I had the recent opportunity to review my own health insurance coverage. It was an interesting experience, especially in light of the recent changes to the health insurance marketplace due to passage of the strangely named Affordable Care Act. As I've said from the beginning with Obamacare, anyone who says PPACA is all good or all bad just doesn't understand it. There are lots of things that are great about it, and lots of things that are terrible.
It all started when I got a notice from my current health insurer that I could keep the plan I'm currently on for the next year. I signed up for it one year ago to save money in comparison to the group plan my partnership offers. My plan is a fairly standard $3K deductible HSA plan with a $10K out of pocket max, and 20% cost sharing between the $3K deductible and the $10K out of pocket max. It had a reasonable panel of physicians on it. Most importantly, it was MUCH cheaper than the plan offered through my partnership thanks to the fact that everyone in my family was young and healthy. It was $522 per month compared to around $920 for the partnership plan. The only real downside was the fact that I live in Utah, land of the baby factories. Now I've seen health insurance in other states. They often have maternity deductibles that are so high that you're essentially paying for a normal pregnancy and delivery yourself. However, if something bad happens like a C-section, ICU stay for a pregnancy-related PE, or eclampsia, the policy pays for it.
In Utah, however, the insurance plans you could buy on the open market as a self-employed person a year ago did not cover maternity at all, including any complications. If your wife ended up in the ICU for a month due to a pregnancy-related complication you just went bankrupt. You could not purchase a plan that covered maternity at any price. So if you wanted a baby, you either went to work for a company with health insurance, or you crossed your fingers, paid cash for your baby, and hoped for the best.
Now our open enrollment period has come around again. My partnership plan premium has gone up over 10% to $1040 with little useful improvement in the plan. I can still buy the plan I had this year for half that price, $522, but this will be the last year I can purchase it.
The Obamacare IT Team
So I decided to get on to the Obamacare website to see what it could offer. Like most of the people who tried it out, I gave up since it was broken. There was no point to using it anyway, since I make too much to be eligible for a subsidy. A good health insurance broker can sell me the exact same plan for the exact same price and provide a whole lot more assistance than I'm getting from Obama and his minions.
The health insurance broker showed me that I can purchase a new plan that is essentially the same as my old one, except now it covers maternity under the same deductible as everything else. The price for this new, Obamacare-compliant plan? $842, a 61% increase. That's some health care inflation for you. No wonder people are complaining of sticker shock.
There's another catch. The open enrollment period for this new Obamacare-compliant plan goes until March 29th, then opens again in October. Since pre-existing conditions are no longer excluded, we can just continue the old plan and if my wife gets pregnant, change over to the more expensive plan at that time. It doesn't feel right, but it's certainly legal, and sure beats tossing an extra 3 Benjamins down the drain every month.
Overall I'm grateful that the self-employed in my state can now actually purchase real health insurance. I'm grateful it is still possible to get insurance despite having pre-existing conditions. I'm not sure it's really a good idea for society to offer no-pre-existing-condition health insurance with frequent enrollment periods, but I plan to play the game at least as well as everyone else until that gets sorted out. Like everyone else, I find it immensely ironic that the legislation bringing us this health insurance carries the word “affordable” in its title. I don't know about you, but I don't find a 61% increase to be affordable at all. It's a good thing there are some subsidies for those who make less than I do, but eventually, those subsidies will have to be paid for by someone and I feel like the sucker at the poker table.
What do you think? How did the PPACA affect your choice of health insurance this year? Comment below!
Nice
Hey
Unfortunately I think you are missing the point of the ACA. It’s not to make insurance cheaper for the top 1% earners in this country (us), it’s to make an affordable option for those who have never had insurance or make it more affordable for those who earn less than ~90k per year for a family of 4. I think the overwhelming majority of Americans will find it makes for a more affordable option if they do not get coverage with their job. Just my 2 cents.
Except it’s not affordable at all. Let’s take my situation, I am a first year medical student, married, and my wife makes $23,000 a year at the hospital.
Currently, I have a halfway-decent private plan. I am young and healthy and just need insurance as a requirement for enrollment in school, so I opted for the cheapest one. The deductible is $250 and the out of pocket max is $2500. Co-insurance is 20% thereafter. It does however cost me 20% to see a physician. Then again, this plan is $53 a month.
A quick search on healthcare.gov finds that a catastrophic plan is $168 a month with a $6350 a year deductible.
