Free Healthcare!

[Lauren]

My experience with Obama care

 

I'm a 33 year old healthy guy. I don't drink or smoke or so drugs. I'm also extremely active given my profession and not a lazy slob. My wife is 28 and at the time we have a 4 year old and a baby on the way.

 

As I small business owner we went through the marketplace for health insurance. To insure our entire family is was something like $1800 a month. To insure just my wife with high deductible it was around $400 a month and the kids. We went that route and because of timing I still paid out of pocket for our daughter that was born. For every doctor visit to the birth.

 

Now all three girls have insurance but I have forgone it because it doesn't make sense. I have had to go to the doctor once this year to a specialist and I paid cash for the visit and cash for the prescription I was prescribed. I see no reason for me to make a mortgage payment for all of us when the girls who are most important are covered.

[kirks5oh]

When you're right, you're right. I am going to find my primary care physician and get blood work done.

 

Find someone you like, and at the very least, once a year. That way you have a "home base" to go back to if you get the flu, throw your back out, etc etc. believe it or not, your family dr will see you as part of their "family" so to speak, and you'll get much better care then at an urgent care, when the dr there has no idea who you are.

 

Thumbs up

[Mojoe]

Insurance cost is so freaking ridiculous right now. I had seen that the national average was $623 a month for a family. That's a nice car payment. It's worth it to join the National Guard, and get full family coverage for $205 an month, or $56 a month for a single person, which is less than you would receive from you drill pay. Hope this health care cost issue changes soon.

[Geeto67]

Load of shit?? Really?? You're telling me that my personal experience as a surgeon is untrue??

no I am saying that you point of view is extremely one sided and based on a lot of generalizations. I'm not saying you didn't have these expirences, but the may not be indicative of the population as a whole.

 

 

 

By abusing the system I mean sit your ass in the waiting area of a local er for 24 hours and tell me about the demographics.

my grandmother was a nurse at flushing hospital for 40 years, I used to do my homework in the waiting room including the ER. You get all kinds. My father used to do rounds at St Vincent's during the AIDS epidemic and I used to come along so I've seen it.

 

Uninsured, unemployed patients overcrowd emergency rooms everywhere with complaints varying from headaches, common colds, to "fake" chest pain in order to get pain medication.

yes but you are not talking about a majority of the population, not everyone who is poor or underinsured is a drug addict, and not everyone who is prescription shopping is poor or underinsured. It's an access problem.

 

Do you have any idea how much it costs to work up chest pain?? Full labs, 12 lead, chest X-ray, possible ct scan. All because this guy wants narcotics.

yes I have a rough idea. It's not cheap. It's also not everyone complaining of chest pains. I've had that work up back in 2006 and they didn't find anything either, I wasn't prescription shopping but even after I declined any pain medication I'm sure my attending physician chalked it up to that just because he couldn't find anything.

 

Certainly your vast experience billing radiology in high school as well as two whole years working in a Manhattan law firm (likely as an intern gopher boy) qualifies you as an expert in any Columbus racing topic. And you were shocked that many plaintiffs were upper/middle class in MANHATTEN??? This is my surprised face. :dumb:

 

That is kind of my point, I have a different expirence from you and a different point of view with the healthcare industry. Actually being a med mal attorney (and that was a fully licensed attorney not some gopher) was my dream job given my feelings on the health care I actually left the practice for two reasons: 1) physicians are mostly arrogant pricks who take every med mal suit personally and are incapable of admitting fault or displaying any hubris even when it was clearly a deviation from the standard of care which made them a genuine pain in the ass to get them to make decisions like settle, and 2) the 210 billable hours a month minimum was giving me chest pains. Remind me some time about the physician we were defending who was on trial for attempted murder after getting caught buying an unlicensed hand gun from an undercover FBI agent for the purposes of killing a patient he was having an affair with. We had to defend the med mal claim where he deviated from the standard of care by sticking his penis in his patent. Do you think he saw it that way?

 

By the way, we were based in Manhattan but covered the tri-state area including all the major ny area hospitals and hundreds of private practices. For med mal we were the firm with the highest volumes in the country. We saw all cases, but I'm glad to hear that you think everyone in Manhattan is rich, it means the PR machine that is the NYC mayors office is doing its job.

 

 

You have to take every complaint seriously, even if that person was there two days ago with the same complaint. There is a huge level of burnout amongst er physicians (my sister has 15 years as an er doc) mainly because of the patient population.

