The PPACA - Implementation Phase I

[DrDemento]

Re: The PPACA - Implementation Phase I

I guess that's the main difference between experience and opinion, Doc. Knowing what works because it's actually been done compared to speculation about what might work if only people are virtuous enough.

One addendum I'd make to your suggestion is that everyone always be shown the entire bill. Under our current plan, I go to the doctor for a routine check up, I get billed for a $10 co-pay, and that's the only bill I see. I have to go well out of my way to find out how much the doctor billed the insurance company for the same visit.

The doctor I had for the past 11 years retired at the end of last year, explicitly to avoid the PPPACA mandates. He was very sorry to be forced to leave private practice, as he truly enjoyed working with his patients. The replacement is unsatisfactory: he doesn't deal with people, he only deals with symptoms. You are just another case study or a set of statistics to him.

Jen and i decided some years ago to do a similar thing. We closed the office and now I limit myself to consulting work only-virtually all of it pro bono. I loved practicing as a physician-but saw the handwriting on the wall. I am not, and will not be a provider. And i will not and never have taken orders from the government or any insurer or allow them to influence what was my best clinical judgement for my patients. It just became too frustrating.

[LynahFan]

Re: The PPACA - Implementation Phase I

Having grown up and lived under Canada's socialized health care system for 41 years, I can tell you that it doesn't always work. And it wasn't/isn't free. Universal health care is funded by federal and provincial income taxes that took almost half of my pay cheques (going back to the Queen's English )

People are literally dying waiting for treatment. Don't believe me? Then take a look at this essay from 2007. And our friends and family back home (including our best friend who is a doctor) would tell you that nothing has changed since the author wrote it in 2007.

Very similar to my experience living in the UK for 3 years. Long delays for appointments is just another form of rationing, which is unavoidable in a resource-limited environment. The US's current (previous?) system simply rations by ability to pay or obtain health insurance. It's not entirely clear what will end up being the "rationing" factor under Obamacare (but there will be one, or more) - long delays will probably be a part of it, as fewer people choose to become doctors due to the decreased profitability and increased regulation.

[FreshFish]

Re: The PPACA - Implementation Phase I

So these subsidized insurance plans, how many people are in for a rude awakening when their $200/month premium is actually more like $400/month and that it only becomes $200/month after you file your annual taxes? How many people are planning their monthly cash outlays/budgets for one number only to find out that they'll really need much more? See, when you sign the insurance contract, it specifically states that insured person owes the full premium, that the government money is more of an annual reimbursement/tax credit. 2014 and up through the 2015 tax filings should be an interesting and sad event.

You must spread some Reputation around before giving it to St. Clown again.

[FreshFish]

Re: The PPACA - Implementation Phase I

FF: I've said it before and will just reiterate it here-if everyone had to make some sort of small copayment(not sure what that amount should be, but I would bet as little as $2 would do it) for every medical visit of any sort-doctor or hospital or ER-the result might surprise a whole bunch of folks. When people have to reach into their wallet and pull out something-it often makes them a bit hesitant. No insurance coverage for the small fee, no credit card accepted, just plain old cash. Your post about catastrophic medical coverage is spot on. That is pretty much what i and my wife have carried all along-you just have to sit down and figure out what deductible you can live with comfortably. We do it with car insurance, home owners insurance, disability insurance, flood insurance, etc-so why should it be such a far stretch to do it with health insurance? This should not be misconstrued as the answer to all our problems-but why would it not be of some help in taming the rapidly expanding medical costs in this country?

I guess that's the main difference between experience and opinion, Doc. Knowing what works because it's actually been done compared to speculation about what might work if only people are virtuous enough.

One addendum I'd make to your suggestion is that everyone always be shown the entire bill. Under our current plan, I go to the doctor for a routine check up, I get billed for a $10 co-pay, and that's the only bill I see. I have to go well out of my way to find out how much the doctor billed the insurance company for the same visit.

The doctor I had for the past 11 years retired at the end of last year, explicitly to avoid the PPPACA mandates. He was very sorry to be forced to leave private practice, as he truly enjoyed working with his patients. The replacement is unsatisfactory: he doesn't deal with people, he only deals with symptoms. You are just another case study or a set of statistics to him.

