Lamp,

Or, mebbe, sometimes, it's about a services receiver who's conscious about what he or she is payin' for (and who demands bang for buck) instead of someone who just kinda ignores price since 'it's covered' (the insurance version of 'the commons').

And did I mention my new caps are almost PERFECT? :) Better than what I had before from my now dead dentist and after two breakings of THOSE caps.

"the incentives for healthcare providers to do things a certain way"

Also the incentives for the insured to turn a blind eye to cost.

After one meets his or her deductible: the cost is absorbed by the pool (the commons) so 'how much' is less important.

And: if 'how much' is less important, one is incentivized to just let the doc or hospital go nuts with tests and whatnot that may not be 'necessary'.

Sure, the insurance company wants to keep costs down but how 'gratuity-laden' is the relationship between insurer and medical provider? Buried in the line items are how many kick backs?

"my new caps are almost PERFECT"

Perfect example of one demanding bang for her buck... ;)

Which is a s lightly different thing to demanding bang from her buck... ;p

One simple explanation is that the dentist is offering a cash discount. Getting paid cash and right away is worth more to the dentist than getting paid more by an insurance company later and with more hassle, claim filing, etc.

Maybe it "costs" the dentist more to deal with insurance patients and he's just passing those costs along to his customers.

I'm not sure anybody's had a buck bang since 1929.

I did not see this last September... but here is something of a surprise (at least to me).

Forbes
9/15/13

I'll count each of those 35k improved health care plans indirect WIN's for the A.C.A.

This whole health care topic is spread through about a dozen threads here. I don't know where to post.

This should possibly even go in the post whore thread, because it's really not contributing to the discussion. But...

It's open enrollment here at work. Today I got the breakdown of the 3 plans I can choose from: the good expensive plan, the crappy expensive plan, and a new high deductible plan that is slightly cheaper but it so crappy, it's almost like not being insured. It only kicks in after a $3000 deductible. But then you'll be glad you have it, because you are SICK.

Anyway, looking at the price tags on all these plans, it occurred to me that when you count my employer's premium contributions, and my premium contributions, and also consider that we recently refinanced our house for a lower payment, we are now spending about double for health insurance what we are spending for housing here in expensive Arlington VA.

We are healthy, and we(including my employer) are spending twice as much for health insurance as we are for housing. I think that's messed up.

Well, excuse me ~

holy shit.

:eek:

Good for Wal-Mart! As we get into the ACA practice, we may find it's better than we thought.

Of course, it would have been nice to have seen it in action in a pilot program first, and to have the website for it working alright, but I digress.

The morning tv talk shows were a disappointment for me today.
Even the moderators used remarks that took the GOP stance of conflating
the Obamacare website performance and President Obama’s pledge
that "if you like the insurance you have, you can keep it".

Here is a more realistic view:

NY Times
Editorial
11/2/13

Insurance Policies Not Worth Keeping

There is nothing to discuss with Obama and what he said dozens of times.
My insurance with BC is being terminated. My son's plan (no, not Dan) with Coventry (now part of Aetna) is also being discontinued. The alternative plans on the exchange are 2-3X the cost of what we had, we could afford and what fit OUR needs. We are basically being forced to go without insurance AND as an added kick in the nuts, I get to pay a penalty because of it. FUCK YOU OBAMA, I regret voting for him almost as much as Shrub.

That sucks, man. What was it about your old plan that made it invalid? I forget, does PA have their own exchange? And did they decide to expand Medicare?

Gov Asshole - Corbett(R) chose not to expand Medicare.
I am not sure what SPECIFICALLY is the reason. The letter states very clearly that the policy is no longer in compliance with the UN-ACA regs, but not why.
Here is the letter my son received. We have not received any more feedback from them since. I called twice, but the wait times were ridiculous and I hung up.

shit.

Why "Shit" ?

The letter is clear that his policy continues thru the end of 2014
... and at that time an ACA-compatible policy will be available.

Mr Whiner has returned...

