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geo123 said:   
ganda said:   
For the last 3 weeks I've been dealing with a sprained ankle.  I have had to get "referrals", and do stupid superfluous paperwork *so* many times.  Every time I go near a medical practitioner they want a $30 co-pay despite me paying $1000/month for health insurance.   I had to pay for apparatus that keeping my ankle straight - so $12,000 per year in insurance premiums doesn't cover a $150 doodad?

You know, I've had plenty of sprained ankles in my life. I've had really bad sprains and have dealt with hairline fractures. There isn't a whole lot that you can do for an ankle sprain, other than to immobilize it, wait for the swelling to go down and then stretching/strengthening it. You don't get to surgical intervention unless there's complete tear/rupture of the ligament. It typically doesn't really matter whether it's a bad sprain or a hairline fracture and it's not necessary to spend a lot of time and money figuring out which one it is, as the treatment is exactly the same either way: you immobilize it and wait for the swelling to go down, at which point you perform stretching and strengthening exercises.

This is also the reason that I found your post so ironic. Here you are, complaining about healthcare costs and yet, based on your post, going to multiple medical practitioners and filling out "superfluous paperwork" (for what? to see a specialist? to get diagnostic tests? for an ankle sprain?) for an ankle sprain.

Do you know how many countries with lower healthcare expenditures would deal with this issue? They'd make you wait a few weeks to see your primary care physician, who, unless there's clear evidence of complete ligament rupture, would not order any diagnostic tests (and, if any diagnostic tests had to be ordered, you'd wait a month or two to get one) and you certainly wouldn't get an option to see a specialist. If the primary care physician felt that a specialist referral was warranted (again, typically in cases where he/she would suspect total ligament rupture requiring surgical intervention), you'd get a referral... and then wait a month or two to see a specialist. If you then needed surgery, you would get it... in about 6 months.

I obviously don't know anything about your ankle but have noticed that people who tend to scream the loudest about our healthcare costs tend to also be the ones who start jumping up and down demanding specialist referrals and the latest diagnostic tests for every ailment out there. I don't know if you fall in that camp but do find your story to be pretty ironic here.

For someone without insurance or using a HDHP, a sprained ankle or hairline fracture shouldn't be a major expense. In the rare instances where I felt a need to see a specialist for an ankle injury, requesting a "cash rate" reduced the stated charge considerably.

Most of the time "RICE" (rest, ice, compression, elevation) is sufficient. While injured I try to avoid activities that I don't like and spend more time doing things that make me feel better. Over time I have learned that injuries heal faster while watching football and drinking beer than they do when actually attending all of the charity events I bought tickets for.  
 

jerosen said:   
dshibb said:   
geo123 said:   
pox3 said:   
Porqin said:   
How do these other countries do it?

  
Multiple reasons:
- Doctor's pay. ER docs are not making $250-300K / year, surgeons $400+K and family doctors 150-200+K over there

Just as an fyi, in the US physician salaries only account for 8% of the healthcare costs. 

  

His entire post was basically a list of meaningless details that basically have no impact.

Our healthcare system is expensive because we have astronomically high utilization rates for healthcare which is a by product of rarely being the payor of any healthcare expenditures ourselves while having a limitless demand for quality and quantity. 

  

Where did you get that we have astronomically high utilization?

This report (exhibit 4)    shows us below median compared to OECD nations looking at doctor visits, hospital stays, and length of hospital stays.

 

  
Tests, medication, procedures, end of life care, expensive treatments, specialist utilization, etc. 

15 minute doctors visits are very cheap by comparison. 

trekwars2000 said:   
cestmoi123 said:   
trekwars2000 said:   So I have a few questions after reading 90% of this thread.

1) What do we think are going to happen to the premiums for employer plans? I assume they will go up 10-20% as they have the last few years, but we shouldn't see a huge rise in cost. This would be due to the group membership demographics not changing, right? Thoughts?

2) I see this talk about HDHP plans being ineligible. That seems odd and I am having some issues understanding it. My HDHP through work has a 2.5K/5K individual and family deductible. In addition, I put $6,450 into my HSA. I am having issues seeing how this doesn't fit the idea of insuring myself and my family.

