Another Obamacare Setback: Patient Out-Of-Pocket Caps Waived Until 2015

[noahvale]

^

[rocker]

From Forbes.com

[..]
There’s no such thing as a free lunch. If you ban lifetime limits, and mandate lower deductibles, and cap out-of-pocket costs, premiums have to go up to reflect these changes.

So, to paraphrase the message of this article:

"It is far far better to keep our current system - where thousands of people die each year, and tens of thousands more lose everything they own they own and are bankrupted due to a single illness - than for me to run the risk of paying even slightly more than the usual rise in health insurance premiums each year."

Just kinda warms the heart.

[Jean]

Things, I would think would be easier if we just scuttled the whole thing and instead, went after the drug companies and the hospitals. I realize it costs money to make these drugs and it costs money to maintain the brick and mortar hospitals. But, if you get a hospital bill and it is itemized, it is ludicrous. One week in the hospital and my drugs were $4000, which is about twice what I spend for a whole year. Yes, I did get morphine and massive antibiotics, but, still. I just cant imagine it being that expensive. The drug companies invest millions to make and supply drugs, but they are making one awesome profit too. Sometimes America is a little too liberal in their allowing companies to make outrageous profits  if the expense of it is on the backs of the very ill. Just my   

[noahvale]

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[rocker]

No, to sum up the article, Obamacare, rammed down the public's throat (or up their a$$es) has screwed those who where happy with their healthcare insurance

What does your rant have to do with a delay in OOP caps?

to insure the 15% who had none - whether for pre- existing condition, being in our country illegally or young and deciding to not make purchasing health insurance a priority. 

Well, goodness, what would anyone here know about having a pre-existing condition??

I'm not sure what the "illegal aliens" jab has to do with anything - Obamacare does not provide insurance for people here illegally.  Not anymore than is already provided by ER requirements to treat them (a Reagan law).

As for "deciding not to make health insurance a priority" - well, me, I'm for personal responsibility.  I know other people aren't. What if the guy who ran over you with his car "decided not to make auto insurance a priority"?

But what is at the heart of all these arguments is - that the things you mention should be punishable by death.  Poor and sick?  Sorry, here's the number for a funeral home.  Poor and illegal?  Dude, go croak on the sidewalk.  We only treat citizens here.  Decided you didn't want to pay for insurance?  Well then, we just decided not to treat you.

The Kaiser Family Foundation notes that a typical family’s health care premiums rose $1,975 on average since 2010, when Obamacare was signed into law. The foundation also noted that “workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,977 and $3,968, respectively).”

I understand that most Americans aren't familiar with health insurance, because they are employees.  As an employer, I can tell you that premiums have shot up far faster than inflation every year since pretty much the dawn of time. The rise in premiums is less now than it otherwise would have been.

Most of the provisions of the law have not yet taken effect.  Please tell me which provisions of the law, that have already taken effect, have caused the premiums to rise - and what the premiums would have been had these statutes not been in force.

And yes - employers screw lower-wage workers.  How this is related to who is the president, I have no idea.

[MooseMom]

Things, I would think would be easier if we just scuttled the whole thing and instead, went after the drug companies and the hospitals. I realize it costs money to make these drugs and it costs money to maintain the brick and mortar hospitals. But, if you get a hospital bill and it is itemized, it is ludicrous. One week in the hospital and my drugs were $4000, which is about twice what I spend for a whole year. Yes, I did get morphine and massive antibiotics, but, still. I just cant imagine it being that expensive. The drug companies invest millions to make and supply drugs, but they are making one awesome profit too. Sometimes America is a little too liberal in their allowing companies to make outrageous profits  if the expense of it is on the backs of the very ill. Just my   

Unfortunately, the pharmaceutical and hospital industries have enormous lobbying power in Congress.  To "go after" these special interests would probably reduce campaign funding to many congresspeople gunning for reelection.  It would be very interesting if each of us could find out how much money our particular congresspeople get from drug companies or hospitals located in their districts.

We are no longer a true democracy.  Citizens United guaranteed that we are now governed by money.  Please someone tell me I'm wrong.

[MooseMom]

Noahvale, what concerns me about both the tenor and the substance of your posts is that you do not offer alternatives or ways to make better what has already been passed as law. 

