OT: Obamacare... Don't say we didn't warn you...

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Submitted by flu on September 10, 2013 - 5:45am

As many of you predicted... (SD Realtor, I think you win the most accurate prediction evar on this one!)

The implications of this on your future healthcare costs is left as an exercise to the reader....

Surprised? You shouldn't be... This is/was a "no-shit-shirlock" that companies would do this....And now that the domino has fallen, you can bet other companies are going to follow suit...

Plan well my friends, if you think your insurance costs are high now, you ain't seen nothing yet...

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http://www.bloomberg.com/news/2013-09-09...

GE to IBM Ending Retiree Health Plans Adds to Taxpayer Burden

America’s biggest employers, from GE to IBM, are increasingly moving retirees to insurance exchanges where they select their own health plans, an historic shift that could push more costs onto U.S. taxpayers.

Time Warner Inc. (TWX) yesterday said it would steer retired workers toward a privately run exchange, days after a similar announcement by International Business Machines Corp. General Electric Co. (GE) last year said it, too, would curb benefits in a move that may send some former employees to the public insurance exchanges created under the 2010 Affordable Care Act.
General Electric said last year that it would close its retiree plan to new entrants starting Jan. 1, 2015.

While retiree health benefits have been shrinking for years, the newest cutbacks may quickly become the norm. About 44 percent of companies plan to stop administering health plans for their former workers over the next two years, a survey last month by consultant Towers Watson & Co. (TW) found. Retirees are concerned their costs may rise, while analysts predict benefits will decline in some cases.
“Things are going to change dramatically,” said Ron Fontanetta, a partner at New York-based Towers Watson, which advises GE and other large companies. “Over the next two to three years, we see a much more aggressive rethinking of what employers are going to provide.”

Submitted by bearishgurl on September 10, 2013 - 3:36pm.

no_such_reality wrote:
I'm still worried about the expense curve between ages 55-65.

That silver/enhanced silver/gold plan is a little squirrely. If you're really expecting a hospital visit, then Platinum may be more cost effective. The silver has a deductible and the gold doesn't and the cost difference is the amount the deductible. Silver has a higher primary care visit but a lower brand drug expense after a $250/deductible. Then there are minor difference in the cost of certain coverage items.

I looked at this also, nsr, I'm in that age group and the details are a bit sketchy at this point. The SD broker I talked to back at the end of June told me that I may very well qualify for the Platinum Plan for $212-$222 mo out-of-pocket based upon the cursory data I gave him. I've got to look at the "Enhanced Silver" (not sure if I can borderline-qualify), Silver, Gold and Platinum plan differences a little more closely.

I don't really know if the two CA premium PPO carriers, Anthem Blue Cross and Blue Shield of CA will be administering the "Enhanced Silver" Plans, which are just a step up from MediCal/CMS (which will be administered my Molina Healthcare). In addition, I cannot use Sharp Health Plan or Anthem EPO because they do not have out-of-network coverage and I am in rural areas out of state for several days or weeks each year. We do not yet know which of the plans on Covered CA these two plans will administer. In any case, I will only choose a PPO and am less concerned about the deductible as ALL of them on CoveredCA are lower than my current deductible plus coinsurance.

I've recently had to fill two prescriptions where I was prescribed brand names but due to the brand names going to cost me 10-15 times as much as the "equivalent" generic, I had the pharmacist try to get permission from my drs to fill it generic. My drs did not want to write the generic prescription but verbally did so to the pharmacy at my request. I don't really know if generics are inferior or not. I guess it depends on what it is. And of course, for many drugs, there is no substitute generic.

I was paying just $318 earlier this year out-of-pocket for my healthcare premium until I decided to formally "retire" to get my healthcare allowance started. After I did so, my premium went wa-a-a-ay up. So $212 to $222 after tax credits and HC allowance (versus ~$80 for an "enhanced silver plan") won't kill me and will likely be worth it in the long run.

It has been my experience that you pay for exactly what you get in this life.

Submitted by SK in CV on September 10, 2013 - 4:09pm.

spdrun wrote:
The real question is "why was the Obamacare law written in such a fucking boneheadedly stupid fashion?"

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc

It is gradually tapered.

Submitted by no_such_reality on September 10, 2013 - 4:36pm.

SK in CV wrote:
spdrun wrote:
The real question is "why was the Obamacare law written in such a fucking boneheadedly stupid fashion?"

