John Edwards was right – there are Two Americas.
In one of them, people of means can get healthcare whenever and whereever they need to.
And in the other? All the poor mopes who are jammed into Obamacare like Tokyo subway straphangers h take whatever they can and say “please, sir, may I have more?”:
As of this week, not one of the plans for sale on New York’s health benefit exchange would cover treatment at Memorial Sloan-Kettering Cancer Center, one of the world’s largest and most respected cancer hospitals.
That could mean that the 615,000 individuals and 450,000 small business employees expected to eventually get their insurance through the exchange would have to go someplace else for treatment, or pay the bill out of their own pockets.
Other premier city hospitals are in the networks of just a few of the new plans.
Now, if you voted for Obama, you should be Happy To Die Pointlessly For A More Level Healthcare Playing Field, and not bitch about it. This was what you wanted.
For everyone else? I’d rather keep my “substandard” plan, which doesn’t provide me prenatal care, but does, y’know, cover diseases I could conceivably get, if that’s OK.
And I’m sure it’s not.
Dear Mitch,
I hope you’ll accept I’ve forgotten more about how health insurance works than you’ll learn in your lifetime having worked for 11 years in it, starting as an examiner, working as an auditor and compliance officer, and finishing as a department head.
Your complaint herein is tripe. The plans offered through ACA are required to cover things your plan is not. They do NOT fail to cover things which your plan does, so your final point is simply false.
Further, it’s absurdity to suggest that somehow the average person is going to be prevented from having a certain level of care they would have otherwise been able to have. You CAN still seek privately delivered, though potentially unreimbursed, care. The fact is that the average person, you and I included, work within our plans. We stay “in network” because that’s how we can afford it. If the ACA plans are fairly ubiquitous in their coverage, they will almost certainly be broadly participated in by doctors and hospitals and in fact, I believe there is some level of compulsion to participate. Consequently, the likelihood your care will be covered by an ACA plan is not likely at all to be lower than under your current plan, and obviously it is FAR higher if your condition being treated would otherwise have been excluded or denied as a pre-existing condition. Still, even if it is, you can pay out of your pocket (as you righties think is the right solution) and go wherever you like, just as the very wealthy can do at any time. The real point, though, is that as a member of the middle class, you stay in your network, you don’t go out of that network looking up doctors outside your network (if you are an average middle-class person). You chose a primary care physician from your list of available physicians, you go to the hospital at which they or the specialist practices.. you go to the specialist they recommend who is in network.
All of that means, so long as your network under the ACA plan is reasonably robust it will be very much the same as your current plan. I know that doesn’t fit your rhetoric, it wrecks your story – yet it’s still true. The level of reimbursement may be different, it may be higher, it may be lower. The fact is that plans are cheaper because they pay less in benefits, Those lower benefits stem from denying pre-existing and chronic conditions. Yet those patients still NEED care, care they can’t afford (often) and so their unreimbursed care gets passed along to you as higher bills as providers look to make up lost revenues. You pay for it one way or the other, either in premiums to an ACA plan, or as a higher cost for your own care. Fundamentally all ACA really has done is to make us a more humane society that says it’s not okay that people go bankrupt if they get a serious illness and have their insurance cancelled. Other than that, the coverage, the costs, the access, the choice, really, for the vast majority of people, won’t materially change. You MAY have your individual insurance cancelled when your insurance carrier decides they can no longer offer the super cheap plan because they can’t deny 25% of claims as pre-existing. while you may see that as a bad thing, I do not.
But I’m sure it’s not okay with you…
Pen,
You might know your insurance – but you don’t know logic.
Your first two arguments are strawmen: you’re debunking points I didn’t make.
For example, you said “The plans offered through ACA are required to cover things your plan is not”. On the other hand, I said “I’d rather keep my “substandard” plan, which doesn’t provide me prenatal care, but does, y’know, cover diseases I could conceivably get, if that’s OK.” That’s my point; the plan will be pointlessly expensive since I’ll be part of “risk pool” for things I’m not in any way at risk for.
You also say “Further, it’s [wrong to say people are] going to be prevented from having a certain level of care they would have otherwise been able to have. You CAN still seek privately delivered, though potentially unreimbursed, care. ”
So in other words, they can get the care they got before; it just isn’t insured. Which was my complaint.
Right?
Then, you say “as a member of the middle class, you stay in your network, you don’t go out of that network looking up doctors outside your network (if you are an average middle-class person). ”
But “Barack” said “you can keep your doctor”. He didn’t say “you’ll have to change out of the network you’re perfectly happy with”. Did he?
“The fact is that plans are cheaper because they pay less in benefits,”
Right. So? When I was 26, I didn’t need a lot of benefits. I needed something to pay for the ambulance if I got hit by a Democrat in an oil-belching Subaru.
“Those lower benefits stem from denying pre-existing and chronic conditions.” That’s a rather misleading way to put it, Pen. Lower-risk people paid lower-risk premiums.
“But I’m sure it’s not okay with you…” Whether it is or isn’t, neither me nor my feelings are the issue here.
“I hope you’ll accept I’ve forgotten more about how health insurance works than you’ll learn in your lifetime”
Stipulated. You’ve forgotten a lot about healthcare.
(You can’t expect me not to take a straight line like that. Come on. I’m only human).
Penigma:
For starters, why can’t we just socialize the poor, low income and people that have excessive premiums because of preexisting conditions by either cutting them checks from the treasury or giving them vouchers for private insurance? Plus that way it’s funded out of PROGRESSIVE TAXATION. Jacking up everyone’s premiums for the community rating policy is effectively REGRESSIVE TAXATION.
