Healthcare discussion from Pointedstick's "I'm Free" thread

[dualstow]

Here's some more bad news.

ObamaCare affected the individual health insurance market, not just Medicaid and the Marketplace Exchanges.

We pay out of pocket for our non-Obamacare ("extra-ACA"?), and the price has gone up several times over 3 years. Still doing better than a friend of mine, though, who was dropped completely.

[Kriegsspiel]

Mine went up to $260 a month for the highest deductible, so I just got rid of it and I guess I'll use the VA if I get sick. Which is doubtful, because I'm healthy. The kind of healthy that thinks $260/month is retarding.

[MachineGhost]

Mine went up to $260 a month for the highest deductible, so I just got rid of it and I guess I'll use the VA if I get sick. Which is doubtful, because I'm healthy. The kind of healthy that thinks $260/month is retarding.

VA isn't considered MEC to avoid the IRS penalty?

[Kriegsspiel]

The VA sent me some form that lets me avoid the healthcare penalty.

The only thing I'd like would be some kind of "emergency room only" insurance, but I'm not sure if that exists.

[MachineGhost]

The VA sent me some form that lets me avoid the healthcare penalty.

The only thing I'd like would be some kind of "emergency room only" insurance, but I'm not sure if that exists.

You better vote for Trump, then. He wants VA customers to be able to use any Medicare provider and that includes emergency rooms.

I've about pulled all my hair out trying to find a way around having to pay the Medicare premium. It's really not fair I can't take advantage of the taxpayer subsidies/cost sharing nor Medicaid. Here's a good explanation of what happened:

Supreme Court Snubs Citizens Whose Social Security Will Be Confiscated If They Refuse Government Health Care
http://www.cato.org/blog/supreme-court- ... government

[MachineGhost]

We pay out of pocket for our non-Obamacare ("extra-ACA"?), and the price has gone up several times over 3 years. Still doing better than a friend of mine, though, who was dropped completely.

Why would you still want to pay for your skyrocketing non-ObamaCare instead of getting the taxpayer subsidies/cost sharing on the Exchange?

[Xan]

We pay out of pocket for our non-Obamacare ("extra-ACA"?), and the price has gone up several times over 3 years. Still doing better than a friend of mine, though, who was dropped completely.

Why would you still want to pay for your skyrocketing non-ObamaCare instead of getting the taxpayer subsidies/cost sharing on the Exchange?

For us:
1) It's skyrocketing, but still much cheaper than the expensive and terrible plans available on the exchanges.
2) We don't qualify for subsidies/cost sharing.

[Kriegsspiel]

The VA sent me some form that lets me avoid the healthcare penalty.

The only thing I'd like would be some kind of "emergency room only" insurance, but I'm not sure if that exists.

You better vote for Trump, then. He wants VA customers to be able to use any Medicare provider and that includes emergency rooms.

I've about pulled all my hair out trying to find a way around having to pay the Medicare premium. It's really not fair I can't take advantage of the taxpayer subsidies/cost sharing nor Medicaid. Here's a good explanation of what happened:

Supreme Court Snubs Citizens Whose Social Security Will Be Confiscated If They Refuse Government Health Care
http://www.cato.org/blog/supreme-court- ... government

Well, I think at this point I'd qualify for some kind of awesome subsidy, so I wouldn't be paying $260 anymore. That's for hard-working suckers!

[dualstow]

We pay out of pocket for our non-Obamacare ("extra-ACA"?), and the price has gone up several times over 3 years. Still doing better than a friend of mine, though, who was dropped completely.

Why would you still want to pay for your skyrocketing non-ObamaCare instead of getting the taxpayer subsidies/cost sharing on the Exchange?

Yeah, what Xan said. I looked at the bronze plans on the exchanges and they were more expensive than what we have.

[MachineGhost]

We pay out of pocket for our non-Obamacare ("extra-ACA"?), and the price has gone up several times over 3 years. Still doing better than a friend of mine, though, who was dropped completely.