[SteveP]

Re: The PPACA - Implementation Phase I

Perspective? Perspective is every other westernized country had socialized medicine that works. We have socialized medicine for retirees that works. Yet You want me to accept that medically caused bankruptcies are okay because at least the person isn't dead? Fark that.

Having grown up and lived under Canada's socialized health care system for 41 years, I can tell you that it doesn't always work. And it wasn't/isn't free. Universal health care is funded by federal and provincial income taxes that took almost half of my pay cheques (going back to the Queen's English )

People are literally dying waiting for treatment. Don't believe me? Then take a look at this essay from 2007. And our friends and family back home (including our best friend who is a doctor) would tell you that nothing has changed since the author wrote it in 2007.

What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.

My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.

[DrDemento]

Re: The PPACA - Implementation Phase I

I worked for a bankruptcy attorney for a year. The whole Chapter 7 process is a turnkey approach from start to finish. You enter client data into a software program and it populates all the forms, you print them out, client signs, attorney goes to court: he could do maybe 16 - 20 hearings in a day as each one takes 15 minutes or so.

I'd say about 40% of the filings were due to uninsured medical bills that totalled over $10,000.

Ironically, the health insurance plan that is being trashed in the left-wing press is the same plan that would have saved most people much grief, which is the higher deductible plan. A plan with a $3,000 deductible would still be burdensome, but it also would be affordable and allow people to get the catastrophic coverage they'd need without shifting all the excess costs to be paid by the rest of us.

A higher deductible plan also empowers people to become smarter shoppers, reducing their costs, because they actually see the price tag and respond accordingly.

When I was in my 20s, I had a plan with a $5,000 deductible (probably akin to $12,500 today). I negotiated my fees for routine and customary visits, the doctors always would agree to a lower sum because there was no paperwork involved which reduced their overhead. I have no doubt whatsoever that when private insurance was involved, the doctors and hospitals would adjust their billing upward accordingly.

Now, I'm already starting to look into the "concierge" type plan. While I'm not quite old enough yet for Medicare, it seems absurd to me that we aren't allowed to opt out of Medicare even if we want to. Why are we forced to subject ourselves to second-rate coverage even if we don't want it?

FF: I've said it before and will just reiterate it here-if everyone had to make some sort of small copayment(not sure what that amount should be, but I would bet as little as $2 would do it) for every medical visit of any sort-doctor or hospital or ER-the result might surprise a whole bunch of folks. When people have to reach into their wallet and pull out something-it often makes them a bit hesitant. No insurance coverage for the small fee, no credit card accepted, just plain old cash. Your post about catastrophic medical coverage is spot on. That is pretty much what i and my wife have carried all along-you just have to sit down and figure out what deductible you can live with comfortably. We do it with car insurance, home owners insurance, disability insurance, flood insurance, etc-so why should it be such a far stretch to do it with health insurance? This should not be misconstrued as the answer to all our problems-but why would it not be of some help in taming the rapidly expanding medical costs in this country?

[DrDemento]

Re: The PPACA - Implementation Phase I

Perspective? Perspective is every other westernized country had socialized medicine that works. We have socialized medicine for retirees that works. Yet You want me to accept that medically caused bankruptcies are okay because at least the person isn't dead? Fark that.

Careful UNO-I am not sure of what the defintion of 'works' is. Statistics are wonderful in that you can use them to prove just about any point one makes. The ratio of population to MRI machines in Canada(a very westernized nation with socialistic medical care) is much higher than here in the US. I can order an MRI right this moment here in NJ and have it approved and performed(and perhaps even read) in 12-24 hours(and perhaps even as fast as 6 if i need it. My friends in Scarborough had to wait 4 months on a list for the same test. True the usual numbers thrown around-infant mortality, life expectancy, etc can give some people all sorts of ammunition-but please remember that those are comparing distinctly different sets of populations. Anyone who believes it fair to compare a homogeneous population like Japan or Sweden or Norway withe the great melting pot of the US is seriously deluding themself. Recent numbers from countries now seeing increased immigration and minority population expansion are beginning to show the same strain on medical resources that we have here. I suspect the jury is out on whether any system currently used for medical care truly works well. probably a ludicrous statement but it may turn out that the only way to limit the cost of providing truly good medical care-is to limit the number of people you have to provide care for. But anything resembling population control is just dead on arrival politically.

