How Is Obamacare Working Out for You?

[GenuineRisk]

Originally Posted by Rupert Pupkin

It turns out they did. They gave me a plan with a $8,800 deductible that was only $210 a month. I was thrilled. But after the ACA passed, they switched me to another plan that was $320 a month this past year. Now this year they raised it to $367 a month. I think this might be the first year that it is an EPO. I didn't even realize it was an EPO until I went to the doctor a couple of weeks ago and they told me that I have an EPO, not a PPO, and they don't take EPOs. Then I called my internist's office to ask them if they take EPOs. They said, "No." So now I don't have any doctors that take my insurance.

Sweet Jesus. Do you have any idea what a crappy plan you were buying from them? An almost $9,000 deductible per year? Was there a lifetime cap on it after that? The reason many of these low-premium, high deductible plans were ended is because they were TERRIBLE. They were the Yugos of the health care industry (to show my age).

Rupert, none of us are getting any younger. At this point you should be on your knees, thanking the ACA for requiring young, healthy people to get insurance, because that's what brings the rates down on older folks. The ACA is what will keep health insurance even possible for you.

You honestly think Anthem wants you as a customer? Please. They want young non-smoking men in their 20s. That's it. No olds, no people with chronic conditions and no women who have an annoying habit of getting pregnant and having expensive babies. THEY DO NOT WANT PEOPLE WHO ACTUALLY NEED HEALTH CARE.

You didn't answer my early question- how did you vote on Prop 45, which would have made it illegal to arbitrarily raise health care premiums by 15 or 20 percent? How did you vote on it?

[GenuineRisk]

Post that does have something to do with the thread-

Here's an example of why the low-cost, high deductible plans are bad, Rupert. I'll use an example from myself this summer, so apologies if it's TMI.

I had miscarriage this year that came on very suddenly and very severely. I called the midwife who had delivered my son, and who was, I thought, going to see me through this very much-wanted pregnancy, to ask what to do and she said the bleeding was bad enough that I needed to go to the ER.

My husband has good, employer provided health insurance, so I was aware our copayment for the trip would be something like $50 (in fact it was $100, which I wasn't thrilled about when I paid, but it's still not going to break us). So, fifteen minutes later, once my best friend had raced over to watch our son and once I was fairly certain I wasn't going to pass out in the taxi (I was getting a bit woozy at that point), we headed to the nearest hospital.

If I'd had one of these low-cost, high deductible plans that are no longer legal under the ACA, my mind would have gone to the cost of an ER visit ($500 just to get into the room, then add on everything they might have to do- D&C, the thingy they put in in case I lost too much blood and needed electrolytes or a transfusion, blah blah blah) and I'm looking at least a few thousand dollars, all of which I'd be responsible for, and which we didn't have, and I might have decided to stay at home in my bathroom and hope for the best. And I might have bled out and died on my bathroom floor and my son might have grown up telling the story of how his mom died from a miscarriage.

But, because I knew I had coverage, I went to the ER, they took care of me, and sent me home the same night to grieve the loss of a pregnancy, which sucked to be sure, but is nothing compared to a child grieving the loss of a mother.

Those catastrophic plans forced people suddenly confronted with a health crisis to choose between their physical health and their financial health. It's good they're gone.

[dellinger63]

Originally Posted by GenuineRisk

Rupert, none of us are getting any younger. At this point you should be on your knees, thanking the ACA for requiring young, healthy people to get insurance, because that's what brings the rates down on older folks. The ACA is what will keep health insurance even possible for you.

Making young, healthy people and healthy people in general pay more than their fair share is what is keeping this afloat. Especially when young healthy people are no longer able to purchase inexpensive, catastrophic policies that were completely adequate w/o being subjected to the 1% and growing fine imposed for not having what the government considers proper insurance.