100% agree.

 

 

The uninsured use the emergency room as their narcotic supplier, as their primary care doctor, and as their work excuse for having to take the day off working at Taco Bell. That's abusing the system, and it drives up the cost of care, burns physicians out, and clogs up er's for patients with real injuries. Over 50% of the patients my sister sees are bullshit cases, that should be seen by a family dr, or not at all. That's abusing the system.

again that's not every uninsured, and while it may seem like a lot because of the volume of patients a physician in the hospital system it still a minority of the overall population. It's a real problem for sure but it's not every damn patient and not a reason to not try and get healthcare to the underinsured.

 

In terms of preventative care, not many are interested. There has to be a change that incentivizes preventive care--like decreased premiums. You can't incentivize a population that expects to get everything for free. And there is a disproportionate amount of the lower socioeconomic population who are morbidly obese, diabetic, substance abusing, etc. that's a fact.

Don't disagree but some of that is attributable to previously unattainable access to healthcare, so why not try to solve for that part of it and take that part out of the problem. It's not going to solve the whole thing but it will help. Still it's not a problem exclusive to the lower classes.

 

You're talking about some random upper middle class guy in manhatten using his health insurance to fraudulently get health care for his mistress as a way to argue against my point that the lower socioeconomic class preferentially abuses the system through their insane, inappropriate usage of the emergency room--which is now spilling over into urgent cares and general practitioners' offices? Seriously? I can see why your stay at the manhatten firm was a short one. Tell me how this is "mostly bullshit" though

 

What I am saying is the current system is rife with abuses at all levels and all varieties, and victim blaming the lower class for one type of abuse is not solving anything. But go ahead, keep blaming a minority population for the ills of the system instead itself, it's totally going the pathway to a solution. :dumb:

[Geeesammy]

Free healthcare sucks a fat cock.

 

Need an example?

Look at workers comp, its a shit system littered with frauds on both ends. I went to some pile of shit doctor off morse rd. Since thats who my employer used. The doc was always late to my appt and just kept giving me pain meds for my back since he was a lazy fuck. Went there for two months with him doing nothing diagnostics wise and just saying it was a "lower lumbar sprain"

 

Over 2 years later my back still kills me all day and i have no clue what it is. Look at the last time a socialist economy worked out...never.

 

This isnt to say every doctor within workers comp is a fraud or shitty, ive yet to hear of anyone having a good experience with workers comp. Im well aware it isnt "free"

[unfunnyryan]

Free healthcare sucks a fat cock.

 

Need an example?

Look at workers comp, its a shit system littered with frauds on both ends. I went to some pile of shit doctor off morse rd. Since thats who my employer used. The doc was always late to my appt and just kept giving me pain meds for my back since he was a lazy fuck. Went there for two months with him doing nothing diagnostics wise and just saying it was a "lower lumbar sprain"

 

Over 2 years later my back still kills me all day and i have no clue what it is. Look at the last time a socialist economy worked out...never.

 

This isnt to say every doctor within workers comp is a fraud or shitty, ive yet to hear of anyone having a good experience with workers comp. Im well aware it isnt "free"

 

 

Workers comp fraud makes me want to be a PI. I might be a bit of a sadist getting joy out of busting people.

[macpyro2]

Workers comp fraud makes me want to be a PI. I might be a bit of a sadist getting joy out of busting people.

 

It's not as fun as it would seem. Most workers comp fraud cases they do not even hid the fact that they are fine.

 

I do agree though workers comp has a lot of fraud.

[HotCarl]

Personally, I'm a fan of High Deduct. plans. I've been on one since 2001 and find it great.

 

The key is to fund the account your first year in. Most employers at least partially fund it for you and if not, get it funded. Then if anything happens, depending on your plan, you're covered.

 

Case in point, if my son breaks his leg, wife a hip, etc. I'm responsible on our plan for the first $2,500. for the next 7,500 I pay 10%, once we're at $10k in bills I'm covered at 100%. Our family max out of pocket is $4,500 Thus for the first very bad incident, I'm going to pay $3,250 out of my pocket and then if another bad thing happens, I'll pay another $1,250 at which our plan is fully funded and we're all covered at 100%.