[unofan]

We can't do that - those "scams" as you call them are the source of the other peoples' money! I know it may be shocking to liberals, but we do, in fact, live in a world of limited resources, so paying Paul not only implies robbing Peter - it necessitates it. All the Peters in the world are just about to find out which end of the transaction they are really on...

Seriously, though - 50 years ago you would have died from that disease, no questions asked, and now you're whining about being alive to suffer through a bankruptcy? Perspective, please!

Perspective? Perspective is every other westernized country had socialized medicine that works. We have socialized medicine for retirees that works. Yet You want me to accept that medically caused bankruptcies are okay because at least the person isn't dead? Fark that.

[SJHovey]

Re: The PPACA - Implementation Phase I

Seriously, though - 50 years ago you would have died from that disease, no questions asked, and now you're whining about being alive to suffer through a bankruptcy? Perspective, please!

I've said it before, and will repeat it. The idea that citizens in this country, or humans in general, have some sort of fundamental right to health care is silly. It's a losing cause, people.

If you really want to make something a fundamental right, and make sure that we all get plenty of it, it's sex. At least that way we have a chance of keeping the species going.

[LynahFan]

Re: The PPACA - Implementation Phase I

Then that low cost insurance option for poor people that Fishy is spouting off about must not actually be that great of a deal, is it? If it covers nothing and still leaves you bankrupt, sounds like a scam by the insurance companies. God forbid we regulate that.

We can't do that - those "scams" as you call them are the source of the other peoples' money! I know it may be shocking to liberals, but we do, in fact, live in a world of limited resources, so paying Paul not only implies robbing Peter - it necessitates it. All the Peters in the world are just about to find out which end of the transaction they are really on...

Seriously, though - 50 years ago you would have died from that disease, no questions asked, and now you're whining about being alive to suffer through a bankruptcy? Perspective, please!

[ScoobyDoo]

Re: The PPACA - Implementation Phase I

And what does any of that self serving agit-prop have to do with the turkey the Democrats delivered to the American people? Why on earth do the ladies of the chorale continue to make the same logical fallacy? Didn't this cheap suit from Chicago tell us he was better than all of that? Smarter, too? Transparent, even. Well, he's transparent, all right. A transparent liar. And the American people are beginning to catch on.

Good, catch on all they want. They've already caught on to the alternative (Cruz) and they don't like that either. One thing is for certain in all this mess. Obama would have been better off if he had let the Republicans kill this bill before it ever became law.

Seems Microsoft and Amazon offered to help with the website and the Government turned them down. Whoever made the decisions about who to hire to develop this website might be the most incompetent moron ever to serve in Washington.

[Old Pio]

Re: The PPACA - Implementation Phase I

George lied to me. Numerous times. Seems to me every President since I've been alive has lied except maybe Jimmy.



That did wonders for the millions of uninsured and the 3 out of 5 bankruptcies that occur due to Health Care. Try again.

Here's another great part of the Republican Plan.

And what does any of that self serving agit-prop have to do with the turkey the Democrats delivered to the American people? Why on earth do the ladies of the chorale continue to make the same logical fallacy? Didn't this cheap suit from Chicago tell us he was better than all of that? Smarter, too? Transparent, even. Well, he's transparent, all right. A transparent liar. And the American people are beginning to catch on.

"Bush lied and people died" may still give you a reltney. But it's an artifact of a bygone age. And proves how hollow your arguments are.

[FreshFish]

Re: The PPACA - Implementation Phase I

I've seen variations of this theme in several places.

Republicans on the [House] committee are expected to talk about a bill they introduced Monday that would authorize insurance carriers to continue offering all plans currently sold on the individual market

Johnson (R- WI) introduced or is introducing a similar bill in the Senate.