What's next? Requiring all citizens with driver's licenses to carry comprehensive, low deductible auto insurance regardless of the condition of one's vehicle or whether one even owns a vehicle, so those who are bad drivers and those with tickets and DUI's can be supplemented to purchase the same?

'Free Choice Hypocrites!'

[GenuineRisk]

Originally Posted by dellinger63

Making young, healthy people and healthy people in general pay more than their fair share is what is keeping this afloat. Especially when young healthy people are no longer able to purchase inexpensive, catastrophic policies that were completely adequate w/o being subjected to the 1% and growing fine imposed for not having what the government considers proper insurance.

Completely adequate until they get leukemia or cancer or Crohn's Disease and then the government has to pay for them because no health insurance company wants customers with chronic illness. My formerly healthy, non-smoking mother died of breast cancer at 35, Dell. If my father had not had health insurance through his job her death would have bankrupted us.

Yes, people who don't use insurance having insurance is what makes insurance work. That's why insurance companies don't want to insure people in flood zones and the government has to do it.

The problem is that we view health care as an insurance product at all. But as the defeat of Prop 45 showed, health insurance companies see great value in keeping the status quo as unchanged as possible, and they'll spend a lot of money to that end.

[Danzig]

Originally Posted by GenuineRisk

Completely adequate until they get leukemia or cancer or Crohn's Disease and then the government has to pay for them because no health insurance company wants customers with chronic illness. My formerly healthy, non-smoking mother died of breast cancer at 35, Dell. If my father had not had health insurance through his job her death would have bankrupted us.

Yes, people who don't use insurance having insurance is what makes insurance work. That's why insurance companies don't want to insure people in flood zones and the government has to do it.

The problem is that we view health care as an insurance product at all. But as the defeat of Prop 45 showed, health insurance companies see great value in keeping the status quo as unchanged as possible, and they'll spend a lot of money to that end.

as for flood insurance....yeah, that's separate so that the majority of us who don't choose to live in flood zones don't have to help pay for those that do.

people like to compare health to other insurance, but it's really not comparable.
one can choose not to drive a car, or to not drive drunk, they can be good drivers so they get good rates.
health is a crap shoot for the most part. non smokers get lung cancer, people who eat well get diabetes, or crohns, or colon cancer, etc.
as long as health insurance is handled for profit, it's going to remain a mess.

when one is a bad driver with multiple violations, one has to buy high risk auto insurance which is costly. obviously health insurance can't be handled the same way.

[dellinger63]

Originally Posted by Danzig

health is a crap shoot for the most part. non smokers get lung cancer, people who eat well get diabetes, or crohns, or colon cancer, etc.
as long as health insurance is handled for profit, it's going to remain a mess.

This is utter BS but not surprising considering the source.

Cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking is linked to about 90% of lung cancers. Using other tobacco products such as cigars or pipes also increases the risk for lung cancer. Tobacco smoke is a toxic mix of more than 7,000 chemicals. Many are poisons. At least 70 are known to cause cancer in people or animals.

http://www.cdc.gov/cancer/lung/basic...sk_factors.htm

•Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death. [Read guidelinesExternal Web Site Icon]
•The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight. [Read summaryExternal Web Site Icon]

http://www.cdc.gov/obesity/data/adult.html

However, unlike obesity smokers billow 2nd hand smoke and if one is regularly exposed to it either at work or home it increases the chances of lung cancer by 20%-30%. And don't get me started on exercise or the lack of it by many who are too lazy to do even basic calisthenics.

Obese people should be paying at least $1,429 per year more (plus whatever the increase since that number is outdated by 6 years) than those who are not and smokers should be paying for 90% of the costs associated with lung cancer.

We need to stop looking for the nanny and start looking in the mirror.
I and many others don't smoke, are not obese and exercise daily yet we are unfairly mandated to supplement obese, lazy, smokers.

Just as at risk drivers pay more for automobile insurance so should the at risk health insured especially considering they did it to themselves.