Five or six years from now, Mr Whiner's son will turn 26, and no longer be on his parent's policy.
But even with "pre-existing condiotions" he can still have insurance due to ACA.
His son's income will be taken into account, and will probably
have very little, maybe zero, out-of-pocket premiuml payments.

For some people, this is the Obamacare they see...

From 1988:


For others, the world is more like this...

Apparently, a number of companies are taking advantage of the situation to upgrade the plans more than required by the ACA, and people have been able to get plans that aren't initially pushed by the letters that announce the dropped plan. This may not be the case in your situation, but a number of the people who showed up in the news with stories that largely matched yours were later able to get much better deals if they didn't accept the insurance company's hard sell.

You mentioned Medicare - if you would have been covered in extended Medicare, and your state refused it, you may be out of luck. The ACA was designed for Medicare to fill a particular hole that the exchanges and subsidies didn't cover.

You may have to wait until there are enough Democrats in Congress to fix any ACA problems. Republicans would rather have ACA problems to crow about than fix them.

How difficult would it be to move across the river to NJ? Do they have Medicare coverage? Or is it too far away?

Why? giving classicman the benefit of the doubt that he's compared apples to apples as far as is possible, an increase in his insurance costs by a factor of two or three makes me say "shit". I don't know how you could have missed it, but since you did, I'll quote him here.

I wonder how many insurance companies are pulling a Humana.Another.

Damn, they're a serial offender.

Well if they were only fined $65k it makes business sense to do continue sending those false letters. Assume that 10% of the 6,400recipients took the letters at face value. That's 640 people, who let's assume paid $5k each, or $3.2 M total. That's an easy choice. $3.2M vs $65K. And those are conservative estimates. If 50% of the recipients followed the letter's instructions and renewed, it would be $16M the company would make.

it's helpful to keep in mind that our nation's for profit health insurance system has as its prime directive profit for the shareholders. that profit motive is *by law* the most important thing for these publicly held companies to take care of. the recent changes in the law like the ACA and earlier changes in the law like (forgetting the name at the moment) the instruction to treat insurance coverage for mental health like coverage for physical health are all done with a mind to regulate the industry, the health insurance industry. But they're all still in business to make money (not quite the same for the non profit/collectives out there).

regulating industries happens in numerous sectors of our economy from energy to automobile manufacturing to food production, etc, etc, etc, etc. these laws and regulations are done with a mind to the public good, usually. and usually, the industry finds a way to accommodate the rules. but they're still trying to make money. like the outfit above. they don't have a built in motivation to make the costs less, until they were compelled/cajoled into competing directly. competition has a long and well established track record of simultaneously allowing profits for effective companies and lowering prices for consumers where they have a choice.

And the converse proves the opposite--look at the cable television choices you have, as an example. Here we have ONE choice, and that monopoly (fuck you Comcast) provides ZERO incentive to lower prices. why the hell should they? and indeed they don't.

So, I'm not surprised that they're trying to lock in some profits like this. disgusted, yeah, suprised. Noper.

Incorrect - You cannot even read for comprehension. The plan will continue "UNTIL THE POLICY PERIOD ENDS" That would be in May.
Wrong son Mr. Asshole.
My son is 23. There is no The cost to "ADD" him to a parental policy is far more than for him to buy his own. Son does not qualify for any subsidies and there is no expanded Medicaid in PA.

So far you are nothing but wrong on all accounts.

And for folks like you, this is all they see.

:D

LIAR

Unless they collude to fix prices so the all get fat.
But they wouldn't do that, would they. :rolleyes:

point well taken . however, what you describe is *not* competition anymore, it's collusion.

The entire health insurance business, I think, started in Texas with Blue Cross/Blue Shield.
back in the 1930's as hospitalization and physician insurance, respectively, for teachers.

The plan coverages were, and still are, based on "usual and customary" fees;
but "reasonable" has been added now that BC/BS licensees process Medicare for the feds.

I don't think competition between physicians was a mechanism, and probably still is not.
It was/is insurance to assure payments to the benefit of hospitals and physicians.