  
1. Premiums in employer-sponsored plans were up 4% in 2013, not 10-20% (http://kff.org/private-insurance/report/2013-employer-health-benefits/  ).
2. Depends on the HDHP plan.  Employer-sponsored ones are generally grandfathered in, and the increased requirements (preventative care not hitting the deductible, etc.) kicked in last year.  Some HDHP plans will be ineligible through the exchanges because they don't meet actuarial payout thresholds (60%, if I recall correctly).  

  
1.  I think my work didn't increase premiums for a few years and then we went up like 17% last year.  
2.  Thats good to know, thanks.  I'd like to think they'd write in some clause to help encourage people to get HDHP plans.  I feel this would reduce health care costs.  

An example of this is what my wife did when get got an "eye cold" (bacterial infection).  The doctor went to write here a script for eye drops that were going to be around $100.  She asked what the alternatives where and it was the eye "goop" they give babies when they are born.  Cost for that was $9.  Sure the eye drops would have been more convenient because the coop causes blurred vision for 10 minutes, but it wasn't $91 more convenient.  If more people opted for this solution then I think the eye drop price would reduce due to demand.  

   those two numbers for1) are not necessarily conflicting. You have to look at the employer contribution portion and see if it changed.  For example, if insurance is $100 and employer paid $60, increases to $105 but employer still pays only $60 -- the premiums only increased by 5%, but the employee portion increased 12.5%.

My private insurance is raping me too, it doubles the premium in last several years. I can't believe that yours double all at once, is it even legal?

dshibb said:   
jerosen said:   
dshibb said:   
geo123 said:   
pox3 said:   
Porqin said:   
How do these other countries do it?

  
Multiple reasons:
- Doctor's pay. ER docs are not making $250-300K / year, surgeons $400+K and family doctors 150-200+K over there

Just as an fyi, in the US physician salaries only account for 8% of the healthcare costs. 

  

His entire post was basically a list of meaningless details that basically have no impact.

Our healthcare system is expensive because we have astronomically high utilization rates for healthcare which is a by product of rarely being the payor of any healthcare expenditures ourselves while having a limitless demand for quality and quantity. 

  

Where did you get that we have astronomically high utilization?

This report (exhibit 4)     shows us below median compared to OECD nations looking at doctor visits, hospital stays, and length of hospital stays.

 

  
Tests, medication, procedures, end of life care, expensive treatments, specialist utilization, etc. 

15 minute doctors visits are very cheap by comparison. 

  
OK our medication use is higher, exhibit 6 in same report, but again I don't know about 'astronomically' higher.    61% of adults in the US are taking a prescription versus 54% median.   And our drugs cost more too.   Other nations spend 25-66% less than we do on the same drugs.

We also do certainly have a LOT more MRI / CT machines and we use them about 2x more often (exhibit 8).    WE spend about double on the exams too.
 

jerosen said:   OK our medication use is higher, exhibit 6 in same report, but again I don't know about 'astronomically' higher.    61% of adults in the US are taking a prescription versus 54% median.   And our drugs cost more too.   Other nations spend 25-66% less than we do on the same drugs.

We also do certainly have a LOT more MRI / CT machines and we use them about 2x more often (exhibit 8).    WE spend about double on the exams too.

  
Quantity of medications per person also. Type of medications. Designer vs. generic(remember people don't really care to get the cheaper drug when someone else is paying for it).

Bold: Cost shifting. Geo described it pretty well above. For example many, other countries don't have to use add operating costs and ancillary costs associated with running a hospital into the bill. This is called contribution margin. Every other private entity in the world has to do it. Entities that have their capex paid for by the government don't have to include that into their numbers(but they're there).

king0fSpades said:   I don't know why are you all whining. My parents migrated in 2009 to US. They don't pay diddly squat for insurance and they are getting super healthcare including prescription for free.

I guess you all are paying for their care. LOL.

