Interesting that one side wants to revisit this issue. From Sunday’s Meet The Press.
{{ “You also want to implement some deregulatory agenda so that people can choose a health care plan that fits them,” he said. “And we want to make sure everybody is covered.
“But the best way to do that is to actually promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families,” {Redacted} added.
There’s an awful lot that isn’t spelled out in those remarks, including whether health plans would still have to offer everyone the same basic benefits or how much premiums could vary from young and healthy to old and sick… }}
{{ snip }}
One of the fundamental principles of health insurance is that, “The larger the pool, the lower the risk that any one person in the pool will get an expensive illness that causes a big premium spike, or bankrupts the plan.” Conservatives hate this simple principle of Probability & Statistics and keep wanting to have a private company slice and dice the risk pool so that they can extract as much profit as possible.
Traditional Medicare operates with about 1.2% of administrative expenses and spends 98.8% of its program budget on actual health care services for beneficiaries.
Medicare Advantage can spend as little as 85% of the money they get from Medicare on actual health care services, and now that all the large insurers have captive Pharmacy Benefit Managers, they can get another 5% or so by price gouging on generic drugs (i.e., the price gouging is considered to be a medical expense rather than additional profit to the insurer that counts against the 85% limit. Such is the state of affairs with a bipartisan culture of corruption in Washington.)
People in WI, MI, PA, NC, GA, NV and AZ who are distracted with Haitians in Springfield ignore this arithmetic at their peril. {{ LOL }}
Preexisting conditions coverage is a major problem w Affordable Care Act. People can get insurance after they are diagnosed. That is expensive for the plan and results in expensive high deductible policies for the young and healthy.
Better to cap benefits for first three years. That encourages all to carry insurance. Helps keep premiums affordable.
It’s insane. Used to be you could get a high deductible family policy for a few hundred a month, let’s say $15k deductible. That was for people willing to pay for all regular medical care, but wanted a policy just in case something big came up. We needed a policy when my cobra ran out and the ACA policy cost us $3800/mo for a high deductible policy!!! Kept it for a few months, not a single claim, not for anything. Finally couldn’t take it anymore and my wife took a part time job just for the medical benefits, and we cancelled that ripoff ACA policy.
Could be an anomoly in your state market. In Missouri (or Missouruh if you’s ignert), I’m paying $697.62 total ($621.98 medical with $9000 deductible, $60.60 dental and $15.04 vision) per month for one person. When I retired, I assumed continuing my corporate plan as long as possible under COBRA would be the cheapest option so I didn’t immediately shop for individual coverage until I neared expiration at 18 months. I then realized I could have saved money by exiting the COBRA extended plan earlier cuz while I got a corporate rate during that time, I only had corporate choices and my company didn’t offer the higher deductible plans cuz relatively few people want them. The cheapest plan my employer had with group rates was equivalent to a “silver” plan. Once I actually shopped as an individual, I could choose a “bronze” level plan which was cheaper than I had been paying in COBRA.
It’s not only getting sick. You could be in an expensive accident, and you can’t sign-up for Obamacare after the fact and get coverage for the $300,000 ER visit.
The real problem is that health insurance is essentially “wealth protection” against the insane level of price gouging and corruption in the health care industry. If you don’t have any savings or assets to protect, it’s a reasonable financial decision to “go bare”.
Even if you have health insurance, the insurance company is still going to try to cheat you out of the health coverage you paid for.
{{ Only about 11 percent of denials of prior authorization requests were appealed, the analysis finds. However, of the appeals that were filed, the vast majority (82%) resulted in fully or partially overturning the initial denial.
The high rate of successful appeals raises questions about whether a larger share of the initial prior authorization requests should have been approved. }}
Ok, but the last attempt to rein in the insurance industry–Hillary care–failed miserably. Negotiated drug prices is a step in the right direction.
What is the right answer. Medicare for all is not likely. Universal health insurance–Affordable Care Act–was our best effort but strongly opposed and disabled at every opportunity.
My heart valve repair (one year ago) was billed to insurance for just over half-a-million. Insurance negotiated to around $140,000. My cost was under $4k. Completely out-of-the-blue surgery. But, what would I have done if I was not insured and had no leverage to negotiate a lower cost?