I understand that there are plenty of Congresspeople, particularly those who are Republican, who do not like the Afordable Care Act, but I am bothered by the glee with which they shout their complaints and really wish they could come up with even more efficient and affordable ways to insure that all American citizens have access to at least basic care.  Defunding the Affordable Care Act is the only strategy they have come up with, and if that is successful, then with what are we left?

Do you, noahvale, have anything constructive to suggest?  And if so, why not approach your congresspeople and share your ideas?

[Bill Peckham]

No, to sum up the article, Obamacare, rammed down the public's throat (or up their a$$es) has screwed those who where happy with their healthcare insurance to insure the 15% who had none - whether for pre- existing condition, being in our country illegally or young and deciding to not make purchasing health insurance a priority. 

We have to pass the bill so you can find out what is in it."  -  Nancy Pelosi

Well, we are now finding out what is in it and the same insurers, pharma you rail against are being catered to by the Obama White House.  Oh, and let's not forget the deals Obama is cutting with the democratic union base, and not requiring white house/congressional staff/congress to participate in the exchange scheme.   Concessions for everyone EXCEPT the common worker.

And don't forget Pelosi's prophetic comment on a July 1, 2012 Meet the Press appearance: "everybody will have lower rates."

The Kaiser Family Foundation notes that a typical family’s health care premiums rose $1,975 on average since 2010, when Obamacare was signed into law. The foundation also noted that “workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,977 and $3,968, respectively).”

The ACA passed after a year long election, a decisive electoral victory and two years of legislative debates - that's rammed down our throats? I think you're thinking of Medicare Part D.


At what rate were premiums increasing from 2000 to 2010? And people at high wage firms have more generous benefits than people at low wage firms? Who would of thunk it?


 

[Hemodoc]

The point of the delays is it is just one more of hundreds of exemptions Obama has granted whoever he pleases to exempt. Union buddies, contributors, various corporations.  Even congress itself wants nothing to do with Obamacare and they exempted themselves which is the ultimate in hypocrisy. Likewise, the head of the IRS charged with enforcing Obamacare says no thanks, he will keep his current insurance coverage.

If you are rich, influential and support Obama, exemptions to Obamacare are one of the perks that they get. That is the essence of this latest of hundreds of Obamacare exemptions to date.

[Bill Peckham]

The point of the delays is it is just one more of hundreds of exemptions Obama has granted whoever he pleases to exempt. Union buddies, contributors, various corporations.  Even congress itself wants nothing to do with Obamacare and they exempted themselves which is the ultimate in hypocrisy. Likewise, the head of the IRS charged with enforcing Obamacare says no thanks, he will keep his current insurance coverage.

If you are rich, influential and support Obama, exemptions to Obamacare are one of the perks that they get. That is the essence of this latest of hundreds of Obamacare exemptions to date.

This particular delay allows some employer plans, that currently exist, to have maximum out of pocket doubled - one for doc visits, one for prescriptions. Some businesses said they needed another year, and they got another year. I can see that if one is determined to make the worse of situation they talk themselves into just about anything.

[noahvale]

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[noahvale]

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[MooseMom]

Noahvale, thank you for your very interesting post.  I can't disagree with your point number 2.  But could this be done without the "politics"?

I wholeheartedly agree with your point number 3.  Perhaps if someone other than President Obama made the same suggestion, we wouldn't hear the shouts of "death panels!"

I'm fascinated by Australia's Health And Character immigration requirements.  I would love to know which resources Australia have defined as being in short supply.  I wonder if dialysis is in short supply in Australia.  I can certainly understand not granting a visa to someone who has a dangerous and easily transmissible disease.  I'm glad to read, however, that waivers can be granted.  Of course, the US requires physical exams during the visa application process.

http://travel.state.gov/visa/immigrants/info/info_3745.html

I don't see, however, any reference to refusal of a visa application due to the COST of healthcare or to the possible denial of such care to US citizens due to "short supply."

As far as your congressman's proposed bill, I'm not through reading it, but I'm not liking Sec. 105.  Since this proposal (like the ACA, frankly) is trying to solve the problem of lack of insurance to poor people, I don't think it is fair that poor people, under this bill, could not get access to abortion while any rich person could.  One may not approve of abortion, but it is not illegal in the US, so this is just one more way in which poor people are discriminated against.

