ot. the other perspective

[bearishgurl]

We need a president to play hardball with countries who have been taking advantage of us for decades and I am so glad we are getting one who has the b@lls to do so. It’s about time…

[spdrun]

What’s wrong with just offering an exchange plan to everyone? Get rid of Medicaid. Get rid of employer mandates. Allow insurance companies to offer the same plan nationwide via the exchanges. Allow states to throw a public option into the ring if they want to.

Subsidize everyone where the second lowest-cost silver plan costs more than x% of income. No top income limit, which gets rid of the subsidy cliff.

In NY, a gold plan ($600 deductible) costs about $500-550 per month in 2017. Medicaid costs the state about $1000 per month per user. It would be cheaper to subsidize everyone fully below a certain income and help them with the copays.

Beautiful thing about NY is that it’s been community rated and guaranteed-issue since the early 1990s. Meaning that you got a fixed price on a specific plan regardless of age, gender, or health status.

Insurance is a misnomer. It should be called health CARE or a health system, designed to cover everyone and keep them healthy.

[spdrun]

BTW, Trump may want to INCREASE subsidies. He’s stated that he wants to allow individuals to deduct premiums from their income taxes, which sounds like a tax CREDIT for the full amount of the insurance, not a deduction. (There’s already a self-employed insurance deduction from income.)

AFAIK, that’s basically what the subsidy is, except that it doesn’t cover the full cost. Semantics 101.

[bearishgurl]

[quote=spdrun]What’s wrong with just offering an exchange plan to everyone? Get rid of Medicaid. Get rid of employer mandates. Allow insurance companies to offer the same plan nationwide via the exchanges. Allow states to throw a public option into the ring if they want to.

Subsidize everyone where the second lowest-cost silver plan costs more than x% of income. No top income limit, which gets rid of the subsidy cliff.

In NY, a gold plan ($600 deductible) costs about $500-550 per month in 2017. Medicaid costs the state about $1000 per month per user. It would be cheaper to subsidize everyone fully below a certain income and help them with the copays.[/quote]Wow, that’s amazing, spd. Medicaid costs approx $632 per month in CA (Medi-Cal) and the exchange dumps them into a very narrow-network, substandard regional managed-care plan. A Gold plan doesn’t have a deductible in CA BUT it costs anywhere between $450 and $1550 month, depending on age. I have a Gold PPO from the exchange and my local provider network has been decimated in the past year and a half. In some specialties, there are now <=5 providers available to me within a 15-mile radius of my (urban) home. My premiums will be just short of $10K this year and I have only used $214 so far in services and the year is almost gone. I have one more test to go (at a cost of <=$75) before the end of the year. I had to seek out a new provider last month because my longtime one folded up his business after practicing since 1969, having a separate lab for clinical trials and teaching his specialty to medical students. He sent his patients letters stating he couldn't pay his staff with the new reimbursements under the ACA. I found a new one just down the street from him but she insisted I pay her a $35 copay (when there shouldn't have been a copay because it was preventative care) because I was on "obamacare." I just got an e-mail today that my EOB for her appt was ready and guess how much Blue Shield of CA paid her (a 38-year veteran in her specialty, all in SD and LA counties) for a 40-minute new patient appt? How about $37.09. That's right, folks, $37.09! On my pre-ACA healthplan, Aetna paid a similarly-situated specialist $168 for an appt like this in 2013. BSoC paid my old provider (who retired in late 2015) $68 for an annual appt (established patient) and that wasn’t enough to keep him and his staff in business. And he owned his medical bldg in Hillcrest outright!

Now I know why my new doctor wanted $35 up front to take me on as a patient. With my “bribe” of $35 and the $37 she got from my carrier, she made $72 off my appt, in which she created a file for me and had my blood drawn in her office and drove it herself to the lab!

Like Bill Clinton admitted, it’s crazymaking. If they’re not employed by an HMO (ex: Kaiser) or EPO (ex: Sharp), these doctors are starting to turn their practices into accepting only cash patients and/or patients with “enterprise” plans (offered by large employers). My 2014 obamacare premiums totaled ~$9K, my 2015 obamacare premiums totaled ~$10K and my 2016 obamacare premiums totaled almost $10K (after dropping down another metal level).

I tried to sign up on Covered CA for my 2017 plan today and the “system” would not allow me to sign up for one. Apparently a CC agent went into the system on 11/8 and filled out an application for me to keep my present plan, which is going up $271 month! They even signed with an X my name at the bottom of the app! I haven’t been in the system in about seven months! I planned on dropping down to silver for ~$9K year but now I will have to call CC again and put them on a tape recorder because they will never admit they locked me out of choosing a plan, fraudulently signed me up and will most certainly try to delete the evidence in the system. I already printed the time and date-stamped screenshot of their technician doing this to cover myself.

All of you people who have never had to avail yourselves of “obamacare” just have no clue what people go thru just to maintain a plan month to month and year to year and remain vigilant that they do not get dumped into Medicaid behind their backs. It gives a lot of people high blood pressure and causes a lot of people to terminate their participation in it.

We can’t get rid of Medicaid. It is the only program which serves the poor (those who can’t pay premiums at all). People who are asset-rich but income-poor should NOT be on Medicaid but they are involuntarily forced onto Medicaid behind their backs under the ACA. The states had no business expanding that program because there weren’t even enough providers to serve the poor in a timely manner BEFORE the ACA. Now, obamacare has increased this population by 500% in many states with “Medicaid Expansion” under the ACA and the system no longer functions. Patients are being crushed with months-long wait-times to see the few providers who will accept Medicaid.

[bearishgurl]

[quote=spdrun]BTW, Trump may want to INCREASE subsidies. He’s stated that he wants to allow individuals to deduct premiums from their income taxes, which sounds like a tax CREDIT for the full amount of the insurance, not a deduction. (There’s already a self-employed insurance deduction from income.)

AFAIK, that’s basically what the subsidy is, except that it doesn’t cover the full cost. Semantics 101.[/quote]I like that idea because the people who pay higher premiums (from the state pool offerings because they have pre-existing conditions) get bigger tax credits. As it should be. And the rest of us should be vetted. I’m standing by to submit to a physical exam by the provider of choice of my new carrier if we can just get some major carriers back into this state who will offer PPO plans on the open market.

We should ALL be priced according to risk. This gives an incentive for the 300-lb smoker to lose weight and stop smoking and the alcoholic to get help before their liver is gone and their lives have been severely shortened.

In addition, females should not be paying for expensive “maternity care” coverage if they are sterilized or past the age of menopause (or both). I hate being charged for this. It is ridiculous and no one was around to subsidize MY premiums when I was of childbearing age.

[Anonymous]

[quote=spdrun]BTW, Trump may want to INCREASE subsidies. He’s stated that he wants to allow individuals to deduct premiums from their income taxes, which sounds like a tax CREDIT for the full amount of the insurance, not a deduction. (There’s already a self-employed insurance deduction from income.)

AFAIK, that’s basically what the subsidy is, except that it doesn’t cover the full cost. Semantics 101.[/quote]

Just apply your “Don’t tread on me” bumper sticker next to your “Make America Great” bumper sticker and everything will just work out.

[spdrun]

bearishgurl: why not have the same rate for everyone, but tax cigarettes, booze, and junk food more highly at the state level? Put the money in a fund to help defray insurance costs.

That seems like the minimally invasive way of changing behavior. The doctor checkup to get insurance at a reasonable price turns doctors into gatekeepers that PREVENT their patients from getting care at a reasonable price.

Note that developed countries which have state-controlled insurance systems generally have a higher life expectancy than the US.

[Author]

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