[GenuineRisk]

Originally Posted by dellinger63

This is utter BS but not surprising considering the source.


http://www.cdc.gov/cancer/lung/basic...sk_factors.htm


http://www.cdc.gov/obesity/data/adult.html

However, unlike obesity smokers billow 2nd hand smoke and if one is regularly exposed to it either at work or home it increases the chances of lung cancer by 20%-30%. And don't get me started on exercise or the lack of it by many who are too lazy to do even basic calisthenics.

Obese people should be paying at least $1,429 per year more (plus whatever the increase since that number is outdated by 6 years) than those who are not and smokers should be paying for 90% of the costs associated with lung cancer.

We need to stop looking for the nanny and start looking in the mirror.
I and many others don't smoke, are not obese and exercise daily yet we are unfairly mandated to supplement obese, lazy, smokers.

Just as at risk drivers pay more for automobile insurance so should the at risk health insured especially considering they did it to themselves.

My aunt, who never weighed more than 105 pounds, had gestational diabetes by the end of her life, Dell. IT'S HEREDITARY. Her parents, my grandparents, were thin (especially my grandfather, who was a 6 foot tall rail) and THEY BOTH HAD TYPE TWO DIABETES. Please tell me how that was their fault?

Please explain to me how my mother, who had both of her kids before the age of 30 and breast fed both of us for an extended time, gave herself breast cancer. Because that's what you do to reduce your risk- have kids before 30 and breast feed. In fact, the first two specialists she saw didn't believe her, because she was in such a low-risk group. They made fun of her alleged hypochondria ("You nurses are all the same") and sent her on her way.

And actually, according to this study, the obese and smokers are cheaper than health nuts:

http://www.nytimes.com/2008/02/05/he...8884.html?_r=0

[Danzig]

Originally Posted by GenuineRisk

My aunt, who never weighed more than 105 pounds, had gestational diabetes by the end of her life, Dell. IT'S HEREDITARY. Her parents, my grandparents, were thin (especially my grandfather, who was a 6 foot tall rail) and THEY BOTH HAD TYPE TWO DIABETES. Please tell me how that was their fault?

Please explain to me how my mother, who had both of her kids before the age of 30 and breast fed both of us for an extended time, gave herself breast cancer. Because that's what you do to reduce your risk- have kids before 30 and breast feed. In fact, the first two specialists she saw didn't believe her, because she was in such a low-risk group. They made fun of her alleged hypochondria ("You nurses are all the same") and sent her on her way.

And actually, according to this study, the obese and smokers are cheaper than health nuts:

http://www.nytimes.com/2008/02/05/he...8884.html?_r=0

that's awful.
reminds me of stories i've heard about guys who get breast cancer-people think that there's no way guys can get that. hello, men have breast tissue, of course they can get breast cancer.

knowing some conditions people are born with, and deal with in their lives, if they had to pay according to their risk...they'd be beyond bankrupt. how would that make sense, to rate like that?

[dellinger63]

Originally Posted by GenuineRisk

My aunt, who never weighed more than 105 pounds, had gestational diabetes by the end of her life, Dell. IT'S HEREDITARY. Her parents, my grandparents, were thin (especially my grandfather, who was a 6 foot tall rail) and THEY BOTH HAD TYPE TWO DIABETES. Please tell me how that was their fault?

Please explain to me how my mother, who had both of her kids before the age of 30 and breast fed both of us for an extended time, gave herself breast cancer. Because that's what you do to reduce your risk- have kids before 30 and breast feed. In fact, the first two specialists she saw didn't believe her, because she was in such a low-risk group. They made fun of her alleged hypochondria ("You nurses are all the same") and sent her on her way.

And actually, according to this study, the obese and smokers are cheaper than health nuts:

http://www.nytimes.com/2008/02/05/he...8884.html?_r=0

Well than she and your grandfather would not have paid a premium as they were not obese and or smokers. Get it? Only those tipping the scale and or testing positive for smoking would be subject to the added premium.