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc

It is gradually tapered.

Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it's a $5000-$7000/year difference.

The curve is basically designed so that 10% of your income is health care premiums and then hits a cliff at 400% FPL, where it can jump to 26% for a $1 income difference.

Submitted by SK in CV on September 10, 2013 - 4:43pm.

no_such_reality wrote:

Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it's a $5000-$7000/year difference.

The curve is basically designed so that 10% of your income is health care premiums and then hits a cliff at 400% FPL, where it can jump to 26% for a $1 income difference.

There is that "drop off a cliff" thing at the 400% of FPL. They screwed up when they attempted to integrate it with the maximum % of income. It's tapered below that level.

Submitted by bearishgurl on September 10, 2013 - 4:44pm.

no_such_reality wrote:
SK in CV wrote:
spdrun wrote:
The real question is "why was the Obamacare law written in such a fucking boneheadedly stupid fashion?"

Instead of making subsidies end at 400% of FPL, they should have gradually tapered subsidies to zero depending on family income, number of dependents, etc

It is gradually tapered.

Not really, at 299% of FPL, you get a $986/month Tax credit, at 399%, you get $863/month credit, at 400% FPL, you get $0.

IOW, two 64 year olds making $62,039/year get a $863/month credit where as those same two at $62,040/yr, get $0/month credit.

The benefits taper much better in the 100% to 200% FPL range, but a quick cliff shows up at the higher ages for 400% and it's a $5000-$7000/year difference.

Regardless whether an applicant can qualify for any subsidies at all, Covered CA premiums are HUGE improvement from what the individual plans are currently charging. I know a 62 yo female in SD who is in GREAT shape and currently paying over $1100 mo for indiv coverage. She will undoubtedly do MUCH BETTER on the exchange.

Other states premiums are lower than CoveredCA, but they do not necessarily correlate to a state's perceived level of cost of living. Since the carriers themselves did the pricing, the exchange pricing is based upon the usage level of the various age groups in different states. For example, some states have a much higher percentage of lifetime smokers than does CA and also higher levels of obesity, diabetes and heart disease due to regional diets and cultural habits and traditions.

Submitted by FlyerInHi on September 10, 2013 - 4:52pm.

GE and IBM and big companies ending retiree health benefits has been a gradual shift for a long time. It would have happened with or without obamacare.

Retirees should be so lucky that there is a a fallback different than being left out in the cold.

I have a relative who is about to retire from IBM in New York after about 40 years. We talk about it all the time. There is a seniority level. The more recent employees get different benefits than decades long employees.

Submitted by bearishgurl on September 10, 2013 - 9:59pm.

FlyerInHi wrote:
GE and IBM and big companies ending retiree health benefits has been a gradual shift for a long time. It would have happened with or without obamacare.

Retirees should be so lucky that there is a a fallback different than being left out in the cold.

I have a relative who is about to retire from IBM in New York after about 40 years. We talk about it all the time. There is a seniority level. The more recent employees get different benefits than decades long employees.

Medicare Part B, MediGap Coverage and Part D (Prescription Coverage) combined are a LOT cheaper per month than a comprehensive health plan for a 50-65 yo or even a HDHP (which, except for the "Bronze Plan" are now going away).

I have an Aetna Medicare Supplement Chart dtd 1/1/13 in front of me showing premiums as low as $90 mo (Plan "N") to $129.60 mo (Plan "F") for age 65 living in all SoCal zip codes. They charge $107.48 to $110.06 for Medicare Part B.

The 2013 Aetna Medicare Premier RX Chart (part D) shows premiums from $86.20 to $122.40 for SoCal ($118.40 mo in SD County). For example, generic drugs are $5 - $33 and preferred brand-name drugs are $45. Their annual drug-coverage cap is a generous $4750.

The total 2013 Part B/D premium PLUS the Plan "F" supplement (the best one) in SD County costs $355.48 mo ($107.48 + $129.60 + $118.40) for a 65 yo.

SoCal is a fairly high-cost region for medical costs. It can't cost those companies in the OP THAT MUCH MORE, if any more than SoCal for Part B/D coverage plus Medigap coverage. I agree that the move to dump these retirees into the marketplace with an allowance was just to prevent them from absorbing any future rate shocks (just in case "Obamacare" blows up in smoke and more revenue from the Medicare programs are sought to make up the difference) :=0

Nearly all the big carriers offer a Medicare Advantage Plan (Part C, which includes Parts B, D and Medigap coverage) in the large metropolitan areas, which have slightly higher premiums but appear to have too many built-in constraints and gatekeepers in my opinion ... they work kind of like "Tricare for Life." However, the patient doesn't have to fool around with medical bills because they never see any.