 

The rest is pure savings for time ahead including when the wife an I are old and gray. By "the rest" I mean the $453 +/- I put into my HSA each month that no one can take away. On the old style plans I paid that money and it was a pure waste. Money I would never see coming back to me.

 

Agreed. My situation is a bit different being single with no family but I opted for the high deductible plan. First 1500 is covered by my employer, second 1500 is covered by myself and anything over 3000 is 100% covered. Annual physicals are free.

 

I only go to the doctor when I absolutely have to anyway.

[Mensan]

My 58 year old mother has health care for the first time in her life due to the affordable care act. She pays $60/month and has excellent coverage, due to her income. She has never abused health care, she would never answer her phone on a visit. She was excited to get coverage because she wanted the things listed by Kirk.

 

I'm sure Kirk is right about the people he listed, but there are other people who need coverage and can't get it. My mom is a real world example of why the system was implemented, and I'm glad she has this opportunity.

 

However, I used to pay $77/week for family with excellent coverage and now my rates are $216/week, with a $2k deductible.

[944s2]

Personally, I'm a fan of High Deduct. plans. I've been on one since 2001 and find it great.

 

The key is to fund the account your first year in. Most employers at least partially fund it for you and if not, get it funded. Then if anything happens, depending on your plan, you're covered.

 

Case in point, if my son breaks his leg, wife a hip, etc. I'm responsible on our plan for the first $2,500. for the next 7,500 I pay 10%, once we're at $10k in bills I'm covered at 100%. Our family max out of pocket is $4,500 Thus for the first very bad incident, I'm going to pay $3,250 out of my pocket and then if another bad thing happens, I'll pay another $1,250 at which our plan is fully funded and we're all covered at 100%.

 

The rest is pure savings for time ahead including when the wife an I are old and gray. By "the rest" I mean the $453 +/- I put into my HSA each month that no one can take away. On the old style plans I paid that money and it was a pure waste. Money I would never see coming back to me.

 

This, all of this. I don't understand why I always have trouble convincing people of this. Just learn to save a little, tax free at that!

[Jewtoys]

My 58 year old mother has health care for the first time in her life due to the affordable care act. She pays $60/month and has excellent coverage, due to her income. She has never abused health care, she would never answer her phone on a visit. She was excited to get coverage because she wanted the things listed by Kirk.

 

I'm sure Kirk is right about the people he listed, but there are other people who need coverage and can't get it. My mom is a real world example of why the system was implemented, and I'm glad she has this opportunity.

 

However, I used to pay $77/week for family with excellent coverage and now my rates are $216/week, with a $2k deductible.

 

 

My company is small, under 20 employees, healthcare costs went up 180k over the previous year with worse coverage. Yay Obamacare.

[ForeverMaker]

My company is small, under 20 employees, healthcare costs went up 180k over the previous year with worse coverage. Yay Obamacare.

 

So at the small company I work for why is my coverage just as good/the same as before and I pay nothing?

 

The owner says he has always provided great coverage because it is the right thing to do and also said Obamacare has had little to no impact. I guess I am ignorant on the topic since I have never had to worry about it.

[Mensan]

My company is small, under 20 employees, healthcare costs went up 180k over the previous year with worse coverage. Yay Obamacare.

 

I think everyone on the side of being FOR this, including myself, naively thought that the companies would absorb the higher costs within their ridiculous profits and things may even out a little. IMO, that's what SHOULD have happened.

[Turbs3000]

My company is small, under 20 employees, healthcare costs went up 180k over the previous year with worse coverage. Yay Obamacare.

 

What kind of feedback did they give you on the jump? Our company of 100 went up about that and ppo's went away but they also sited things like:

-they (say) paid out in claims more then we paid in.

-our prescription costs are 3x that of average customers

-we were choosing more name brand vs generic options

-high rate of lifestyle illnesses ie. High blood pressure, High Cholesterol, Type II Diabetes.

 

Not that this is justification for an extremely broken system, it just speaks to the sickening costs associated with unhealthy lifestyles in said broken system.

 

Also at over 20k per employee, at what point do you just start cutting them a check and asking them to search for it on their own.

[C-Mart]

I could go on and on about this, as it is what I do for a living, but I'll keep it short.

 

"naively thought that the companies would absorb the higher costs within their ridiculous profits"

 

Most businesses are small businesses and most of those don't have ridiculous profits. The question becomes how many times can a company take a 40% increase on healthcare and where does it stop?