A bronze plan is $184 a month, with a $6250 deductible and $6250 out of pocket max. However, you look a bit further and primary care visits are only covered after your deductible is met. I do not expect to spend $6250 in PCP visits. In other words, I am paying $184 a month for absolutely no reason. This coverage offers me nothing (and I probably couldn’t afford a PCP visit anyhow under this plan).
The cheapest silver plan is $205 a month, with a $5750 deductible and a $6250 out of pocket max. Looking closer, it costs $75 to see a primary care physician! That is ridiculous! To see a specialist it is 10% of the visit after the deductible is met.
If we go up to the gold plan for $235 a month, it seems like most employer sponsored plans. A PCP visit is only a $20 copay. A specialist is $50. The deductible is $2500 a year with a $6250 max.
So you’re looking at a minimum increase of 317% in my premiums to get catastrophic coverage that is essentially negligible. How is that in anyway affordable?
Whoops – typo for my plan. I pay 20% up until the out of pocket max, and then the insurance company pays 100%
Obviously I am not aware of your complete situation, but if your annual income is only $23k for the two of you you should be eligible for a significant subsidy. I just plugged in some numbers on healthcare.gov for a family of two in their 20’s making 23k/year in Michigan (I just picked that state, not where I live) and most of the bronze plans were $0/month. Again, as I pointed out, not everyone is going to benefit, but as a whole, many more will benefit from this healthcare policy.
I think you’re missing the point of catastrophic coverage. Yes it’s more expensive than your current plan and doesn’t cover much, but that’s not what “catastrophic” means. It means you get covered if you have a life threatening illness, which coincidentally is the whole purpose behind insurance anyways.
I’m actually a little surprised by some of the comments by WCI. He would be the first person that I would expect to champion the “don’t insure against minor things” philosophy by his previous posts about electronics/etc. The reality is that the law is designed to encourage market pricing, that means that people will have to pay when the use services.
Insurance shouldn’t be used to cover well visits at all, that’s part of our responsibility to stay healthy. Insurance kicks in when you’re diagnosed with heart failure or get in a car accident. If people can’t afford to pay for a visit to the PCP, the PCP will have to adjust prices and find something that is workable for patients but still profitable.
The increased expense is an unfortunate side effect of uncertainty and trying to subsidize everyone. I do hope they figure that out in the future, and that price controls on insurance company profits are actually effective, but for the moment you pay more for your care because you can.
That’s actually one of my beefs with Obamacare- it didn’t do anything to bring costs down. The key to bringing costs down is shared responsibility and pricing transparency. These are required in order to bring market forces to bear. Obamacare didn’t do anything with those. The key to reducing the cost of health care is to consume less health care. People will only choose that if they can see what the price is FOR THEM, and choose to spend their money on something else. For example, if people had to pay $300 of their $3000 MRIs, there would be a lot fewer MRIs done, but better or for worse. I’ll have to have a lot more discussions with patients about whether or not they really need that CBC, but it will bring costs down.
That is my issue as well. Personally I have always felt preventive care (immunizations, well visits for kids, screening tests/labs) should be covered but all other outpatient primary care should be out of pocket. It puts the onus on the patient.
I think plenty of people would be fine paying 10% for their MRI if their MRI was reasonably priced. Most hospitals charge 5-6 times the outpatient prices.
Shades, agree with all that. As an ER doctor, I have a skewed view that people do not take responsibility for staying healthy and also have an unreasonable expectation of what healthcare should cost. I admitted someone the other day for worsening cellulitis because she couldn’t pay $8 for her prescriptions from an earlier visit when her infection was mild (note that she was playing a game on her smartphone when I entered her room). This cost will be passed on to society. It’s also interesting that you mention heart failure. I suspect many non-physicians are unaware that Medicare will not pay for any cause 30 days after a patient is discharged with a diagnosis of CHF. Get hit by a bus on your way home or stop taking your Lasix and eat a big Christmas ham–the bureaucrats won’t pay. Further, I think it is reasonable to pay my plumber $700 so that my boiler works and I have hot water; I also think it reasonable to charge $120 when I use 7 years of post-college training to conduct an H&P to exclude pneumonia/meningitis/etc and diagnose a URI and give appropriate counseling…many patients do not.
Yes – as Adam points out – the ACA is about wealth re-dsitribution.