I'm also uneasy about Sec 211 and IMAs.  I guess I'm not really against them per se, but I wouldn't enroll in one.  They seem unreliable.  I'd like to hear more about how exactly how one would work.  Could you perhaps give me a hypothetical and guide me through how you see the logistics of such an arrangement?

I like Title III, I think. 

My eyes are tired, so that's as far as I've read.  Is there a particular section that vastly improves upon what is offered by the ACA that I should pay special attention to?  Honestly, this hasn't been a lot of fun to read!  Any "shortcuts" would be appreciated.

[MooseMom]

Likewise, the head of the IRS charged with enforcing Obamacare says no thanks, he will keep his current insurance coverage.

Well, wait a minute.  I thought one of the main selling points was that you could keep your current coverage if you wanted.  So, what's wrong with him wanting to do just that?

[rocker]

I actually do have some constructive suggestions to help with the healthcare system in the U.S.

[..]

1) Follow Australian example

I agree.  Single-payer is the only sane model.

of its Health and Character immigration requirements

This doesn't make the slightest bit of sense in a unlimited-profit healthcare system.

"Australia enjoys some of the best health standards in the world.

Go, single-payer.

2) As much as I deplore over regulation, maybe it is time to treat medical facilities/hospitals the same as public utilities.

I agree completely.  But weren't you just railing against government control?

3) Start to have a healthy discussion on end of life care and alternatives. [..]

Another excellent idea.  It was also originally included in Obamacare - until lunatics started frothing at the mouth about "death panels" (yes, this is what they were referring to by "death panel" - a discussion with your physician about your end-of-life wishes).

See?  We agree about almost everything.  Single-payer, strong government oversight, limiting the profits of the medical system, rejecting unwanted "care".

[noahvale]

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[Hemodoc]

Looking at the many models of healthcare around the world, the single payor system is NOT the ultimate in healthcare since that always leads to rationing of one form or another. My sister lives in a single payor country, Canada and she has the Canadian health system AND she has her own privately purchased health care coverage. For those that can afford the coverage, it is a choice made quite often to avoid the long wait lists and have the option of seeking care in the US for uncovered benefits.

The best national policy I believe is in Switzerland. You can see a documentary on this and how other developed nations approached the same issue.  Their answer in Switzerland, make all health providers non-profit, require all citizens to buy health insurance but allow the insurance companies to compete for those patients in a free market system where patients choose their own providers. If they are not happy with that company, they switch to another one.

For those that cannot afford to buy the insurance, a small percentage of the population, they have government subsidies.

http://video.pbs.org/video/1050712790/

The ACA is nothing of the sort and is a complete train wreck heading our way. In a very real sense, there was no health care debate before the ACA was passed since the GOP was shut out of the closed door meetings. I would support the Swiss model, the Obama model on the other hand is designed to destroy the employer based system and set it up with a single payor system which goes against the will of the majority of Americans. They were sold a bill of goods with the ACA and Nancy said, you must pass it so you can see what is in it. Great, the ACA is here and even Obama won't be able to keep it on the tracks.

[MooseMom]

Hemodoc, don't you think the employer based system of providing access to health care is somewhat outdated?  It just seems to me to be a terrible burden on businesses in general. 

I agree with you about the Swiss health system, but who in America would ever support making health providers non-profit?  I guarantee you that there would be screams of "socialized medicine".  And that's the real problem with the ACA; it just funnels money to the insurance industry.  If someone isn't making a healthy profit, then it's un-American.

I'm not sure what the will is of the majority of Americans.  I don't think anyone knows that.

[Hemodoc]

Hemodoc, don't you think the employer based system of providing access to health care is somewhat outdated?  It just seems to me to be a terrible burden on businesses in general. 

I agree with you about the Swiss health system, but who in America would ever support making health providers non-profit?  I guarantee you that there would be screams of "socialized medicine".  And that's the real problem with the ACA; it just funnels money to the insurance industry.  If someone isn't making a healthy profit, then it's un-American.

