Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
Not sure that sort of thing would ever fly or would have flown, these days, since ACA was impossible to get buy-in on too after a pol with brown skin became its driver.
(Conservative views used to include a degree of mandated personal responsibility, incentives-disincentives, etc. Also of course ACA started as a seriously conservative initiative.)
More important now, HC minds way wiser than mine have written extensively about the unwisdom / drawbacks of single-payer, in some respects. I can post some links later on.
Hi, gang! So, I guess you figured out that I wasn't returning to the other thread, so you'd come over here...welcome! And @davidrmoran, thanks for the link to the SOURCE that has nothing to do with Medishare...but you probably worked hard to find it, so that is appreciated, even though I think your motive was not to inform, but to antagonize.
You know, for a group of grown men who consider themselves intellectually superior to everyone on this board, you sure act childishly at times. But I'm going to be kind, because I've heard it's a symptom of aging and I'll be there myself one day.
Not sure that sort of thing would ever fly or would have flown, these days, since ACA was impossible to get buy-in on too after a pol with brown skin became its driver.
(Conservative views used to include a degree of mandated personal responsibility, incentives-disincentives, etc. Also of course ACA started as a seriously conservative initiative.)
More important now, HC minds way wiser than mine have written extensively about the unwisdom / drawbacks of single-payer, in some respects. I can post some links later on.
I have myself figured, realistically, I assert--- that administering Single Payer in US would be more difficult than Canada, for example. Their national plan is indeed all-inclusive, but is run by each Province, with different details and requirements and co-pays. (At the start, there were NO co-pays. Because, ostensibly, costs were covered because people pay-in via taxes, and isn't that the whole point?) But Canada has one-tenth our population, and 10 Provinces. Used to be 2 territories. Now 3, since NWT has been split to create Nunavut.
50 States (plus Guam, US Virgins, Puerto Rico, Northern Marianas, Saipan. Which ones did I miss?) That does sound unwieldy, yes. But not impossible. If the thing were CENTRALLY administered, it could be uniform everywhere, so no one feels like they're getting screwed. Administration would then be simpler, even if "streamlined" is not the proper word.
Just occurred to me: even ILLEGALS would pay-in. Currently, they are given TIN rather than SS number. Paying-into the plan could be compelled.
To continue with Canada as the example: I've been up there many times, and for a couple of extended stays. The cost of living is nuts. But when you need a doctor or hospital or surgery or long-term care, you're covered. And no one can say you don't deserve coverage, because all along, everyone's paying-in. Those who (like myself) have residency under "visitor" status would NOT be covered, same as tourists.
I should have posted it elsewhere, I now agree; I had not sufficiently considered territoriality and encroachment or thread-hijacking. Apologies.
Interesting that you imagine your place here as more child than peer.
Informing you is antagonizing, seems like, almost by definition.
Wow, no sense of humor, either, I see...always looking for the dark cloud. Must be a blast at parties.
Sorry, I can't stay on this board...when I saw a thread on civility, I thought I'd give it another try, but apparently, everything is gloom and doom and if you try to point out the good in anything...like I did with Medi-share..., or if you dare to defy the cabal in power...you are met with a barrage of insults. I disagreed with Obama's policies, but I never let it consume me...and I NEVER lost my sense of humor.
I can't be around you Debbie Downers any longer...can't even imagine living my life always looking for problems....that would be a waste and a shame. Like I said in my very first post of my short-lived comeback...instead of enjoying her last days on earth, my 90 year old aunt complains about her neighbor's fence.
Maybe my permanent departure will bring you a modicum of happiness...I hope so, but it will probably be short-lived.
.......Which is not to say that it couldn't be done, though. You were not saying that Single Payer could not be done here. But I am quite CERTAIN that what's keeping us from getting REAL health care coverage in the US is: a) vested interests and b) the knee-jerk automatic reaction on the part of too many, loudly making sure to tell the rest of us: "but it's not realistic!"
Basic SS was rather novel and unrealistic too, back in 1940 when the first checks were issued.
Ask any medicare enrollee if they would prefer to give it up and go back to commercial insurance. You won't find too many.even those consider it "socialism" wouldn't give it up.
