The Sad Case of the Patient Protection and Affordable Care Act

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Anyone remember when it was a good recommendation to have at least 5 grand in the bank for emergency situations? I know that's another thread, but seriously...

I woke up thinking about this comment this morning. This sounds OK but take a reasonable scenario and see how it wouldn't be enough.

Meet Mr. X, a 30 yr old man who has squirreled away about 7K. He works hard at his job as a delivery man as well as a second job on the side doing some carpentry. The second job allows him to put aside $ for a rainy day. He has insurance with a 5K deductible because he is a healthy guy with no problems. He walks out onto the back steps one AM, slips on a patch of ice, and goes down a flight of stairs wrong way up. On the way down he badly fractures his right ankle and when he grips the bannister to stop his fall, wrecks his right shoulder and lacerates his forehead as he strikes his head and briefly loses conciousness. He badly enough hurt that he needs to ride in an ambulance. Lucky for him he just needs the ride and not much more attention (250$ (this is probably 2ce that))

ER visit- CT of head (1000$), xrays of neck, spine, ankle, shoulder and upper arm (1000$ to be minimist), Dr eval- (250+), Pain meds (another 200). They determine he has a concussion but no bleed, needs surgery on ankle with the placement of a plate and a few screws and has a minimal rotator cuff tear. He gets stitches in his head (100). He needs to stay in the hospital overnight waiting for the OR and a surgeon for his ankle (300 for the room and board, 7K for the surgery if we are being really nice/no complications. Oops there goes his nest egg but Yeay for him, he has met his deductible and only has a 250$ for copay and his coverage requires him to pay the first 1K for hospitalization). He gets discharged home in a cast after another day (300 + another 200 charged for various meds and IVs) with crutches, a wheelchair because he can't crutch too well with a bum shoulder (500$ this is not covered, excluded in his insurance). He can't work. He can't drive until after he is cleared by ortho in about 4-6 weeks if he heals amazingly well. He can't do his carpentry because altho he can get someone to drive him and his shoulder doesn't need surgery he has enough pain he can't use his arm consistanty. He didn't think he needed disability insurance because he was healthy. His job gives him 3 weeks of earned time for sick and vacation. He needs PT for both the ankle and shoulder 3 times a week for about 4 weeks because he has both ankle and shoulder issues (200/visit but his insurance only has a 50$ copay X 12). He will probably need PT after he returns to work once a week for a few weeks (50 X2) He needs to see the ortho for post op f/U (200 but only a 50$ copay) and again in 4 weeks (another 200 but he has a 50$ copay). He sees the primary care for removal of the stitches in his head (30$ copay). He needs a cast change in the middle of that (100 but only a copay of 50). He also has HA from the concussion that is persisting after 2 weeks so sees primary for that (30).

Meanwhile he is now out of work for 6 weeks because of his dual injry to shoulder and ankle. He has no income for 3 wks of it. This guy is probably not going to be able to tolerate 2 jobs for about 5-6 months, even if he is Superman, without ending up out again. If he is lucky he won't have lost his job but will probably lost some of his carpenty customer base. He will have residual pain and some loss of function no matter how good the outcome.

This is a best case scenario- the guy has no co-morbidities, doesn't end up needing shoulder surgery (which they would wait to do until he was mobile and would take 6 more weeks of out of work, PT, etc), his post concussive sx go away and he has a nice recovery from his surgery. He has no sick or vacation time left so he better not get sick or have any complications from the injuries because he can't take further time off and get paid.

Work out the math (I hate math so you can do it). This isn't an actual case but a composite of things I have seen with none of the complications that usually show up because they have dog's luck. I have probably underestimated most of the costs.

If the guy is uninsured the $ are even scarier. Go ahead and attach his pay. How much do you want of it % wise? How long do you think it will take for it to be paid off? How long is it going to take to build up a contingency fund of 5K for him, if he can?

This is a trauma, not a sudden dx of a chronic illness such as diabetes. If it was a chronic illness it require an equal amt or more of $ for testing/hospitalization but then require chronic expenditure for meds, follow up, testing etc. Most likely, despite absolute compliance on the patient's part sequelae occur which will increase the cost as more meds/treatment/testing occur. If it was your kid, not you, you would need to take time out from work to do all of that.

Think about it.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Thanks for the clarification. My choice of "founding fathers" was an ambiguous term, as technically I meant something a bit different than what I actually said.

