This whole healthcare conversation is so fucked up, that people aren't even talking about anything that matters... just abstractions of abstractions of abstractions. When I first started working a real job, in 1987, I had insurance through my employer. If I needed to go to the doctor, dentist, optician, whatever, I went. I paid for the services I received. If it was a lot of money, then I set up a monthly payment plan with my Doc, and then filed an insurance claim to get some portion of my money back. Most care you just paid out-of-pocket for. That was it. Insurance was for when something major happened - you broke a leg, needed a root canal, or whatever - and all other medical services were paid for on the spot with whatever cash you had, or they billed you in monthly installments. Then, in the 1990's, heathcare costs began skyrocketing. A broken arm wasn't $1500 any more, it was $15,000. I never really understood why. Was it just Doctors realizing they COULD charge that much? Was it Tort Law and Malpractice insurance now costing them $10k/mo for protection coverage? I have no idea. So then, somehow, the narrative changed. You didn't know what any procedure would cost any more... you'd just get the care you needed, sign a piece of paper, pay your $20 co-pay, and about a month later the insurance company would send you a completely incomprehensible form that said you owe them $2300. There was never an itemized list of expenses, or what was covered, or what the total amount was, and how much insurance was paying for, and how much you were paying for. It was completely opaque. Then Generic drugs came around, and there were Options. The Insurance company would force the doctor to go with the cheaper option, but if the patient wanted "the good stuff", then Insurance wouldn't cover anything. "Your choice!" They crowed! "Now you get to CHOOSE the healthcare that is right for you! Want generics? We will cover you? Want brand-name? You can have that too! (If you pay for it yourself.)" And now, somehow, we have gotten to the point where everyone just expects all heathcare to cost a $20 copay, and somehow "Insurance" is supposed to cover the rest? There are obviously humanitarian issues, and questions around how a society cares for those who have chronic or terminal diseases, and how those services get paid for... but nobody is actually talking about that. They are talking about giving tax credits to pay for your healthcare ... which is fucking moronic, because if you have a terminal disease you ain't working a 9-5, and therefore not making a salary, and therefore not paying huge taxes, and definitely not making enough to offset the cost of your $250k in chemo treatments. The conversation around healthcare is so fucked, it can't actually accomplish anything! What the hell....?!?
The insinuation that "I can't afford to get sick or injured" is somehow not "anything that matters" is offensive to the core. There's nothing abstract about it. I'll point out that in 1987 you were a 20-year-old man. Your health care expenses were effectively zero. That's the whole argument for mandatory health insurance: for the system to work, you have to pay for insurance you'll never need because your parents are paying far less than the insurance they actually consume. Take mandatory market participation off the table, and your parents start paying what they cost and all of a sudden they're living off dog food because they needed a hip replacement. Meanwhile, my employer paid my health insurance from the age of 19 through the age of 33 and in that time, I had three blood tests, actual cost ~$12 ea, and a checkup - and my employer was no doubt paying $200-$300/mo for fourteen years. And that's the game: In that same time period, my buddy Fuckin' Rob decided to debut his mad street luge skillz down an inadvisable hill in Magnolia and ended up with a helicopter ride to Harborview and six months in traction. That's $130k to him because he had no insurance. Didn't affect me at all 'cuz he wasn't in my pool. However, my employer's expenses went up when they hired a 24 year old woman because well, you see, statistically she's likely to have a baby and babies are expensive. See, when you were young, things cost what things cost. And then things got deregulated so that people had a "choice." And everyone gets upset because that "choice" made everything more expensive. But listen: Open in front of me right now is a list of "allowed amounts" for the things my wife does. It lists fifteen different insurance companies. These are the "best case scenario" amounts that we can charge if we hit the right ICD10 codes and get the right reviewer at the insurance company. One particular line item varies from $584 to $2500. That's their "if you take our insurance, this is the most we will ever pay you for this" reimbursement. For the state insurance vendors, that number has actually gone down since 1997. For many of the line items, the reimbursement is below cost. As in, if my wife gives medicine to keep your baby from going blind, she loses money with every application. And guess what. It's not just a good idea and good healthcare, it's state-mandated that she give that medication. So you play bingo with the codes to see how close you can get to your rack rate. That's where shit goes south: you, as a healthcare provider, need to make as much money as possible (and the bigger your organization, the better you are at it). You, as an insurance provider, need to make as much money as possible (and the bigger your organization yadda yadda). And between this irresistable force and that immovable object are people who think that somehow, you paid what it cost in 1987. You didn't. But there were more regulations in place to keep you from being ground into powder. And that's why you think "that people aren't even talking about anything that matters". If you want healthcare like the rest of the world, the risk pool has to be "everyone" and the profit has to be "zero." As it is right now, the risk pool is "people who can afford it" and the profit is "maximum." The health insurance industry nets about $200b a year in profit. The Obama administration had a choice between "destroy that" or "figure out a way to increase 'people who can afford it.'" And that's why this makes no sense - when Napster destroyed the music industry in 2000, they were doing about $14b in sales. Cutting profits of the health insurance industry by 10% is the equivalent of eliminating the music industry. My company had 13 people in it. If they'd been able to not give me insurance and just pay me instead, I would have made an extra $14,000 in the time I was there. But then I probably wouldn't have because my boss' two open-heart surgeries would have bankrupted him, dissolved the company and I would have been out of a job. There's your real problem: the bigger your risk pool, the less risk there is and republicans want a risk pool of one.And now, somehow, we have gotten to the point where everyone just expects all heathcare to cost a $20 copay, and somehow "Insurance" is supposed to cover the rest?