Probably the only path to holding down health care costs is now thru Medicare/Medicaid limits,
and I hope the policies dictated within the Obamacare exchanges will eventually do that.

They still don't - they do have a motivation to keep them all about the same - more or less.

To be fair, the same could be said of any industry. That's why price-fixing and collusion among competitors is illegal. That's not to say it doesn't happen, but at least now there is a *potential* element of competition in the healthcare marketplace.

This is a very LONG posting, but it seems to be an authoritative summary of the cost-reducing effects of Obamacare.
It includes implications of the initial web-site problems. I have sniped out most of that.

Washington Post
David Cutler
November 8, 2013
The health-care law’s success story: Slowing down medical costs
For those who want to blame Obama for anything and everything that affects them personally,
they should put the blame where it belongs, on the GOP and the GOP Governors
who are fighting tooth and nail to defeat the A.C.A. law for their own political purposes.

So there, I said it

We went through similar problems with automobile insurance in the 1960 and 70s. The solution was to change how insurance was conducted - at state levels. That included requiring auto insurance. Also was not fair - according to naysayers. But it solved skyrocketing costs. Permitted the free market to work properly.

Health insurance is being restructured to solve a similar problem. But increasing costs are not limited to how health insurance was implemented. If our extremists want to advance America, then we are already moving on to other parts of the problem - ie hospital billing. That could not be solved without Obamacare. It is now possible to fix reasons for skyrocketing hospital bills.

Unfortunately naysayers want to maintain a bad system rather than address problems. Unfortunately a discussion of how to solve hospital billing is impossible - because many have been told and therefore believe we want America to fail. So many want a defective status quo; have and refuse to offer any solutions.

So many critics. So few want to address or even discuss reasons for radically increasing hospital costs.

Clod - I know and agree to a point.

Lamp - sorry to say that your post is nothing more than one team pointing the finger at the other. I think there is plenty of blame to go around. The R's are being asshats in some respects, but the law itself was written very poorly, none of them read it and when you only have one tool (writing laws) the old "when all you have is a hammer, everything looks like a nail" comes to mind. This law was nothing more than an attack on one industry while completely missing the other cost drivers which are Big Pharma, Medical equipment manufacturers, hospitals and providers.

What industry did it attack? Insurance?

I wish.

It defined some minimum standards for insurance, but added the mandate. Insurance providers were on board. Now they are blaming the ACA for whatever their customers don't like, whether or not the ACA is actually to blame, but they aren't victims here.

edit- "Attacking the problem from limited direction" perhaps, but not attacking the industry.

Classic, just which "one industry" are you saying is being attacked ?

I doubt you can make the argument that the "health insurance" industry is being attacked.
They (the insurers) are just being given some minimum requirements.
They will still be setting the extent of their coverages, the limits, and the co-pays.
They still are setting the prices as they do now; but subsidies and tax credits
and %-of-income limits will be available to those who may need them, their clients.
So how is the insurance industry being attacked ?

OTOH, it is exactly the hospitals and providers who are being limited in their inflation of costs.
If they don't want to live with the M/M reimbursements, that is their choice.
Unfortunately, their first choice is to pass the difference on to you, the patient.
Eventually, hospitals and providers will come around,
exactly through the mechanisms described in the above article.

Big Pharma is the result of GW Bush and Republican's writing Part D
as forbidding the government from negotiating the cost of proprietary drugs.
So, you end up with "preventative immunizations" like Shingles being
set at Tier 3 (patient pay) at a cost of $200-$400, instead of being free.
Change M/M Part D, and you'll see some major cost reductions.

As I and others are saying, put the blame where it belongs
... on your GOP Governor, and the national leadership of the GOP .

sure they will
Of course its the other teams fault.

As I and others are saying, put the blame where it belongs ....
on the other team. sigh...

"More than 1 million cancellation notices have been sent to Californians as the Affordable Care Act begins allowing individuals to buy insurance through exchanges, Jones said. The federal law requires policies to offer minimum levels of coverage, forcing companies to terminate many existing plans. But Jones said that under the law, insurers have another year to do so."