Make sure to line them up for free Supplemental Security Income (SSI) /sarcasm.
We are all paying for that too.

cestmoi123 said:   
trekwars2000 said:   ...1) What do we think are going to happen to the premiums for employer plans? I assume they will go up 10-20% as they have the last few years, but we shouldn't see a huge rise in cost. This would be due to the group membership demographics not changing, right? Thoughts?

....

  
1. Premiums in employer-sponsored plans were up 4% in 2013, not 10-20% (http://kff.org/private-insurance/report/2013-employer-health-benefits/  ).
2. ....

I cannot speak for all plans, but my business plan has gone up >20% and my broker tells me it was just about all plans available.  He provided a spreadsheet, and it looked like some were way more than >20% .

At $790/mo why even have coverage?

It seems that coverage is still per state - so if you move to a new state you'll have to buy new coverage. Does this mean if I don't cover my family, but have something huge come up (cancer, etc.) I just move? (obviously this would not work in an emergency situation like a car wreck etc. - but it could work for the care after that emergency situation).

Doing the math it might actually be cheaper to pay for another mortgage in a 2nd state, and if the worst happens have someone pack the Uhaul the next day.

dcmorrin said:   
Porqin said:   How do these other countries do it?
How much bureaucracy did you have to deal with to get service?

How much did the doctor have to deal with to get paid?

Hope that helps.

  
Well, let's see.  I called them on a Saturday morning, and explained my basic condition.  They told me they would see me, but it would be a long wait.  It turned out to be about 30 min.  I asked them for an estimate of charges, and their estimate over the phone ahead of time was within a few dollars of the final charge.  When I got there, I gave them my name, and maybe a few other cursory pieces of information, and that was about it.

dshibb said:   
LorenPechtel said:   
  
Ehh wrong!!! It's called state high risk pools and the vast majority of states had them. The premiums for those were actually cheaper than what everybody paid for in the high premium states and what the entire country will be paying(either directly or now through premium + taxes for subsidies). 

In California... the only state I know....  Yes, the premiums for the high risk pool are reasonable, but the waiting list for entering the pool is very long and the coverage provided by the pool is bad... your medical costs can easily exceed the maximum payout of the high risk pool.

BradMajors said:   In California... the only state I know....  Yes, the premiums for the high risk pool are reasonable, but the waiting list for entering the pool is very long and the coverage provided by the pool is bad... your medical costs can easily exceed the maximum payout of the high risk pool.
Don't get blue states love for HMO plans much because if I'm not mistaken that was what California's was modeled after. 

I both live in a state and originally from a state that had great high risk pools(not really that costly to a state either). My mother back home was on one for about 5 years. I remember it being a pretty decent sized deductible and co-pay, but like ~$350 a month for herself. I was in college for part of that and I remember my dad and I combined were about the same amount(I think a little less) than her by herself. 

You should check into Medi-Share which is a christian based product. Not insurance per se so it does not have all the mandates that jack up the traditional insurance price. I strongly considered it when I was wanting to change jobs and the only thing holding me back was the insurance issue. Fortunately I did find a job and never had to go the Medi-Share route, but I almost did. There are actually 2 or 3 of these types of programs out there. Enrollment is something like this at least prevents where we are headed with obamocare which is socialized medicine which is scary.

Have you considered any of the christian based health cost programs like Medi-Share. Since it doesn't cover a lot of things that are in the state mandates, the cost is quite affordable (at least so far). Its a way of keeping some type of protection should you get really ill and need assistance. I considered it about 2 years ago when I was trying to change jobs and worried about coverage. I was able to get insurance through new employer , so never had to opt for the Medi-Share program but I STRONGLY considered it in lieu of being uninsured since COBRA costs are excessive.

Have you perhaps considered a Christian based health cost program like Medi-Share?

okwiater said:   
bNeta86 said:   ...and I take at least some solice in the fact that profits for the insurance companies are capped and so the bulk of the benefit will go to those that need it most...well besides the Docs and hospitals.
Go ahead and take solace... until you realize that the profit is capped at a PERCENTAGE of premium revenue, and therefore the incentive is for health insurers to GROW health care expenses (a 10% slice of a LARGE pie is much, much bigger than a 10% slice of a tiny pie) rather than control them.