Your study though is telling.

On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.

Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.

The cost of care for obese people was $371,000, and for smokers, about $326,000.

The results counter the common perception that preventing obesity will save health systems worldwide millions of dollars.

Only I haven't heard any complaints from you about Michelle O demanding healthy lunches, especially to kids whose family have no resources to pay for insurance. If only we could get everyone to chain smoke and get to 400lbs.

Also why in the hell are you worried about measles vaccinations? Imagine the savings to the system visa vi a measles epidemic? Especially since it would rid us of 'unhealthy' children eating up health costs?

How about extending the late term abortion limit to children under say 8, as surely they are incapable of sustaining life on there own. And for God's sake stop treating diseases like leukemia and AIDS.

Bingo bongo!

[Rupert Pupkin]

Originally Posted by GenuineRisk

Sweet Jesus. Do you have any idea what a crappy plan you were buying from them? An almost $9,000 deductible per year? Was there a lifetime cap on it after that? The reason many of these low-premium, high deductible plans were ended is because they were TERRIBLE. They were the Yugos of the health care industry (to show my age).

Rupert, none of us are getting any younger. At this point you should be on your knees, thanking the ACA for requiring young, healthy people to get insurance, because that's what brings the rates down on older folks. The ACA is what will keep health insurance even possible for you.

You honestly think Anthem wants you as a customer? Please. They want young non-smoking men in their 20s. That's it. No olds, no people with chronic conditions and no women who have an annoying habit of getting pregnant and having expensive babies. THEY DO NOT WANT PEOPLE WHO ACTUALLY NEED HEALTH CARE.

You didn't answer my early question- how did you vote on Prop 45, which would have made it illegal to arbitrarily raise health care premiums by 15 or 20 percent? How did you vote on it?

I'm sorry about your miscarriage. That is a shame.

I don't remember Prop 45 at all. I usually remember most propositions. I would think I would have had to vote yes on it. How could anyone be in favor of insurance companies raising rates by huge amounts? Are you sure that there wasn't more to the proposition? I don't know how a proposition like that could have lost. Although the prop about labeling GMO food lost, so it shows you that the voters can easily be fooled by tons of misleading advertisements by one side.

With regard to having a really high deductible and a low premium, I think that is the way to go for a really healthy person. For me, the point of insurance is to insure against a catastrophic illness. My medical bills are extremely low. I take good care of myself. I eat right and exercise daily. Even though I'm in my 40s, my blood pressure is 105 over 70. I certainly don't want to pay $4,500 a year for insurance when my medical bills are typically less than $1,000 a year.

With regards to what you were saying in another post about an emergency room visit, if I have a cheap deductible I am saving close to $2,000 a year. When my monthly premium dropped from $520 a month to $210 a month, I was saving $3,600 a year. So over just a 3 year period, I was going to save almost $10,000. I would have no problem spending $2,000 on an emergency room visit once every 5-10 years. I would much rather do that than spend an extra $2,000-$3,000 a year on premiums.

[GenuineRisk]

Originally Posted by Rupert Pupkin

I'm sorry about your miscarriage. That is a shame.

I don't remember Prop 45 at all. I usually remember most propositions. I would think I would have had to vote yes on it. How could anyone be in favor of insurance companies raising rates by huge amounts? Are you sure that there wasn't more to the proposition? I don't know how a proposition like that could have lost. Although the prop about labeling GMO food lost, so it shows you that the voters can easily be fooled by tons of misleading advertisements by one side.

With regard to having a really high deductible and a low premium, I think that is the way to go for a really healthy person. For me, the point of insurance is to insure against a catastrophic illness. My medical bills are extremely low. I take good care of myself. I eat right and exercise daily. Even though I'm in my 40s, my blood pressure is 105 over 70. I certainly don't want to pay $4,500 a year for insurance when my medical bills are typically less than $1,000 a year.

