patrick.net

I see the problem of the author. No one should be bashing him.

Before Obamacare, you could buy your own insurance. In my case, I could pay about $200/month.

Like the author, I have had income swings but when I was really making some dough in the early 90's I invested all of my savings. So, I have a large nest egg.

Today, I must buy Obamacare for $550/month, which I can't afford. However, if I have income under $24,000 in 2012, I'm subsidized. I don't want a subsidy, I want to buy insurance just as before before Obama made it illegal.

Obama makes you choose between being 1. uninsured 2. a welfare case.

Like the author, I object to listing my assets so that they can be stolen someday by the US Govt.

"Today, I must buy Obamacare for $550/month, which I can't afford. However, if I have income under $24,000 in 2012, I'm subsidized. I don't want a subsidy, I want to buy insurance just as before before Obama made it illegal.".

You can reject the subsidy and buy from insurance companies. You can buy on the market and get a subsidy. You can get Medicaid. You can also ignore all of it and pay a penalty (or not, if you aren't getting a refund, you can likely not even pay a penalty). You have myriad choices?

So, the only gripe is you're getting a subsidy you don't want or your old policy is discontinued. Seems like weak tea.

CL says

So, the only gripe is you're getting a subsidy you don't want or your old policy is discontinued. Seems like weak tea.

Some of us are disappointed that Obama Care was not the reform we hoped for but was instead a lobbyist written Insurance Support Bill that does nothing to address the widely acknowledged systemic failings of the American Healthcare System.
And then we are further disappointed to find out where we personally fit into this cumbersome boondoggle.

You INSIST that we be happy with our lot and grateful to the cartel interests and the corrupt politicians that gave us this complex bullshit in lieu of reform.
Steven Brill (http://livingwithmcl.com/BitterPill.pdf http://www.thedailyshow.com/watch/thu-january-16-2014/exclusive---steven-brill-extended-interview-pt--1) has done good unbiased reporting on the sad state of contorted incentives, perverse feedbacks and obscene profit taking of these entrenched interests. You might take a minute to acquaint your self with his reporting. When you defend ACA you defend this absurd system.

I will accept the circumstances that I live in and try to get access to Allopathy American Style (for what it is worth), that I can afford, but I am never going to bleat out a "Thank you sir, may I have another" to these motherfuckers.

Robert, saw this and thought of you:

http://www.huffingtonpost.com/2014/01/27/medicaid-estate-recovery-program-alec_n_4674277.html

But, I had another question (if you're done, you're done, no need to reply). What is it that makes you not want the subsidy? If whatever you were willing to pay prior to ACA plus subsidy gives you better than catastrophic coverage, why not?

(I'll read more of the Brill stuff soon. I used to subscribe to Brill's content, so it will be interesting to see what he's up to)

CL says

What is it that makes you not want the subsidy?

I don't understand why Obamacare supporters have so much difficulty comprehending this issue. YOU DON'T GET ANY SUBSIDY. THE SUBSIDY IS NOT FOR YOU. YOU DON'T GET TO KEEP ANY OF IT. You are an involuntary conduit by which subsidies go to the lobbyists that wrote the legislation, and in fact with Medicaid their subsidy can later be deducted from your estate, i.e. YOU SUBSIDIZE THEM, not the other way around.

Consider this example. An aspirin costs a penny - literally, at Walgreens, aspirin retails for one penny each. A "charity" hospital charges you $10 for that same aspirin (and pays no tax because it's supposedly a "charity", devoting 2% of its revenue to "charity" care). Oh, but because you're poor, you get a subsidy that might reduce your cost to $1. But, that subsidy is a loan, with the remaining $9 deducted from your estate when you die - which might very well be at the same hospital. Why aren't you hopping mad about that? Homefool goes on and on about how previously hospitals were charging $8 for that aspirin, then $9, a "double digit" (%) increase, then $9.50 and then $10, which are single digit (%) increases, so the $10 aspirin is "reduced" somehow by Obamacare even though it should only cost a penny. Mandatory subsidized insurance is the mechanism that enables the hospital corporations to charge $10 for something that should cost a penny, not to mention PhRMA's patented toxic placebos that make billions but aren't worth anything. You aren't the beneficiary, you are instead put in harm's way because the stampede of pigs rushing to the money trough runs right over you, like that hapless woman scarred for life because of a clogged pore that would have resolved on its own if she hadn't bought insurance that made her a target for a $20k procedure. You get overcharged for everything the legislation touches, and at best the subsidy shifts some of the overcharge onto your neighbors or younger people e.g. your kids.

Strangely, CL, you seemed barely even to acknowledge the Medicaid issue until HuffPo blamed it on ALEC - so now you can write about it, to say it's the other tribe's fault.

curious2 says

I don't understand why Obamacare supporters have so much difficulty comprehending this issue.

Well, wait a second. One answer is just don't go to the hospital. Since you likely will no matter what, it's certainly better to have insurance and no caps than the alternative.