I'm not sure what the will is of the majority of Americans.  I don't think anyone knows that.

Sorry, that is historically quite wrong when looking back at the history of American medicine which was founded almost entirely by non-profit entities prior to Johnson messing up the whole pot. Illegal immigration was not an issue until we began government entitlements. The entire illegal immigration issue boils down to not being able to afford to pay for free health care to anyone who slips across the borders. The two are entirely related.

The simple fact remains that American cannot afford to pay for healthcare for that our own paying citizens. One of the issues other nations who have settled health care systems is to have closed borders to best extent possible. Even Mexico has paradoxically, very stiff penalties for illegal immigrants crossing their southern borders.

The employer based health system came into place due to government price controls after WWII that continued through the Korean conflict into the 1960's. To compete with other businesses constrained by price controls, many began offering other paid benefits not considered salary. So, once again, this whole mess started with government interference in the business arena with price controls.

Surveys prior to the ACA showed 85-90% quite happy with their current employer based coverage, yet Obama was not satisfied but to mess up the entire system since his goal is a single payor system. The ACA is NOT the end action that the DEMS as seeking, just a stepping stone to destroy the current system even though it provided well for a large majority. He did not focus on the 10-15% that were in need.

In reality, since Reagan and EMTALA in 1986, illegals have had access to free health care and this once again sparked increased illegal immigration from Mexico. The reason a hospital charges a hundred dollars or something absurd like that for a band aide is to shift the cost to private health insurance. One of the reasons health insurance has gained in cost over the last 3 decades relates directly to EMTALA and free medical care to illegals and indigent.

Other nations with national health care don't have open border policies understanding a simple principle that it will bankrupt their system. So stating that millions of people have no health care today in the US is simply in error. At the hospital I practiced, internal medicine had a group that sought a contract with the hospital for all of the panel patients without insurance. However, OB and Pediatrics had no such group contracted. All docs in those specialities had to do a rotating panel call.

My colleagues at Kaiser in OB complained bitterly about the panel patients for two reasons. Huge lawsuits from this population more so than the paying Kaiser patients, many of whom were high risk pregnancies and a lack of appreciation for the high quality care that they received free of charge. Most of the OB docs at my clinic were also some of the most highly regarded UCLA professors who started at UCLA and then went to Kaiser for improved financial compensation but retained their ties to UCLA. Two of the OB docs were granted professor of the year several times over by the rotating OB fellows. It was a very high powered and high quality department that was abused greatly by ungrateful non-paying folks granted lifesaving care. To say this lead to a bad attitude toward panel call with huge risks to these docs with an 18 year tail of malpractice to boot is an understatement. (OB docs can be sued for up to 18 years until the kids rich adult status when most docs have a 5 to 7 year statute of limitation depending on the state you live in)

So who is paying today for all of this free health care? You and I who have private health insurance and pay our bills.

[MooseMom]

I didn't say anything about illegal immigration so am not sure why you've veered in that direction, unless your goal is to make worse the headache I already have.   I'm sure you realize that this country has a net zero rate of illegal immigration, so the problem remains on what to do with those that are here.  As a Christian, I am fairly certain that you would not like to see anyone, no matter their immigration status, being left untreated.  I mean, doesn't the Bible talk about treating the sojourner as one of your own and not wishing him harm?  Even if it were true that it is solely illegal immigrants who have made our healthcare so expensive, then what do we do besides complain about it?

I am aware of how the current employer based healthcare system came to be, but my question still is why do we still stick to it?  Why do we still expect employers to contribute to our health insurance expenses?  I would have thought that most employers would be happy to shift that particular financial burden elsewhere.  I'm just asking!  The conditions that gave rise to this practice no longer exist, so why keep this particular relic?  If there is a sound financial reason, just please someone explain it to me.  I really don't understand.

Does the current system really provide that well for "a large majority"?  I'd rather see a system that provides well for everyone.  Maybe the answer ISN'T the ACA, but that's what we've got, and I wish that our politicians would work to mend it rather than end it.  Surely that would serve us all better than constant House votes on repealing it for the sole purpose of pandering to the base in the upcoming mid-terms.