  
This is partially true. Though, there are multiple companies on the exchange offering the same service.  The only difference is cost.  So, if one of two companies raise prices, they'll price themselves out of the exchanges.  As well, the exchange operators can pick and chose the participants.  You have to qualify to be on the exchange.

cr3s said:   
This is partially true. Though, there are multiple companies on the exchange offering the same service.  The only difference is cost.

That's not the only difference. Although the basic parameters are going to be the same, the structure of each policy is going to be different. In other words, the "platinum," "gold," "silver" and "bronze" designations just have to do with the minimum levels of coverage that has to be provided under the policies. The policies themselves can always provide more than the minimums. Further, provider networks are going to be different for each one.

In essence, I think that it's going to be analogous to the Medicare Advantage policy situations in the sense that the policies are actually not identical, provide various add-ons and have different provider networks.
As well, the exchange operators can pick and chose the participants.
That's only true for state run policy exchanges. All of the federal exchanges (and many of the state exchanges) are going to show you ALL of the providers.
 

Read this you will know pros of obamacare

http://www.kiplinger.com/article/insurance/T027-C000-S001--1-bil...  
http://www.huffingtonpost.com/2013/06/20/health-insurance-rebate...  

This also means they can't increase health insurance premium(unless they find loop holes) to increase just the profits which earlier they could.

ggmon said:   Read this you will know pros of obamacare

http://www.kiplinger.com/article/insurance/T027-C000-S001--1-bil...  
http://www.huffingtonpost.com/2013/06/20/health-insurance-rebate...  

This also means they can't increase health insurance premium(unless they find loop holes)

  
"By Aug. 1, 8.5 million people will get rebates valued at an average of $100 because their health insurance providers spent too much on overhead and not enough on medical care last year,"

Oooohhh....$100.  Yeah, now those new premiums don't look so bad!

ggmon said:   Read this you will know pros of obamacare

This also means they can't increase health insurance premium(unless they find loop holes)
  
So they may not be able to increase the costs for you specifically, but they can increase the costs for everyone, which is exactly what's happening. 100%+ premium increases are par for the course next year.

As for other (unintended?) consequences, the medical loss ratio caps cited in your articles are the same ones that are destroying one of the few truly affordable options for personal insurance - the high deductible, catastrophic-only coverage policies.

ggmon said:   Read this you will know pros of obamacare

http://www.kiplinger.com/article/insurance/T027-C000-S001--1-bil...  
http://www.huffingtonpost.com/2013/06/20/health-insurance-rebate...  

This also means they can't increase health insurance premium(unless they find loop holes)

  
Of course they can increase premiums.  

The rebate is based on the % of money used for health care vs insurance overhead/profits.   Doesn't mean that costs can't rise.
 

cr3s said:   
okwiater said:   
bNeta86 said:   ...and I take at least some solice in the fact that profits for the insurance companies are capped and so the bulk of the benefit will go to those that need it most...well besides the Docs and hospitals.
Go ahead and take solace... until you realize that the profit is capped at a PERCENTAGE of premium revenue, and therefore the incentive is for health insurers to GROW health care expenses (a 10% slice of a LARGE pie is much, much bigger than a 10% slice of a tiny pie) rather than control them.

  
This is partially true. Though, there are multiple companies on the exchange offering the same service.  The only difference is cost.  So, if one of two companies raise prices, they'll price themselves out of the exchanges.
 

That doesn't have anything to do with whether or not there is an incentive for insurers to grow total expenditures on health services. As long as this percentage-profit restriction is in place, there is an economic incentive for insurers to lobby for more and more services to be mandated for coverage under the plans.

xerty said:   
ggmon said:   Read this you will know pros of obamacare

This also means they can't increase health insurance premium(unless they find loop holes)

  
So they may not be able to increase the costs for you specifically, but they can increase the costs for everyone, which is exactly what's happening. 100%+ premium increases are par for the course next year.