It's my understanding that part of the reason hospitals as you mentioned charge the $10 for the aspirin is because there are so many that pay so little.

I'll agree that insurance distorts pricing. I had my car towed recently for a flat...I was covered by 5 different policies, but I couldn't help but think that I couldn't give a goddamn about how much it cost since it's covered. I can see how that can happen easily in medical insurance.

Short of the elimination of the entire insurance industry, it would seem that tying their profits to the amount they pay to the providers, caps on Executive pay, etc would at least make the Insurance companies be more mindful of the money they pay out. Since they are the actual payer, the cost will be more likely to be controlled if the payer, and the consumer make difficult choices. There will be people who should have bought Platinum when they bought Bronze. The consumer and the insurance companies both will feel pain from poor decisions, or be happy they made the right ones.

curious2 says

Strangely, CL, you seemed barely even to acknowledge the Medicaid issue until HuffPo blamed it on ALEC - so now you can write about it, to say it's the other tribe's fault.

I added the link mostly because it contains some history behind it. The fact that ALEC was a supporter, or that it was a conservative idea at one point mostly shows the GOP's blatant hypocrisy. I wasn't going for that, but to illuminate if there was some background he wasn't privy to.

RE: Medicaid. Don't just they make sure that (like in the Washington Post article), there isn't someone like "A 54-year-old former lawyer from New York City, who spoke on the condition of anonymity because she will be looking for a job soon, said that despite the prospect of free insurance, she did not enroll in Medicaid because she owns an $850,000 apartment she hopes to bequeath to a family member."

Don't they just illustrate that long term care is expensive? And that they'd like to have long-term care AND keep their assets for their heirs?

CL says

It's my understanding that part of the reason hospitals as you mentioned charge the $10 for the aspirin is because there are so many that pay so little.

As Curious2 mentioned, the actual cost is 1 cent. Do you really believe that 999 people are not paying for every 1 person that pays? No. Price is not determined by cost but supply and demand. When you went for job interviews last time, did you tell the employer that since your cost of living is only $2000/mo, so only want $24,000/yr instead of his job offer of $50,000/yr? Hospitals charge $10 per pill because they can do it! with the help of 3rd party pay.

CL says

Short of the elimination of the entire insurance industry, it would seem that tying their profits to the amount they pay to the providers, caps on Executive pay, etc would at least make the Insurance companies be more mindful of the money they pay out.

Only in the minds that are not cranking like the typical smart people running those companies. Insurance companies are already buying up hospitals and suppliers . . . so they can jack up the payout! and layer their government mandated capped profit margin on top of it. The result will not be lower cost for medicine, but even higher! We have gone through this sort of exercise numerous times before (e.g. 10% profit margin cap on munition makers leading to them throwing in the cost of everything including kitchen sink). The gullible are just too ignorant to learn; probably because they are too conceited to realize other people are smart too, perhaps even smarter than themselves!

Caps on executive pay are easily circumvented by stock options, like they did to the 1980's executive pay caps!

CL says

tying [insurers'] profits to the amount they pay to the providers....

has induced insurers to buy providers, e.g. hospital corporations, then raising prices further.

CL says

Don't they just illustrate that long term care is expensive?

Don't you ever ponder why these things are so expensive? Isn't that the real problem, that every step you take you are followed by vultures waiting to rob you if you stumble? You blame some woman for not wanting to lose the value of her home, but I don't understand how you can be so credulous when discussing an industry that routinely robs and kills people for profit (or "non-profit", which in California means spending on average 2% of net revenue on "charity" care that they billed for but were unable to collect, a loss ratio less than many retail stores and restaurants).

P.S. In case you can't be bothered to click on any links, I'll copy and paste for you:

"A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries.
***
Though hospitals’ nonprofit status allows them to reap tens or hundreds of millions of dollars in tax benefits, California Pacific Medical Center’s main campuses spent 1.27 percent of their more than $1.1 billion in net patient revenues in 2011 on free care for indigent or uninsured patients, lower than the state average of 2.07 percent, according to statistics compiled by the San Francisco Department of Public Health."

While lasik or invisalign braces are not essential care, they perfectly illustrate how prices are dropping in the free market as technology improves and/or becomes widespread, that is IF the insurances don't pay (dental pays a fraction for the braces and AFAIK lasik is not covered at all). All the mainstream medical technology, procedures and even some drugs routinely covered by insurance however keep getting more expensive (even without improvement), that's because price discovery is impossible and you have hardly any say in your visits/treatments. The system is broken, and Obamacare doesn't make it better (not addressing the veils of extortion), some say worse.

As Pelosi said, "we have to pass the bill so that you can find out what's in it" and your representative in Washington did just that. Also, any system of insurance costs money so you'd have to assume it was going to not be free. Be happy they are at least allowing you to hold your assets until death. I was thinking that if anyone accrues a medical debt, the balance of payment would be due immediately......

control point says

Robert Sproul says

The premium is in no sense "subsidized" except by tax credit which is zero use

to me. That puts my premium at full retail which is in excess of my house note

and most other bills that come into my modest household. I can't rationally do

it.