These bills seem so reasonable: "if you like your current health insurance plan, you can keep it." How will the Ds vote? To honor their President's promise and uphold his word? or to put their electoral prospects at risk for 2014 to defend an increasingly unpopular bill that now seems to have been deliberately marketed with known falsehoods?


I'm disappointed that so many people are responding "so what if the President deliberately lied? it was for people's own good." Really? you like being treated like an incompetent child? that's your best defense??

[FreshFish]

Re: The PPACA - Implementation Phase I

Filing for bankruptcy is not the Sisyphean task some make it out to be. They make you jump through some hoops, but obviously it's being done, and if not at the same levels as before the law changed, not remarkably different.

I worked for a bankruptcy attorney for a year. The whole Chapter 7 process is a turnkey approach from start to finish. You enter client data into a software program and it populates all the forms, you print them out, client signs, attorney goes to court: he could do maybe 16 - 20 hearings in a day as each one takes 15 minutes or so.

I'd say about 40% of the filings were due to uninsured medical bills that totalled over $10,000.

Ironically, the health insurance plan that is being trashed in the left-wing press is the same plan that would have saved most people much grief, which is the higher deductible plan. A plan with a $3,000 deductible would still be burdensome, but it also would be affordable and allow people to get the catastrophic coverage they'd need without shifting all the excess costs to be paid by the rest of us.

A higher deductible plan also empowers people to become smarter shoppers, reducing their costs, because they actually see the price tag and respond accordingly.

When I was in my 20s, I had a plan with a $5,000 deductible (probably akin to $12,500 today). I negotiated my fees for routine and customary visits, the doctors always would agree to a lower sum because there was no paperwork involved which reduced their overhead. I have no doubt whatsoever that when private insurance was involved, the doctors and hospitals would adjust their billing upward accordingly.

Now, I'm already starting to look into the "concierge" type plan. While I'm not quite old enough yet for Medicare, it seems absurd to me that we aren't allowed to opt out of Medicare even if we want to. Why are we forced to subject ourselves to second-rate coverage even if we don't want it?

[SJHovey]

Re: The PPACA - Implementation Phase I

You're still missing the point. It's very difficult to file bankruptcy now. You have to go through credit counseling and jump through 5 other hoops before you can get it approved now. It isn't simple anymore. My bill from Mass General for my brain tumor was over $170K. Depending on how much my insurance covered, I was looking at filing bankruptcy. I was really looking forward to the counseling. "How could you have avoided gong into debt?" 'Let the tumor kill me.'

Actually, no it's not, but that was a nice little bit of media frenzy that created a big boon for bankruptcy attorneys back in 2005 when the law was changed.

If you look at the Federal bankruptcy court statistics going back to 2001, and dealing with the "non-business" filings (since we got onto this topic due to individuals being overwhelmed by medical bills), you'll see the numbers for Chapters 7 (liquidation), 11 (big income, big debt reorganization) and 13 (limited debt, limited income reorganization). http://www.uscourts.gov/Statistics/B...-december.aspx

Chapter 7, the complete startover method is far and away the most common method selected.

Between 2001 and 2004 Chapter 7 filings ran between 1,031,493 and 1,156,274, or about 1.1 million annually, on average.

Then 2005 came and the big burst of coverage proclaiming the impossibility of filing for bankruptcy when the law became effective at the end of the year, and we see a 50% spike to 1,631,011.

Then, of course, the numbers dropped off remarkably in 2006, likely due to multiple factors, including many who would have filed in 2006 hurried up and filed in 2005, while others accepted the impossibility of their situation and likely didn't even try.

By 2009 and 2010 we were back up over one million filers annually in Chapter 7, and back to the 1.4-1.5 million total in the non-business category.

To me the only interesting, and noticeable change in bankruptcy filings over the last dozen years (minus the 2005 spike), is the fact that Chapter 11 filings, those with unlimited incomes and unlimited debts, have doubled, on average. Admittedly it's a small number anyway, but you used to see around 900-1000 annually, and now they run as high as 1900 annually, and 1500-1600 on average.

Filing for bankruptcy is not the Sisyphean task some make it out to be. They make you jump through some hoops, but obviously it's being done, and if not at the same levels as before the law changed, not remarkably different.