Why would you still want to pay for your skyrocketing non-ObamaCare instead of getting the taxpayer subsidies/cost sharing on the Exchange?

Yeah, what Xan said. I looked at the bronze plans on the exchanges and they were more expensive than what we have.

Would either of you join Medicare if Slick Hilly makes it available to 50+ or 55+? It's got a higher threshold than the subsidy cliff before the premium goes up:



Hmm, I wonder how they're gonna get the premium up to whatever it should be with these pathetic SS COLA increases. I bet they will find some way to screw over beneficiaries sooner or later.

What a nightmare. I hope Trump wins.

[Xan]

Would either of you join Medicare if Slick Hilly makes it available to 50+ or 55+?

I'd consider it in another 15 or 20 years...

[WiseOne]

It's a step in the direction of single payer, and I am hugely in favor of this. Medicare is cheap partly because reimbursements are generally lower than most private insurances offer, but also because their overhead costs are far lower than any of the private insurers. If it happens, step back and watch the flood of people retiring early. Including physicians

Of course, if they could just stop adding new administrative requirements for medical practices that would be so much appreciated...

[MachineGhost]

It's a step in the direction of single payer, and I am hugely in favor of this. Medicare is cheap partly because reimbursements are generally lower than most private insurances offer, but also because their overhead costs are far lower than any of the private insurers. If it happens, step back and watch the flood of people retiring early. Including physicians

Of course, if they could just stop adding new administrative requirements for medical practices that would be so much appreciated...

Medicare's overhead costs aren't normalized for the dramatically increased fraud over private insuers (since they pay first, verify later). Once you correct for that sheer stupidity, Medicare has more overhead than any private insurance. No government boondoggle is ever going to be as efficient or cost less than the free market, even single payer. Canada has a lot of problems with its single payer approach, includng insolvency. "Free market principles" have to be applied at all levels to work, especially the administrative, not just the delivery.

http://healthcare-economist.com/2006/07 ... ive-costs/

Seriously, you think that a government run single payer is NOT going to stop adding new administrative requirements? That would become their whole reason for being!!! Eventually it would turn into socialised healthcare because single payer "didn't work". The only way to stop this insanity is to get off the train.

Don't overlook that Medicare is due for insolvency in 2028. Adding people to the Medicare risk pool (at a lower cost) in the interim will only delay the inevitable day of reckoning. I want to argue that single payer is intrinsically uneconomically sustainable but don't have any data.

[MachineGhost]

I'm 56 and paying $450/month for a crappy $6000 deductible plan with no subsidy. I wish I could get onto medicare at those rates!

What level, bronze, silver, gold or platinum? As far as I can tell, Medicare is most similar to a gold plan.

You know, how can there not be more uproar and outrage over the fact everyone is being forced to buy these shitty government-approved Obamacare plans? Once the pre-Obamacare, non-Obamacare compliant grandfathered plans cease after 2017, I suspect people are gonna throw the bums out of Congress.

I read somewhere that Obamacare extended the bankruptcy date out by a few years for Medicare. I'm not sure how that worked, but giving out taxpayer subsidies against overpriced insurance seems like a stupid way to do it instead of getting more people into the Medicare pool.

[MachineGhost]

When is a government program ever "bankrupt" or "insolvent"?

Medicare Is Not “Bankrupt”
http://www.cbpp.org/research/health/med ... t-bankrupt

[Xan]

You know, how can there not be more uproar and outrage over the fact everyone is being forced to buy these shitty government-approved Obamacare plans? Once the pre-Obamacare, non-Obamacare compliant grandfathered plans cease after 2017, I suspect people are gonna throw the bums out of Congress.

I'm petrified of my grandfathered plan going away. How official is this 2017 date? I figured, especially with the recent Obamacare troubles, that there'd be no way they'd kill my grandfathered plan...

[MachineGhost]

I'm petrified of my grandfathered plan going away. How official is this 2017 date? I figured, especially with the recent Obamacare troubles, that there'd be no way they'd kill my grandfathered plan...

Very official. The deadline has been extended two times and the end of 2017 is final.