  Huh?  Where on earth are you getting this?  All the actual analysis indicates that the only group facing significant premium increases because of the ACA are people with extremely limited, extremely low actuarial value catastrophic policies, who will have to get more extensive coverage, which will come with higher premiums.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR100/RR189/RAND_RR189.pdf 

cestmoi123 said:   Huh?  Where on earth are you getting this?  All the actual analysis indicates that the only group facing significant premium increases because of the ACA are people with extremely limited, extremely low actuarial value catastrophic policies, who will have to get more extensive coverage, which will come with higher premiums.
http://www.rand.org/content/dam/rand/pubs/research_reports/RR100/RR189/RAND_RR189.pdf   
  
Note that the conclusions of your study are that health insurance coverage will go up (no surprise when you add subsidies for people who couldn't afford it before), but they tactfully decline to comment on how much the premium increases will be, citing lots of complicating factors. That doesn't give me a lot of confidence.

Here's a Congressional committee's report on the ACA impact, which surveyed over a dozen major insurance companies on their anticipated pricing changes. So it's a lot closer to facts than speculating on relevant factors. Read the report yourself - they cover each state separately, as well as by individual, small group, and large group plan impacts. None of them are good, although of course the old and sick benefit at the expense of the young and healthy per the law's design.

On March 14, 2013, members of the Energy and Commerce Committee sent letters to 17 of the nation's largest health insurance companies requesting analyses of the effect of the Patient Protection and Affordable Care Act's (PPACA's) policies, mandates, taxes, and fees on health insurance premiums....

<from the conclusions>
One of the nation’s leading insurance companies that insures millions of Americans predicts premiums will nearly double for individuals getting a new plan, those keeping their insurance will see an average increase of 73 percent, and some individuals could see increases of as much as 413 percent.


http://energycommerce.house.gov/sites/republicans.energycommerce...


dshibb said:   
LorenPechtel said:   
dshibb said:   I should remind people that only about 5 years there were approximately 10 states in the US where a family of 4 with a $1500(low) deductible could get a policy for about $5-6k a year(and they were high quality/low uninsured population states).

At that same time there were another 8 or so states that were about $20k a year for the same family of 4. Apparently we decided that not only were those 8 states the model, but we needed to go well beyond their apparently amazingly brilliant ideas into crazy town.


Remember that as you see your bills showing up in your mailbox over the coming months.

  
The basic problem is that if you had any appreciable health issues you simply couldn't get coverage at all.  Now you can.

  
Ehh wrong!!! It's called state high risk pools and the vast majority of states had them. The premiums for those were actually cheaper than what everybody paid for in the high premium states and what the entire country will be paying(either directly or now through premium + taxes for subsidies). 

  
Some states had them, some didn't.  I live in one that didn't.  And that doesn't mean the coverage was any good, either.

LorenPechtel said:     
Some states had them, some didn't.  I live in one that didn't.  And that doesn't mean the coverage was any good, either.

  
That isn't a counterargument. Instead of passing a bill that just required each state to set up a high risk pool the US government instead decided to pass a bill around guaranteed issue. The data was right in front of them that high risk pools worked better yet they did the opposite. 

The bottom line is the younger generation is getting raked over the coals by older generations.

Social security is now paying out full benefits to the older generations knowing full-well it has been borrowed against to its near-depletion, and all the money is now coming from younger generations. Those same benefits will not be reality when they become the 'older generation.'

Owebamacare is about to come into play where older generations will benefit from either decreased or steady premiums with insurance, all the while HEALTHY younger generations are forced into an overly expensive insurance system against their will that will likely be drastically different/reduced by the time they claim to be the 'older generation.'

The politicians in office generally all relate to whom, based on their age? Older generations.

It's a vicious cycle that really is unfair to the young. If the system were more honest and open about the realities, it would be preparing young people to save and think ahead for the social issues that lie ahead, but instead they are being lied to and forced into a situation that will be difficult to deal with in 50 years time.