We have a health care system that charges more to the people who can least afford it.
Well, Medicare for all is. As you said it won’t pass. The excuse given is “it is socialism”. But the reason is it will keep some people from skimming us and getting filthy rich in the process.
I think the real problem is how to pay for it. It will be expensive–unless you rein in health care costs.
I suspect most voters like the idea of universal health care coverage. I doubt they buy the socialism argument. That is mostly theoretical and over their head. Cost is the issue.
We certainly hope for progress toward better health care for the disadvantaged. But lobbyists with deep pockets are powerful in Congress. Getting changes passed takes a major effort. At minimum strong leadership.
I’d like to see that study. You imply that some existing services will be trimmed. Which ones? How?
Yes, treating everyone in the emergency room has to be costly. Better to get them going to see a doctor before it gets serious. That has to be cost effective. But how? France is famous for its required prenatal care. That can be a step in the right direction.
Getting people healthier has to be a plus for everyone. And a path to lower health care costs.
We are finding Medicare far from perfect. DH started on it this year. He has been a Type 1 diabetic for over 52 years and has it well under control, knows what he is doing. None the less, Medicare insists he goes to his endocrinologist quarterly, and starting in 2025 that has to be in person, which tethers us to our residence. One does not get cured from having Type 1, which is failure of the body to manufacture insulin, but Medicare is still insisting he go to the doctor more than necessary, or he will lose coverage for the medical materials he needs to manage his diabetes. His doctors don’t think it necessary, and we don’t think it necessary, but Medicare insists. What a waste of our time and everyone’s money.
When DH had to take medicare this year, he lost our retiree healthcare from work, which was excellent. The demise of retiree healthcare for most was an unintended consequence of medicare. As I am younger than he, that put me on the search for coverage as well. Looked at ACA, which was almost $700/month for a Silver plan, which came with a deductible of something like $10K. Bizarrely, the bronze was more expensive. A HMO was our only option, which is less than stellar given all the travel we do. We did find a private PPO that precludes pre-existing conditions and has a $5K deductible for meds, though coverage is less than 100%. I have/take none. It also doesn’t cover fertility/mental health, which works for me. The cost was roughly $500/month, with no deductibles other than for meds. I will use it for the first time today, having to pay $100 for my Covid vaccine, which was free under Retiree Health Care and DH’s Medicare. I have my annual screens coming up and will see how well those are covered, leaving me enough time to switch over to ACA if there are too many surprises.
Medicare needs to leave medical decisions to the doctors. ACA needs to be more portable.
At the same time, Medicare doesn’t know that your husband is compliant. I suspect they’ve learned that a number of people don’t follow long-term treatments. Think of it as a form of preventative medicine.
But the doctors, who have repeatedly stated that he is the healthiest long term diabetic they have ever seen, do know that. That is why I said Medicare should leave medical decisions up to the doctors!
I think of it as a lack of understanding of the difference between type 1 and type 2 diabetes. His body is incapable of producing insulin, something that happened to him after a virus at 13. That is never coming back. DH is not insulin resistant, Type 2 diabetes, which has the potential for reversal. Healthcare administrators have to stay in their lane and let the doctors do their jobs, if they want efficiencies.
What is his co-pay for specialist visits? I’m type 2 diabetic. United Health Care HMO Medicare Advantage. Co-pay is $25. No visits required but strongly encouraged. Main one is annual to opthamologist to watch for diabetic retanopathy.
Nothing with medigap. It’s not the cost that’s the issue, it’s having to be in our home town to go to the doctor every 3 months, and the hassle of going when it’s just not necessary. We are out of town so much that we have a house sitter living in the downstairs apartment, and it’s our style to take off for months at a time. (I guess it will just have to be for less than 3 months at a time, which eliminates some of our dream trips.) It’s the waste of Medicare money to pay the doctors for two extra visits over the twice a year he already goes to them, when there is no medical need to do so.
We suspect they require the visits so that the doctors can get eyeballs on his insulin pump and make sure he didn’t sell it. Keeping honest people honest while doing absolutely nothing to prevent fraud.