The PPACA - Implementation Phase I

[DrDemento]

Re: The PPACA - Implementation Phase I

Does Bill Gates need health insurance? Does Warren Buffett? They can buy the practice, the hospital, and the local clinic and still refinance the Greek debt. You should not need health insurance to see the doctor for a common cold or for prescriptions (though some are pretty pricey)

I have homeowners and car insurance that protect me from catastrophic events - not routine maintenance. I have a $1,000 deductible for both.

Why can't I buy a medical policy that covers the big stuff and leaves me to pay for the routine stuff with an identical deductible? If I am chronically ill, then I voluntarily purchase another policy that covers the routine stuff.

Probably one of the proposals that was looked at and discarded was just catastophic coverage. In my thinking-makes the most sense. No one needs first dollar coverage on anything-just as long as any deductible is manageable. In fact having some sort of mandatory deductible might well be one of the best ways to decrease the cost of care. If everyone that presented to an ER had to pay some small token(perhaps as low as $2) for the visit-I would venture to guess a fair percentage of unnecessary visits would not occur. I try to manage our insurance costs(homeowners, long term care, disability, flood, automobile, etc) by maintaining the highest deductilbe i am comfortable with. Same with our health insurance-Jen's policy which will no longer be renewed by Horizon had a $5000 deductible and and a 20/80 copay. I just try to keep us covered against catastrophic events.

[unofan]

Does Bill Gates need health insurance? Does Warren Buffett?

What's funny is that Buffett supports Obamacare and criticizes it for not going far enough. Given the gates foundation's history of supporting medicine, I'm guessing he has similar views.

You really want to use them as your examples?

[Rover]

Re: The PPACA - Implementation Phase I

Why can't I buy a medical policy that covers the big stuff and leaves me to pay for the routine stuff with an identical deductible? If I am chronically ill, then I voluntarily purchase another policy that covers the routine stuff.

You can. What's stopping you?

[Rover]

Re: The PPACA - Implementation Phase I

You'd think so, but not so much the case anymore.

First of all, the stigma of filing for bankruptcy, like the stigma of divorce, is gone.

Second, someone who has received a bankruptcy discharge is actually a pretty good credit risk. First, they don't have a pile of debt. Second, they are limited, iirc, with respect to how soon they can receive a second discharge, should they default on your loan.

I'm just basing this on my own experience in the finance industry (and not as someone who's been bankrupt ) but from a lending perspective post-economic crash these people get avoided like the plague. Now that's just my own observations, but I know of people with plenty of assets getting bounced for a loan that was less than what they had in cash in the bank because of bad credit. Mind you, I'm not sure about the internet based lenders...

[joecct]

Re: The PPACA - Implementation Phase I

Then why do millions of Americans not have health insurance? Why is one of the leading causes of personal bankruptcy medical debt?

Does Bill Gates need health insurance? Does Warren Buffett? They can buy the practice, the hospital, and the local clinic and still refinance the Greek debt. You should not need health insurance to see the doctor for a common cold or for prescriptions (though some are pretty pricey)

I have homeowners and car insurance that protect me from catastrophic events - not routine maintenance. I have a $1,000 deductible for both.

Why can't I buy a medical policy that covers the big stuff and leaves me to pay for the routine stuff with an identical deductible? If I am chronically ill, then I voluntarily purchase another policy that covers the routine stuff.

[SJHovey]

Re: The PPACA - Implementation Phase I

A couple of follow up points:

1) Not sure of your timeframe, but its not easy at all thanks to recent legislation over the past decade or so to just declare bankrupcy and have your debts wiped clean. Also, if you plan on buying a house anytime over the course of your entire life good luck doing so with ruined credit.

You'd think so, but not so much the case anymore.

First of all, the stigma of filing for bankruptcy, like the stigma of divorce, is gone.

Second, someone who has received a bankruptcy discharge is actually a pretty good credit risk. First, they don't have a pile of debt. Second, they are limited, iirc, with respect to how soon they can receive a second discharge, should they default on your loan.