So I have a question that I can't seem to quite find the answer to - maybe somebody knows.  Currently I maintain 3 separate individual insurance plans for our 3 family members, because to me, insurance is about minimizing risk.  Thus our current, we each have a $3500 deductible and $5k out of pocket max per year, whereas with a family plan, the family deductible would be $10k with a $12k out of pocket max.  To me, the chance of one person having something big happen is much greater than all 3 of us having something happen, and this caps our probable out of pocket at the individual rate vs the family rate. 

So the question: with the ACA, can I keep doing this?  The individual/family deductibles are even worse from what I've seen - I want to maintain the separation so as to decrease out of pocket risk. 

chaster86 said:   The bottom line is the younger generation is getting raked over the coals by older generations.

Social security is now paying out full benefits to the older generations knowing full-well it has been borrowed against to its near-depletion, and all the money is now coming from younger generations. Those same benefits will not be reality when they become the 'older generation.'

Owebamacare is about to come into play where older generations will benefit from either decreased or steady premiums with insurance, all the while HEALTHY younger generations are forced into an overly expensive insurance system against their will that will likely be drastically different/reduced by the time they claim to be the 'older generation.'

The politicians in office generally all relate to whom, based on their age? Older generations.

It's a vicious cycle that really is unfair to the young. If the system were more honest and open about the realities, it would be preparing young people to save and think ahead for the social issues that lie ahead, but instead they are being lied to and forced into a situation that will be difficult to deal with in 50 years time.

At the national level, the younger generation voted primarily for politicians that were in favor of Obamacare and against most changes to Social Security. As long as younger voters continue to support politicians that promote programs that favor the elderly over their own generation, don't be surprised if this trend continues.

bluegreenturtle said:   So I have a question that I can't seem to quite find the answer to - maybe somebody knows.  Currently I maintain 3 separate individual insurance plans for our 3 family members, because to me, insurance is about minimizing risk.  Thus our current, we each have a $3500 deductible and $5k out of pocket max per year, whereas with a family plan, the family deductible would be $10k with a $12k out of pocket max.  To me, the chance of one person having something big happen is much greater than all 3 of us having something happen, and this caps our probable out of pocket at the individual rate vs the family rate. 

So the question: with the ACA, can I keep doing this?  The individual/family deductibles are even worse from what I've seen - I want to maintain the separation so as to decrease out of pocket risk. 

  This seems like a really smart idea...I think I'll look into these options as well.  I suspect they are at least somewhat giving a slight discount for piling together but it will be interesting to shop that scenario at least.

Got a notice that we're required to notify the company employees that changes are coming and that we have no updates until Oct 1, but that the changes are coming on Oct 1.  What a joke... http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf    http://www.bcbsm.com/content/microsites/health-care-reform/en/reform-alerts/employer-notification-of-the-marketplace.html 

okwiater said:   
bNeta86 said:   ...and I take at least some solice in the fact that profits for the insurance companies are capped and so the bulk of the benefit will go to those that need it most...well besides the Docs and hospitals.
Go ahead and take solace... until you realize that the profit is capped at a PERCENTAGE of premium revenue, and therefore the incentive is for health insurers to GROW health care expenses (a 10% slice of a LARGE pie is much, much bigger than a 10% slice of a tiny pie) rather than control them.

<sarcasm>  Wait - you mean the AFFORDABILITY Care Act skipped the affordability part- I find that SO hard to believe... </sarcasm>

The problem with ObamaCare is that it expands a broken system.  The health insurance system is broken.  We have now expanded the health insurance system.  

dshibb said:    
That isn't a counterargument. Instead of passing a bill that just required each state to set up a high risk pool the US government instead decided to pass a bill around guaranteed issue. The data was right in front of them that high risk pools worked better yet they did the opposite. 

  
35 states had high risk pools in 2007. Overall enrollment in them was 207,000. How can you say the data was right in front of them that high risk pooled worked when they only covered the same amount of people as half of a percent of the number of people who didn't have insurance. http://www.naschip.org/membership07.htm 

Heard a piece on the radio this AM basically saying there is a rush right now on the part of all the insurers to lock in the "healthy" people RIGHT NOW (presumably the people that currently have insurance) because when the rush of sick people start signing up via exchanges and otherwise, many insurers are worried that they will not have a large enough pool of healthy rate payers to offset all the sickies that will now join their pools. 