The Canadian Province Model for health insurance wouldn't work in US due to theories of federalism and state rights. IIRC, the wealthier provinces at some level make transfer payments to the poorer Maritime Provinces. How would you get TX and AL to administer same programs in the same manner as say OR, CA or NY? But this should spur some useful board discussions.
Instead of looking for any reason why single payor in the US would not work,,,, why not look at every other advanced nation in the world where it does? Are all those countries stupid? Or do we have just have too many repuglicans?
if you try to point out the good in anything...like I did with Medi-share...,
moderator: please delete my account.
I have significant issues with health care sharing ministries, something that I have stated explicitly. Nevertheless, they exist as a real, legal option for many. I appreciate the post, and it would have been nice to have seen more discussion of pros and cons from a financial/economic perspective.
I hope @little5bee will reconsider participating here.
Some others seem to be living in their own post-fact worlds ...
Instead, Congress was told to vote on a 18K page document before reading it.
Can someone explain why Medicare (an affordable government health program) was not expanded to include the ACA?
The Public Law passed was under 1K pages. Much of the ACA does deal specifically with Medicare, e.g. most of Most of Title III, Improving the Quality and Efficiency of Healthcare.
Ask any medicare enrollee if they would prefer to give it up and go back to commercial insurance. You won't find too many.even those consider it "socialism" wouldn't give it up.
1/3 of medicare enrollees have given up "original" Medicare and gone back to commercial insurance. It's called Medicare Advantage, and has very much the feel of commercial group plans.
The Canadian Province Model for health insurance wouldn't work in US due to theories of federalism and state rights. IIRC, the wealthier provinces at some level make transfer payments to the poorer Maritime Provinces. How would you get TX and AL to administer same programs in the same manner as say OR, CA or NY? But this should spur some useful board discussions.
There is an existence proof this can be done: Medicaid. Operated by the states in accordance with federal rules, it gives a nod to federalism ("laboratories of democracy") by enabling states to request exemptions (such as the Section 1115 waivers recently sought by some states to add a work requirement for Medicaid recipients).
Instead of looking for any reason why single payor in the US would not work,,,, why not look at every other advanced nation in the world where it does?
Because there are working models of universal coverage without using single payer system. For example, Switzerland, where coverage looks like ACA plans.
Here's my question: why does everyone seem so focused something that affects just 2% of the US population (high and rising prices of individual health insurance), when there's a problem affecting nearly 5x as many people - the ones who don't have coverage, period?
I'm part of the 2%. I lost group insurance when my state (not the federal government, not the ACA, not the insurer) terminated grandmothered plans. As a result, I also lost "access" to one of my specialists, because he does not accept any individual health insurance plan.
How about a little more concern for those who can't get coverage, and a little less fretting about the few people like me who make enough to be ineligible for subsidies? It's appreciated, but far more are in a much worse situation. And many of those 2% (like little5bee, but not me) are eligible to buy ACA catastrophic insurance next year if one's objective is simply to reduce the cost of buying a high deductible insurance plan.
@msf OK, valid points. No arguments from me that you're getting screwed. Yet it does sound to me that your choice of words and the way you frame the picture indicates a built-in assumption against truly universal Single Payer. Talk about that, for the sake of the rest of us, so that we can more fully grasp where you're coming from. ********************************** "...How about a little more concern for those who can't get coverage..."
Seems to me that you're "talking past" the point: why- not- just- plain- simply- cover - everybody?. No games, no bullshit. Pay into the System according to your means. It's equitable. Then there's no need to create arguments or to defend against arguments that involve State vs. State. As we ALL are already aware, the old federalism died when the North won the Civil War. Example: I have heard that Montana, with its wide open spaces, did not want to have freeway speed limits at all. But to continue to get transportation money from out of Washington, they were REQUIRED to institute a speed limit. So they made the speed limit effective only at night.
The State authorities bowed to authority at the national level, though they figured out a way to "do it their own way." Any such shenanigans does NOT have to be presumed. And Switzerland has universal coverage which is not gov't run Single Payer? Ok. What's their population, and how much less of a challenge was it to accomplish universal coverage by doing it that way?