With regards to what you were saying in another post about an emergency room visit, if I have a cheap deductible I am saving close to $2,000 a year. When my monthly premium dropped from $520 a month to $210 a month, I was saving $3,600 a year. So over just a 3 year period, I was going to save almost $10,000. I would have no problem spending $2,000 on an emergency room visit once every 5-10 years. I would much rather do that than spend an extra $2,000-$3,000 a year on premiums.

Thank you for your kind words.

http://ballotpedia.org/California_Pr...itiative_(2014)

Anthem was one of the top 5 donors working to defeat it (contributed $250,000 towards campaigning against it) but didn't spend nearly as much as Kaiser and Wellpoint, which spent over $18 million. Each.

Propositions like that lose because people are influenced by advertising. Look at how much money grifters have made off of charter schools, which do no better than public schools and in many cases, do worse. And yet they are still being served up as the solution to education (when in fact the real issue is poverty, of course). It takes a lot of time and effort to be well informed on an issue, and most people have neither the time nor the inclination, though they still do get to vote on them.

As to your example of money saved, that's a fine idea if a person has the disposable income to put into a savings account that is reserved only for health care and if that person suffers illness or injury that is not more expensive than the money saved. For an example, here is the cost of a broken leg, which an active, 20 something might suffer while riding a bike, or crossing the street.

http://health.costhelper.com/broken-leg.html

Now, at the low end, three years of saving in your premiums would not have been enough to cover the cost of a broken leg that needed setting. And of course, the lifetime cap can become an issue if there is long term physical therapy needed. Did yours have a lifetime cap?

So many things can go wrong with the human body. I have a friend, in (she thought) great health, who, while volunteering at a riding stable, had a locker fall on her, breaking her neck. In treating the neck, they found she had a tumor growing there, which (oh, the irony!) likely would have killed her if she hadn't had a locker fall on her and break her neck. Tests also revealed she has multiple myeloma. While the combination of the broken bones in her spine and the tumor have resulted in her no longer being able to shake her head side to side (and, at this point, drive, or ride, or work sitting at a desk), she has, after a year, gone into remission. So now they can finally address the physical therapy for her neck, although she still must go through several more rounds of chemo.

How much of this would your old policy have covered?

A friend from high school had a double lung transplant 4 years ago- she has idiopathic pulmonary fibrosis, which killed her father in his 30s. Her medical costs are now well into seven figures. But she was unaware she had a problem until her 30s, when she started having trouble breathing- hell, she ran track in high school, and her siblings are fine. As her father died of it, you'd better believe that was considered a pre-existing condition. What was your plan like about pre-existing conditions?

It's excellent that you take good care of yourself, but a huge part of health, especially where things like cancer are concerned, is just luck (with, as Dell often points out, the exception of lung cancer, though I had a professor who died of it and had never smoked in his life). You've been lucky so far, and here's to hoping that you continue to be lucky and enjoy good health into old age. But life doesn't owe you anything, and as infuriated as you are now about your premiums, I would wager it's better coverage overall than what you had before.

And hey, if your health is that good, then one doctor is pretty much like another at this point and if you have to switch, it's no big deal. I had to switch a lot in my 20s and early 30s when I was buying my own insurance. If it's that you happen to just personally like certain doctors over others (which is natural), then that just falls into, well, sucks to be middle class; the rich get to have nice things the rest of us don't.

[dellinger63]

Fantastic program for those trying to kick the cigarette habit

http://www.latimes.com/world/middlee...212-story.html

[Kasept]

http://www.nytimes.com/interactive/2...s-working.html

[Sightseek]

Originally Posted by Kasept

http://www.nytimes.com/interactive/2...s-working.html

[Pants II]

Shiny graphs and whatnot.

Seniors on Medicare Advantage aren't technically receiving services from medicare. They give up that right to the private insurance companies.

I thought democrats hated medicare advantage? Now they like it?

Oh the spinning never ends when you're on the Titanic.