Sheesh, I'm almost tempted to pull a Reub and put "Vote Trump!" in my signature.

[Maddy]

Would Medicare be insolvent if it cashed in all those IOUs it's got stuffed in the top drawer?

Re the shitty Obamacare policies, what is the typical deductible at this point? I've wondered how the Ordinary Joes are deriving any benefit at all from these plans, since under most normal circumstances the deductible is never met and since the deductibe alone is enough to bankrupt most folks that are living from paycheck to paycheck. What's happening to these people?

[Xan]

I'm petrified of my grandfathered plan going away. How official is this 2017 date? I figured, especially with the recent Obamacare troubles, that there'd be no way they'd kill my grandfathered plan...

Very official. The deadline has been extended two times and the end of 2017 is final.

Sheesh, I'm almost tempted to pull a Reub and put "Vote Trump!" in my signature.

The fact that they've extended it twice makes it sound more likely to me that they'll extend it again rather than let it die. I guess we'll just have to wait and see.

Wait a minute! I was told that if I liked my plan I could keep it!

[WiseOne]

MG, please remember that in the world of Medicare, avoiding "fraud" is like trying to play a game of Fisbin. Here's some ways you can get tripped up:

- writing a note with only 12 instead of 14 points in the review of systems
- leaving out a fundoscopy in a patient for whom that exam is totally irrelevant
- documenting complaints in two organ systems instead of three.
- Vague documentation requirements for notes that we write to attest to a medical student's note. The latter can be six pages long, but it doesn't matter if some jerk with a high school equivalency diploma decides our note isn't extensive enough.

Even with all this, I still think Medicare is the most cost-effective system we have currently. Sorry MG. You're just going to have to live with that gold plan of yours for $100/month.

[MachineGhost]

Even with all this, I still think Medicare is the most cost-effective system we have currently. Sorry MG. You're just going to have to live with that gold plan of yours for $100/month.

Just so long as we acknowledge this is due to economies of scale and not the fact that it is goverment run. But at some point the economies of scale will meet that government boondoggle. I'm all for "Medicare For All" but we have to be realistic that you can't keep taxing productivity ad infinitum and not expect there to be adverse consequences. Perhaps taxing robots will actually make the world work as the politicians think it does.

And do note that the Medicare premium only covers 25% of costs. The other 75% is coming from general revenues. If socialism collapses over the next few years as it looks to do (more so in EU than here?), so will Medicare. Prudence would dictate that we still have private insurance as backup. Even Canada has bowed to the inevitable.

[WiseOne]

MG, do you want to have a think about your last post?

First of all, the "economy of scale" of which you speak is precisely BECAUSE Medicare is a government program, with compulsory participation by a large segment of the US population.

Second, Medicare costs are not covered from the "general revenue". There's a payroll tax that provides the revenue. Think of it as prepaid premiums.

Some interesting facts. In 2014, Medicare spending was $618 billion, Medicaid was $495 billion, and private insurance was $919 billion. The Medicare population (over 65, permanently disabled, high-cost qualifying conditions like renal failure and complicated diabetes) would be expected to be far sicker than either of the other two groups. The Medicaid spending is a combination of disabled and low-income people, whose numbers are growing quickly thanks to unbridled immigration. Private insurance covers those who are left - largely healthy and working people, easily managed chronic conditions, and self-limited problems. Think sore throats, ear infections, and broken ankles, along with the host of screening tests and preventative pharmaceuticals. It can't escape any of us that private insurance spending is way out of proportion to the government programs.

https://www.cms.gov/research-statistics ... sheet.html

[MachineGhost]

First of all, the "economy of scale" of which you speak is precisely BECAUSE Medicare is a government program, with compulsory participation by a large segment of the US population.