Universal Single Payer is not possible until we can get from "me" to "we." (Michael Moore, "Sicko.") And the vital essential thing that never ever gets expressed is the reality of VESTED INTERESTS. So... if we MUST, let's pay the bastards off, so we can move FORWARD and do the ETHICAL thing, and have actual, real coverage that doesn't penalize a person for needing it.
>> 1/3 of medicare enrollees have given up "original" Medicare and gone back to commercial insurance. It's called Medicare Advantage, and has very much the feel of commercial group plans.
hmm, what could have caused you to write this? Maybe Massachusetts is different, but MC Advantage, in my wife's and my experience, doesn't remotely feel like or resemble any employer policies we've ever had over 45 years. Maybe it's a question of smoothness and efficiency and lack of hassle / paperwork / exclusions / phonecalls to c/s. Maybe remotely is overstatement. But 'much the feel' is not our experience the last 5y.
>> There is an existence proof this can be done: Medicaid. Operated by the states in accordance with federal rules, it gives a nod to federalism ...
uh, do you know people on Medicaid? I have had more than one poor friend who has actually moved, with his disabled wife, packing up and paying movers, from state to state to state, and from county to county within states, because of variations. (You know about this to some extent because you mention earlier about country variations in MCare.)
At the time it seemed quite unbelievable to me.
Less and less seems unbelievable to me now, insurance and otherwise, by the day.
>> why does everyone seem so focused something that affects just 2% of the US population (high and rising prices of individual health insurance)
Weren't you badgering me a while back for saying just this? Maybe I didn't put it plainly enough.
>> it would have been nice to have seen more discussion of pros and cons from a financial/economic perspective.
meh, I thought all that was fairly well elucidated in the cited christiancare links if you read them closely and the least bit quizzically or skeptically.
And the inherent limitations of strict affinity groups are offensive ipso facto, to some of us.
The partial failure nationwide of what group insurance means is one of the dumbfounding outcomes of this whole megillah.
I do not accept the premise that for universal coverage to exist you must have single payer. I gave Switzerland as an existence proof that the former can exist without the latter.
If one wants to discredit it, one should go beyond simply saying that things are different. By this reasoning, there are no models to look at, because all advanced nations have smaller populations than the US.
The funny thing about that argument is that it's the opposite of the explanation given for why single payer failed at the state level (e.g. Vermont).
The objectives are universality (coverage), affordability (can an individual take advantage of that coverage), and cost (percent of GDP, i.e. macro level). Single payer is a means to these ends, it is not an end in and of itself.
I'm not hostile to single payer. I'm suggesting it to be taken out of the equation as being merely an implementation detail.
Maybe Massachusetts is different, but MC Advantage, in my wife's and my experience, doesn't remotely feel like or resemble any employer policies we've ever had over 45 years. Maybe it's a question of smoothness and efficiency and lack of hassle / paperwork / exclusions / phonecalls to c/s. Maybe remotely is overstatement. But 'much the feel' is not our experience the last 5y.
I've helped a few people with MA. In their signup meetings, insurers have been unable to explain why their physician directory didn't include a doctor that was not only in-network but was currently providing care. (I've had similar problems with ACA plans.)
Or why a specialist copy was charged for an OB/GYN visit (which is supposed to be charged at PCP level); or why the extra charge was reversed the next year, charged back to a credit card that had been canceled, with no paperwork or notification from the insurer.
How about all the pestering they do to get subscribers to agree to let someone come their homes and examine them? The purpose of this is to game the risk adjustment system - the insurer is trying to find something that it can use to tag the subscribers as less healthy. Group insurance can't be gamed this way.
Obviously YMMV.
The similarities include; size of networks (often nationwide), structure of plans (HMO and PPO primarily); types and amounts of copays, deductibles, coinsurance, caps. Very different from ACA plans: extremely narrow networks, high deductibles, high copays (often 50% on bronze plans, including generic drugs).