Firstly, many of the people involved in the initial bid for independence (e.g Sam Adams and Thomas Paine, most notably) I'd consider "radicals" not "conservatives"; it was an unlikely alliance between radicals like Sam and conservatives like the well-to-do merchants who wanted to keep the tax dollars here rather than repatriate them out of the country, that fought side by side during the American Revolution. Jefferson in my taxonomy is clearly a "liberal" and not a "conservative", as well, and The Declaration of Independence, along with Martin Luther King Jr's "I have a dream" speech, are probably two of the most significant and eloquent expressions of "liberal" philosophy you can find anywhere, any time.

As I'm sure you recall, the first attempt at a central government, the Articles of Confederation, was not working as well as some people would have liked. That first "central" government did not have the necessary authority (in their view) adequately to referee conflicts between the states nor collectively to represent the states in foreign affairs. Many feared that the nascent nation would founder, rent asunder by internal conflicts, too weak to defend itself against an external foe.

Many historians call the enactment of the US Constitution the "conservative counter-revolution."

By "founding fathers" I was thinking more of luminaries like Hamilton, Madison, Jay (see The Federalist Papers), Washington, Franklin, "conservatives" all, the people whose writing and proselytizing convinced people to adopt the US Constitution, which is very much a "conservative" document. As I believe Rover pointed out, Washington "freed" his slaves in his will only after his wife's death.

And so, yes, our "first wave" of "founding fathers" was a nice mix of radicals, liberals, and conservatives, and even a few "monarchists" (who wanted to make Washington our first king!); which subsequently was upstaged by the persuasiveness of the solid "conservative" bloc that followed ten years later.



PS it does seem to be a truism that today's successful radicals become tomorrow's hide-bound conservatives! I think that drives some people crazy; because "the wisdom of your elders" keeps evolving.

Good post.

I would also add that though I like your distinction between the Revolutionary Wave and the Federalist Wave, a Third Wave that wiped out the Federalists came shortly on the heels of the second. I would call that third wave the "Democratic Wave," not in the sense of the current party (obviously) but in the sense of Jeffersonian elitist agrarian liberalism opposing itself to Hamiltonian elitist industrial conservatism. The Fourth Wave would then be the "Populist Wave," which began the process of extending rights to the general population in a sense that we would understand it as a modern democratic people, roughly like (and coeval with) the Chartist Movement in England.

Though the American tradition of political freedom starts even before the Revolution (I recommend Bernard Bailyn's "Ideological Origins of the American Revolution" as a good intro to the precursor movements in the state legislatures, town councils, and congregational organizations), the American traditional of political equality really only takes hold with Jackson.

I have to say, when you're not being copy-paste polemical you're one of the more interesting political posters on the board. More good stuff, less bad stuff, please!

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I woke up thinking about this comment this morning. This sounds OK but take a reasonable scenario and see how it wouldn't be enough.

Meet Mr. X, a 30 yr old man who has squirreled away about 7K. He works hard at his job as a delivery man as well as a second job on the side doing some carpentry. The second job allows him to put aside $ for a rainy day. He has insurance with a 5K deductible because he is a healthy guy with no problems. He walks out onto the back steps one AM, slips on a patch of ice, and goes down a flight of stairs wrong way up. On the way down he badly fractures his right ankle and when he grips the bannister to stop his fall, wrecks his right shoulder and lacerates his forehead as he strikes his head and briefly loses conciousness. He badly enough hurt that he needs to ride in an ambulance. Lucky for him he just needs the ride and not much more attention (250$ (this is probably 2ce that))

ER visit- CT of head (1000$), xrays of neck, spine, ankle, shoulder and upper arm (1000$ to be minimist), Dr eval- (250+), Pain meds (another 200). They determine he has a concussion but no bleed, needs surgery on ankle with the placement of a plate and a few screws and has a minimal rotator cuff tear. He gets stitches in his head (100). He needs to stay in the hospital overnight waiting for the OR and a surgeon for his ankle (300 for the room and board, 7K for the surgery if we are being really nice/no complications. Oops there goes his nest egg but Yeay for him, he has met his deductible and only has a 250$ for copay and his coverage requires him to pay the first 1K for hospitalization). He gets discharged home in a cast after another day (300 + another 200 charged for various meds and IVs) with crutches, a wheelchair because he can't crutch too well with a bum shoulder (500$ this is not covered, excluded in his insurance). He can't work. He can't drive until after he is cleared by ortho in about 4-6 weeks if he heals amazingly well. He can't do his carpentry because altho he can get someone to drive him and his shoulder doesn't need surgery he has enough pain he can't use his arm consistanty. He didn't think he needed disability insurance because he was healthy. His job gives him 3 weeks of earned time for sick and vacation. He needs PT for both the ankle and shoulder 3 times a week for about 4 weeks because he has both ankle and shoulder issues (200/visit but his insurance only has a 50$ copay X 12). He will probably need PT after he returns to work once a week for a few weeks (50 X2) He needs to see the ortho for post op f/U (200 but only a 50$ copay) and again in 4 weeks (another 200 but he has a 50$ copay). He sees the primary care for removal of the stitches in his head (30$ copay). He needs a cast change in the middle of that (100 but only a copay of 50). He also has HA from the concussion that is persisting after 2 weeks so sees primary for that (30).

