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The patient-dumping seems to only be a problem in cities in blue states that have high poverty/homeless rates.
Which, of course, begs the question... If Democrats' policies are so great, WHY do they have such significant problems with high poverty and homeless rates in Dem-governed cities? And before someone claims poverty is mostly a rural white problem, that's not true. The highest poverty rates are in inner-cities.
Before the ACA, buying private insurance for yourself if you're self-employed, etc. was way cheaper.
True. Before the ACA disaster, a LOT of self-employed were self-insured for routine medical expenses and only had catastrophic policies for major injury/illness. MUCH cheaper and more cost-effective, as there is a strong financial incentive to remain fit and healthy.
Before the ACA, buying private insurance for yourself if you're self-employed, etc. was way cheaper.
Not really. You had more choices that covered less and less. But private major medical individual HC insurance was far from cheap. We were paying in the $14-16K range, and our premiums actually went down with ACA, and with less copays and deductibles.
When I worked as a military contractor I had Aflac which as a hiker these days I could really use just in case I break something, etc. a bit off topic I’m sure.
As far as insurance goes I’m not sure what if anything would work. My wife and I can’t afford a $1,000 deductible a lot of people can’t. Sure transparency is a good idea, but how is that going to help lower ones rates? 🤔
Depending on ones job health insurance doesn’t really cover much of anything these days. We got insurance for visual because we wear contacts/glasses but anything else we can’t afford. My wife has four tumors non-cancerous but that doesn’t mean down they won’t be. Whose going to insure her with Pre-existing conditions? Sure everyone says they will cover someone like her but not without a high deductible they won’t.
1) The problem isn't too little insurance - it's too much. When you require insurance companies to cover every last dime of every visit and procedure, such as we have with lower-income on subsidies, costs skyrocket on everyone else. We should thus go back to where catastrophic coverage is the norm, and premiums are around $100. (Those who are so poor as to not even have $100 already have Medicaid.)
2) For lower-income, a "routine expenses" account of around $2,500 would be provided (much cheaper than the $10,000 in annual subsidies we now provide) by which they could pay for a doctor's visit, a test for strep, whatever. Because services are free but are part of a count-down, lower-income would be mindful of the expense, and fees would drop as competition kicks in. This in turn would help the middle-class.
3) As far as transparency, we should require doctors and labs to tie - and disclose - their fees as relative to Medicare reimbursements, which is information readily available. Let's say the Medicare reimbursement for a test for strep throat is $80. The lab is free to set its own price, but would have to state it as 125% (or whatever) of Medicare. Thus, you could look up the strep test reimbursement, and know exactly what you'd owe - in advance. This would kick-start competition, and the ridiculous fees would drop.
3b) Similar requirements for hospitals. If they charge $1700 for 30 minutes in the OR, that would be known upfront. And hospital bills would drop.
1)The poor on Medicaid have trouble coming up with cab fare let alone having $100 at their disposal. These first few dollars part of our overall HC costs is very small. The trouble trying to collect it at the docs' offices is hardly worth the return. And it probably does not create higher HC premiums for you. Especially since you are more likely with a different insurance company. The bulk of your premium is based on your medical risks.
Catastrophic coverage would be way more than $100. A very large part of our overall HC spending is related to the enormous medical bills in a relatively small number of patients. This is a large part of our uninsurables/pre-existing dilemma. As new, highly technical and expensive treatments for previous lethal conditions emerge into general medical use, total costs go up significantly for full coverage insurance.
2)$2500 isn't going to cut it. This hurts the poor, the providers and hospitals, and doesn't do much for the middle class. Do you think your middle class taxes would go down? Do you live in a Red state that did not expand Medicaid?
3)Call and get the fees, or look online. Fee quote can be done these days. The problem is that total fees are hard to calculate when the needs for services is not clear. As with many acute, more serious and complicated medical issues. And that is where the big money lies.
3b)Call your hospital. If know how long your surgery is going to take, you can then compare with the hospital down the road. If there is one conveniently nearby, and your surgeon works there too.
I basically never agree with your posts , but I agree with everything here. There would need to be a few tweaks because there's a lot of ground between routine expenses and catastrophic (like specialist visits), but overall, this seems like a great compromise between the "pay for nothing" people and the "pay for everything" people. And I hate, hate, hate how everything is so veiled and non-transparent when it comes to medical costs.