Thanks for asking (seriously). Fortunately, I'm only under observation/testing, but continuity was and is important to me, especially since he was so familiar with my history and had altered the regimen. Because of this, I paid out of pocket (about 2x what I would have paid with a high deductible plan and negotiated rate) for awhile. I couldn't get him to give me any cash discount, and finally figured that so long as I am only at the observation stage, I'd try elsewhere.
I found another doctor affiliated with an excellent hospital (with testing done at those facilities). I was forced to make another insurance change, but fortunately this new doctor was added by the insurer I picked up this year. If I need treatment, then I'll face a more difficult decision.
>> it would have been nice to have seen more discussion of pros and cons from a financial/economic perspective.
meh, I thought all that was fairly well elucidated in the cited christiancare links if you read them closely and the least bit quizzically or skeptically.
And the inherent limitations of strict affinity groups are offensive ipso facto, to some of us.
I was hoping for some text around your links. For example, you posted a link to Medi-Share's FAQ. That doesn't tell me what you think is good or bad about it. For example, they seem to pick up child care until age six automatically, while under ACA you'd have to switch from a couple plan to a family plan assuming this was your first child. That seems like a plus for Medi-Share.
Consumer Reports among others has suggested that annual physicals are for some people a waste of money (at this point it's the government's money, but still a waste). So not covering physicals and charging less in exchange might be a positive from both a personal cost perspective and a national health care expenditure perspective. I do question these things because the answers aren't always obvious.
The fact that you (or someone else) might be unable to participate may offend you, but that doesn't address how good or bad they may be for those people who can participate. If I could find some professional association that offered a group plan and that I could join, I would jump at the opportunity, while simultaneously working to get it voided. No different from someone disagreeing with the mortgage deduction but still taking it so long as it's legal.
The partial failure nationwide of what group insurance means is one of the dumbfounding outcomes of this whole megillah.
I continue to wonder why free marketers seem to love the idea of employer sponsored group insurance, when it ladens companies with an expense that foreign companies don't have. Want to make American companies competitive? Get everyone out of employer plans and into the same universal pool.
(The good news for me is that I recently stated to a friend that 62% of people like this, whatever it means, but I wasn't able to source it. The VOX piece says where that number came from.)
not his wording, but my takeaway is something like possibly sufficient but not necessary
see his last sentence, no?
and my own add would have to do w sellability
Yes, he's not "hostile" to single payer. But @msf clearly comes across preferring not to have SP, before anything even gets expressed. THAT'S what I'm pointing out. And @davidmoran you think "sellability" is an issue.
My response is simply this: let's just get out of our own way. Let it happen, whether SP or not. But the current cluster-f*** non-system of hoops to jump through, and flaming hoops to jump through, and obstacles and stumbling blocks and nonsense and higher and higher expenses out-of-pocket and non-covered procedures, and drugs that are covered only after you try other drugs first, and prescription formularies that are like jigsaw puzzles, and different tiers of coverage.... And on and on... It's a hopeless, deliberately arcane bunch of chickenshit. And the insurance provider we have is good enough each half-year to send us updates with changes that we're supposed to MEMORIZE????? I got this to say about that: go DO yourself, AND the horse you rode in on.
.....Not to mention a thing like THIS: lately, my doctor prescribed cough medicine with codeine. She warned me to fill the scrip there, in Connecticut, because in Massachusetts where I live, it will not be filled by ANY pharmacy. So, in the State where I reside, some bag of farts, or some agency or committee, has decided what my DOCTOR can prescribe for me. Are you catching just a bit of how indignant I am about that?
The FDA doesn't let your doctor prescribe snake oil. Be careful about suggesting that the government has NO business saying what a doctor can prescribe.
See, e.g. Laetrile®: "Amygdalin [Laetrile® is a purified form] is banned in the United States but it is available in other countries and online."
If you're the one who makes the determination, that's tantamount to the government being unable to bar any prescription. You could just say that the substance is okay. Lots of people say that Laetrile® is okay.
If the government is the one to make the determination, then what are you indignant about?
As for the rest of this sub-discussion, what is it when you combine chopbusting with hairsplitting?