The tax credit is refundable.

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

This has been very helpful, control point.
My sincere thanks for trying to be useful to a stranger on the net.
A shout-out to drew_eckhardt as well for his helpful comment.
I may get to be a victim of Iatrogenesis after all.

curious2 says

Don't you ever ponder why these things are so expensive?

I do. Maybe I'm simple. I'm admittedly not an expert on insurance and medical issues.

It seems to me (correct me if I'm wrong) that yes, insurance distorts pricing. But we also enjoy the benefits of insurance for risk mitigation.

If we were to have no auto insurance, one would think that we'd be too paralyzed to drive, knowing that we may at any point be on the hook for $100K to replace your vehicle and the vehicle you accidentally hit. The results would be bad for the economy, as well as your own fortunes since you'd likely not go to work for fear of losing more than your income.

On a larger scale, medical costs would be devastating to most citizens. Long term care would wipe the majority out, hence the woman's goal of not paying for her own long term care.

Further, isn't insurance just a contract where policy holders agree to pay for each others' misfortunes. In its most basic sense, you and I could engage in the same contract..we could agree to pay each others' rent if we lost our jobs, or pool food resources if your crops failed to grow. Can the government even limit these types of contracts?

Given our relatively new (and costly) abilities to save children born months premature, or to animate bodies that are technically dead, the citizenry believe that any and all measures that are available to some should be available to them. The scarcity and costs of these situations also get passed on in the form of premiums.

So, it would seem we as a society are at an impasse. We need to ration, but hate anyone who does it (government or insurance), we "need" insurance, and can't stop legal contracts like insurance from being brokered, and insurance inherently interferes with price discovery.

So, what do we do? One thing seems to be true, though: the costs of some expensive patients is better distributed across millions of policy holders than 1,2 or 10.

And tell me which of the main changes from ACA would be desirable to repeal if you could itemize? Women or the elderly paying more? Less competition? More free-loaders? Less preventative care? Less portability? More rescission? Less standardization?

Even making people engage in making choices between coverage seems like it would be beneficial. Most of the complaints I hear seem like people are paying attention to the fact that they can't get everything they want, all the time, for "free". That seems like a very good thing.

(Uggh...I'm sounding like a Republican)

CL says

And tell me which of the main changes from ACA would be desirable to repeal if you could itemize? Women or the elderly paying more? Less competition? More free-loaders?

Maybe I'm misunderstanding you, but these rhetorical questions sound like sarcasm and mockery in the context of a serious discussion. At the risk of swinging at dirt, or at best a lowball, I'll try to respond to some of the more obvious misdirections. You seem to be using double negatives in a way that says the opposite of what you mean, or maybe you don't understand what the legislation does. Your comment about the elderly seems lost, unless you count age 64 as "elderly." You should know that Obamacare makes both men and women pay more than they did before, but charges men the same as women. It seems like you are trying credulously to suggest that ACA reduces "free-loaders," which would be an absurd contention, probably a reference to Democrats' "cost shifting" myth about "free-loaders" driving up prices by showing up at the emergency room and not paying. I've refuted that myth repeatedly: total "charity" care for people who don't pay, counted at full overinflated retail, is 2% of "charity" hospitals' net patient revenue, while the cost shifting of Obamacare is dramatically higher. Besides, hospitals could reduce their EMTALA "free-loaders" to zero simply by opting out of Medicare, but hospitals make so much $$$ off Medicare that they continue to participate, then they whine about that 2% loss factor and stir up useful idiots to punish "free-loaders" in order to rake in that extra 2%. You do sound like a Republican when you say that you want people to pay even more, but you sound completely delusional when you imply that Obamacare reduces cost shifting or "free-loaders". Obamacare increases spending, including cost shifting of all kinds, vastly more than those "free-loaders" you mock ever could; Obamacare also leaves 30 million citizens and 10 million aliens uninsured, so most of the original "free-loaders" you were gleefully hoping to punish will simply continue with higher prices producing even larger Dollar totals.

Oh, as a postscript, don't you wonder why the cost of insuring women increased even above the cost of insuring men, and even excluding pregnancy coverage? Didn't it occur to you to wonder if there might be a connection to all that diagnostic radiation, getting breast X-rays until they get breast cancer so they can be "saved" like Elizabeth Edwards? You sound like Paul the Apostle when you suggest with disingenuous seeming modesty that you're "simple," but it would be more accurate to say you're deluded and intrinsic to Obamacare's mandate is the refusal to tolerate others not sharing your delusion.

CL says

If we were to have no auto insurance,

But imagine what a tune-up would cost if it was "insured" I can picture $1100 oil changes with a $100 co-pay.
That is the warping effect of insuring against usual, routine costs. They say a colonoscopy can cost a couple hundred bucks in Europe without this manipulation.
You gotta read the Brill piece, friend.

