Obama Care vs Republicans

[Adak]

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.
*maternity care - in case I decide to get pregnant.
*breast cancer screenings - some men do get breast cancer, but I don't know any men who get breast cancer screenings.

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.

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.

[Lamplighter]

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.

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.

[Adak]

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.

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.

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.

[BigV]

Originally Posted by Adak

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.
*maternity care - in case I decide to get pregnant.
*breast cancer screenings - some men do get breast cancer, but I don't know any men who get breast cancer screenings.

--snip

Let me ask you Adak, how many times have you used the women's restroom in a public place?

Probably your answer is zero. Yet, your tax dollars pay for that part of the program and that's been true since you've paid taxes, but I've never heard you crying about that. The same logic applies to requiring all ACA compliant polices to cover maternity care, just as no public building would ever be built with bathroom facilities for only one gender. We're one public, there's one reasonable standard of care, and that's been established in the minimum standards for policies.

Let's look at it another way. Presume the rules were different, and we didn't require policies issued to males to have maternity care, and that policies issued to females did have maternity coverage. Now, the policies are different, how would you rationalize the different costs of these different classes of coverage? Would you let the prices be different, based on the sex of the insured? Would you hold the costs the same and force one group to subsidize the other? Let one group pay for something they'd never use? Let one group get coverage for something they didn't pay for? How do you slice that up? How many exceptions do you want to include once you travel down this path?

How many prostate cancer screenings will women have? How many childhood immunizations will you have? The list could go on and on and on, as I'm sure you can see. Lots of federal regulations are in place that don't touch my life directly, but they serve a purpose appropriately.

I had thought about taking a cheap shot about your mental illness not having been a choice of yours at all, but I have thought better about it. Mental illness is not a choice, you know that, you're just being an ass about it.

[orthodoc]

Originally Posted by Adak

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

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

OF COURSE your insurance policy will have to cover things you are highly unlikely to personally need. The point is that the pool of insured clients must be large enough that expenses don't exceed revenue.

[infinite monkey]

Just one of many articles outlining the short-sighted ignorance illustrated by Adak in his railings against paying for care he thinks he doesn't need, or care that he thinks doesn't affect him.

In an era when political discourse is regularly laced with fact-free fulmination, it's tempting to just let it go. But we just can't pass up the baloney being spouted even in Congress about how unfair it is to require all insurance policies under the new health care law to cover maternity care -- even policies sold to, perish the thought, men.

It shows such colossal ignorance of how insurance works. (And possibly of how pregnancy occurs. Here's a hint: It takes two to tango.)
This festering controversy burst into the spotlight a few weeks ago during testimony from Secretary of Health and Human Services Kathleen Sebelius, when Rep. Renee Ellmers -- yes, a woman -- of North Carolina asked her: "To the best of your knowledge, has a man ever delivered a baby?"

Ellmers appeared to think she had nailed the secretary with airtight logic. Insurance industry executives must have cringed.

In a functioning insurance marketplace, healthy people pay into the pool with the understanding that when they someday need care, they will get it. The greater the number buying policies covering a broad range of conditions, the lower the rates can be.

So women pay for policies that happen to cover treatment for prostate cancer -- which, by the way, they don't even cause -- and Viagra for men.
And men, often known as "husbands" and "fathers," pay into the pool for maternity coverage, which would be unaffordable if only women of childbearing age paid premiums for it.

The core of Ellmers' argument is: I shouldn't have to pay for anyone else's care. That's an argument against insurance itself. Instead of paying premiums, everyone should just save up to pay for chemotherapy, blood pressure medicine and kidney transplants in case they're needed. Of course the inability of nearly all Americans to do that is the reason the private insurance industry developed.

Conservatives' choice of maternity care as an avenue to discredit health care reform is the latest volley in what some see as a GOP war on women. It makes no sense for a party posturing as pro-life: The inclusion of maternity care in the Affordable Care Act, as well as requirements to cover newborn and pediatric care, are the ultimate pro-life policies. They ensure care for moms and basic protections for children outside the womb, which should help reduce the rate of abortion. Kids who get medical care are more likely to succeed in school and grow up to be productive citizens rather than a drain on taxpayers.

Those who carp at maternity coverage in insurance policies show they understand neither the insurance market nor this basic fact: If mothers get the care they need to give birth to healthy children, every single American is better off.

Dads included.

http://www.mercurynews.com/opinion/c...ent-goes-heart

p.s. I think men should pay for their own hard-ons. (hards-on?)

[Lamplighter]

IM, Justifying who pays for what insurance is only a matter of perspective.

Maternity benefits are for the benefit of the baby... so the baby should pay !

This view is consistent in that everyone is born... both men and women
... but not everyone has children.

With this perspective, Adak can rest more comfortably because he is
only paying for his own delivery... just a few years after his personal event.

Now we only have to figure out what to do with those people who don't/won't pay their bills.