As for providing text when the FQ is right there, I think some of these discussions are needlessly spoonfed-cluttered and might benefit from skimmability. I trust readers here to read a little. Just my approach. msf is more patient and helpful much of the time.
My chief offense-taking for religious affinity groups (and similar) wrt insurance is that it goes against the entire idea of group insurance and the social contract, which is in enough trouble these days.
@Crash, docs have all sorts of limits on what they can rx for you, high-level to low-level. If you were curious you could find out why Mass. precludes that cough medicine. Maybe it's just sellability in the local HS parking lot? Some legislatures are slower than others, or wiser.
@msf, next time you advise people in Mass., just sent them to Tufts Health Plan for MC Advantage. Perhaps it varies by county, though, dunno. None of the issues you describe has ever applied in our experience, and when there were other issues, their c/s seemed expert and swift. My old acquaintance the head of BCBS says their Advantage plan is about identical.
This purports to be an unbiased analysis of Medishare:https://google.com/amp/s/www.thepennyhoarder.com/life/wellness/medishare-reviews/amp/ If we’re going to be true to little5bee’s intent of this thread as she claims it’s been hijacked why not really analyze this alternative? From the sound of it, Medishare is good if you want to save money and are healthy, but if you’re sick it is pretty bad. But as far as I’m concerned, that defeats the whole purpose of having insurance.
Since I cited Sloan Kettering, I followed their naming convention. This is cut and pasted from the referenced page:
Amygdalin (also called Laetrile®)
FWIW, USPTO says that it was a live trademark through most of the 1980s. Perhaps the editor in you could communicate with the editor in Sloan Kettering.
Comments
Instead, Congress was told to vote on a 18K page document before reading it.
Can someone explain why Medicare (an affordable government health program) was not expanded to include the ACA?
The challenge could have been making Medicare sustainable.
One way would have been including the very same healthy individuals that makes the ACA affordable.
Also, subsidies (premium variation) already exist with Medicare in the form of higher premiums for wealthy individuals.
The article really highlight that politics plays too much of a role in healthcare and both parties are bought by special interest groups. Very sad.
(Conservative views used to include a degree of mandated personal responsibility, incentives-disincentives, etc. Also of course ACA started as a seriously conservative initiative.)
More important now, HC minds way wiser than mine have written extensively about the unwisdom / drawbacks of single-payer, in some respects. I can post some links later on.
You know, for a group of grown men who consider themselves intellectually superior to everyone on this board, you sure act childishly at times. But I'm going to be kind, because I've heard it's a symptom of aging and I'll be there myself one day.
HuffPo an approved source?:
https://www.huffingtonpost.com/new-harbinger-publications-inc/parents-who-drive-you-cra_b_7511242.html
Interesting that you imagine your place here as more child than peer.
Informing you is antagonizing, seems like, almost by definition.
50 States (plus Guam, US Virgins, Puerto Rico, Northern Marianas, Saipan. Which ones did I miss?)
That does sound unwieldy, yes. But not impossible. If the thing were CENTRALLY administered, it could be uniform everywhere, so no one feels like they're getting screwed. Administration would then be simpler, even if "streamlined" is not the proper word.
Just occurred to me: even ILLEGALS would pay-in. Currently, they are given TIN rather than SS number. Paying-into the plan could be compelled.
To continue with Canada as the example: I've been up there many times, and for a couple of extended stays. The cost of living is nuts. But when you need a doctor or hospital or surgery or long-term care, you're covered. And no one can say you don't deserve coverage, because all along, everyone's paying-in. Those who (like myself) have residency under "visitor" status would NOT be covered, same as tourists.
I always find this humbling:
https://en.wikipedia.org/wiki/List_of_countries_by_population_(United_Nations)
Sorry, I can't stay on this board...when I saw a thread on civility, I thought I'd give it another try, but apparently, everything is gloom and doom and if you try to point out the good in anything...like I did with Medi-share..., or if you dare to defy the cabal in power...you are met with a barrage of insults. I disagreed with Obama's policies, but I never let it consume me...and I NEVER lost my sense of humor.