In any case, I'm going to "go away" to a rural-ish area where these types of plans aren't available.

(This posted was slightly edited later when I discovered I read the Medicare Supplement chart wrong.)

Submitted by FlyerInHi on September 10, 2013 - 8:37pm.

Someone said earlier that linking employment to insurance is bad. I agree.

That the link discourages mobility in the economy, especially for people who have families and medical conditions.

Submitted by livinincali on September 11, 2013 - 9:40am.

FlyerInHi wrote:
Someone said earlier that linking employment to insurance is bad. I agree.

That the link discourages mobility in the economy, especially for people who have families and medical conditions.

So you'd probably agree that defined benefit pension pensions do the same thing correct?

Submitted by SK in CV on September 11, 2013 - 9:57am.

livinincali wrote:
FlyerInHi wrote:
Someone said earlier that linking employment to insurance is bad. I agree.

That the link discourages mobility in the economy, especially for people who have families and medical conditions.

So you'd probably agree that defined benefit pension pensions do the same thing correct?

I wouldn't. The two have almost no similarity. You can separate from an employer and defined benefit pension plans remain intact (to the extent vested). Many allow for an immediate rollover to another plan. But they never disappear so long as the employer is following the law and funding the plan. Which means defined benefit plans are identical to defined contribution plans in that respect. Employer paid medical insurance disappears upon separation.

Submitted by harvey on September 11, 2013 - 11:44am.

What's the advantage of a system where employees have any financial ties to a former employer?

Many of the problems in the "retirement" systems would just go away if we got rid of the notion of "retirement savings." It's all really just "savings."

There's really no reason for employers to be in the health insurance business, even if they simply outsource it, as most do.

Likewise, there's no good reason for employers to be in the retirement savings/investment business. This is particularly true for government as an employer.

One's employer, health care provider, and long-term investments are separate concerns that should be handled be separate entities. The notion of mixing all these things together is a late 20th century phenomenon that needs to go away.

Note that I don't see issues with government being in the insurance business - e.g. Social Security and public health care. Insurance systems work better with scale, and there is no bigger scale than the federal government. But there are way too many issues with government being in the investment business.

Submitted by FlyerInHi on September 11, 2013 - 4:16pm.

I just got an email from someone saying Obamacare sucks with a link to a huffington post article reporting that trader joes is cutting health insurance for part time employees

Obamacare sucks or trader joes sucks? I think more the latter.

The real policy issue is that health care costs us all a society.

The real money is being spent on emergency services and end of life care. If everyone has regular checkups and is healthy, costs will go down.

I've known many people in between jobs with benefits who did without health insurance for years. Their health deteriorated during those years. Total health care costs are a function of the general health of the population.

Submitted by no_such_reality on September 12, 2013 - 2:22pm.

Quote:
"Depending on income you may earn outside of Trader Joe's" -- i.e., another job -- "we believe that with the $500 from Trader Joe's and the tax credits available under the ACA, many of you should be able to obtain health care coverage at very little if any net cost to you," Bane wrote in the memo.

Actually, much more cost effective for Trader Joes to let the government pick them up. I just punched it into CoveredCA.com and assumed $18K/yr in income (29 hours a week at $12) and came up with a 87% silver plan for $63 a month. Of which Trader Joes is kicking in $500.

Basically, out of pocket cranks in at $20/month for an 87% of costs health coverage.

Submitted by bearishgurl on September 12, 2013 - 3:23pm.

no_such_reality wrote:
Quote:
"Depending on income you may earn outside of Trader Joe's" -- i.e., another job -- "we believe that with the $500 from Trader Joe's and the tax credits available under the ACA, many of you should be able to obtain health care coverage at very little if any net cost to you," Bane wrote in the memo.

Actually, much more cost effective for Trader Joes to let the government pick them up. I just punched it into CoveredCA.com and assumed $18K/yr in income (29 hours a week at $12) and came up with a 87% silver plan for $63 a month. Of which Trader Joes is kicking in $500.

Basically, out of pocket cranks in at $20/month for an 87% of costs health coverage.

What age of employee did you punch into the website?

And how are you figuring that the "out-of-pocket" for an "87% Silver Plan member" will only be $20 month?