From here
This might be a "Ya' see, Timmy... " moment.

Doesn't that really sound more as tho the policies were going to expire anyway ?
And then the corporation made it's own decision to re-market inferior policies while they still had time.

And then, coincidentally, Anthem Blue Cross also screwed up notices
"due to a computer glitch" and failed to notify some 104K policy holders

Of course, we should never be suspicious of corporate decisions, or their computers.

...And offer new plans that do meet the guidelines of basic human decency the law. That's like saying the minimum wage "forced" employers to fire all their $2-per-hour workers. Of course the old plans have to go. That was the whole point.

Obama appears to be making some changes to accommodate
those whose "non-ACA-compliant" policies were canceled in 2013.

In his talk today, there were a couple of places where he seemed to be
parsing his words very carefully.
One was when he described the specific policies that would be "grandfathered",
and his sentence ended with something like "and will expire in 2014".
... maybe I heard it wrong.

He also said these insurance providers would have to notify their policy holders
of the specific ways in which these policies do NOT meet the
requirements of the ACA.

I do hope, however, that as part of this political concession, these changes
do not include either the subsidies or the tax credits that are available
in the exchanges for some, based on their income.
Of course, that would undoubtedly set off another chorus of "LIAR"

I did hear it wrong...

Here is the transcript of what Obama said:

Ugh.

My father called tonight to gloat about how Obamacare is "completely falling apart," and haven't I been watching the news in the last two days?! It's "imploding." The whole thing is "going to be dismantled" and The Democrats(tm) will hang their heads in shame!

I dared to disagree with his interpretation of events, and got to listen to another 30 minutes of ranting before I finally got him off the phone. Glurg.

But Clod, in the same vein as InfMonkey described in another thread,
you were given an opportunity for 30 minutes to honor your father ;)

Good on you...

Fuck him, hang up.

Acknowledge and redirect ... 'We'll have to agree to disagree. So, how are YOU doing?'

This attempt on Obama's part to be "no drama Obama" will become the camel's nose for him.
It's not the particular "fix" that he proposes, it's the event of any "change" in the ACA, itself.
The GOP will attack with the fact that he changed it at all, and more changes will never be enough.

IMO, the salvation for Obamacare now lies with the individual State Insurance Commissioners.
The following is a taken from an interview with the State of Washington's Insurance Commissioner.
I sincerely hope others follow suit, just for the reasons he gives.

Washington Post
Sarah Kliff,
November 16

Wash. insurance regulator supports Obamacare — and rejected Obama’s ‘fix.’ Here’s why.

No doubt that the roll out of Obamacare, has been a disaster, but I can't see getting excited about it.

It's a big plan, and one that has gone through several changes, so the web site creators didn't get the info they needed, in time to do a good job.

Big deal.

I can blame Obama for a lot of things, but the roll out of his healthcare plan, is the least of them. Everyone with a brain knew that sub-ACA plans wouldn't be able to stay in place for long. They would be (obviously), much cheaper, and thus subvert the ACA goal, wouldn't they?

I relish Obama getting skewered for several other mistakes (Benghazi, etc.), but the ACA roll out? No. We just need to settle down and work with the plan. The time for political action against it, should be over, imo. Obamacare might not be good right now, but it could reasonably do a great job, down the road, after it has received the tweaks it needs.

As for his lying about being able to keep your plan if you liked it. Admit it, you never gave a damn about his several blatant lies in the past several years, but NOW you're incensed?

You're a little late for that, imo.

Hey Adak, good on you. You've come to a reasonable position on Obamacare !

???

ETA: Added after reading the morning news:

Adak's current position on Obamacare seems to be the way to getting elected in Louisana:

Newsmax
11/17/13

It just seems like people are blaming Obama, because the web site for it, is the shits. Obama didn't create the web site!

The Republicans tried to tell everyone that there was a bad side to Obamacare - higher rates for one thing, and cancelled low cost policies for another - but nobody believed that.