 

To combat this companies have:

Raised deductibles

Switched to HDHPs (high deductible healthcare plans) with tax advantaged savings for their employees

Raised the % the employee pays vs what the employer pays

Dropped healthcare all together (if under 50 employees)

Switched from fully insured to self funded and proactively educated its employees about bad habits that cost money - smoking, frequent emergency room visits, etc.

 

The smaller you are the less you can do. I have clients who got flat renewals this year and we have people in our agency that got 180% increases. There are so many variables that go into the calculation it is hard to say XYZ is why you got a raise and XYZ is why you didn't without looking at the specific companies losses and census data.

 

If anyone has specific questions I'd be happy to answer them.

[Supplicium]

Starbucks pays more money a year for employee health care, compared to all the coffee beans it buys per year.

 

I am seeing it in my business with 75~ employees. Costs doubled year over year since Obamacare. We now have to spend a ton of money and do a bunch of "healthy" work to maintain a 1-3% increase y-o-y by staying in a preferred risk pool. Healthcare is now my #2 expense.

 

To C-marts points:

we switched to high deductible HSA accounts

we raised what tobacco users pay and discount nonsmokers

we proactively educated our employees about bad habits that cost money - smoking, frequent emergency room visits, etc. etc.. that is for us to stay in our preferred risk pool.

 

The self-funded insurance is that the same as captive insurance? If you know anything about captive id like to chat.

[C-Mart]

I will PM you, but in case others are interested no, self funded and captive are not the same.

 

In self funding you are basically becoming a healthcare 'carrier'. You pay an aggregate and per employee stop loss, pay a TPA (third party administrator) to handle claims, and you are responsible for claims that aren't covered by the stop loss.

 

Captive insurance is a self-funded model that several companies make to share risk and group purchase the stop loss. It is a great way to 'dip your toe' in the water of self funding as you get data and transparency. The captive is typically, but not required to be founded outside of the country. After being in the captive for a number of yours you get an experience rating that raises or lowers your cost depending on your losses.

 

Companies that have 1000 employees don't need to be in a captive as they are large enough to purchase cheaply and have enough members to be actuarially sound. Companies 50-500ish can go self funded, but it comes down to the owners understanding of healthcare and appetite for risk.

[TTQ B4U]

My company is small, under 20 employees, healthcare costs went up 180k over the previous year with worse coverage. Yay Obamacare.

 

I think everyone on the side of being FOR this, including myself, naively thought that the companies would absorb the higher costs within their ridiculous profits and things may even out a little. IMO, that's what SHOULD have happened.

 

So a 20 person company should have to eat a $180k increase? Let's talk a 300 person company, can you imagine the increase they took? How about a 2,000 person company?

 

I find it hard to believe that anyone thought that passing that buck onto a company was going to even remotely be just be sucked up as part of the deal. No way.

[Jewtoys]

So a 20 person company should have to eat a $180k increase? Let's talk a 300 person company, can you imagine the increase they took? How about a 2,000 person company?

 

I find it hard to believe that anyone thought that passing that buck onto a company was going to even remotely be just be sucked up as part of the deal. No way.

 

Exactly.

 

It's the same thing with raising the min wage to $15 an hour, basically doubling someone's salary could easily cripple many small businesses that can only afford to pay min wage. Luckily my company pays well, and that's one less thing to be annoyed over.

 

 

But the cost hike was for no reason, in fact we had less claims than the previous year. Endless shopping around and went with the best deal. 180k increase is no joke, I can see the future, and having to drop it all together.... Sucks.

[Orion]

Pretty sure Mensan was talking about insurance companies, not small employers.

 

EMTALA back in 1986 was the beginning of the end for this country's healthcare system.

 

/End thread

[Turbs3000]

Pretty sure Mensan was talking about insurance companies, not small employers.

 

 

 

/End thread

 

I thought Eli was talking about insurance companies as well but could be wrong...

 

What do you guys mean by EMTALA being the end? I mean this as a serious question because I don't know. my super simple understanding is that it made it so hospitals couldn't both, collect government money and turn away people who were in dire need of care in the ER. Which at skin level seems fair.

 

For what that's worth Wiki says those that cannot pay account for 6% of hospital expenditures which, while a lot of money as a whole, a 6% increase on 1986 rated invoices would be nothing compared to how inflated the costs have become.