Meanwhile he is now out of work for 6 weeks because of his dual injry to shoulder and ankle. He has no income for 3 wks of it. This guy is probably not going to be able to tolerate 2 jobs for about 5-6 months, even if he is Superman, without ending up out again. If he is lucky he won't have lost his job but will probably lost some of his carpenty customer base. He will have residual pain and some loss of function no matter how good the outcome.

This is a best case scenario- the guy has no co-morbidities, doesn't end up needing shoulder surgery (which they would wait to do until he was mobile and would take 6 more weeks of out of work, PT, etc), his post concussive sx go away and he has a nice recovery from his surgery. He has no sick or vacation time left so he better not get sick or have any complications from the injuries because he can't take further time off and get paid.

Work out the math (I hate math so you can do it). This isn't an actual case but a composite of things I have seen with none of the complications that usually show up because they have dog's luck. I have probably underestimated most of the costs.

If the guy is uninsured the $ are even scarier. Go ahead and attach his pay. How much do you want of it % wise? How long do you think it will take for it to be paid off? How long is it going to take to build up a contingency fund of 5K for him, if he can?

This is a trauma, not a sudden dx of a chronic illness such as diabetes. If it was a chronic illness it require an equal amt or more of $ for testing/hospitalization but then require chronic expenditure for meds, follow up, testing etc. Most likely, despite absolute compliance on the patient's part sequelae occur which will increase the cost as more meds/treatment/testing occur. If it was your kid, not you, you would need to take time out from work to do all of that.

Think about it.

You could keep tacking stuff onto your story, and it'd be like the cartoon where the two enemies repeatedly pull out bigger and bigger guns to top each other. Sure, 5 grand may not be enough in this day and age (might be up to at least 10 grand), but I would think it'd be up to the person to decide the safety net they need, do what they need to achieve it, and accept the resulting consequences (whether good or bad). Savings techniques need to be brought back at a young age (for example, do you REALLY need to go to that $10 viewing of Harry Potter with your buddies). It's like the old Aesop fable about the grasshopper and the ant.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

It's like the old Aesop fable about the grasshopper and the ant.

The question has always been, can we have a solution where people are expected to be responsible but are also covered in the case of catastrophe. That's the whole point of insurance, after all.

There are two problems: the risk of getting wiped out and the moral hazard of having free riders. I think what advocates on each side are saying is you

BTW, did anybody else know there is an alternative Ant and Grasshopper Greek fable where the ant is the bad guy? I sure didn't -- very interesting.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

The question has always been, can we have a solution where people are expected to be responsible but are also covered in the case of catastrophe. That's the whole point of insurance, after all.

BTW, did anybody else know there is an alternative Ant and Grasshopper Greek fable where the ant is the bad guy? I sure didn't -- very interesting.

I don't know if you can, because true enforcement of that (i.e. keeping it from being abused) brings in a lot of subjectivity, which is not something a law should have. There's probably a way you could do it, like offering an insurance policy where you have a maximum deductible that exists for all associated costs over a moving 14-day period (or however long would be a reasonable period for two large payments associated with the same catastrophe). This is one reason why I mentioned the government should simply come out with an insurance plan funded by those who choose to participate (NOT by stealing from people that don't qualify).

There were all sorts of those alternatives, like where Cinderella's stepsisters would cut off part of their foot in order to make the slipper fit.

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I recommend Bernard Bailyn's "Ideological Origins of the American Revolution"

Ironic that you should mention this book, I actually took that course from Bailyn himself, back in the day. A very good teacher; he seemed truly concerned that his students learn to marshall evidence, sift it and weigh it, review it analytically. He truly seemed more interested that you present a cogent analysis than whether you agreed with him or not.

when you're not being copy-paste polemical you're one of the more interesting political posters on the board.

It may be worth repeating that I rarely copy - paste anything with which I already agree; either
> I've noticed other posters discussing a subject, and I copy something that might be germane to them

"You folks were talking about this topic recently, and I read this and thought you might find it interesting"

> I have mixed feelings about the subject matter

"I read this recently and I'm not quite sure what to think...how do you folks see it?"