I admit the idea of a monopoly private company providing health insurance to all is probably impractical, but if a national risk pool can serve the same function along with competitive free market principles via insurance companies, I will vote for that instead of a single government-run boondoggle. Mostly because bureaucrats don't respond to consumer demand, are the opposite of consumer driven, nor are they on the ball quickly when it comes to approving vanguard medical procedures or technology to their "Government Approved List" (nevermind the corrupt crony capitalism that goes on behind the curtain). The "big breakthrough" with Medicare as of late is putting up a bunch of low effect "preventive" measures that's mostly for sick and/or old people to extend their life a wee little bitty by preventing Black Swan events from happening sooner rather than later. It's not gonna revolutionize the practice of medicine, just lower costs a little bit while expenses in other areas overwhelm those meager savings. Color me unimpressed, but it reflects the kind of bureaucratic-political mentality we could expect from a single-payor government run boondoggle for all. It could only get worse than that if we had socialized medicine... truly the stuff of nightmares.

Second, Medicare costs are not covered from the "general revenue". There's a payroll tax that provides the revenue. Think of it as prepaid premiums.

Au contraire! It's never been that way, but the payroll tax was a much larger proportion at outset than it is now. The payroll tax primarily funds all of Part A which is the hopsital insurance. Part B (physician) and D (drugs) comes from the premiums and general revenues. That explains why I don't have to pay a Part A premium. That makes sense, but of course you can't really get just Part A to make it a de facto catastrophobic plan without accumulating the onerous Part B and D penalties. Actually, now I wonder why I couldn't just drop out of Part B & D? Part A alone is considered Minimal Essential Coverage and the lawsuit that linked SS benefits to Medicare was only about dropping Part A. Hmm! Really, the only advantage Part B Medicare gives you is pre-negotiated prices instead of paying full "retail". But you could get the same effect with a discounted medical card without paying the Part B premiums or writing the appropriate legalese on the contracts from the doctors (I've done it before). Prices are all a contractual scam anyway as they can be set at whatever anyone wants it to be. Relying on coercion from a government-run boodoggle for price setting has its consequences.

Some interesting facts. In 2014, Medicare spending was $618 billion, Medicaid was $495 billion, and private insurance was $919 billion. The Medicare population (over 65, permanently disabled, high-cost qualifying conditions like renal failure and complicated diabetes) would be expected to be far sicker than either of the other two groups. The Medicaid spending is a combination of disabled and low-income people, whose numbers are growing quickly thanks to unbridled immigration. Private insurance covers those who are left - largely healthy and working people, easily managed chronic conditions, and self-limited problems. Think sore throats, ear infections, and broken ankles, along with the host of screening tests and preventative pharmaceuticals. It can't escape any of us that private insurance spending is way out of proportion to the government programs.

Spending isn't the same thing as "expenses" though. If spending is done privately, it is of no concerns to taxpayer and shouldn't be anyone else's business other than insurance companies and the consumer. If there is an adverse selection problem with healthy people all being on private insurance, then why should it logically cost more than government-run boondoggles? Also, Obamacare put on profit caps on private insurance, i.e. price controls.

Nearly all of our problems with health care has come from government intervention. In a country based on free market principles, I have to think this is purely by design by naive or evil Progressives to gradualize us to single payer or socialized medicine over time.

[Mountaineer]

Nearly all of our problems with health care has come from government intervention. In a country based on free market principles, I have to think this is purely by design by naive or evil Progressives to gradualize us to single payer or socialized medicine over time.

Although I frequently agree with your views, I must disagree with this one.

Nearly all of our problems with health care are because people get sick. Makes one wonder why, with all our supposed progress in medical science, life spans have not increased all that much.

http://www.livescience.com/10569-human- ... years.html

[Cortopassi]

I think in the next 10-20 years there will be some amazing breakthroughs, which may not necessarily extend life, but make it better to the end. Cures or management of Alzheimer's, cancer, heart disease, diabetes, etc. -- some are already well underway.

At some point I am sure we'll be able to unlock the mystery of why we get older and be able to halt it or severely slow it down. Not sure that's a good thing, but I just can't imagine at the pace of development we won't figure aging out.

I for one will gladly take a shot of nano machines and stem cells to improve my joints, eyesight, hearing, etc!