[TTQ B4U]

Pretty sure Mensan was talking about insurance companies, not small employers.

 

Okay. That makes more sense but still not all of it. There's no way one should have expected them to pick up the costs either. Why would they do that? They don't exist to provide Obamacare to all and simply eat it.

[Orion]

I thought Eli was talking about insurance companies as well but could be wrong...

 

What do you guys mean by EMTALA being the end? I mean this as a serious question because I don't know. my super simple understanding is that it made it so hospitals couldn't both, collect government money and turn away people who were in dire need of care in the ER. Which at skin level seems fair.

 

For what that's worth Wiki says those that cannot pay account for 6% of hospital expenditures which, while a lot of money as a whole, a 6% increase on 1986 rated invoices would be nothing compared to how inflated the costs have become.

 

EMTALA was the 1986 care act that caused the entire healthcare system to collapse. It's the Emergency medical treatment and liabilities act - which prevented hospitals from not treating emergency victims based on ability to pay, and also prevented patient dumping when insurance maxed out. So good news - people don't die unnecessarily from treatable traumatic injuries and pregnant women in labor aren't turned away and giving birth on hospital drop off areas... BUT;

 

It was an unfunded mandate. Congress and Reagan never allocated funds to PAY for the treatment it demanded the private sector now administer by law. So 3 things happened:

 

1: The private sector did what it always does: pass the buck to the consumer though higher prices at hospitals, so insurers paid more and then in turn demanded more from their premiums and copays.

 

2. Emergency rooms immediately became how the extreme poor (all 75 MILLION OF THEM ) sought medical treatment from everything from emergencies to asthma, which meant emergency care suddenly became the most in demand and expensive care, which extrapolated #1 above, THEN;

 

3. As medical insurance became more expensive, companies stopped offering it, or made it almost unattainable at family of 4 prices, so we started having larger and larger pools of Americans without coverage, using emergency rooms in a pinch. Pre-existing conditions KILL more than 365,000 americans between 1995 and 2010 who could not obtain insurance covereage (by reason of denial of coverage, not inability to pay). The cost of medical treatment becomes the #1 reason for bankruptcy.

 

 

Why? EMTALA. A case study in what seemingly idealistic but unfunded mandates can do to an ecomony.

 

 

Had they funded the mandate, of course taxes would have gone up. However, an additional bonus would have been that the .gov would be able to negotiate prices for Medication and procedures (in a similar fashion to how it happens in other countries with more socialized healthcare systems), thus keeping the costs for those items at least somewhat in check. Fund EMTALA, and I really think that we are not in this mess that we are today.

[C-Mart]

One of the strangest things about healthcare is the concealment of information. Information between providers (hospitals), carriers (insurance companies), and even the information shared with the carrier and the employer. Turbs3000 mentioned above the carrier told him his rate was going up because losses were higher than premium paid, but you are luck to get your loss ratio (losses vs premiums) let alone what types of claims they were so you can try to implement programs to cut down those costs.

 

When you are self funded you get this information, but companies don't typically go self funded until they are larger than ~250 employees and brokers tell them it is a bad idea because fully insured pays a lot more than self funded.

 

To jewtoys point, companies under 100 if not properly managed/advised by their broker had to switch to a premium calculation method called community rating (not saying this is what happened to him, but we saw it from some business we won). Community rating does not look at past claims, rather age and zip code - that's it. They changed the rate structure from a 10/1 max to a 3/1 max. In the old system a person with cancer could pay 10x more than the healthy person, in the new system it is 3x. What this did shorten the distribution so healthy companies that were previously underwritten paid a lot more and unhealthy companies paid a lot less.

Edited November 2, 2015 by C-Mart
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[2highpsi]

I would love to see a study comparing insurance premiums from 1986-2013 vs 2013-2015

 

EMTALA is not the problem. For damn near 30 years after EMTALA hospitals were profitable, insurance companies were profitable, and insurance was a hell of a lot more affordable. (For the people actually paying for it) The few people that I have seen actually get very affordable insurance through the ACA actually already qualified for assistance through existing programs like Medicaid.

 

Our insurance premiums have doubled in less than 3 years. My business's single largest annual expense is health insurance. The policy covers 8 full time employees (some of them are family plans) and costs more than I pay myself annually.

 

Between taxes and insurance costs, I honestly ask myself some days why I even bother.