> I find myself annoyed at two or three people (rarely you) and I feel spiteful

"You think your such a smart&ss, don't you, well nyah nyah nyah"

I think I will do a lot less of the last one, it's not very considerate of everyone else who isn't directly involved....also I think of an old saying, "never try to teach porcines to sing, it frustrates you and annoys them."

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Ironic that you should mention this book, I actually took that course from Bailyn himself, back in the day. A very good teacher; he seemed truly concerned that his students learn to marshall evidence, sift it and weigh it, review it analytically. He truly seemed more interested that you present a cogent analysis than whether you agreed with him or not.

I took con law from Mary Beth Norton who was a Bailyn protege, and almost had a mother-in-law (that was close!) who was another Bailyn protege. Their synopsis of BB was "many academics spend their entire careers rewriting the same book, but if you're going to do that it may as well be a great book!"

[FreshFish]

Re: The Sad Case of the Patient Protection and Affordable Care Act

BTW, did anybody else know there is an alternative Ant and Grasshopper Greek fable where the ant is the bad guy? I sure didn't -- very interesting.

um, yes, it seemed to me that this tension always was latent in the story as I'd heard it told, the fable always was interpreted to me that both parties needed to adjust, not only one.

As soon as I saw the reference, my mind immediately thought of the Walt Disney cartoon. I was so impressed with that the very first time I saw it, it was a revelation, a blinding piece of brilliant insight that helped shape all of my subsequent moral thinking. That influence is apparent in my discussions here, about reciprocity and how everyone should contribute something. It was a very nice touch in the Disney cartoon, I thought, for the ant to remind the grasshopper that it actually did have something useful to contribute after all, when the grasshopper had forlornly started to turn away, before being called back by the ant!

I am quite impressed that the collective authorship of that wiki entry devoted so much space in the article to it. It is well deserved. I highly recommend people view it if / when they have a chance!

[ScoobyDoo]

Re: The Sad Case of the Patient Protection and Affordable Care Act

Just keep in mind that for a lot of people, 5 grand is about 3 months income. If 5 grand is 3 months income, there's not a snowball's chance in hell of saving it.

This and the 5 grand isn't the key item anyway. You need the 5 grand and insurance. If you can afford to save that much and have all the coverage you need then you're probably in a good spot.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

You could keep tacking stuff onto your story, and it'd be like the cartoon where the two enemies repeatedly pull out bigger and bigger guns to top each other. Sure, 5 grand may not be enough in this day and age (might be up to at least 10 grand), but I would think it'd be up to the person to decide the safety net they need, do what they need to achieve it, and accept the resulting consequences (whether good or bad). Savings techniques need to be brought back at a young age (for example, do you REALLY need to go to that $10 viewing of Harry Potter with your buddies). It's like the old Aesop fable about the grasshopper and the ant.

I think the point is (and I obviously did something wrong that you missed it) that people who do save and have good habits still land in big trouble that affects their long term ability to stay afloat despite their good habits. Accepting the consequence isn't in a vacuum. All of us suffer when those bills go unpaid. It affects the person's household, our insurance rates, the hospital's solvency, etc.

I do not disagree that there are some people who think they don't have $ but won't give up the latte or the manicure. They make me wild- esp if they are on public insurance and have more gold around their neck than I do in my house and are driving an incredible car. This does not discount the people who have very good habits and still can't make it.

[leswp1]

Re: The Sad Case of the Patient Protection and Affordable Care Act

This and the 5 grand isn't the key item anyway. You need the 5 grand and insurance. If you can afford to save that much and have all the coverage you need then you're probably in a good spot.

Man wins the prize.

[Carter]

Re: The Sad Case of the Patient Protection and Affordable Care Act

I woke up thinking about this comment this morning. This sounds OK but take a reasonable scenario and see how it wouldn't be enough.