Submitted by no_such_reality on September 12, 2013 - 4:10pm.

If you're under 400% FPL in SoCal, age doesn't matter much, ACA tax credits, drive your cost for coverage to a common point.

San Diego has an anomaly, in that the HealthNet plans for older people actually have a premium that is below the ACA credit level which is determined by taking (I think) the average of the three lowest plans and calculating a max percentage of income to purchase health coverage.

In other words, whether you are 20, 40 or 60, at a certain income level, ACA credits push your net cost for coverage to ~4% (at $18K single) range and I think 10% at 400% FPL. It doesn't matter how much the average premium costs, the tax credits push it to same level.

Submitted by FlyerInHi on September 12, 2013 - 4:27pm.

Honestly, I don't know much about the details of Obamacare. My insurance is great so doing the research is useless to me.

I don't however see how anyone can be against the concept of getting everyone covered with the goal of a healthier population.

Premiums may vary between different employers and individuals, but total health care costs are born by the whole country. Under the status quo, for decades, health care has been eating up a bigger and bigger percentage of our national wealth. We need to stop escalating costs and such things as the use of the emergency room by the uninsured population. Is sounds to me like Obamacare is designed to do that. There may be some transition pains but as the population is covered, costs will come down.

Submitted by citydweller on September 12, 2013 - 5:22pm.

I've just been looking at the Covered California sight and it appears I don't qualify for any tax credits (I'm single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I've even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does "maximum out of pocket" really mean what it says? In other words, once I've spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?

Submitted by scaredyclassic on September 13, 2013 - 7:17am.

this is so complex.

can we just have something simple?

Submitted by spdrun on September 13, 2013 - 7:20am.

Sure. Public option, but nooooooo, we'd have death panels if this were ever implemented. Right.

Submitted by livinincali on September 13, 2013 - 8:53am.

FlyerInHi wrote:
Honestly, I don't know much about the details of Obamacare. My insurance is great so doing the research is useless to me.

I don't however see how anyone can be against the concept of getting everyone covered with the goal of a healthier population.

Premiums may vary between different employers and individuals, but total health care costs are born by the whole country. Under the status quo, for decades, health care has been eating up a bigger and bigger percentage of our national wealth. We need to stop escalating costs and such things as the use of the emergency room by the uninsured population. Is sounds to me like Obamacare is designed to do that. There may be some transition pains but as the population is covered, costs will come down.

What makes you think costs will come down. Say there's a 20% reduction in emergency rooms visits because patients go see the doctor before they end up in the emergency room. Are some emergency rooms going to close? Are some emergency rooms going to downsize? What if instead the emergency rooms jack up the prices on their remaining patients to make up for the decrease in the number of patients they see. Does that lower the cost of healthcare in this country?

Obamacare is likely adding 30 million people to the demand side of the equation and it will likely take years for the supply side of the equation (more doctors, nurses, and clinics) to catch up. What's likely to happen to the costs if demand goes up a bunch and it takes a while for supply to show up. Will the costs go up or down?

Submitted by SK in CV on September 13, 2013 - 9:22am.

livinincali wrote:

What makes you think costs will come down. Say there's a 20% reduction in emergency rooms visits because patients go see the doctor before they end up in the emergency room. Are some emergency rooms going to close? Are some emergency rooms going to downsize? What if instead the emergency rooms jack up the prices on their remaining patients to make up for the decrease in the number of patients they see. Does that lower the cost of healthcare in this country?

You have this kind of backwards. Reductions of ER visits are much more likely to be from patients that previously had no coverage and weren't paying. That won't reduce ERs viability, it will increase it. They'll be servicing a higher percentage of paying patients, so if anything, they can decrease prices. And those patients who were previously getting free ER treatment, are more likely to see non-ER providers, with treatment at a much lower cost. So yes, it will lower the overall cost of healthcare.

Submitted by bearishgurl on September 13, 2013 - 11:15am.

citydweller wrote:
I've just been looking at the Covered California sight and it appears I don't qualify for any tax credits (I'm single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I've even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does "maximum out of pocket" really mean what it says? In other words, once I've spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?

citydweller, I haven't had the chance to look at CoveredCa's charts on your behalf, but would surmise you are a "boomer."