[Undertoad]

OBVIOUSLY, health insurance should have always covered mental health, maternity care, and breast cancer screenings. That's all part of health and the people will become unhealthy if they don't have these things.

But insurance didn't cover them, because it became a tricky mix of companies trying to remain profitable and state insurance regulators being broadly incompetent while fighting the political will to do nothing so the money would continue to flow.

One hopes that the federal effort would cut this Gordian knot and ensure that health insurance actually, you know, insures health. If car insurance didn't cover back seats just because your car doesn't have one, that would be considered fraud: "Oh you have $5000 of damage, but your check is for $3000 because we don't cover the area between where the driver's seat ends and the rear bumper begins."

[Adak]

I'm not sure how maternity care and breast screenings were paid for by the pool of the insured, in the past. However it was done, it should continue that same way, as much as possible, now.

But mental health? THAT's a big Big, BIG expense, that most companies don't even offer in their health insurance plans for their employees. Not to mention that mental health insurance was not mentioned previously by the Democrats, as a requirement for ACA approved health insurance.

Forcing that cost onto us now, is one more BIG price increase in people's health insurance. It won't be well accepted when we start getting the price hikes that must accompany this forced, extra coverage.

It's hard to accept a new coverage being forced onto us, when we have no idea how much that extra cost will be. And in fact, we have no idea what the cost of our current plans will be, because the characteristics of the pool for each plan that's offered, is still unknown.

It's like we never heard of running a small scale pilot program - what a concept!

International Franchise Association and U.S. Chamber of Commerce say only 1 in 12 small businesses will be helped by Obamacare.

http://www.aei.org/media/economics/i...icas-newsroom/

[richlevy]

Originally Posted by Adak

But mental health?

Basically, if our country wants to be the largest industrial nation in the world with easy access to firearms, then we should also have cheap or free access to mental health.

We pay BILLIONS of dollars to protect ourselves from terrorist attacks. The fact is that we are more likely to be killed by someone 'losing it' with a gun than by a terrorist.

If junior is hearing voices and owns a few guns, I would be willing to pay extra into the system so that when his mom warns the cops there is a place for him to stay and whatever professional help and drugs he needs.

The alternative is having an unpleasant meeting with him in a school, movie theater, mall.....

If more insurance companies get involved, the costs will go down as contracts are negotiated. The reason they are high now is that not enough attention was being paid.

[Undertoad]

Originally Posted by richlevy

Basically, if our country wants to be the largest industrial nation in the world with easy access to firearms, then we should also have cheap or free access to mental health.

This line of reasoning is extremely offensive to the mental health community and its patients. You may want to apologize.

[richlevy]

Originally Posted by Undertoad

This line of reasoning is extremely offensive to the mental health community and its patients. You may want to apologize.

For saying that they are needed? After hearing the backstories of some of these recent massacres, that really appeared to be an issue.

I'm not being trivial here. There is a point at which the ease of access to healthcare for someone else affects me. It becomes more enlightened self-interest than pure altruism. Firearms are an extreme example, but there are also strangers whose lives intersect and affect my own. Companies make a big deal about impairment due to recreational drugs, because an intrusive drug test and a 'drug free' sticker is cheap. They don't say anything about how a person's mental state might affect their performance or interaction with me.

[glatt]

Because not treating mental health has no costs associated with it.

[Lamplighter]

It's like we never heard of running a small scale pilot program - what a concept!

This is a repetitive refrain that shows lack of knowledge of community health programs
in various states, counties, and cities, not to mention countries on our border and/or overseas.

Maybe some diligent research and definition of "small pilot program" would help,
otherwise it's just "we never heard" wiggle-words.

Start with "MDRC"

[Lamplighter]

Not to mention that mental health insurance was not mentioned
previously by the Democrats, as a requirement for ACA approved health insurance.

Again... denial or lack of knowledge.

Just a "political clue"... remember John Edwards in the primaries ?

Health care
On February 5, 2007, Edwards unveiled his plan for universal health care.

The plan subsidizes health insurance purchases for poorer Americans,
requires that all Americans purchase health care,[24] "requires that everybody get preventive care,"[25]
and requires employers to offer health insurance through the Medicare system as one option for their workers.
Since Medicare has lower administrative costs — under 4%, versus 20% or more for many HMOs[26] <snip>
...Cost Containment
<snip>
...Revenue sources
<snip>
Individuals who are not covered by their employers or by an expanded
Medicaid program (covering individuals and families with incomes up
to 250% of the poverty level) or Medicare will be required to purchase insurance from these Health Markets.

Insurance companies must compete to win the right to be one of the providers
in these Health Markets and must provide full comprehensive care (including mental health parity).
In addition, one of the insurance plans will be directly provided by the federal government
(similar to, but separate from Medicare).

Edwards was first to announce a national health plan,
but the other Democratic candidates soon followed with similar ideas.

Sound familiar ?
If for political reasons, GOP Governors refuse to aid the citizens in their state... blame the GOP.