Here is the "Insurance effect":
"Snakebite victim charged $89,000 for 18-hour hospital stay"
"Eric Ferguson, 54, from Mooresville, N.C., got the staggering bill for anti-venom medicine and a short visit at Lake Norman Regional Center, according to the Charlotte Observer, after a snake bit him in the foot while he was taking out the garbage.
According to his bill, the hospital charged a whopping $81,000 for a four-vial dose of the medication.
For comparison, Ferguson and his wife found the same vials online for retail prices as low as $750."
http://news.yahoo.com/snake-bite-89000-162515519.html

CL says

If we were to have no auto insurance, one would think that we'd be too paralyzed to drive, knowing that we may at any point be on the hook for $100K to replace your vehicle and the vehicle you accidentally hit. The results would be bad for the economy, as well as your own fortunes since you'd likely not go to work for fear of losing more than your income.

Then stay home! The maximum coverage of your existing auto policy is not likely to be more than half a million, or even $100k for most motorists. The typical state mandates are like $50k or less coverage. You can easily cause more than half a million in damages and medical costs. So stay the heck off the road, and let the rest of us drive.

BTW, food is really dangerous too. Thousands of people die of choking on food each year. That's before we talk about food poisoning, which kills tens of thousands of people around the world each year. So stop eating would be safer for you too. And better for the rest of us.

Robert Sproul says

But imagine what a tune-up would cost if it was "insured" I can picture $1100 oil changes with a $100 co-pay.

That is the warping effect of insuring against usual, routine costs.

Right. I can totally see how insurance can do that. When my car was towed, I didn't shop around, nor find out the range of service rates they might have. When someone else is paying, the consumer doesn't care. I said as much above. The question then would be, do we outlaw insurance? Can the Government limit a basic contract like that?

curious2 says

Maybe I'm misunderstanding you, but these rhetorical questions sound like sarcasm and mockery in the context of a serious discussion.

Not at all. I don't like Republican laissez-faire silliness, but perhaps in the interest of trying to see their points I've been duped. It seems to me that lots of different people from all ends of the spectrum have illustrated (like bacon & eggs, here) that they don't "need" insurance because they understand nutrition, or they believe in Jeebus, or just don't want to pay because if something happens, fuck it, the hospitals will not refuse me. I would have to think that people who don't pay into a system but use it must come at someone's expense.

Reality says

BTW, food is really dangerous too. Thousands of people die of choking on food each year. That's before we talk about food poisoning, which kills tens of thousands of people around the world each year. So stop eating would be safer for you too. And better for the rest of us.

Huh? That's why we have hospitals, and coincidentally, insurance, n'est-ce pas? Because if choking on a goddamned pretzel can topple the leader of the free world, eating is dangerous indeed.

The point is that insurance mitigates the financial danger to you so that you can continue to contribute to society rather than freaking out that you'll be bankrupted or killed. Whether or not someone USES their insurance as discount card, the service they've received is this mitigation.

Is that wrong?curious2 says

Obamacare also leaves 30 million citizens and 10 million aliens uninsured, so most of the original "free-loaders" you were gleefully hoping to punish will simply continue with higher prices producing even larger Dollar totals.

Again, financially speaking, I would think it would be a "good" to have anyone who is benefiting from the system to pay into the system.

Conversely, if those same immigrants pay into Social Security but don't receive the benefits, financially, that would benefit the US. More payers is better than less, right?

CL says

That's why we have hospitals, and coincidentally, insurance, n'est-ce pas?

Definitely "pas". Check where hospital revenues come from: it's mostly elective procedures. Actual emergencies like choking on food account for a small fraction. That's why most hospitals opt into EMTALA: it's a small price to pay for all that Medicare $.

Less than 10% of insurance goes to actually helping people in emergencies of the type that you seem to think Obamacare is about, e.g. getting hit by a truck. Most of it goes to things that confer no real benefit, e.g. Homefool's SSRIs, useless procedures, etc. 70% of of Medicare emergency hospitalizations result from four legal drugs, and Romneycare and Oregon both found that putting more people on Rx pills increased hospital emergencies. But, President Obama said anyone can get hit by a truck, so that must be what it's about, right? Wrong. That's a drop of coffee spilled into a bucket of saltwater, to keep you from seeing through it and maybe even fool you into drinking it. (Your tea metaphor seemed silly to me, but if you think only in beverages, what the heck.)

CL says

More payers is better than less, right?

First of all, everyone who pays taxes is already paying something. Even illegal aliens pay sales tax and often Medicare tax if they're working under a fake SSN. Obamacare makes everyone pay more, which increases revenue and power for its authors, though why you would say that's better is puzzling. You seem to be suffering some sort of lobster syndrome, where lobsters trying to crawl out of the pot are pulled back down by those stuck inside; perhaps you're paying a lot, and so you want others to pay more - misery loves company, even though it doesn't objectively improve your situation. I can observe that, but I can't respect it or approve of it.

