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.
Reply to @Mona: Sorry to hear of your tribulations. May I suggest, if you really want the plan you were denied, try to work through other channels. Perhaps a dr. can phone the insurance company and attest to the robust good health of your renal system. In 30 years of self-insured hell, I've heard of many cases resolving in this or like fashion, but it usually requires the involvement of a 3rd party and some persistence. Good luck.
A few points. "X" number of folks, as we know; don't pay attention to much other than sports or leisure. Others will spend more time doing research on items related to sports teams, buying a new smart phone and whatever else one chooses to throw into the list.
More folks relied upon an amount of truth or implied truth about health care plans and statements like "it is as easy as using Orbitz or Amazon".
While many folks should do their homework about all of this, many will not or have limited time; as there are those in need of a new health plan and can not sort the facts. Some in need of a plan live on the edge or into the poverty levels and do have the time or proper access.
I am out of time today; but there are many factors that may cause problems for many folks in this area. And, we all know how complex or overwhelming the area of insurances can become.
As always, thank you for your continued excellent inputs here.
There is an upside to ObamaCare, believe it or not. This thing will certainly implode under its own weight, more rapidly than anyone anticipates. The limitations of Big Government will be obvious to virtually everyone. Then intelligent remedies to our health care challenges will be found by members of the health care industry and consumers of health care, not bureaucrats and politicians. The solutions are really not all that hard, if common sense is employed. So in the long run, we will, indeed, have better health care.
Unfortunately, in the short run, some real pain will be endured. Rationing of medical services will be unavoidable (more patients + no additional doctors and nurses = bad news for sick patients). And costs will dramatically go up for many. But, that's the price we must pay for our "learning curve." And it's what the most Americans wanted on Election Day, as President Obama repeatedly reminds us.
"Then intelligent remedies to our health care challenges will be found by members of the health care industry and consumers of health care..."......So why haven't these "members" made the appropriate changes before? Umm, what were they waiting for?
"The solutions are really not all that hard, if common sense is employed." ...So the solution has been there all along. Just takes common sense. Why didn't someone say that before?
Sorry about the sarcasm, but it's been all about money man. First of all, you left out mentioning big business heath care companies, insurance companies and the politicians beholding to their money. They are and have been in control of your costs. It has had nothing to do with health care providers (doctors, nurses, technicians...) and consumers finding remidies. Do you think these corporations and their pocket-politicians want to lower prices for the good of humanity? Get real. It had to be a push from government. Costs have been sky-rocketing for a over a generation with no end in sight and no incentive to fix it by those in control.
Health care reform has been talked about many times before by both political parties. It just happens that this time it had legs. Was this legislation the best it could be? Obviously not. But the failure comes from both political parties, one legislating in a bubble and the other saying no to whatever comes out of that bubble. This could have solved a huge problem if common sense "cooperation" was employed.
" Rationing of medical services will be unavoidable (more patients + no additional doctors and nurses = bad news for sick patients)."
The oft-repeated shibboleth - we can't start treating all those formerly uninsured (and often poorer, sicker) people; what will happen to "the rest" of us?
Health care pre-2014 is already rationed - with the employed and the wealthy getting more, and many others left to get late, inadequate and costly care via ERs. It's not a zero sum game. Increasing preventive care, timely care can make more effective use of resources, not to mention improve overall public health (thus reducing epidemics and other health risks). A positive feedback loop.
That is really BS! You already have rationing of medical services and it is done by private sector to protect their bulging profits. If this current system was working well, why is US the most expensive country to get medical services anywhere on the planet?
For expensive medical services, your insurance company does the rationing by rejecting or limiting the payouts for services already. You really have little recourse when your insurance rejects the treatment your doctor has ordered. For prescription refills if you show up to the pharmacy a few days earlier your insurance rejects to pay until you wait out their required refill period.
Also, uninsured go to ER to get their very expensive medical services. Often times, if the health was maintained when the issues first came up, the demand for ER services would be less.
These are initial startup pains. Yes, the government site was not ready and they should have done better job there. But, insurance plans are still run by private sector with some minimal standards set by the government. Other than sign-up you really do not have any interaction with goverment in the administration of those plans.
Once the dust settles, I expect it will be more good than bad.