Agree. The ACA isn’t about saving costs, but is a pathway to single payer utopia via centralized bureaucratic control. Further, when insurance companies must accept people with pre-existing conditions, it ceases to be insurance and is simply welfare. I’m not in the medical field, but I liken that to buying car insurance after the wreck.
So by your logic, if you have a major car accident and total your car and possibly injure someone when it is your fault, then you should not be allowed to drive anymore (because you can no longer be insured?) That’s a “pre-existing driving record now.
I’ll also add to my comments above that the insurance companies don’t know what to expect in these coming years of the ACA. They are essentially guessing what these premiums should be based on the pool of uninsured and how “sick” they are. It is also important to point out that the premiums generated by the insurance companies also get redistributed to if particular insurance companies bring in more dollars than others. It also places a cap on how much profit the insurance companies can make and if it is too high it gets redistributed to the policy holders at the end of the year.
Overall I do agree with this post that there are clearly positives and negatives but as a whole I believe this is the right direction for our country and healthcare in general. There will obviously be fixes along the way but as a whole this is going to benefit many in our country.
Adam, to be fair to WCI, the title of the post involves “My Personal Health Insurance” so we’ll allow him some first-person license. My insurance went up 12% this year. I would think that most physicians will not be bothered by this or a 60% increase…just like we really don’t care what gas costs although we will gripe about it anyway…whether it costs $14 (remember those days?!) or $114, I’m filling up my tank. The rest of my comments are not directed at you, just a chance to vent:
I appreciate Josh providing numbers to back up my gut feeling. I anticipate this will only get worse…I’m looking forward to seeing the enrollment data in March or whenever it comes out. Ultimately insurers are in the business of making money, not offering affordable healthcare. These plans are already not affordable to a vast majority of people who need them. If you are young, healthy, with a low income, these premiums are a lot to ask; if you end up needing to use your insurance, you will still be buried by bills. So, I suspect these folks will not sign up or not renew (when they experience what a poor deal it is)…leaving insurers with only sick/expensive folks…so they raise prices or cut reimbursement…and the cycle continues. So, perhaps more people go onto medicaid as we “fix” things…this also costs money. So hospitals/doctors ask for more money from private insurers to cover the medicaid shortfall providing fuel for that private cost feedback loop. And at some point the government will require more money from “the wealthy” to pay for medicaid. Eventually, Atlas Shrugged will take effect.
You’re right on that. $300 a month isn’t going to break me.
Exactly my point. I would rather not have health insurance at this point because the premiums are way too large relative to how often I expect to use healthcare. Even then, the bills would bury me if I needed it. A successful model would have to maintain physician salaries to the point where it is still worthwhile to attend medical school (there is a reason 95% of the young people I met while I worked in the hospital before medical school wanted to become a PA), but at the same time make routine care affordable to people so they rely less on auto insurance. I do not have a solution for how this can happen, however.
Josh, you still seem to be thinking of insurance as a primary care model in relation to you. Insurance isn’t for your cold. Its for your hospitalization and rehab when you get hit by a car while biking to school to catch your anatomy lab.
You could go without insurance but I assure you it could be a horrible mistake as well. Try getting loan approval to finish school when you have $80K in unpaid medical bills.
**It also places a cap on how much profit the insurance companies can make and if it is too high it gets redistributed to the policy holders at the end of the year.**
No it wont. That is the idea but all the insurance companies are “non-profit”. If their profit margin is about 15% (which by the way is a PHENOMENAL profit margin for a large company) they will just pay higher salaries and bonuses to their executives and managers. Problem fixed. These aren’t credit unions, their insurance companies, which in general are possibly the shrewdest and most unfair industry in America.
I would love to see a start-up Health Insurance company that actually operated as a true credit union model. I bet its prices would be massively lower.
I may have to turn in my Republican card after this post, but I agree with some of the principals of the ACA. Primarily, everyone not on Medicaid is going to have to put some skin in the game. The reality is there is no “free” birth control or “wellness” exams under the ACA, these benefits are paid for out of the relatively higher premiums and most insured are responsible for the first $1,000 to $3,000 (and potentially higher) of health care costs; in other words for most people in most years; they will pay 100% of their healthcare costs without even using insurance.