To me the issue is that way too many people think that health insurance = health care.  Health insurance is just that - insurance that if something goes wrong, you're not on the hook for a bankrupting amount.  It doesn't mean you get free teeth cleaning for life and the right to walk into the doctor's office for every little twinge.  The reason so many people of the frugal nature like the HDHP's is that premiums are just money flushed down the toilet.  I'm happy to pay for the services I use from the medical profession though, but see no reason to pay a huge tax every month just for breathing.  Which if you look at it, is essentially what this law does - there's no way now in this country to get by without having monthly costs that are related to health insurance (not health care). 

My HDHP premium is now more expensive than the standard option PPO - not discounting the $750 HSA contribution. Still, it's like paying a premium for having a rollover FSA and/or a little more tax deferred retirement savings.

bluegreenturtle said:   Heard a piece on the radio this AM basically saying there is a rush right now on the part of all the insurers to lock in the "healthy" people RIGHT NOW (presumably the people that currently have insurance) because when the rush of sick people start signing up via exchanges and otherwise, many insurers are worried that they will not have a large enough pool of healthy rate payers to offset all the sickies that will now join their pools. 

To me the issue is that way too many people think that health insurance = health care.  Health insurance is just that - insurance that if something goes wrong, you're not on the hook for a bankrupting amount.  It doesn't mean you get free teeth cleaning for life and the right to walk into the doctor's office for every little twinge.  The reason so many people of the frugal nature like the HDHP's is that premiums are just money flushed down the toilet.  I'm happy to pay for the services I use from the medical profession though, but see no reason to pay a huge tax every month just for breathing.  Which if you look at it, is essentially what this law does - there's no way now in this country to get by without having monthly costs that are related to health insurance (not health care). 

Also, for larger deductibles, the pool self selects OUT the people who "walk into the doctor's office for every little twinge". Or, if they do, they'll have to pay out of pocket for a good amount before 

I just wish there was some tiered coinsurance beyond the OOP max. Perhaps it could be tied - in a smooth and continuous manner - according to the payout. Eg. 10% for smaller amounts of hundreds of dollars, a fractional percentage for 5 figures, etc. That way, the frugal person won't have incentives to balloon costs after the OOP max.

 

dshibb said:   
LorenPechtel said:     
Some states had them, some didn't.  I live in one that didn't.  And that doesn't mean the coverage was any good, either.
 

  
That isn't a counterargument. Instead of passing a bill that just required each state to set up a high risk pool the US government instead decided to pass a bill around guaranteed issue. The data was right in front of them that high risk pools worked better yet they did the opposite. 

  
Did you not see what others said about how the high risk pools actually functioned?  Not well at all!

bluegreenturtle said:   Heard a piece on the radio this AM basically saying there is a rush right now on the part of all the insurers to lock in the "healthy" people RIGHT NOW (presumably the people that currently have insurance) because when the rush of sick people start signing up via exchanges and otherwise, many insurers are worried that they will not have a large enough pool of healthy rate payers to offset all the sickies that will now join their pools. 

To me the issue is that way too many people think that health insurance = health care.  Health insurance is just that - insurance that if something goes wrong, you're not on the hook for a bankrupting amount.  It doesn't mean you get free teeth cleaning for life and the right to walk into the doctor's office for every little twinge.  The reason so many people of the frugal nature like the HDHP's is that premiums are just money flushed down the toilet.  I'm happy to pay for the services I use from the medical profession though, but see no reason to pay a huge tax every month just for breathing.  Which if you look at it, is essentially what this law does - there's no way now in this country to get by without having monthly costs that are related to health insurance (not health care). 

  
The HDHPs are good for those who are healthy (or at least don't have problems that are expensive on a regular basis) and have plenty of money in the bank.  They are in effect a way of making the sick pay more.



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