Most people wanted reform that would reduce spending, i.e. paying less, but we got the opposite. There was plenty of room for reduction, but that would reduce revenues for the lobbyists who wanted more. They won, we lost. We might have to get over it, but we don't have to like it.

Honestly, your comments and Homefool's sound like somebody at Jonestown saying he really likes the Kool-Aid and can't understand why other people seem unhappy about it. I also must confess I'm tired. I'm not even going to bother re-posting the many links disproving the myths about preventive care supposedly saving money and so on, you can check my prior comments if you're curious but you probably don't care. I'm just through with wasting time on it. It's like the religion section, anonymous Internet comments and numerical evidence don't persuade people who want to believe, especially where a charismatic preacher fills their heads with platitudes that seem plausible if you don't check them. BTW, Jones was a great faith healer, he cured a woman in a wheelchair, so she could get up and walk, it was a miracle, every Sunday he healed her, right in front of everyone.

curious2 says

First of all, everyone who pays taxes is already paying something.

Sure. Something. But not enough to pay for everything we want. Alternatively, you could say we pay enough for all that we want, but Congress has a lot of nests to feather---They pay for a lot of things we don't want too. We don't get to line item the budget, only vote for vague principles embodied in individuals.

RE: Food. Not sure what you mean by tea, other than when I said it was 'weak tea'. Weak tea is an idiom that I did not invent--it means "less than convincing".

Lobsters: I have no problem with people receiving medical care on my dime. I would think that it would be responsible for people who CAN afford insurance to buy their own insurance. The mandate makes sense. I would have compassion for those who are unable to afford to pay. The subsidies take care of most of those issues, though.

I certainly don't want to pay for a nursing home. I'd like to keep all of my money and get all of those people to house, feed and treat me for free. I'm not sure they feel the same! :)

If you are not recommending the outlawing of insurance contracts, we have to deal with the reality of its benefits and its downsides.

The benefits are risk mitigation. The downside is that prices increase. Putting pressure on the insurance as the payer would help.

Isn't insurance regulated by state commissioners? Aren't premium increases reviewed and approved (or denied)? Didn't ACA add some regulations to make the patchwork quilt of State Regulators slightly more uniform?

Why would both Romney, a Conservative, and Sanders, a Socialist, even entertain this type of reform, much less praise it? Are you accusing Bernie of being in the pocket of Big Insurance? Sherrod Brown?

Could it be that ACA is large and complex, because there are a lot of issues that add up to a large problem?

Could it be that capitalism and a lack of regulation is to blame for most of our problems?

Why do we have retirement crisis? Why aren't people saving enough? Why is tuition so ridiculously high?

Is anything that increases the number of insured bad, in your view? If there were no mandate, but all uninsured went out and bought policies, would premiums go up? Would that be bad or good for those us who dutifully pay?

Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha…..Oh My!
Well, I figured out a way to sidestep my automatic enrollment in Medi-Cal and got an Anthem Blue Cross Silver Pathway X PPO Plan.
This led to the punchline of Obama's "Health" Care joke. It was quite the long build up, but a hysterical finish!
Turns out that when you are finally signed up, after you have navigated the cumbersome Covered California site, and wended through the obviously obstructionist provider interfaces (including several interminable calls to the Philippine "Customer Service" Center) and you have made your first payment (despite ABC's best efforts to not accept online payments) and received your shiny laminated Silver Direct Access Card….then, and only then, do you find out that NOBODY accepts this Covered California Crap Coverage. ABC provided me a list of 17 local Doctors who are "able to serve as primary care physician", NONE of whom are accepting this coverage. The local Gastro Clinic/Colooscopy Mill, that I have an appointment with next week, called me back to let me know they are not accepting it. Probably for the best as the web is full of stories about Anthem declining coverage even weeks or months after the service was provided.
Well, at least this "Health Insurance" that I can't use is pretty cheap!

Call it Crazy says

Wait, Harry Reid said the other day that all these stories of cancelled coverage and lack of doctors were all lies, all made up and weren't true...

Wait..wasn't Robert Sproul's issue that the Medi-cal folks were going to come after his assets? That's different than this problem, right?

CL, do you imagine that snowing people with blizzards of rhetorical questions will persuade them of anything? The OP avoided the first issue by signing up for an overpriced insurance policy that you pay for, but that cost doesn't confer much benefit upon him, if any, because he can't find anyone who accepts it. Is that clearer for you now? Should I add some more question marks, for emphasis or distraction? Which is the fire, and which is the frying pan?

CL says

Wait..wasn't Robert Sproul's issue that the Medi-cal folks were going to come after his assets?

Well, yeah, that was a problem for me.
But I think my real problem is the unmitigated greed of the corrupt sick care cartels and this simulacrum of reform that it has foisted on the American public.
Oh, and all the partisan apologists that love this absurdity because it has Obama's name attached and swear it represents "progress" and who are resistant to any dialog about its shortcomings. They are problematic as well.