Yeah... I know way more of the sausage factory of medical billing than I like to let on... I wrote a database application for a medical office that handled all the ICD9 codes (yes, ICD9... it was that long ago) and CPT codes. Took almost a year to write, and still didn't catch all the edge cases and weirdnesses of that messed up system. This is really the crux of it. There is no plan that works in a purely capitalist way. Because you have to force people who don't need things into buying them. The healthy have to underwrite the sick. Period. That's it. Without that pool of swirling money that everyone gets to dip in to when they need it, you have people going bankrupt and still dying of their cancer because they can't afford treatment. Incidentally, I've filed maybe 20 insurance claims throughout my life. Sprained ankle, broken finger, cavity fillings, root canals, eye exams, glasses, liver "weird readings" diagnoses (multiple times), etc. (All "covered" expenses under whatever plan I was on at the time.) And the FIRST time I EVER had insurance accept ANY of my claims was about 2 years ago. Working for a tech company, something happened to my brain and I couldn't stand up. In-home doctor visit within 2 hours of my call, and I was diagnosed (something minor, I think it was viral, can't recall), and insurance paid for ALL of it. Every single other claim I have ever filed in my entire life has been denied due to some loophole. So I fully expect if I ever come down with anything truly nasty, it's a shotgun and a shallow hole in the back yard for me. And that's why you think "that people aren't even talking about anything that matters". If you want healthcare like the rest of the world, the risk pool has to be "everyone" and the profit has to be "zero." As it is right now, the risk pool is "people who can afford it" and the profit is "maximum."
Having had two parents with nasty somethings, denied often doesn't mean "denied" so much as "we know we should be paying for this, but we're going to make you pick a fight with our callcenter drones under the assumption that if you can pay for it yourself you're rather do that than fight with our callcenter drones." And they're right. When the cost is less than an afternoon of hold music, vague threats about lawyers and shouting I just pay my father's bills out of pocket. They always cave when it's worth the trouble to fight over, but they save a lot of money when it isn't. Hooray for capitalism.
My employer and I will spend exactly $15,694.32 this year on health insurance premiums ($1307.86 per month) for a family. For that low, low price, I get a $4000 In-Network deductible and a $10,000 Out-Of-Network deductible. There is no prescription coverage until I hit the deductible. Oh... and when/if I hit that deductible? They pay 80% of the bills until I hit my "out of pocket maximum" which I think is $6000. So assuming I get to stay in network.... I get to pay the first $4000 straight - then I pay $2000 of the next $10000 worth of medical expenses. If I have ZERO healthcare expenses... I have put $15k into the system. If I have a "normal" year when a kid or two get a runny nose/ear infection, maybe a broken bone or a bad rash... I'm dropping a couple hundred bucks per Doctor visit... maybe a couple thousand bucks. So I'm pumping $17k into the system. Even in a year when my wife gave birth to one of these mongrels... I think the most healthcare we consumed was about $25k. And for some reason I feel lucky.... like I won the healthcare lottery... because I have it.. Look - if I'm paying $17k to have a healthy year? This system is MESSED UP.