I can't be around you Debbie Downers any longer...can't even imagine living my life always looking for problems....that would be a waste and a shame. Like I said in my very first post of my short-lived comeback...instead of enjoying her last days on earth, my 90 year old aunt complains about her neighbor's fence.
Maybe my permanent departure will bring you a modicum of happiness...I hope so, but it will probably be short-lived.
moderator: please delete my account.
a) vested interests and
b) the knee-jerk automatic reaction on the part of too many, loudly making sure to tell the rest of us: "but it's not realistic!"
Basic SS was rather novel and unrealistic too, back in 1940 when the first checks were issued.
I hope @little5bee will reconsider participating here.
Some others seem to be living in their own post-fact worlds ... The Public Law passed was under 1K pages. Much of the ACA does deal specifically with Medicare, e.g. most of Most of Title III, Improving the Quality and Efficiency of Healthcare.
Here's the version from Congress' website, 906 pages:
https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf
Double spaced, with lots of blank lines, the version actually voted on ran 2K+ pages. https://www.forbes.com/sites/carolynmcclanahan/2012/07/09/cliffs-notes-version-of-the-affordable-care-act/#263298ca3955
There is something that runs18K pages, but it's not the PPACA that Congress voted into law. 1/3 of medicare enrollees have given up "original" Medicare and gone back to commercial insurance. It's called Medicare Advantage, and has very much the feel of commercial group plans. There is an existence proof this can be done: Medicaid. Operated by the states in accordance with federal rules, it gives a nod to federalism ("laboratories of democracy") by enabling states to request exemptions (such as the Section 1115 waivers recently sought by some states to add a work requirement for Medicaid recipients). Because there are working models of universal coverage without using single payer system. For example, Switzerland, where coverage looks like ACA plans.
Here's my question: why does everyone seem so focused something that affects just 2% of the US population (high and rising prices of individual health insurance), when there's a problem affecting nearly 5x as many people - the ones who don't have coverage, period?
I'm part of the 2%. I lost group insurance when my state (not the federal government, not the ACA, not the insurer) terminated grandmothered plans. As a result, I also lost "access" to one of my specialists, because he does not accept any individual health insurance plan.
How about a little more concern for those who can't get coverage, and a little less fretting about the few people like me who make enough to be ineligible for subsidies? It's appreciated, but far more are in a much worse situation. And many of those 2% (like little5bee, but not me) are eligible to buy ACA catastrophic insurance next year if one's objective is simply to reduce the cost of buying a high deductible insurance plan.
**********************************
"...How about a little more concern for those who can't get coverage..."
Seems to me that you're "talking past" the point: why- not- just- plain- simply- cover - everybody?. No games, no bullshit. Pay into the System according to your means. It's equitable. Then there's no need to create arguments or to defend against arguments that involve State vs. State. As we ALL are already aware, the old federalism died when the North won the Civil War. Example: I have heard that Montana, with its wide open spaces, did not want to have freeway speed limits at all. But to continue to get transportation money from out of Washington, they were REQUIRED to institute a speed limit. So they made the speed limit effective only at night.
The State authorities bowed to authority at the national level, though they figured out a way to "do it their own way." Any such shenanigans does NOT have to be presumed. And Switzerland has universal coverage which is not gov't run Single Payer? Ok. What's their population, and how much less of a challenge was it to accomplish universal coverage by doing it that way?
Universal Single Payer is not possible until we can get from "me" to "we." (Michael Moore, "Sicko.") And the vital essential thing that never ever gets expressed is the reality of VESTED INTERESTS. So... if we MUST, let's pay the bastards off, so we can move FORWARD and do the ETHICAL thing, and have actual, real coverage that doesn't penalize a person for needing it.
>> 1/3 of medicare enrollees have given up "original" Medicare and gone back to commercial insurance. It's called Medicare Advantage, and has very much the feel of commercial group plans.
hmm, what could have caused you to write this? Maybe Massachusetts is different, but MC Advantage, in my wife's and my experience, doesn't remotely feel like or resemble any employer policies we've ever had over 45 years. Maybe it's a question of smoothness and efficiency and lack of hassle / paperwork / exclusions / phonecalls to c/s. Maybe remotely is overstatement. But 'much the feel' is not our experience the last 5y.