This is certainly not what the administration is highlighting as the benefits of the ACA, but in reality most people in the individual market really have a catastrophic policy. They will pay most of the routine costs; but will be covered (potentially with a 20% co-pay aka 80% coverage) in the event of a severe problem. That is the whole point of insurance, to cover the rare costs that an individual cannot cover themselves; so the ACA is making health insurance more like actual insurance.
Again, I am not sure that most people will see it this way; but the savvy will start HSAs so they can pay their routine costs with pre-tax dollars (if they haven’t already) and the young and healthy will benefit primarily from not having to spend the money to meet the deductible (never go to the doctor, never have to pay the $1,000 deductible).
Politically, the thing is a train wreck and most people like not having to pay a $500 or $1000 deductible even when they can afford it; so I think the act is going to become more unpopular. But in terms of giving the healthcare consumer an incentive to stay healthy and minimize healthcare spending; the act does that but in a very sneaky and likely unpopular manner.
Not entirely true, since preventative care is mandated to be free. There is more health care cost sharing than previously, but not enough, and nothing was done to encourage cost transparency.
Economist hate the word free. You should too, nothing is ever so expensive as something that is free.
Let use the government’s own numbers. Page 6 of the HHS document on 2014 premiums lists the median bronze monthly premium in the range of $150 to $200 for a 27-year old.
So, a single 27-year old would pay $1,800 to $2,400 per year in premiums for the privilege of a “free” preventative care office visit. I would imagine that one could find a primary care doctor who will perform an annual physical as well as immunizations for well less than $1,000 cash (including lab work).
My point is that, the costs for the “free” birth control (out of pocket costs would otherwise be; generic birth control at Wal-Mart is $5/month + annual OB visit with lab-work, lets call $700 cash) are included in the premiums and one could buy those items outside of an insurance policy for lower-costs than the annual premium. So, the main benefit to having this insurance is not the “free” items, but the protection from high-cost medical bills (for the young, these are relatively rare events).
Furthermore, I would argue that many consumers will still face high out-of-pocket expenses (an individual would have $2,400 in annual premiums and $6,350 as an annual maximum out-of-pocket limit = $8,750 paid by the consumer if there is a heart-attack, accident, etc). Family out-of-pockets expenses are capped at $12,569. These expenses are not going to be too popular once consumers start encountering them.
Again, I think that having to shell out $8,750 before coverage is 100% will make consumers more aware of health-care spending and will therefore provide an economic incentive to stay healthy. I don’t hear too much from the administration regarding the maximum out-of-pocket expenses (because they are high).
My original post was arguing that, while unpopular, the ACA will move us away from shielding health-care consumers from costs. I think the law will raise expenses for the average middle class family, but lower expenses for the poor and/or otherwise uninsured. The plan was not sold as such, and the resulting unpopularity may result in further modifications. But, as economists say, there is no such thing as a free lunch. We are beginning to learn that.
Source:
median bronze premium
http://aspe.hhs.gov/health/reports/2013/MarketplacePremiums/ib_premiumslandscape.pdf
maximum out of pocket expenses:
http://www.healthpocket.com/individual-health-insurance/bronze-health-plans#.Ur2q9_RDtWI
Your point was much better articulated than my own. The fact of the matter is that in my view, there is no point to spending $2,000+ a year on health insurance that I know I won’t use. That is why I have my $50 a month plan. It’s something required for school, so I have it. Otherwise, I’m healthy and don’t need to carry insurance at this point. If I end up going to the PCP or a specialist, the cost would be gigantic compared to what it should be because the insurance won’t kick in until after multiple visits. The problem is that health insurance rates are taking a gigantic leap, forcing people, as others have mentioned, to put skin in the game and pay for their own healthcare costs, but this is not happening concurrently with a drop in healthcare prices to affordable levels. Why is that CBC $300 again?
“I’m healthy and don’t need to carry insurance.” Uh….I’m alive so I don’t need life insurance. I’m able to work so I don’t need disability insurance. I drive safely so I don’t need auto insurance. I have smoke alarms so I don’t need homeowner’s insurance….
I don’t feel that I need to carry insurance “at this point”. I have a small life insurance in case I suddenly die and so my wife is not stuck with my student loans. So does she. I carry auto insurance in case I am in an accident. I have disability insurance in case I become disabled. I have renter’s insurance in case my townhouse burns down (my neighbor’s did). Unless I have an MI or CVA at the ripe age of 23, I do not feel the need to have health insurance. Something truly catastrophic would have to happen for me to benefit from it.