Reply to @MikeM: ". Do you think these corporations and their pocket-politicians want to lower prices for the good of humanity? Get real. It had to be a push from government. Costs have been sky-rocketing for a over a generation with no end in sight and no incentive to fix it by those in control. '
I'm genuinely curious how this is at all negative for big pharma and insurance co's. I agree with you that these companies don't do what they do for the good of humanity, but all I see are benefits in their favor from this - why do they have to lower their prices? If this actually works, they just get a lot more customers. If not, the government gets $$$ in penalties.
Reply to @scott: Certainly increased demand (from more insured patients) helps a lot of these companies. But there are some other requirements built into the ACA that weigh on the other side of the ledger.
Insurance companies have more reporting requirements now; and they are required to spend 80-85% of premiums for medical services and improving health care quality (thus restricting the amount left for overhead and profits).
While hospitals will have to handle fewer uninsured patients, the government subsidies they were receiving to cover these costs are being cut somewhat commensurately. Here's a good Q&A on those two programs (Medicare and Medicaid Disproportionate Share Hospital payments), and how they're affected by ACA.
Ultimately if this doesn't work, the government winds up a net loser in $$$. The premise is that rates won't rise much even with guaranteed issue requirements, because the pool will be much larger, including more healthy people. If those people opt out of the pool, it is very likely that the rates will rise so high (and the government subsidies with them) that the "shared responsibility" (penalty) payments the government collects won't be adequate to cover that additional rise in premiums.
IMHO, that's the biggest risk created by the fed's technology "glitch". Too many people may not sign up - not because of a failure in ACA's design, but because of a transitory implementation issue that turns people away.
Reply to @scott: Hi Scott. I don't believe it is all negative for pharmaceutical companies, but I think they believe there could be less profit taking down the road. You have to wonder if they worry of government price controls on drugs and medical procedures which I believe is the case with Medicare. Right now they (and insurance companies) dictate pricing for your health needs. I've seen those decisions made for cancer patients in my family.
ACA policies also push better life style and pre-screening methods that could reduce the need for their medicines. How would that affect pharmaceutical profits? I don't think it's all negative for pharma, but they may see a net loss from where they are today.
And here is a nugget from a Barron's article which describes a drawback for insurance companies, which I believe msf also mentions:
...So, why would AHIP (the insurance industry) try to secretly destroy a legislative scheme that would drive millions of new customers into their arms thanks to the mandated insurance provisions?
According to Neera Tanden, who served as the senior advisor for health reform at the Department of Health and Human Services and was a member of the Obama White House health reform team, it was all about the Medical Loss Ratio (MLR)—the provision of the ACA that not only requires the health insurance companies to spend 80 percent of your premium dollars on actual health care expenditures, but further requires that they refund to their customers any amounts they fail to spend as required by the MLR.
The total rebates under the law that will shortly be refunded to insurance customers are estimated to total $1.1 billion for 2011 alone—clearly motivation for the insurers to defeat the law...
Also saw an interesting blog that stated ..."Insurance companies are also worried about non-profit insurers. Some big companies like Aetna, Cigna, Humana and UnitedHealth Group are not planning to participate in many of the marketplaces... it’s because they know they cannot be competitive and still satisfy the profit expectations of their shareholders."
What's good for Americans isn't always what's good for big companies I guess. And they have a lot of money to make this difficult.
My, my . . . I'm really surprised by the number of ObamaCare enthusiasts here. I'm delighted you are keeping our spirits up during what must be a somewhat depressing time. Good for you!
I do hope I'm wrong about ObamaCare. I have seven members of my immediate family who are intimately involved in the medical field . . . so for for their sakes, I hope ObamaCare is an unambiguous success, and it does not destroy America's health care system, the best in the world.
But . . . time will tell, won't it? Not me. Not you. Time. Empirical evidence will tell. ObamaCare is here to stay ("it's the law of the land"). It will work or it will not work. Simple as that. For the life of me, I don't know how it can possibly work, but, hey . . . it won't be the first time I'm wrong.
Please check back with me in a few years, and we'll compare notes.
Remember, the 100% of ObamaCare does not kick in until . . . aaaah 2017 . . . conveniently after the next presidential election. That's on the assumption it does not implode first. (It may take us that long to read the 27,000 pages, and growing by the day, of regulations which "spell out" how ObamaCare will be implemented.)