>> There is an existence proof this can be done: Medicaid. Operated by the states in accordance with federal rules, it gives a nod to federalism ...
uh, do you know people on Medicaid? I have had more than one poor friend who has actually moved, with his disabled wife, packing up and paying movers, from state to state to state, and from county to county within states, because of variations. (You know about this to some extent because you mention earlier about country variations in MCare.)
At the time it seemed quite unbelievable to me.
Less and less seems unbelievable to me now, insurance and otherwise, by the day.
>> why does everyone seem so focused something that affects just 2% of the US population (high and rising prices of individual health insurance)
3% according to this, so maybe it's fallen, and point taken:
https://www.nytimes.com/interactive/2017/03/09/us/politics/who-is-really-affected-by-rising-obamacare-premiums.html
The answer is political drama and pointmaking, I suppose.
So were you able to replace your specialist?
>> insurance [...] Premiums (and deductibles, co-pays, etc.) simply reflect those [healthcare] costs.
Weren't you badgering me a while back for saying just this? Maybe I didn't put it plainly enough.
>> it would have been nice to have seen more discussion of pros and cons from a financial/economic perspective.
meh, I thought all that was fairly well elucidated in the cited christiancare links if you read them closely and the least bit quizzically or skeptically.
And the inherent limitations of strict affinity groups are offensive ipso facto, to some of us.
The partial failure nationwide of what group insurance means is one of the dumbfounding outcomes of this whole megillah.
If one wants to discredit it, one should go beyond simply saying that things are different. By this reasoning, there are no models to look at, because all advanced nations have smaller populations than the US.
The funny thing about that argument is that it's the opposite of the explanation given for why single payer failed at the state level (e.g. Vermont).
"He didn’t think Vermont’s struggles had much bearing on the Empire State effort. 'New York is a dramatically larger state with a much wealthier economy.'"
https://www.politico.com/story/2014/12/single-payer-vermont-113711
The objectives are universality (coverage), affordability (can an individual take advantage of that coverage), and cost (percent of GDP, i.e. macro level). Single payer is a means to these ends, it is not an end in and of itself.
I'm not hostile to single payer. I'm suggesting it to be taken out of the equation as being merely an implementation detail.
see his last sentence, no?
and my own add would have to do w sellability
Or why a specialist copy was charged for an OB/GYN visit (which is supposed to be charged at PCP level); or why the extra charge was reversed the next year, charged back to a credit card that had been canceled, with no paperwork or notification from the insurer.
How about all the pestering they do to get subscribers to agree to let someone come their homes and examine them? The purpose of this is to game the risk adjustment system - the insurer is trying to find something that it can use to tag the subscribers as less healthy. Group insurance can't be gamed this way.
Obviously YMMV.
The similarities include; size of networks (often nationwide), structure of plans (HMO and PPO primarily); types and amounts of copays, deductibles, coinsurance, caps. Very different from ACA plans: extremely narrow networks, high deductibles, high copays (often 50% on bronze plans, including generic drugs). Thanks for asking (seriously). Fortunately, I'm only under observation/testing, but continuity was and is important to me, especially since he was so familiar with my history and had altered the regimen. Because of this, I paid out of pocket (about 2x what I would have paid with a high deductible plan and negotiated rate) for awhile. I couldn't get him to give me any cash discount, and finally figured that so long as I am only at the observation stage, I'd try elsewhere.
I found another doctor affiliated with an excellent hospital (with testing done at those facilities). I was forced to make another insurance change, but fortunately this new doctor was added by the insurer I picked up this year. If I need treatment, then I'll face a more difficult decision. I was hoping for some text around your links. For example, you posted a link to Medi-Share's FAQ. That doesn't tell me what you think is good or bad about it. For example, they seem to pick up child care until age six automatically, while under ACA you'd have to switch from a couple plan to a family plan assuming this was your first child. That seems like a plus for Medi-Share.
Consumer Reports among others has suggested that annual physicals are for some people a waste of money (at this point it's the government's money, but still a waste). So not covering physicals and charging less in exchange might be a positive from both a personal cost perspective and a national health care expenditure perspective. I do question these things because the answers aren't always obvious.