QUOTE: The plans offered through ACA are required to cover things your plan is not.
…and this is good, why?
QUOTE: so long as your network under the ACA plan is reasonably robust it will be very much the same as your current plan.
I’m not going to get into a gigantic argument about this, but the anecdotes on Hate Radio and Hate Television are not a good sign.
QUOTE: You MAY have your individual insurance cancelled when your insurance carrier decides they can no longer offer the super cheap plan because they can’t deny 25% of claims as pre-existing.
Do they really screw with people in this way? As long as you are honest on your application, doesn’t this all get worked out with a legal letter about what is not going to be covered? Don’t insurance commissioners have a say in this process?
My understanding is this all got resolved over two decades ago.
25%????????????
FYI This is must read on ACA, health insurance, and the economy. Notice I got nine RTs http://bit.ly/1cdhTA2
This is also outstanding if you have the time http://bit.ly/18fcPOz PERFECT.
What was intended was for young, healthy, and richer Americans to pay more for their existing healthcare, so that more older, sicker and poorer Americans would receive more healthcare. That’s what “adding people to the risk pool” means. It increases the level of transfers and subsidies that already existed. It does not affect the overall cost of healthcare. It just increases the level of socialism in what was already a socialist system.
The corollory to this is that, because Obamacare doesn’t actually increase Federal spending much, the extra transfers are coming from higher premiums, from healthy, young individuals purchasing healthcare first and foremost, but also from those on corporate plans.
Those inexpensive “not very good” plans being cancelled were inexpensive because the individuals were young and healthy.
Emery: a) if they don’t do that out of taxation and redistribution instead of premiums, it’s definitionally REGRESSIVE.
b) what is good about all of these mandates? Including PREPAID MEDICINE (and a way too broad menu of it) premiums is STUPID.
Whatever they do, major medical, prepaid medicine and socializing the poor and the preexisting conditions HAVE TO BE SEPARATED OUT ACTUARIALLY AND FUNDED SEPARATELY AS APPROPRIATE. Taxes for preexisting and the poor, premiums for major medical, and prepaid medicine is optional through doctors and hospitals. What we have now is a mathematical mess of collectivism (which isn’t even set up progressively, necessarily) and the ACA made it WORSE.
Now someone is going to say we should guide and fund preventive medicine by GOVERNMENT FORCE AND CENTRAL PLANNING in 3,2,1…
Disgracefully stupid and wasteful. Terrible. http://bit.ly/1a6MiAX
“That’s what “adding people to the risk pool” means”
I generally agree with your comment (!), but this…has opportunities for improvement.
This is perverting the idea of the “risk pool”. Putting *everyone * in the same “risk pool” is like making a prioritized task list and calling everything “urgent”.
QUOTE: “This is perverting the idea of the “risk pool”. Putting *everyone * in the same “risk pool” is like making a prioritized task list and calling everything “urgent”.”
The risk pools have to have a certain structure to work and be cost efficient otherwise something will give, and not in a good way: premiums, clinic / hospital service, coverage etc.
Which is why single payor is so dumb. All it will do is either generate debt, bad service, or death panels.
Insurance has to be rationed from the bottom up as much as possible. ALL of the top down heavy handed stuff is wasteful and cruel.
The other thing is, if we could make it a good deal for the young and healthy and poor to have and manage major medical policies, that would bring everyone’s insurance down because the industry would become more stable.
Of course we a ruled by ignorant whores that will never let this happen, even if they understand it.
Here’s another must read. Short, too. http://bit.ly/1bKbwDS
What is Penigma’s twitter handle? tia
LOOK AT THIS: As Larry Levitt, a senior vice president of the Kaiser Family Foundation, explained to me, if costs are more than 3 percent higher than anticipated in the first few years of Obamacare, the federal government will have to pick up at least half of the additional expense.
http://wapo.st/1cJdapC
Penigma fails to acknowledge the consequences of social engineering.
It’s not absurd to suggest my level of health care will go down if my existing low deductible plan is cancelled and replaced with a more expensive plan. I will have less of my bill paid through insurance and more out-of-pocket. I’ll have to choose between paying the rent or paying the doctor. That’s not a choice I must make now, it’s a choice I will have to make under Obama-care. It means I take an aspirin for a mild heart attack instead of going to the emergency room, because it’s all I can afford under the new Affordable Health Care Act.
This is not what Democrats promised us.
.
Shamefully stupid government policy. All they had to do is think a little and sell it in a straightforward way. Leave the private market MOSTLY as is (at least compared to this monstrosity), but help out with GASP! PROGRESSIVE TAXES AND REDISTRIBUTION! http://bit.ly/1haX8dO
Instead we get a bunch of destructive Orwellian bullshit.
Penigma? Bueller? Anyone? RICK___DFL?
Government insurance and pension programs are simply graft, theft, and rent-seeking scams. http://bit.ly/1fxqHWl
Intergenerational theft.
Senate nuclear option = More central government and political whore promises
We are doomed.
The corollory to this is that, because Obamacare doesn’t actually increase Federal spending much
EmeryTheUSAHater must have crashed Ford’s crack party.
For someone who claims to have worked in insurance for 11 years, Penigma sure lacks a basic understanding that when one treats a correlated risk as uncorrelated, it creates all kinds of perverse incentives.
That’s the core of the issue; she can say that the major medical plans I’ve had and enjoyed are not “robust”, but the fact of the matter is that when I had them, they covered for every possible condition I could have had, and they also gave me a great incentive to stay healthy and avoid needless risks.
The Health Insurance Deform Act turns all that upside down, really, and that will destroy it–hopefuly before HIDA destroys the U.S. healthcare system!