I posted several pages ago about the direct primary care model, which I participate in and which is similar to this in terms of transparency.
It's sickening that something simple like getting stitches in the ER costs literally thousands of dollars. We can go to our direct primary care specialist for stuff like that and not pay anything at all (other than our monthly premium, which is very inexpensive), but if one of us got a nasty cut on a weekend, we'd have no real option other than the ER. We do have urgent care 15 minutes away, which is less expensive, but there's no list of prices, so I can't even say how much less expensive. The prices are out of control and the fact that it's all a secret is just about criminal.
Whimsy.....you agree with me for once! (You're getting smarter...)
Yes, I am aware there is a gap between the $2,500 provided low-income for medical expenses and the point at which catastrophic care would kick in, and that is where the breakdown will form between Republicans and the "leftist" faction of the Democrats. I would say there should remain a gap between where the taxpayers cover the costs for the low-income (via the $2,500 "expense account") and where the catastrophic insurance plan covers the costs, say $7,500. (These numbers are theoretical for this discussion.) That "gap" would be the low-income person's responsibility. The plan would have to be phased in, over, say 5 years, allowing the low-income person a chance to put away the $5,000 in the event a medical catastrophe strikes.
Say what, liberals? The low-income can't save $1,000 a year, and thus we can't put that on them? I say they can. It will take sacrifice, going without extras perhaps (like a dinner out here and there, monthly movies, whatever), but it can be done. My grandparents, like everyone of their generation, didn't know from Medicaid or Medicare. (Didn't exist.) They were very low-income, yet lived even more frugally than one would expect, in order to save for what was then called "a rainy day fund."
And remember....I'm talking about low-income, not the poor, who would still get Medicaid. I am talking about an individual earning $35,000 or $40,000.* People in that range can indeed put away $1,000 a year, or less than $100 a month, to build a "medical responsibility fund." I know one woman, for example, who earns about that, and she could save that amount just by forgoing her manicures and expensive "ready-made" dinners at Whole Foods.
So....that's the compromise. Taxpayers would STILL fund routine expenses up to $2,500, and it will be a rare year that one goes over. If one does go over with something major, the catastrophic plan covers it. But the "in-between" years, where medical costs total $4,000 or $5,000 - well, minus the $2,500 "pre-paid" bennie, people will have to dig into their "medical responsibility fund."
*If a person earning $50,000 is being asked to pay nearly $1,000 a month in insurance premiums, then a person earning $40,000 can put away that amount over the course of an entire year.
Location: Live:Downtown Phoenix, AZ/Work:Greater Los Angeles, CA
27,606 posts, read 14,630,065 times
Reputation: 9169
Quote:
Originally Posted by Rachel976
Whimsy.....you agree with me for once! (You're getting smarter...)
Yes, I am aware there is a gap between the $2,500 provided low-income for medical expenses and the point at which catastrophic care would kick in, and that is where the breakdown will form between Republicans and the "leftist" faction of the Democrats. I would say there should remain a gap between where the taxpayers cover the costs for the low-income (via the $2,500 "expense account") and where the catastrophic insurance plan covers the costs, say $7,500. (These numbers are theoretical for this discussion.) That "gap" would be the low-income person's responsibility. The plan would have to be phased in, over, say 5 years, allowing the low-income person a chance to put away the $5,000 in the event a medical catastrophe strikes.
Say what, liberals? The low-income can't save $1,000 a year, and thus we can't put that on them? I say they can. It will take sacrifice, going without extras perhaps (like a dinner out here and there, monthly movies, whatever), but it can be done. My grandparents, like everyone of their generation, didn't know from Medicaid or Medicare. (Didn't exist.) They were very low-income, yet lived even more frugally than one would expect, in order to save for what was then called "a rainy day fund."
And remember....I'm talking about low-income, not the poor, who would still get Medicaid. I am talking about an individual earning $35,000 or $40,000.* People in that range can indeed put away $1,000 a year, or less than $100 a month, to build a "medical responsibility fund." I know one woman, for example, who earns about that, and she could save that amount just by forgoing her manicures and expensive "ready-made" dinners at Whole Foods.