[Hemodoc]

I didn't say anything about illegal immigration so am not sure why you've veered in that direction, unless your goal is to make worse the headache I already have.   I'm sure you realize that this country has a net zero rate of illegal immigration, so the problem remains on what to do with those that are here.  As a Christian, I am fairly certain that you would not like to see anyone, no matter their immigration status, being left untreated.  I mean, doesn't the Bible talk about treating the sojourner as one of your own and not wishing him harm?  Even if it were true that it is solely illegal immigrants who have made our healthcare so expensive, then what do we do besides complain about it?

I am aware of how the current employer based healthcare system came to be, but my question still is why do we still stick to it?  Why do we still expect employers to contribute to our health insurance expenses?  I would have thought that most employers would be happy to shift that particular financial burden elsewhere.  I'm just asking!  The conditions that gave rise to this practice no longer exist, so why keep this particular relic?  If there is a sound financial reason, just please someone explain it to me.  I really don't understand.

Does the current system really provide that well for "a large majority"?  I'd rather see a system that provides well for everyone.  Maybe the answer ISN'T the ACA, but that's what we've got, and I wish that our politicians would work to mend it rather than end it.  Surely that would serve us all better than constant House votes on repealing it for the sole purpose of pandering to the base in the upcoming mid-terms.

First of all the health care solvency issue is greatly related to EMTALA and illegal immigration especially in southern states. That is not changing the thread, but adding another layer of the story of our health system and why universal health care in the US will not succeed while it has in other nations with closed borders and universal health care.

As Christian, we believe it is God that supplies all of our needs and historically, the church was indeed one of the biggest organizers of hospitals across America.

             Privately supported voluntary hospitals, products of Protestant
patronage and stewardship for the poor, were managed by lay trustees and
funded by public subscriptions, bequests, and philanthropic donations. By
contrast, Catholic sisters and brothers were the owners, nurses, and
administrators of Catholic institutions, which, without a large donor base,
relied primarily on nuns‟ fundraising abilities along with patient fees. Public
or tax-supported municipal hospitals accepted charity patients, including
the aged, orphaned, sick, or debilitated. Some physicians established
proprietary hospitals that supplemented the wealth and income of owners.
Owners of not-for-profit voluntary and religious hospitals on the other
hand took no share of hospital income.  Physicians also developed
specialties such as ophthalmology and obstetrics and opened their own
institutions for this new kind of practice.[9] 


During the depression, government became much more involved in hospitals and then the 1947 Hill-Burton Act and then the great society placed the non-profit hospitals in the minimum as the government took over more and more of the healthcare in this nation leaving a very small proportion today that are non-profit and religious based, but the initial development of hospitals was largely out of Christian charity.

As far as employers, under the ACA and Obama, the largest segment of new jobs are part time and no health benefits. Great job Obama adding more and more to the public domain.

As far as paying the IRS fine vs keeping existing health plans that are getting more and more expensive under ObamaCare, yes, eventually and probably quite quickly, Obama without a public referendum on this issue, remember, you can keep your own doctor and health plan, will move away from an employer based system to ObamaCare and then to single payor by default. So, yes, soon you won't have to worry about private insurance and you can join everyone else in a wonderful utopian Obama health care system.

I remember a meeting with Lori Hartwell talking about ObamaCare and how happy they were it passed. We talked about the disincentives for keeping employer based health care. Lori likes her plan where she goes to Cedar Sinai for much of her health care and her stating matter of factly I don't want to lose my health care. ObamaCare is good for others, but I suspect many are just quite happy to keep their employer based health care in the ultimate hypocrisy.  I have heard quite few who are strong supporters of the ACA make such a statement over and over again.

Well, guess what, it will only be a matter of time before Obama destroys the employer based system and the majority of full time full paid benefits. I suspect folks really do like and appreciate free benefits paid by employers after all, but Obama will certainly destroy that. So, just wait a while and you will have your utopian health system. I hope you enjoy it as much then as you think you will now. I have my doubts.

[rocker]

Obamacare has government or a governmental surrogate making the decisions not only on when to pull the plug on a life, but also on rationing care.  Again, not government's place to do so.

Please quote the exact provision of Obamacare that mandates that the government decides who is to be taken off life support.