As I get older, it will become more beneficial as my risk becoming chronically sick is more realistic.
Seriously, it’s like you’ve never seen a bad trauma or something. I can spend $10K in 10 minutes when a trauma rolls in the door and they haven’t even been admitted yet. The press always talks about the “young invincibles”, I guess you’re one of them.
Gotta agree w/ WCI on this one. Of course Josh’s mindset is not at all unique. In the past three months I have heard that same complaint from tons of people. They feel like they are paying a lot of money but they are getting *nothing* for it. Sometimes if you spell it out for them (as WCI has done), they will get it. But a lot of times even that is insufficient.
Obviously the risk of getting a major trauma or cancer is very low at Josh’s age. That’s the whole point of of insurance. You pay a very small amount so that you can avoid the astronomical expense associated with the rare event. Now I realize that the amount that you are paying doesn’t seem very small, but that’s only because health care is extremely expensive. The concept is exactly the same as it is for all of the other insurance that you own.
Josh – you are one of these “young invincible” ones. Fortunately for you, during your 3rd-year clinical rotations (or earlier), you will encounter enough of these “invincible’s” who have become unexpectedly ill or injured to make you re-think your analysis of the value of health insurance (especially if you look at the cost of their total care). This is separate from discussions of the merits and downsides of the ACA, but you will quickly realize that even with rising out-of-pocket costs, opting to not be insured at all is not a sensible option in almost every scenario.
If you get leukemia or have a serious MVA you are bankrupt. You will not buy a house or a car for 10 years. All insurance is based on fear. I am personally very healthy and love to complain about insurance costs but I would not dream of being uninsured because this protects my retirement nest egg and home. The risks are too high not to have it. No matter how healthy your life style you can have an accident or be dealt some bad genes. I discontinued disability insurance when I hit “my number” and do not plan to buy long term care insurance. It would take a Warren Buffet type fortune to self insure for an organ transplant or something equally hideous and expensive.
As others have said, “young invicible” is a pretty good descriptor. Hopefully you will only see the consequences when you are a third year on the wards. My class was not so lucky.
First year: a “healthy” 20ish year old medical student had numbness in the arm, thought it was carpal tunnel. $500k later (billed to insurance) to remove a golf ball sized meningioma pressing on the motor cortex that had probably been growing for 10 years
Second year: normal looking young 20’s female student, diagnosed with Chron’s disease….bills will continue forever.
Third year: student biking to a rotation gets hit by a car, easily $10k in the ED (as WCI said ironically enough…) plus he was out for months recovering, not sure if he needed rehab but factor in something for that
It sucks paying when you are too healthy for health insurance, just enjoy it and study hard. 😉
Agree WCI. No price transparency was one of the many things that made the ACA bad legislation. The original model was based off the German model but it has been so bastardized that it isn’t recognizable.
I have a question! Say my family 2014 ACA plan will cost $900 (ballpark figure)
as a self employed dont I get to claim it 100% in my federal taxes (live in Washington State-No State Taxes)????????????
If so I should be able to get at least 1/3 of it back??? (Guess based on previous tax files)
If I ‘m correct the actual price is at $600 a month! Someone who knows please shed some light on this for me please!
Yes, you can deduct your health insurance premiums if you’re self-employed. So you pay for it with pre-tax dollars.
Just a quick add on – Actually I think the specifics for deducting the cost of your health insurance if you are self employed require you to be self employed and that you NOT have the option of coverage through your spouse’s employer. (Not just bad or expensive options from your spouse’s employer, but no option of coverage through them at all.)
The 1040 instructions for line 29 (the self-employed health insurance premium deduction) state that:
if you were also eligible to participate in any SUBSIDIZED health plan maintained by you or your spouse’s employer (or your dependent’s employer) then you cannot take the deduction for that month’s premium.
If you’re paying the full cost of the health insurance as many docs including myself are, you can still claim the deduction by purchasing a plan on the open market. It’s all about the subsidy.
http://www.irs.gov/pub/irs-pdf/i1040.pdf page 32
Interesting. But it has to be an explicit subsidy by the employer? The tax benefits of paying for the plan using pre-tax dollars on a pay-check don’t count as a subsidy in the eyes of the IRS? Weird. But I guess no one ever said the IRS was always logical.
Transparency is coming.
