "out of network". I could get screwed up or sick in California and my insurance would have covered the bill no questions asked.
You're quite wrong about that. Health insurance has imposed networks onto consumers at least since I entered the workforce in the late 70s.
Quote:
Originally Posted by Hoonose
Oh there surely were all sorts of HC networks before ACA.
Don't worry - neither of us were hallucinating that.
I worked for a non-profit that switched insurance carriers every two years to save us money. A nice gesture, but every two years many of us had to switch doctors because our doctors on the previous plan were no longer in the new plan's network.
That was in the 80s, which I do believe was pre-ACA.
Quote:
Originally Posted by NY_refugee87
I want to know who the ACA benefitted. Had to be unemployed bums welfare recipients etc.
Well, what a charming sentiment!
I benefited nicely from the ACA as I built a consulting business. Initially, my income was pretty low and the tax credit was extremely helpful. As my income rose, the tax credit shrank - and even when I no longer qualified for a credit, I still was paying a lower premium than I was in my previous job.
Quote:
Originally Posted by Grlzrl
I guess I fall into that category so I will tell you how I feel. I don't mind helping people out. I don't mind social programs to a point. But when you want to import 11 million people and open up the borders, enough is enough.
You do realize that immigration, legal or otherwise, has nothing at all to do with the topic of this thread?
Quote:
Originally Posted by Delahanty
While I understand that an emergency and imminent event preclude doing research at that time, and I sympathize with this teacher, he should have done his research beforehand.
Sure thing! He should have hopped out of bed that day and realized that later on he was going to have a heart attack, and immediately started his research. Then once the pain started, he should have whipped out his cell phone to determine which hospital personnel were not in his network. Oh, and in the ER, he should have interrogated each medical practitioner who approached his bed, just in case.
Just a reminder how F up our health system is. If you end up getting treatment form a hospital that is out of network or even if you are in an in-network hospital but the physician treating you is not in-network; you can end up in financial ruin.
I'm so thankful to have good health insurance. I feel for too many Americans who don't.
So am I. The union pays 100% of our healthcare. I could be in the hospital for a week and my cost would be $10 which is my co-pay. And some are against unions.
Even if he knew that, how would that information help him when he's in an ambulance fighting for his life?
What none of us know is the gap in time between hitting the ER and the surgery.
An hour? A day? Was he sufficiently stabilized so that a transfer was possible?
People are usually transported to the nearest ER which may or may not be perceived by the patient as the best hospital for a given surgery. People are transferred all the time for reasons that have nothing to do with insurance and all to do with actual or perceived hospital’s reputation for specific diagnosis.
According to the OP’s link the guy did Enquirer about Insurance covering everything and was allegedly told all is well. Assuming this is true, it probably contributed to a satisfactory outcome.
Neither Trumpcare 1.0 or 2.0 addressed it. It is one of many, many issues that have been left to the state, all along. It’s right up there with how most states allowed state regulated insurers to deny coverage to applicants with preexisting conditions, or deny claims related to such conditions or charge a substantially higher premium.
States have historically had the authority ( and some would assert the responsibility) to advocate for consumers instead of insurance lobbies.
There are more than 400 medical conditions that insurers, left to their own devices, would rather not insure.
Diabetes which afflicts 20 million + people is one of those conditions. On average it costs the insurer nearly $10,000/ year to treat when complications arising from Diabetes are factored in.
Then there’s the 14 year old with a yuck Cancer diagnosis who could be seriously challenged to buy insurance in the Individual Plan market going forward.
I am fortunate that I have no preexisting conditions. It has not however prevented me from advocating for those who do. It’s one of those “ till it happens to you” things.
It made things worse for those of us who get our health insurance through our employers but the Obamacare plans are actually good. I know people who have them and their plans are much better than mine.
And tort reform hasn't lowered overall HC costs anywhere.
Why would it?
Medical malpractice claims have little to no bearing on medical costs.
Doctors make errors, and many errors are egregious.
Twice within 2 years, doctors at Tampa General amputated the wrong limb from two different patients.
Both men suffered from complications of diabetes that necessitated the amputate of a leg, but thanks to the doctor's errors, both men lost both of their legs.
Should the doctors get a lollipop?
No, the doctors should have paid each man $1 Million for the loss of the leg, plus $3 Million to make the doctor think twice in the future.
At the VA hospital, the surgeon comes round with the surgical nurse and physically marks the location of the incision on your body with a blue magic marker, while you're still conscious in pre-op, so there are no mistakes.
It's not rocket science.
Yes, 68% of medical malpractice cases were dropped, withdrawn or dismissed with prejudice in 2015, but that only suggests that one in two claims is frivolous.
There are remedies for that.
Both case law and State laws are shifting to require that "experts" now be 1) licensed in the same field (nothing like having a dermatologist testifying as an expert against an OB-GYN), and 2) the "expert" has to have been in practice or in academia within 5 years of the occurrence of the incident (no more using doctors who retired 20 years prior).
And a few States now require an expert to submit testimony on the standard of care within 60 days of filing the lawsuit, or the lawsuit is permanently dismissed.
Normally, because of the statute of limitations, lawyers will file the lawsuit, then they have several years to shop for an "expert."
Now, the focus is shifting to getting a doctor to admit another doctor breached the standard of care, which is tantamount to getting a cop to admit another cop broke the law or made a mistake, before they file the lawsuit.
Unfortunately, AMA lobbyists have successfully lobbied some States to cap damages for pain and suffering at $250,000 which is unjust.
Anyway, reducing frivolous lawsuits is much more effective at reducing costs than capping damages.
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what was wrong with it?