The Week had an editorial last week about a woman salty that nobody would let her have an elective c-section. I told my wife and she said "what, nobody wants to give her $80k in free surgery? shocker." The c-section rate in the United States is about 1 in 3. If you take a normal hospital delivery ($20-22k) and average two of them with a c-section, the average cost for a birth in the United States is $40k. Primera Blue Cross will pay us $3200. Why? We're not a hospital, we don't do c-sections, and we don't have ninetynine skidillion ICD10 codes to bill. But then, we also don't have the overhead of a hospital. Shit, take away the malpractice and we don't have the overhead of a dentist's office. Down in LA insurance wasn't required to pay my wife at all. She was a cash-pay business. So people would pay her $4500 and she'd say "you should at least get a high-deductible policy in case we need to go to the hospital" because statistically speaking, there was a 1 in 5 chance they would. At least a couple times people with no insurance ended up $120k out of pocket. It's fucked up from all sides. (and by the way, here's a working link Having seen it from the patient side, having seen it from the provider side, and having seen it from the insurance side, the reason the system is so disfunctional is it's a zero sum game. If you want your nation to be healthy, you need to pay for them to be healthy. That's what everybody else does. But then, nobody else has dismantled a $200b industry before.
My guess is that this whole stunt is a way for Paul Ryan to not really have to repeal the ACA. The entire republican machine since 2009 has been defined by the idea that national health is un-American and anti-freedom. To replace the ACA with anything is to concede that it isn't, and to repeal it without replacement is to solidify your party's place as the minority party for many years. They can't win. So Ryan figured out that he just has to propose a law that is repugnant enough to all of his members who love freedom that they will never vote for it. That way, he can say he tried, but that the political will just isn't there. If we learned anything in the 2016 election it's that Paul Ryan will do literally anything he thinks is politically expedient, without regard for or second thought of his own professed ideology. (Except maybe I'm wrong. Maybe his confessed ideology is that he has no other allegiance than to himself--isn't that the whole point of 'objectivism' to being with? In that case, this and his behavior last year would be in perfect lock goose step with his creedo.)
I've spent more on my employer subsidized healthcare since buying my last phone than the phone cost me.
I can buy three iPhones for every month my employer pays in health insurance. Worse logic possible.
I like how this is tagged as only #lolchaffetz so as not to pollute the other (not 100% disgusting) tags.
What does a low-income healthcare plan currently look like, and what will it look like without the individual mandate? In dollars, I mean - I have no frame of reference for this. The biggest healthcare talking point for the upcoming elections here in the Netherlands is whether the government-set deductible of €385 should go down or not. Plans here are mandatory and between 80 and 120 euros per month, with partial or full reductions if you're below certain income thresholds.
I became unemployed in 2007. There was no available healthcare coverage for self-employed people in Washington State until 2012. So the plan was "you have no plan." If you're truly low income, there's medicare. You have to make less than $20k a year to qualify in Washington State. In 2011 we were able to buy healthcare in CA. For me and my wife, mid '30s, with a $10k deductible and effectively nothing covered, coverage was $350 a month. Then Obamacare happened and that plan got blown away (it was one of the good ones) and the plan became $800 a month. I talked to a guy who runs a bicycle shop. For him, his wife and his two kids, his $10k deductible was $2500 a month. That's with Obamacare. Prior to that, no coverage was conceivably available to him. We have something called COBRA, which means "lost your job? You can keep buying your insurance at what it costs, minus the subsidies we're providing your employer." Through my union, my coverage is $600 a year. Through COBRA, my coverage is $1800 a month. That's what's lost in these discussions - "affordable healthcare" is $30k a year for a family of four. Prior to the ACA, "affordable healthcare" was "hope you don't get sick or injured."
I really just can't fathom dealing with such an onerous burden, universal in its effect (everyone visits a hospital), that's asymmetrical in its informational distribution, without the government to coordinate and help. We helped cover Texan farmers in the hill country when the topsoil blew away a century ago. Texas. I don't think it's unfair to say the Republican stance on healthcare is fuck poor people, if god wanted them to be healthy he would've made them rich.
Holy shieet, $30k? Kids are "on their parent's plan" here until 18 years old, meaning that the parent doesn't pay extra. My parents have never paid more than €2500 per year for our family of four back when I still lived there. As a student, I get €85 for my €95 plan (no dental though) from the IRS. Welfare state, man. Doesn't kill me that's for sure.