[DrDemento]

Re: The PPACA - Implementation Phase I

I am in no way questioning your medical expertise which I'm well aware of nor claiming I have anything approaching it as I'm not in the industry. What I'm saying is a lot of things that would happen anyway are being chalked up to Obamacare when they have nothing to do with it. Now this isn't necessarily an argument you yourself are making, but a good example is the "businesses are laying off/hiring part-timers due to ACA". When this claim was made with a real business owner on Hannity's show, and a reporter followed up, it turns out his layoffs had zero to do with the ACA as he only had 4 employees and it was all about him wanted to cut staffing for his own purposes.

now that, i can fully agree with. Anytime this government passes legislation that is thousands of pages-and most of those who vote have not read(and if they did, they did not understand) there is always unexpected difficulties. This entire roll out was done probably with good intentions. Unfortunately they were terribly misguided and based a lot of assumptions on things that are just illogical. In 40+ years of medical practice-i have never once seen anyone happy to pay anything for anything. As a patient, I don't want to pay another doctor or a hospital for my own misfortunes. I also understand that the insurance industry will take every and any opportunity to use any of this to their advantage-which they are already doing.

[Rover]

Re: The PPACA - Implementation Phase I

That number doesn't surprise me at all. In fact, I'm surprised it isn't higher.

Many, many years ago, after I got out of college, before I had a family, and maybe most importantly, before I had any assets to protect, I played health roulette. I was no longer covered under my parents plan and I wasn't eligible under any employer plans. I remember distinctly talking with my dad about this. We talked about how if some disaster should strike and I'd incur a bunch of medical bills, I'd just have to file for bankruptcy and get rid of them.

There have to be any number of people who make that same choice now. They're just rolling the dice. They don't have anything to protect (lose) if they have to file for bankruptcy, so they're willing to take the chance.

For many it's not the small, everyday bills like the credit cards and mortgages that drive you into bankruptcy. It's the catastrophic loss, like unexpected medical bills or loss of employment that trigger it.

By the way, neither ordinary health insurance nor Obamacare are going to cure this. Many, many people can't even stand the hit of a $3000 bill not covered because of the deductible, when you pile it on top of their ordinary expenses.

A couple of follow up points:

1) Not sure of your timeframe, but its not easy at all thanks to recent legislation over the past decade or so to just declare bankrupcy and have your debts wiped clean. Also, if you plan on buying a house anytime over the course of your entire life good luck doing so with ruined credit. Banks aren't exactly handing out free money anymore. If anything its the opposite.

2) Every generation thinks the one that comes after them are candy-asses. Having said that, I think people in the 20's will make the right decisions. As I've often said to the people I affectionately call the "knucks'" out here, saying young people will just pay the fine assumes that they put zero value on actually being covered. Personally I don't think they're that cavalier about their own health.

3) Lastly I can't speak to every insurance policy. However the ones I've had operate on a sliding scale whereby you pay up to certain dollar amount (say 2K) over the course of the year for whatever rate the insurance company can get, then they start paying a greater % of the bills after that (80% in my case) up to a total out of pocket amount (maybe 7K). After that insurance pays everything in that given year.

[Rover]

Re: The PPACA - Implementation Phase I

I have made no arguement about anything other than the health insurance-don't infer. There is no mindset and i truly believe that the idea of providing health insurance is indeed a good one. The jury is out on what kind of coverage you or anyone else will receive in the future. I am one of the fortunate ones who know and can make decisions about what is a proper medical diagnostic workup and what is proper treatment. When it comes to medical expertise-it is not all created equal. As far as medical insurance is concerned i am simply quoting exactly what has happened for my wife with Horizon BC of NJ. You are bright and well informed and make some wonderful points about a lot of things-but this is one area of expertise that i think i might have a considerable advantage of over 40 years of medical practice dealing both with disease entities and all aspects of insurance to cover patient care.

I am in no way questioning your medical expertise which I'm well aware of nor claiming I have anything approaching it as I'm not in the industry. What I'm saying is a lot of things that would happen anyway are being chalked up to Obamacare when they have nothing to do with it. Now this isn't necessarily an argument you yourself are making, but a good example is the "businesses are laying off/hiring part-timers due to ACA". When this claim was made with a real business owner on Hannity's show, and a reporter followed up, it turns out his layoffs had zero to do with the ACA as he only had 4 employees and it was all about him wanted to cut staffing for his own purposes.

[SJHovey]

Re: The PPACA - Implementation Phase I

3 of 5 personal bankruptcies are medically related. Possibly more depending how much credit card debt you want to attribute to putting medical expenses on the card.http://www.cnbc.com/id/100840148

That number doesn't surprise me at all. In fact, I'm surprised it isn't higher.

Many, many years ago, after I got out of college, before I had a family, and maybe most importantly, before I had any assets to protect, I played health roulette. I was no longer covered under my parents plan and I wasn't eligible under any employer plans. I remember distinctly talking with my dad about this. We talked about how if some disaster should strike and I'd incur a bunch of medical bills, I'd just have to file for bankruptcy and get rid of them.