Robert Sproul says

ABC's best efforts to not accept online payments

Other insurers also try to make online payments difficult or impossible. I suspect the reason is deniability: if you have an injury that might cost them a lot of money, they want to be able to say they didn't receive your check and therefore you're not covered. Their business model, which Obamacare makes mandatory, is to collect as much as possible up front, then shift it around and hide it in such a way that they don't have to pay anything. (For example, the mandatory prepaid "free" preventive care, including diagnostic radiation that you'd be better off without, but that they can charge a huge markup for at captive providers in order to meet the MLR requirement and shift the profit to the captive provider subsidiary so it doesn't appear on the books of the insurance subsidiary.)

Robert, Thanks for the update. This seems to be THE story in California. Will have to see if it has legs. From CBS:
The California Medical Association blames a big part of the inaccuracies on confusion over whether doctors are required or not to participate in Covered California plans. The Association said most of the insurers on the exchange have fine print to their contracts requiring that doctors in their networks accept Covered California policies. As a result, some of those doctors are mistakenly turning patients away.
Other insurers, including Anthem Blue Cross and Blue Shield, are giving doctors a choice. And many, particularly independent physicians, are choosing not to participate.
Some doctors told KPIX 5 that they are opting out because they said reimbursement rates for patients with Covered California plans are too low.
It should be noted: Consumers can also dis-enroll in a plan and choose another option, if they do so before the initial open enrollment period ends March 31.
I'm guessing Kaiser ends up the winner in this whole mess -- though, the Blue's may temporarily see a boost to their bottom line if no one accepts their coverage. Anyway, wait and see if we can find any feel good stories (Man finds PCP!) as only the worst are published.

curious2 says

The OP avoided the first issue by signing up for an overpriced insurance policy that you pay for, but that cost doesn't confer much benefit upon him, if any, because he can't find anyone who accepts it.

Well, yeah. But we've pivoted from "I don't want any insurance, I don't want Medi-cal" to "I have insurance, and it doesn't cover what I want it to".

Different problem.

EBGuy says

Consumers can also dis-enroll in a plan and choose another option, if they do so before the initial open enrollment period ends March 31.

So, Robert has the option of choosing a plan that covers what he wants, where he wants it (I assume). He can even switch plans before EOM.

At the risk of asking questions, did Robert get a subsidy?

CL says

At the risk of asking questions, did Robert get a subsidy?

Anthem Blue Cross got a subsidy. Or, rather, its parent corporation did. (Wellpoint, last I checked, but they keep merging and changing names.) In their last reporting year, Wellpoint made more than $2 billion net profit, after paying huge salaries and bonuses to all their top executives, who enjoy their private jets and public subsidies that you so slavishly extol.

Robert got a run-around, at your expense.

CL says

EBGuy says

Consumers can also dis-enroll in a plan and choose another option, if they do so before the initial open enrollment period ends March 31.

So, Robert has the option of choosing a plan that covers what he wants, where he wants it (I assume). He can even switch plans before EOM.

A press report says so, but Covered CA does not, so I would hesitate to rely on that advice. Anyway, with open enrollment ending this month, burned consumers will not be allowed to switch frying pans; they can only jump into the fire, at which point they may be liable for any remaining premiums that they agreed to pay during the enrollment process.

EBGuy says

Consumers can also dis-enroll in a plan and choose another option, if they do so before the initial open enrollment period ends March 31.

Thanks for the reminder that you supposedly can switch before the end of month.
I wish I was in Kaisers network area, I am nostalgic, now, for my years at Kaiser.
Far from perfect but I never felt scammed like I do by this boondoggle.

CL says

Different problem

You are correct, multiple problems.

CL says

the option of choosing a plan that covers what he wants, where he wants it (I assume)

I chose the "best" plan available to me. Silver, Baby!
It turns out it was shite.

One abiding irritation regarding this broken catastrophe of a health care system is the fact of effectively overcharging the cash customer.
I drove 45 minutes to see a General Practitioner yesterday and had my brand new insurance refused (Anthem lists him as a participating office)
So I shell out 137 bucks.
I understand that his reimbursement for that visit if I had been insured is about $89 or $84 if Medicare. I know of no other service transaction that penalizes instant cash receipt.

Robert Sproul says

So I shell out 137 bucks.

I understand that his reimbursement for that visit if I had been insured is about $89 or $84 if Medicare. I know of no other service transaction that penalizes instant cash receipt.

And, in Mexico, that same visit would probably have cost $30 or less. That's why the provider lobbyists required you to prepay via insurance, at American prices: they don't want to compete with Mexican provider prices. They saw Californians and Texans crossing the border to Mexico, and buying medicine from abroad too, and said effectively, "We saw what NAFTA did to union labor and we're not going to compete with those prices." The official penalty in the legislation (minimum $700/person starting next year, or higher depending on income) is only one side of the penalty; the artificially inflated provider prices are the bigger side.