Do you have an HSA at present? That "Kaiser Bronze 60 HSA HMO" is nowhere near equivalent to your present coverage, IMHO. Not only do you currently have a much better carrier, your deductible is much lower than the Bronze plan (lowest, cheapest plan on the exchange). You also likely have a PPO with a large choice of providers. As a "boomer," you're likely not going to want to go from "choice" to "locked into an HMO."

An HSA makes the most sense if you know you will have W-2 or taxable self-employed income to fund it going forward.

What is troubling to me, though is that you stated your present out-of-pocket maximum is $11,810, which is a typical out-of-pocket cost for a family plan, not an individual plan.

Was your policy "grandfathered" by Anthem/Blue Cross, citydweller? In other words, was your policy already in effect in March 2010, when the HCRA was signed into law? Something doesn't seem right with you having a (very reasonable) $2950 deductible and a soaring $11,810 maximum out of pocket requirement. That is, in effect, an $8,860 annual coinsurance requirement!

In all of the plans I've ever seen offered on paper, the coinsurance requirement was 75% or LESS of the deductible.

Is your coverage part of a family plan, citydweller? And how are you figuring out your current out-of-pocket maximum expense?

In the absence of the answers to those questions, I think you should leave well enough alone for now, citydweller. ESPecially if you have a "grandfathered" plan and are 55+ years of age. There are worlds of difference between a Kaiser HMO (ESP a 60% one that needs the infusion of MSA $$) and an Anthem/Blue Cross PPO.

"Open enrollment" for CoveredCA runs though March 2014, IIRC. Your coverage is not going away so you have plenty of time to make a decision for 2014. And of course, there's always 2015.

If my old, "grandfathered" coverage wasn't "going away" on 12/31/13 (my carrier, Aetna is leaving the state), I wouldn't even be remotely interested in signing up on the exchange.

Submitted by no_such_reality on September 13, 2013 - 11:30am.

citydweller wrote:
I've just been looking at the Covered California sight and it appears I don't qualify for any tax credits (I'm single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I've even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does "maximum out of pocket" really mean what it says? In other words, once I've spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?

Any reason you're not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There's horror stories, but horror stories are common place across any group that is that large.

As for OOPM, yes and no. The kicker is they'll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you're covered.

Submitted by bearishgurl on September 13, 2013 - 11:44am.

no_such_reality wrote:
citydweller wrote:
I've just been looking at the Covered California sight and it appears I don't qualify for any tax credits (I'm single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).

It has been years since I've even reached my current deductible, so the cheaper plan seems like a good idea.

I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does "maximum out of pocket" really mean what it says? In other words, once I've spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?

Any reason you're not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There's horror stories, but horror stories are common place across any group that is that large.

As for OOPM, yes and no. The kicker is they'll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you're covered.

nsr, there is a good reason why the plans you are suggesting (above) are "cheaper." My research on them indicated that they have virtually zero out-of-network coverage. I'm not sure how that applies to emergency coverage but as a road traveler, I'm concerned that these carriers wouldn't cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.

If one spends 46+ weeks per year in a large metropolitan area because they are a "worker bee" (ex: SD County) and takes "staycations," drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.

But they don't work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.

Submitted by citydweller on September 13, 2013 - 12:33pm.

Thanks for all the comments. Yes my current policy is grandfathered in from way back. I was only looking at Kaiser because a friend of mine recently got coverage there and said she was happy with it, but I would hate to switch based on one persons experience.

Thanks to your feedback I took another look at CoveredCA and the "Anthem Multi State Plan Silver 70 EPO" looks better and cheaper than what I have now. $520 month premium, $2,000 deductible, $6,350 max out of pocket, also copays that are not subject to deductible.

I'm assuming that "Multi State" means I would be covered in other states, I'll have to do some more research.

Submitted by livinincali on September 13, 2013 - 1:22pm.

SK in CV wrote:

You have this kind of backwards. Reductions of ER visits are much more likely to be from patients that previously had no coverage and weren't paying. That won't reduce ERs viability, it will increase it. They'll be servicing a higher percentage of paying patients, so if anything, they can decrease prices. And those patients who were previously getting free ER treatment, are more likely to see non-ER providers, with treatment at a much lower cost. So yes, it will lower the overall cost of healthcare.

How do figure that it will lower the total cost of health care. Look at it from the vantage point of the ER. They have x amount of staff to pay, y amount of fixed costs, and some profit margin. Whether they charge 10 patients $1 million each and get paid on 30% of them or they charge $300K each and get paid on all of them doesn't change the total cost of health care at all. Those 10 patients brought in 3 million dollars to the ER. It just changes who's paying for it. Suppose this scenario.