At least out here in California it’s becoming obvious that ACA is causing narrow networks and for the first time in a long time, it’s pushing down the rates charged by medical groups and hospitals. Leverage is everything.
The purpose of insurance is to buy it and hope you never need it. Will the ACA cause many people to pay more? Yes. Will it provide better coverage for many people who never need it? Yes. Is it subsidizing the health care of the poor via the wealthy? Yes. If those are the criticisms they are all correct. Were lies told to pass it? Yes. Was the rollout awful? Quadruple yes.
Do the ends justify the means? I guess it depends on your definition of a civilized society…
I think you are missing the point on what the ACA will really cause. Unfunded liability is the problem. Yes more people will have health insurance, but the people who get it for free (subsidized) will still not pay their hospital bills (deductible). This accomplishes very little other than forcing people who make more money to pay more for health insurance while hospitals and doctors get shafted. Thereby charging other private insurances more causing an increase in premiums.
Next is the “cadillac plan” tax. Insurances costing more than $10,200/year will be taxed at 40% on anything above $10,200 but this tax is not hedged for inflation forcing people into Obama care as the years go by. Eventually most of the US will be under Obama Care.
This is a sad state of affairs because I highly doubt Obama Care will pay us as well as other private insurances.
BTW, I am not a Republican, just a guy who can do math.
Alex, this is one of my fears as well, unpaid liability. A public option would have helped this but that was never really in play.
Foss,
None of this actually brings better health to patients. Nowhere in “society” does it state that poor lifestyle choices need to be paid for by the wealthy. We are spending our money in the wrong place. We should be spending it on patient education not on some bill that allows patients to do whatever they want in their lives and someone else will give them some pill or procedure to fix it all. Especially for free.
No joke – how many times do patients say “I can’t afford my meds” but somehow they come up with the money for booze and smokes?
Do we really wonder if open enrollment and no pre-existing conditions is a good idea. I want that deal on car insurance- wrecked my car- what kind of a policy can you write me- let’s pay extra for no deductible.
Wow.
So my best friends wife who died of AML at 34 died due to a bad lifestyle choice?
So my 38 yo friend with stage Iv colon ca made a bad lifestyle choice?
My med school classmate who died of a brain tumor made a bad lifestyle choice?
My friends 10 year old son with a glioma that will kill him made a bad lifestyle choice?
My good friend in a hit and run and shattered pelvis now largely recovered made a bad lifestyle choice?
There are plenty of valid criticisms of the ACA, but just like the tea partiers who say ‘keep your hands of my Medicare ‘ (a large unfunded liability that many but not all physicians have helped to create) the criticisms I see above fall back on the theory of lifestyle choice = health and physician income as the most important of our goals. Somewhere we as physicians lost our way, myself included.
As a practicing physician for over 25 years, I can say that there was problems with our healthcare system. But, the problems could have been addressed without the mandates and overhaul of our entire system.
Basically in a nutshell, The ACA is another democratic mechanism to redistribute wealth from those that are working to those who are not. We have great examples in Europe and other countries what occurs when you reach a tipping point……those who are working are tired of more taxes, and those who are not do not want benefits cut.
Sadly, I do believe we are very near point fellow physicians.
Wow is that a bad analogy. The non-working already had health care, its called Medicaid. The ACA helps provide coverage for the already sick, the working poor and lower middle class. Does it cause some redistribution, yes, but that was kinda the point. If you treat the illnesses sooner they cost less long term (even to the rich)
Now it also provides health insurance for those who had it but got their policies canceled. Like my child care provider- thank god the 60 year old now has birth control and maternity benefits – along with 200 bucks more in premiums. Is the administration going to separate those 15million people out?
not directed to WCI –
Yes, the young invincible’s – The only reason why many people feel that they do not need insurance is because of EMLTA – ie, if I am in a car wreck the hospital will fix me up at their own expense.
Costs – Yes, the costs to the young seem high – but that is to get the cost to the older folks to an affordable rate. Actuarialy the older folks should be paying more – so if there is a wealth redistribution going on, it is for the older (50-65) age group. Funny that many people complaining about the cost are spending more on a mobile phone plan or cable bill.
Expenses – how does one control cost when a) no one knows how much anything costs and b) the one doing the cost cutting (providers) are not the ones saving the money (insurance companies).
Pre-existing conditions – Rape, Acne, Cancer – try to get an affordable policy when you have that in your past.