BTW, if you wonder why Mexican prices are so low, part of the reason is nearly free public education for medical professions, in exchange for a year of public service in an underserved area. Also, Rx requirements are not enforced, so doctors are effectively competing against "free," i.e. patients seek them out when they need expertise, not permission. Mexico provides a public floor including basic emergency care and free clinics, and there is a comparatively free market (due to lack of enforcement of the Rx requirement), with plenty of supply due to the subsidized education of providers.

rooemoore says

Better yet, read the book I read about the effects of ingesting animal protein and fat.

http://www.amazon.com/The-China-Study-Comprehensive-Implications/dp/1932100660

This book's conclusions are largely ideological. While the *data* from the China Study are quite good and are useful to analyze, the actual book called The China Study by that guy Campbell is a load of crap.

He ignores the actual data from the China Study and also ignores data from his own independent studies and comes to the conclusion that animal protein causes "western" diseases, even though a lot of the data show that some of the people who had the most "western" diseases were people who ate the most vegetable protein.

For example, some of the most vegan areas of China had high numbers for diabetes and cancer. He also ignores a lot of confounding factors too. He largely mischaracterizes the data in the actual China Study and also analyzes some of it incorrectly.

There is a good takedown of the book available here by a former vegetarian:
http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/

And there's another one that I can dig up that discusses how Campbell even mischaracterized his own independent research outside of the China Study in order to push his agenda.

The war on saturated fat is a bit overplayed.

First of all, the conclusions from studies of this are often flawed, and the studies themselves are often flawed. Some show that coronary heart disease goes up and others don't. Some have cherry-picked data. Many of the studies show that eating more animal fat means that people often have lower death rates from non-heart-related issues. Even one of the greatly cited studies suggests that there is no relationship between dietary cholesterol and atherosclerosis (probably largely because the body has its own mechanisms to regulate cholesterol).

Second, it's no surprise that we use tons of corn and soybean oil in the US because those industries have good lobbyists, whereas we have imposed taxes on foreign-made oils such as palm or coconut and have vilified them in the media as being "bad" oils.

Third, we've greatly reduced things like use of lard, beef tallow, butter, etc. in our cooking, and if anything we've become less healthy -- more heart attacks, more obesity, etc:
http://authoritynutrition.com/6-graphs-the-war-on-fat-was-a-mistake/

The reality is that we don't know as much about food and eating as we think. People thought margarine was better than butter, until they realized it had tons of trans fats due to hydrogenation. We don't have a lot of good research telling us what we should eat because it's not like most of the studies show causal relationships or involve control groups -- they are largely correlations based on people's memories of what they did in the past.

corntrollio says

This book's conclusions are largely ideological.

That is a distressingly common problem in the whole area of deciding what is good or bad for your health. Outside of a few obvious facts, e.g. smoking and ionizing radiation are generally bad for your health, it is difficult to know what is best. At its core, Obamacare is fundamentally about taking away your choices, making you prepay for what the lobbyists say is "best," which tends to be whatever is most lucrative for them. If Obamacare had been only about true emergencies, which was the original Heritage idea,[see below] or even if it added vaccines, then it might have been a different story, but those total less than 10% of current spending so there wouldn't be enough revenue to push that proposal; we ended up with a federal corporate takeover, because that's much more lucrative.

curious2 says

If Obamacare had been only about true emergencies, which was the original Heritage idea

First of all, you can buy a catastrophic coverage policy that only covers emergencies if you're under 30 or meet the hardship requirements. Second, the Heritage idea was not just about catastrophic coverage, and I've already provided the link on this forum:

http://patrick.net/?p=1238991&c=1057267#comment-1057267

I don't think the Affordable Care Act is ideal, but it's better than what we had before, and most people in the aggregate will be better off, either by saving money or getting better coverage than their money bought before.

corntrollio says

the Heritage idea was not just about catastrophic coverage, and I've already provided the link on this forum:

http://patrick.net/?p=1238991&c=1057267#comment-1057267

Thanks, I crossed out that part. I had based my comment on an article that a defender of Heritage wrote, but you're right, even their 1989 proposal looked more like Obamneycare than true emergency coverage.