[Bill Peckham]

Obamacare has government or a governmental surrogate making the decisions not only on when to pull the plug on a life, but also on rationing care.  Again, not government's place to do so.

Please quote the exact provision of Obamacare that mandates that the government decides who is to be taken off life support.

It's a complete fabrication. Wrong on so many levels. I think when you consider the political ramifications of cutting services to seniors you understand that it won't happen. Anyone with a passing familiarity with US politics understands that the ACA and every other piece of legislation that passses through Congress advantages seniors over the young. The ACA transfers from young to old by limiting the premium rates that can be charged to people based on age. The idea that there will be death panels and overt rationing is laughable - healthcare for seniors will be the last federal program standing.

But this also tells you why this keeps coming up - scaring seniors is a political winner. Of course partisan operators will push narratives about how today's US seniors - the most entitled and catered to group of people to ever live in the history of the world - are getting screwed somehow. It's raw political calculus.

[rocker]

Looking at the many models of healthcare around the world, the single payor system is NOT the ultimate in healthcare since that always leads to rationing of one form or another.

If you think there is no rationing in American healthcare, then you know so little about the system as to be utterly ridiculous.

I personally know of three middle-aged men whose primary cause of death was "being uninsured."

The best national policy I believe is in Switzerland. You can see a documentary on this and how other developed nations approached the same issue.  Their answer in Switzerland, make all health providers non-profit, require all citizens to buy health insurance but allow the insurance companies to compete for those patients in a free market system where patients choose their own providers. If they are not happy with that company, they switch to another one.

For those that cannot afford to buy the insurance, a small percentage of the population, they have government subsidies.

I would be happy with more regulation, and removing the profit from healthcare.  (A huge number of "non-profit" hospitals run large "operating surpluses" every year.)

Switzerland is also a system where the maximum price of insurance is set by the government, no?

The ACA is nothing of the sort

I agree.  The ACA didn't go nearly far enough.  Welcome to the corrosive influence of money in politics.  (The medical industry spends, I believe, five times the amount on lobbying as the oil and gas industries.)

In a very real sense, there was no health care debate before the ACA was passed since the GOP was shut out of the closed door meetings. I would support the Swiss model, the Obama model on the other hand is designed to destroy the employer based system and set it up with a single payor system which goes against the will of the majority of Americans. They were sold a bill of goods with the ACA and Nancy said, you must pass it so you can see what is in it. Great, the ACA is here and even Obama won't be able to keep it on the tracks.

This is complete and utter nonsense.  The ACA was debated and amended for over a year in Congress.  Many of the best provisions (like the public option) were removed due to lobbying pressure. Concession after concession was made to Republicans and right-wing Democrats.  What was eventually passed barely resembles what came out of committee.

As for single-payer - they couldn't even get a government-sponsored commercial insurance policy into the bill, and you're fantasizing about "single-payer"?

Please please, cite me the provision of the ACA that allows for a single-payer system - I will begin spreading the word immediately.

The problem with the ACA is that it does nothing to touch the profit-based system that has served the US so poorly for so long.

[Hemodoc]

Sorry Rocker, your memory of "open" negotiations does not line up with the historical account. The left wing DEMs even shut out the moderate and conservative "blue-dog" DEMS who made a formal complaint against that.

http://www.nytimes.com/2009/05/12/us/politics/12dems.html?adxnnl=1&ref=us&adxnnlx=1242133580-BAMJSJYbmjbBoEQASz72Zg&_r=0

ObamaCare came to us through back room politics from one sided left wing DEMS who had the votes in the House and Senate. Pelosi put enormous pressure on her troops to hold the line and vote. Pelosi told the public we have to pass it so we could find out what is in the bill. You call this an "open" debate.

http://www.youtube.com/watch?v=hV-05TLiiLU

Rocker, where did I state that single payer was in the ACA. Not what I stated at all. I stated that the goal of the ACA is to lead to a single payer system, not that it contained a single payer clause. Interestingly, Harry Reid so stated a few days ago that that is their goal. Sorry that this is news to you, but that has been apparent for a long time to those who oppose Obamacare. The government-sponsored commercial insurance policy was opposed simply because it was as a direct step towards a single payer system that even the DEMS couldn't pass since that is not what the majority of Americans want.