Now under the new changes, I'll have to be insured for:

*mental health - in case I decide to go crazy. :p:
*maternity care - in case I decide to get pregnant. :eek:
*breast cancer screenings - some men do get breast cancer, but I don't know any men who get breast cancer screenings. :rolleyes:

The dark secret still to be found in Obamacare, won't hit us until 2015. In 2014, the insurance carriers in ACA will be reimbursed, if the "pool" of insured they get are unexpectedly poor in health. (say the older folks enroll, but the younger people don't). After a 3% variance, the gov't will reimburse the insurance company, for their losses.

In 2015, this risk abatement feature will disappear, and the insurance company will have to adjust their rates to account for their "pool" of enrolled people - regardless of their health costs. THAT is when the full cost of Obamacare will be known, as it stands now.

Hopefully by then, a much larger percent of the population will be enrolled, and the pool of each company, will be normalized (young vs. old, healthy vs. unhealthy).

There is also a serious Doctor issue with the ACA, where the doc's have to have hospital affiliation - which of course, many doc's in private practice don't have. If that becomes a problem, then lots of doc's won't be seeing patients with ACA insurance. :mad:

I know the Republicans will be highlighting the problems of the ACA, in the 2014 elections, but I wish they would wait, and give the ACA a chance to show whether it's good overall, or not, before campaigning against it. We HAVE the ACA, let's kick the tires on her a bit, and take it for a test drive, before we decide on it's merits.

What do you mean with "ACA insurance"
Private insurance companies will be carrying the vast majority of health care plans.
Only Medicare/Medicaid will be "ACA insurance". Is this what you mean ?

I haven't heard anything of the ACA requiring (all) doc's to have an affiliation with a hospital.
Is that what you are saying ? Maybe you could provide a link...

The only laws I have heard that sound like that are the anti-abortion proposals.

I have read articles about the "doctor-owned hospitals" (DOH's) having
limits placed on Medicare-reimbursement levels by the ACA.

DOH's have been investor-jewels, making >25% profits off of Medicare reimbursements.
IMO, it seems reasonable for the government, via the ACA,
to say how much profit on Medicare-reimbursements will be allowed.

The response of some DOH's has been to stop accepting Medicare patients completely,
and some DOH's have refused referrals from non-affiliated, doctor-owned private practices.

Currently, some DOH's are scurrying about trying to find legal ways around such ACA restrictions.
They have tried separating private-pay from Medicare-patients into "legally separate" practices.
They have tried "legal mergers" with outside practices of private physicians.
They have tried arguing that some DOH's are located in low income population areas,
and so they should be allowed an exemption

... so far the courts have uniformly ruled against them.

You may be right that they are DOH's. This was the topic I was just starting to listen to on the radio, but the football game came on. :D

They mentioned that in New Hampshire, 40% of the hospitals would not be available for those covered by Obamacare. So far, they've only signed up 259 people in the state, which is less than the number of tags sold to moose hunters, so maybe it's not a big deal, yet. :rolleyes:

I do wish they'd get the roll out for Obamacare, rolling along a bit better. We've paid a lot of $$$ for it so far. I'd like to see it taken for a test ride, at least. We might just get a good national health care plan out of it. Imo, we need one.

Nothing to do with the law, it's the insurance companies using this as an opportunity to squeeze the hospitals. There will be more of this and the solution is single payer.

Are you sure of that, Bruce? I have been unable to spend time with it, but what little I have heard is that this was a requirement they put into the ACA.

I agree with you about single payer. When you are trying to steal second base, you can't keep one foot still on first base. You have to go for it big time.

This was something that Hillary had right, when Bill was in office. All the special interest groups railed against it - and naturally killed it.

The insurance companies, and especially insurance brokers because they deal with most of the people that are buying direct, have taken advantage of the confusion/disinformation to make money. That shouldn't be a surprise. Humana has been particularly nefarious in "guiding" people into much higher premium policies than the ACA requires.

Bulletin... Attention Mr & Mrs America, and all the ships at sea... no company, or broker, is going to tell you all your options. http://cellar.org/2012/nono.gif