I disagree with you though about Obamacare being better or worse than what we had before, I think it's worse and that most people in the aggregate will be worse off. First, even the federal government's own projections show spending will increase faster than under prior law, which was already the most expensive system in the history of the world, so in the aggregate people will be paying more. If you except certain groups, e.g. hardship cases or ppl under 30 buying catastrophic plans, then (a) those people aren't getting a benefit from the legislation and (b) they are coping with a "market" where the legislation has artificially inflated provider prices even above where they were before. Second, in the aggregate people won't necessarily be getting better coverage, although they'll probably be getting more diagnostic radiation (causing more cancers), more toxic SSRI placebos, etc., all to increase spending even further. More to the point, tragedy can be defined as the gap between what might have been, and what is. I reject the partisan contention that Democrats couldn't have written better legislation, and I reject totally their efforts to blame that failure on people who voted against what they wrote. We had a moment, in 2008-2009, when change was possible; that hope got subverted, and the opportunity was lost, and now matters are worse.

curious2 says

If Obamacare had been only about true emergencies, which was the original Heritage idea,[see below] or even if it added vaccines, then it might have been a different story, but those total less than 10% of current spending so there wouldn't be enough revenue to push that proposal

What? The Affordable Care Act requires insurers to cover vaccines recommended by ACIP, last I checked. No deductible, no copay, no coinsurance, as long as you are in-network. I'm pretty sure this includes a yearly flu shot.

Also, not really sure why you're talking about re: CT scans, seems like a strawman. Every doctor I've dealt with has thought of CTs as a last resort thing -- try other stuff first, and if that's the last thing that helps diagnose, then do that. If anything, it's probably patients requesting them and doctors saying, "fine, whatever."

Once, I observed a doctor say "oh good, then I don't have to convince you not to get one," when the patient didn't want a CT if it was possible to go without one.

corntrollio says

What?

I don't understand your question. What are you asking?

As for vaccine coverage, Obamacare covers a restricted list of vaccines, and coverage is only relevant to the people who've bought the full freight coverage with all the baggage that entails. Actual vaccines cost even more now, due to the additional taxes and providers' markups ("no lifetime caps"). An actual flu vaccine costs around $10 wholesale, but through Obamacare with all the mandatory prepaid "preventative care" (including radiation) your flu shot visit can cost over $1k. Even if most of your cost gets shifted onto other people via higher premiums and taxes, it's still a >10,000% markup for a flu vaccine, with the markup being shared out to various revenue recipients and their lobbyists and the politicians they control.

As for C-T scans, America does more than 70 million/year. You're not dealing with a representative sample of doctors. The plural of anecdote is not data. The data show >70 million C-T scans every year.

curious2 says

As for C-T scans, America does more than 70 million/year. You're not dealing with a representative sample of doctors. The plural of anecdote is not data. The data show >70 million C-T scans every year.

Yeah, but my main point is that you basically read one slanted article and are acting like you're an expert on CT scans and are trying to generally say that health insurance encourages them (debatable -- they don't always want to pay for them). More generally, you are assuming that insurance companies are willing to pay for every test a doctor orders, which is very not true. It's naïve to assume that that's true.

CT scans aren't a monolithic entity, and despite the possible cancer risk of certain types, some types of them are safer than conventional therapy. Apologize for shitty source (USA Today), but here's an example:

http://www.usatoday.com/story/news/nation/2013/03/21/ct-scan-concerns/2005729/

They've replaced other tests that often carry more risk, he said. For instance, CT angiography has replaced catheter angiography to look for aneurysms and blockages, reducing the risk of stroke from 1% to 3% to nearly zero.

Yes, a large percentage of CTs are abdominal, and certainly some could be avoided. However, part of the reason for the proliferation of CT scans is that there are now highly specialized CT scans that weren't available back in the day, and many of these scans have lower risk and use lower doses.

Moreover, if you are getting repeated unnecessary CT scans, you should consider blaming (and possibly suing) your doctor, not the insurance company or Obamacare -- some of this sounds more ideological than based on fact/evidence.

curious2 says

but through Obamacare with all the mandatory prepaid "preventative care" (including radiation) your flu shot visit can cost over $1k

This is absolute nonsense and drivel. It's very clear you aren't a subject matter expert here and have made very little attempt to get informed. You can go to any drugstore or doctor and find out why you're wrong on this flu shot thing. You're just making some of this up at this point and using jargon like "no lifetime caps" nonsensically.

corntrollio says

This is absolute nonsense and drivel. It's very clear you aren't a subject matter expert here and have made very little attempt to get informed.

Funny, that was my reaction reading your comment. Mine is accurate, you can even find examples on PatNet where people have posted proudly about getting >$1k of "preventative" radiation where the only real benefit they got was a flu vaccine. If you want to blame the patients for their determination to "get more" for their mandatory premium dollar, that's blaming the victim, and it still comes back to the issue of leadership, with Obamacare's mandatory insurance including misnamed (even Orwellian) "preventative care" going the wrong way. The rest of your comment was mostly straw men, the USA Today quote being your only interesting statement, but even there "less bad is not better". In any event, you refuse to understand the economics of the scans, and the consequences of insurance companies buying providers, shifting the profit from the insurance side to the provider side within the same parent corporation. Insurers are often unwilling to pay for scans at providers they don't own, but it's a different story where they own the provider and can book >$1k radiation (that costs them under $100) as profit on the provider side and a "medical loss" on the insurance side. With the risk corridors and MLR, they get a guaranteed profit at the expense of everyone else, while you get irradiated. "Thanks, Obamacare."