Meet Mr. X, a 30 yr old man who has squirreled away about 7K. He works hard at his job as a delivery man as well as a second job on the side doing some carpentry. The second job allows him to put aside $ for a rainy day. He has insurance with a 5K deductible because he is a healthy guy with no problems. He walks out onto the back steps one AM, slips on a patch of ice, and goes down a flight of stairs wrong way up. On the way down he badly fractures his right ankle and when he grips the bannister to stop his fall, wrecks his right shoulder and lacerates his forehead as he strikes his head and briefly loses conciousness. He badly enough hurt that he needs to ride in an ambulance. Lucky for him he just needs the ride and not much more attention (250$ (this is probably 2ce that))

ER visit- CT of head (1000$), xrays of neck, spine, ankle, shoulder and upper arm (1000$ to be minimist), Dr eval- (250+), Pain meds (another 200). They determine he has a concussion but no bleed, needs surgery on ankle with the placement of a plate and a few screws and has a minimal rotator cuff tear. He gets stitches in his head (100). He needs to stay in the hospital overnight waiting for the OR and a surgeon for his ankle (300 for the room and board, 7K for the surgery if we are being really nice/no complications. Oops there goes his nest egg but Yeay for him, he has met his deductible and only has a 250$ for copay and his coverage requires him to pay the first 1K for hospitalization). He gets discharged home in a cast after another day (300 + another 200 charged for various meds and IVs) with crutches, a wheelchair because he can't crutch too well with a bum shoulder (500$ this is not covered, excluded in his insurance). He can't work. He can't drive until after he is cleared by ortho in about 4-6 weeks if he heals amazingly well. He can't do his carpentry because altho he can get someone to drive him and his shoulder doesn't need surgery he has enough pain he can't use his arm consistanty. He didn't think he needed disability insurance because he was healthy. His job gives him 3 weeks of earned time for sick and vacation. He needs PT for both the ankle and shoulder 3 times a week for about 4 weeks because he has both ankle and shoulder issues (200/visit but his insurance only has a 50$ copay X 12). He will probably need PT after he returns to work once a week for a few weeks (50 X2) He needs to see the ortho for post op f/U (200 but only a 50$ copay) and again in 4 weeks (another 200 but he has a 50$ copay). He sees the primary care for removal of the stitches in his head (30$ copay). He needs a cast change in the middle of that (100 but only a copay of 50). He also has HA from the concussion that is persisting after 2 weeks so sees primary for that (30).

Meanwhile he is now out of work for 6 weeks because of his dual injry to shoulder and ankle. He has no income for 3 wks of it. This guy is probably not going to be able to tolerate 2 jobs for about 5-6 months, even if he is Superman, without ending up out again. If he is lucky he won't have lost his job but will probably lost some of his carpenty customer base. He will have residual pain and some loss of function no matter how good the outcome.

This is a best case scenario- the guy has no co-morbidities, doesn't end up needing shoulder surgery (which they would wait to do until he was mobile and would take 6 more weeks of out of work, PT, etc), his post concussive sx go away and he has a nice recovery from his surgery. He has no sick or vacation time left so he better not get sick or have any complications from the injuries because he can't take further time off and get paid.

Work out the math (I hate math so you can do it). This isn't an actual case but a composite of things I have seen with none of the complications that usually show up because they have dog's luck. I have probably underestimated most of the costs.

If the guy is uninsured the $ are even scarier. Go ahead and attach his pay. How much do you want of it % wise? How long do you think it will take for it to be paid off? How long is it going to take to build up a contingency fund of 5K for him, if he can?

This is a trauma, not a sudden dx of a chronic illness such as diabetes. If it was a chronic illness it require an equal amt or more of $ for testing/hospitalization but then require chronic expenditure for meds, follow up, testing etc. Most likely, despite absolute compliance on the patient's part sequelae occur which will increase the cost as more meds/treatment/testing occur. If it was your kid, not you, you would need to take time out from work to do all of that.

Think about it.

For the last 10 years or so prior to my retirement, I was responsible for payroll and benefits for about 1000 employees. Near the end of my career, I had an employee come to my office expressing a need to change her health care provider since her husband had blown through his $2,000,000 limit for health care! I couldn't fathom reaching that max, but she explained how it happened. He was very ill with cancer, and needed doses of a blood product every 2 hours for about 3 days. Cost per dose? $30,000. That's only $360,000 per day. And that's just for that particular course of treatment. It had nothing to do with the rest of his intensive care. It just brought it all home to me that no matter how prudent you are about saving for a rainy day, when you get those 40 day/40 night rains, none of us can handle it. Very, very few people have an ark.

[Kepler]

Re: The Sad Case of the Patient Protection and Affordable Care Act

One large reason why the health insurance debate goes the way it goes.

[FlagDUDE08]

Re: The Sad Case of the Patient Protection and Affordable Care Act

One large reason why the health insurance debate goes the way it goes.

We'll die. It just won't happen that way.

[joecct]

Re: The Sad Case of the Patient Protection and Affordable Care Act

One large reason why the health insurance debate goes the way it goes.

Anyone check the actuarial tables?