Included services – when something is provided, like birth control or physical, for no additional charge – many more will take advantage of it.
Plans – many existing plans are crap with little coverage.
Exchanges – a marketplace for plans to advertise and sell the plans. What was there before – going to a broker that may or may not offer the best plans available? The private insurance plan market was rife with problems – dropped coverage, changing plans, etc. Many people cannot even compare Mobile phone plans never mind a health insurance plan.
Good things from ACA –
Kids are covered through age 26 on their parents plan (as they are low cost and invincible), no more pre-existing penalty, no more caps, the foundation for more reform. Being able to compare plans that are equal in coverage.
Something has to change to address the increase in out of control healthcare costs while still making the medical profession attractive. One of the ways to start is to get everyone covered and then to make other changes.
One of the biggest problems with ACA is that it is framed in the political and media arena’s to form divisiveness and partisanship. The entire industry needs reform and although far from perfect, ACA is the first attempt we have had at real reform. The status quo was not sustainable.
WCI thanks for your experience.
Foss,
Your comments once again confuse the real problem. health insurance does not equal health care. I agree people should have health insurance and it should be exactly that insurance and not a pay for everything remotely medical plan. Insurance should have a high deductible I believe $10K and everything there after is covered. Yes those less fortunate should get a subsidy for their catastrophic insurance plans. But they need to get some semblance of responsibility as well.
I’m not sure what relevance to this conversation those unfortunate people you know have to the topic, but since we are handing out examples, how about I give you a couple.
1) Pt comes to ED via ambulance with a joint pain for several weeks. Has been to a different hospital 2 days ago for similar problem. You need to remove them from their iPhone 5 to get them to explain why they are their, and when they go home they want a medicaid cab to be called for them.
2) Pt comes to ED with 2 year history of abdominal pain and demands an MRI. Despite having a negative CT last week for similar complaints, also arrives via ambulance. Has medicaid
3) Pt with history of 1 pack per day smoking, recently discharged for COPD exacerbation comes in with SOB, still smoking and requires intubation and ICU stay. On disability, has medicaid.
4) Pt after years of drinking has liver cirrhosis yet continues to drink and now requires almost weekly paracentesis. Has Medicaid.
I can go on and on. And by the way, you best be nice to these patients because if you don’t get 5s on your press-ganey survey your hospital will loose money. if your scores stay low, then administration will be discussing on how you can improve those scores or maybe consider another place for work.
Next, End of life care is eating away a huge chunk of our expenditures. in 2011 28% of health care was spent on the last 6 months of life. http://www.medicarenewsgroup.com/context/understanding-medicare-blog/understanding-medicare-blog/2013/06/03/end-of-life-care-constitutes-third-rail-of-u.s.-health-care-policy-debate
This needs to be drastically addressed. We as fiduciary health care providers need to have the strength and control to decide when enough is enough and help patients get into hospice and out of our health care system.
Finally, transparency and decreasing costs. The only way to decrease cost and improve quality is to allow transparency, and force some ownership in the decision and cost process. When something is free, then it has no value and costs rise.
Another example. I got into a car accident years ago in the Caribbean, I took a cab to a nearby hospital which deducted $1000 from my credit card. They then ran x-rays and a CT head for which they first informed me of the cost for which I agreed. I was given pain medication and offered overnight observation. When I was discharged I received a refund of $300. This same type of care costs thousands in the US even though nothing was different. Same x-ray machine, same CT, same overnight observation unit with the same bed, pillow, and sheets. So what is different? I paid cash, there was no bureaucracy, and I knew the costs going in. And BTW, no one charged me $60 for gauze and tape.
I think change needs to occur, and the ACA has some decent ideas, but the way the plan is devised only increases costs and is not affordable. Why even get health insurance now. You can’t be denied for pre-existing conditions. Pay the penalty which is cheaper than insurance, considering you have a large deductible anyways, and if you get really sick, sign up for Obamacare. As it stands we are in for a world of hurt, the question is when. Hopefully by then I have a pretty good nest egg and will semi retire, working a few shifts a month because I enjoy my job, not because I need the money.
Great post, so true. I see patients all the time who have the latest, greatest smartphone/iPhone, smoke 1-2 ppd cig and drink every night, yet they are on Medicaid/Title 19.
They always have money for the things they want. But, I guess whose to blame them?