So....that's the compromise. Taxpayers would STILL fund routine expenses up to $2,500, and it will be a rare year that one goes over. If one does go over with something major, the catastrophic plan covers it. But the "in-between" years, where medical costs total $4,000 or $5,000 - well, minus the $2,500 "pre-paid" bennie, people will have to dig into their "medical responsibility fund."
*If a person earning $50,000 is being asked to pay nearly $1,000 a month in insurance premiums, then a person earning $40,000 can put away that amount over the course of an entire year.
Most people who consider themselves middle class (whether they are or not) can't put together $5k in cold hard cash. Expecting the working poor to do that is like wishing for a unicorn
1)The poor on Medicaid have trouble coming up with cab fare let alone having $100 at their disposal. These first few dollars part of our overall HC costs is very small. The trouble trying to collect it at the docs' offices is hardly worth the return. And it probably does not create higher HC premiums for you. Especially since you are more likely with a different insurance company. The bulk of your premium is based on your medical risks.
Catastrophic coverage would be way more than $100. A very large part of our overall HC spending is related to the enormous medical bills in a relatively small number of patients. This is a large part of our uninsurables/pre-existing dilemma. As new, highly technical and expensive treatments for previous lethal conditions emerge into general medical use, total costs go up significantly for full coverage insurance.
2)$2500 isn't going to cut it. This hurts the poor, the providers and hospitals, and doesn't do much for the middle class. Do you think your middle class taxes would go down? Do you live in a Red state that did not expand Medicaid?
3)Call and get the fees, or look online. Fee quote can be done these days. The problem is that total fees are hard to calculate when the needs for services is not clear. As with many acute, more serious and complicated medical issues. And that is where the big money lies.
3b)Call your hospital. If know how long your surgery is going to take, you can then compare with the hospital down the road. If there is one conveniently nearby, and your surgeon works there too.
OK, and now we hear from the liberal who claims that "$2,500 won't cut it" for the poor (conflating low-income with poor, who would still get Medicaid). I am talking about someone earning $35,000 - now getting subsidies that costs taxpayers as much as $10,000 a year! - pitching in a bit more. He will still get help, via the $2,500, and he will have catastrophic care for a major calamity. The true poor would still get Medicaid, but those above that need to have some responsibility.
You are demonstrating how liberals would destroy a reasonable compromise such as I am putting out, since they are focused totally on the low-income and poor, and what they need. The problem is that being giving, giving, giving them everything, to cover every little medical need, the middle class is unable to afford the health care THEY need. There's got to be a middle ground, and low-income earners above the Medicaid level need to pitch in. Don't tell me that someone earning $40,000 cannot manage to reduce spending by $100 a month. People earning $50,000, after all, have been asked to reduce spending by $1,000 to cover their ridiculous premiums.
Location: Live:Downtown Phoenix, AZ/Work:Greater Los Angeles, CA
27,606 posts, read 14,630,065 times
Reputation: 9169
Quote:
Originally Posted by Rachel976
OK, and now we hear from the liberal who claims that "$2,500 won't cut it" for the poor (conflating low-income with poor, who would still get Medicaid). I am talking about someone earning $35,000 - now getting subsidies that costs taxpayers as much as $10,000 a year! - pitching in a bit more. He will still get help, via the $2,500, and he will have catastrophic care for a major calamity. The true poor would still get Medicaid, but those above that need to have some responsibility.
You are demonstrating how liberals would destroy a reasonable compromise such as I am putting out, since they are focused totally on the low-income and poor, and what they need. The problem is that being giving, giving, giving them everything, to cover every little medical need, the middle class is unable to afford the health care THEY need. There's got to be a middle ground, and low-income earners above the Medicaid level need to pitch in. Don't tell me that someone earning $40,000 cannot manage to reduce spending by $100 a month. People earning $50,000, after all, have been asked to reduce spending by $1,000 to cover their ridiculous premiums.
The low income and poor make up the majority of this country due to the hierarchy of the job market
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, but I agree with everything here. There would need to be a few tweaks because there's a lot of ground between routine expenses and catastrophic (like specialist visits), but overall, this seems like a great compromise between the "pay for nothing" people and the "pay for everything" people. And I hate, hate, hate how everything is so veiled and non-transparent when it comes to medical costs. 