There have to be any number of people who make that same choice now. They're just rolling the dice. They don't have anything to protect (lose) if they have to file for bankruptcy, so they're willing to take the chance.

For many it's not the small, everyday bills like the credit cards and mortgages that drive you into bankruptcy. It's the catastrophic loss, like unexpected medical bills or loss of employment that trigger it.

By the way, neither ordinary health insurance nor Obamacare are going to cure this. Many, many people can't even stand the hit of a $3000 bill not covered because of the deductible, when you pile it on top of their ordinary expenses.

[DrDemento]

Re: The PPACA - Implementation Phase I

3 of 5 personal bankruptcies are medically related. Possibly more depending how much credit card debt you want to attribute to putting medical expenses on the card.http://www.cnbc.com/id/100840148

Now that is a number that I can fully appreciate-60% is substantial.

[DrDemento]

Re: The PPACA - Implementation Phase I

No offense, but this is the same sort of arguments conservatives make about the unemployed. Basically, its the "people who don't want to work so they get what they deserve" mindset, and you're far to reasonable to be delving down into stuff like this.

Regarding healthcare, there is a natural turnover in private insurance that has nothing to do with Obamacare as insurers change policies. The difference now is that you have an option when said insurers offer a new, even crappier policy - you can obtain insurance on the exchanges. As unofan correctly pointed out, a lot of people don't have insurance. The reason is most likely not that they're blowing money on big screen TV's . Its because they couldn't afford it or had trouble acquiring it. Problem solved now.

For my own insurance, no change in price this year to next year FWIW.

I have made no arguement about anything other than the health insurance-don't infer. There is no mindset and i truly believe that the idea of providing health insurance is indeed a good one. The jury is out on what kind of coverage you or anyone else will receive in the future. I am one of the fortunate ones who know and can make decisions about what is a proper medical diagnostic workup and what is proper treatment. When it comes to medical expertise-it is not all created equal. As far as medical insurance is concerned i am simply quoting exactly what has happened for my wife with Horizon BC of NJ. You are bright and well informed and make some wonderful points about a lot of things-but this is one area of expertise that i think i might have a considerable advantage of over 40 years of medical practice dealing both with disease entities and all aspects of insurance to cover patient care.

[unofan]

i would like to know if anyone can provide it-the percentage of personal bankruptcy that is caused by medical debt versus the percentage caused by credit card and mortgage debt from overpurchasing relative to income.

3 of 5 personal bankruptcies are medically related. Possibly more depending how much credit card debt you want to attribute to putting medical expenses on the card.http://www.cnbc.com/id/100840148

[Rover]

Re: The PPACA - Implementation Phase I

Unfortunately very true. But remember also to include a rather large number of people who actually choose not to purchase any sort of health coverage-many because they want to buy that new BMW or to pay for a large LCD TV. What we may be seeing is a somewhat apathetic public, that the government has underestimated the number of people who just do not feel that they need to spend the money to purchase any sort of health coverage. Just sayin.... This entire situation is just far more complex than what has been presented thus far. i would like to know if anyone can provide it-the percentage of personal bankruptcy that is caused by medical debt versus the percentage caused by credit card and mortgage debt from overpurchasing relative to income.

No offense, but this is the same sort of arguments conservatives make about the unemployed. Basically, its the "people who don't want to work so they get what they deserve" mindset, and you're far to reasonable to be delving down into stuff like this.

Regarding healthcare, there is a natural turnover in private insurance that has nothing to do with Obamacare as insurers change policies. The difference now is that you have an option when said insurers offer a new, even crappier policy - you can obtain insurance on the exchanges. As unofan correctly pointed out, a lot of people don't have insurance. The reason is most likely not that they're blowing money on big screen TV's . Its because they couldn't afford it or had trouble acquiring it. Problem solved now.

For my own insurance, no change in price this year to next year FWIW.

[DrDemento]

Re: The PPACA - Implementation Phase I

Then why do millions of Americans not have health insurance? Why is one of the leading causes of personal bankruptcy medical debt?

Unfortunately very true. But remember also to include a rather large number of people who actually choose not to purchase any sort of health coverage-many because they want to buy that new BMW or to pay for a large LCD TV. What we may be seeing is a somewhat apathetic public, that the government has underestimated the number of people who just do not feel that they need to spend the money to purchase any sort of health coverage. Just sayin.... This entire situation is just far more complex than what has been presented thus far. i would like to know if anyone can provide it-the percentage of personal bankruptcy that is caused by medical debt versus the percentage caused by credit card and mortgage debt from overpurchasing relative to income.