The fact that you (or someone else) might be unable to participate may offend you, but that doesn't address how good or bad they may be for those people who can participate. If I could find some professional association that offered a group plan and that I could join, I would jump at the opportunity, while simultaneously working to get it voided. No different from someone disagreeing with the mortgage deduction but still taking it so long as it's legal. I continue to wonder why free marketers seem to love the idea of employer sponsored group insurance, when it ladens companies with an expense that foreign companies don't have. Want to make American companies competitive? Get everyone out of employer plans and into the same universal pool.
Consider that "Medicare for All" is used as a rallying cry, yet it means very different things to different people.
https://www.vox.com/policy-and-politics/2018/7/2/17468448/medicare-for-all-single-payer-health-care-2018-elections
(The good news for me is that I recently stated to a friend that 62% of people like this, whatever it means, but I wasn't able to source it. The VOX piece says where that number came from.)
My response is simply this: let's just get out of our own way. Let it happen, whether SP or not. But the current cluster-f*** non-system of hoops to jump through, and flaming hoops to jump through, and obstacles and stumbling blocks and nonsense and higher and higher expenses out-of-pocket and non-covered procedures, and drugs that are covered only after you try other drugs first, and prescription formularies that are like jigsaw puzzles, and different tiers of coverage.... And on and on... It's a hopeless, deliberately arcane bunch of chickenshit. And the insurance provider we have is good enough each half-year to send us updates with changes that we're supposed to MEMORIZE????? I got this to say about that: go DO yourself, AND the horse you rode in on.
.....Not to mention a thing like THIS: lately, my doctor prescribed cough medicine with codeine. She warned me to fill the scrip there, in Connecticut, because in Massachusetts where I live, it will not be filled by ANY pharmacy. So, in the State where I reside, some bag of farts, or some agency or committee, has decided what my DOCTOR can prescribe for me. Are you catching just a bit of how indignant I am about that?
https://www.verywellhealth.com/difference-between-universal-coverage-and-single-payer-system-1738546 The FDA doesn't let your doctor prescribe snake oil. Be careful about suggesting that the government has NO business saying what a doctor can prescribe.
See, e.g. Laetrile®: "Amygdalin [Laetrile® is a purified form] is banned in the United States but it is available in other countries and online."
Memorial Sloan Kettering: https://www.mskcc.org/cancer-care/integrative-medicine/herbs/amygdalin
What's the difference, and who determines that?
If you're the one who makes the determination, that's tantamount to the government being unable to bar any prescription. You could just say that the substance is okay. Lots of people say that Laetrile® is okay.
If the government is the one to make the determination, then what are you indignant about?
https://www.cancer.gov/about-cancer/treatment/cam/patient/laetrile-pdq#section/all
https://en.wikipedia.org/wiki/Amygdalin
etc.
As for the rest of this sub-discussion, what is it when you combine chopbusting with hairsplitting?
As for providing text when the FQ is right there, I think some of these discussions are needlessly spoonfed-cluttered and might benefit from skimmability. I trust readers here to read a little. Just my approach. msf is more patient and helpful much of the time.
My chief offense-taking for religious affinity groups (and similar) wrt insurance is that it goes against the entire idea of group insurance and the social contract, which is in enough trouble these days.
@Crash, docs have all sorts of limits on what they can rx for you, high-level to low-level. If you were curious you could find out why Mass. precludes that cough medicine. Maybe it's just sellability in the local HS parking lot? Some legislatures are slower than others, or wiser.
@msf, next time you advise people in Mass., just sent them to Tufts Health Plan for MC Advantage. Perhaps it varies by county, though, dunno. None of the issues you describe has ever applied in our experience, and when there were other issues, their c/s seemed expert and swift. My old acquaintance the head of BCBS says their Advantage plan is about identical.
And here’s what some customers of Medi-share had to say about it at the Better Business Bureau:https://bbb.org/central-florida/business-reviews/medical-service-organizations/christian-care-ministry-in-melbourne-fl-12000835/reviews-and-complaints