The ER sees 7 patients cuts the $1 million charge to $500K and gets paid on all of them. The ER just made an addition $500K and total health care costs went up even though each individual patient was charged less.

Now if the ER responds by cutting their workforce (costs) because they see less patients the total costs could go down but nothing in Obamacare makes them do that.

Submitted by FlyerInHi on September 13, 2013 - 1:51pm.

We are spending more as share of national wealth than older healthier societies. Something is screwed up. Something needed to be done.

Everything is a process, not a be-all-end-all solution. ObamaCare is the beginning of reform.

I think a lot of the visceral opposition is emotional rather than rational.

Obamacare will be helpful to independent business people such as family farmers, electricians, plumbers, actors, writers, etc who currently go without health insurance.

Submitted by livinincali on September 13, 2013 - 4:22pm.

FlyerInHi wrote:
We are spending more as share of national wealth than older healthier societies. Something is screwed up. Something needed to be done.

Everything is a process, not a be-all-end-all solution. ObamaCare is the beginning of reform.

I think a lot of the visceral opposition is emotional rather than rational.

I think emotion rather than rational thinking gave us ObamaCare. The first question to ask would have been why do we spend more as a share of national wealth than the rest of the world. Is it because we subsidize the rest of the world with R&D spending on medical research? Is it because we support small rural emergency rooms that are under utilized? Is it because of illegal immigrants using up resources? Is it because we're a nation that insists that we're all entitled to the best care regardless of cost and we don't want to wait for said care.

I will agree that other nations do spend less on medical care for a variety of reasons, but I will argue that the solution isn't pumping another couple hundred billion into the medical insurance industry. I'm willing to bet that after ObamaCare goes into effect at less half of the total premiums collected as will be an increase to the total medical spending in this nation. The reason is fairly simple. The new money that is collected is going to go somewhere and likely be counted as medical spending.

Submitted by SK in CV on September 13, 2013 - 4:26pm.

livinincali wrote:

How do figure that it will lower the total cost of health care. Look at it from the vantage point of the ER. They have x amount of staff to pay, y amount of fixed costs, and some profit margin. Whether they charge 10 patients $1 million each and get paid on 30% of them or they charge $300K each and get paid on all of them doesn't change the total cost of health care at all. Those 10 patients brought in 3 million dollars to the ER. It just changes who's paying for it. Suppose this scenario.

The ER sees 7 patients cuts the $1 million charge to $500K and gets paid on all of them. The ER just made an addition $500K and total health care costs went up even though each individual patient was charged less.

Now if the ER responds by cutting their workforce (costs) because they see less patients the total costs could go down but nothing in Obamacare makes them do that.

Ignoring professional staff for the moment, there are other marginal costs for running an ER. Drugs, consumables, DME, admin costs and salaries. Using the beginning of your example, instead of 10 pts with 8 paying, they may only have 9 pts with all of them paying. Some ER visits for formerly uninsured will remain, but some will entirely disappear as covered patients see non-ER physicians with a much lower cost, and some visits entirely disappear as a result of preventive care.

The cost savings in having more people covered (as specifically related to ER's only) will come from two areas. First, preventive care is less expensive than acute care. (e.g., successfully treating for hypertension is significantly less expensive than treating for a heart attack.) Second, treating in a non-emergency clinical setting is significantly less expensive than treating in an ER.

One of the by-products will be a reduction in cost-shifting. Currently non-profit hospitals that are required by law to treat indigent patients (where zero-pay patients often reach 20%, in some hospitals much higher) must charge insured patients to cover the cost of their zero-pay patients. With a reduction in indigent patients, that cost-shifting will be reduced.

Submitted by svelte on September 15, 2013 - 12:07pm.

FlyerInHi wrote:
I don't however see how anyone can be against the concept of getting everyone covered with the goal of a healthier population.

Agree totally.

On a related topic, can you name what the following countries have in common?

Sweden
Iceland
Norway
Denmark
Finland
Japan
Canada
Australia
Italy
Portugal
Greece
Spain
Brazil
Austria
Belgium
France
Germany
Luxembourg
Netherlands
Switzerland
United Kingdom

Universal health care.

http://en.wikipedia.org/wiki/Universal_h...

Personally I'm happy we've finally joined the rest of the developed nations.

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