Reply to @RJalpha: Well, I am enthused that there is a start of a health care system open to every American citizen, no matter their economic or health status. I am happy that health care can become a right, not a privilege. I'm not happy that it appears complicated and ambiguous. I'm not happy that people like Mindy are taking a hit for what appears to be a poor roll-out of the law. Depressing? The only depressing part for me is people trying to tear down the universal health care idea rather than working together to make the concept work. You say we have the best health care system in the world. Really? What we have is great innovative technology, but a HC system that has for a long time been self imploding with high costs and selective treatment. Hmm, the same arguments being used against the ACA before it's up and running.
You say,
time will tell, not me, not you,
yet your original post is about
This thing will certainly implode under its own weight
and giving nothing but political talking points as your facts. Well, it just might implode if it has to go through a war to reach it's goal. But as you said, time will tell.
Comments
May I suggest, if you really want the plan you were denied, try to work through other channels. Perhaps a dr. can phone the insurance company and attest to the robust good health of your renal system. In 30 years of self-insured hell, I've heard of many cases resolving in this or like fashion, but it usually requires the involvement of a 3rd party and some persistence.
Good luck.
You noted: "This is, unfortunately, only a surprise to those who chose not to inform themselves of what to expect." For example, NPR (via the California Report) reported this last August.
http://blogs.kqed.org/stateofhealth/2013/08/26/obamacare-to-force-millions-to-upgrade-insurance/
I can't disagree with this.
A few points. "X" number of folks, as we know; don't pay attention to much other than sports or leisure. Others will spend more time doing research on items related to sports teams, buying a new smart phone and whatever else one chooses to throw into the list.
More folks relied upon an amount of truth or implied truth about health care plans and statements like "it is as easy as using Orbitz or Amazon".
While many folks should do their homework about all of this, many will not or have limited time; as there are those in need of a new health plan and can not sort the facts. Some in need of a plan live on the edge or into the poverty levels and do have the time or proper access.
I am out of time today; but there are many factors that may cause problems for many folks in this area. And, we all know how complex or overwhelming the area of insurances can become.
As always, thank you for your continued excellent inputs here.
Take care of you and yours,
Catch
Unfortunately, in the short run, some real pain will be endured. Rationing of medical services will be unavoidable (more patients + no additional doctors and nurses = bad news for sick patients). And costs will dramatically go up for many. But, that's the price we must pay for our "learning curve." And it's what the most Americans wanted on Election Day, as President Obama repeatedly reminds us.
"Then intelligent remedies to our health care challenges will be found by members of the health care industry and consumers of health care..."......So why haven't these "members" made the appropriate changes before? Umm, what were they waiting for?
"The solutions are really not all that hard, if common sense is employed." ...So the solution has been there all along. Just takes common sense. Why didn't someone say that before?
Sorry about the sarcasm, but it's been all about money man. First of all, you left out mentioning big business heath care companies, insurance companies and the politicians beholding to their money. They are and have been in control of your costs. It has had nothing to do with health care providers (doctors, nurses, technicians...) and consumers finding remidies. Do you think these corporations and their pocket-politicians want to lower prices for the good of humanity? Get real. It had to be a push from government. Costs have been sky-rocketing for a over a generation with no end in sight and no incentive to fix it by those in control.
Health care reform has been talked about many times before by both political parties. It just happens that this time it had legs. Was this legislation the best it could be? Obviously not. But the failure comes from both political parties, one legislating in a bubble and the other saying no to whatever comes out of that bubble. This could have solved a huge problem if common sense "cooperation" was employed.
The oft-repeated shibboleth - we can't start treating all those formerly uninsured (and often poorer, sicker) people; what will happen to "the rest" of us?
Health care pre-2014 is already rationed - with the employed and the wealthy getting more, and many others left to get late, inadequate and costly care via ERs. It's not a zero sum game. Increasing preventive care, timely care can make more effective use of resources, not to mention improve overall public health (thus reducing epidemics and other health risks). A positive feedback loop.
That is really BS! You already have rationing of medical services and it is done by private sector to protect their bulging profits. If this current system was working well, why is US the most expensive country to get medical services anywhere on the planet?
For expensive medical services, your insurance company does the rationing by rejecting or limiting the payouts for services already. You really have little recourse when your insurance rejects the treatment your doctor has ordered. For prescription refills if you show up to the pharmacy a few days earlier your insurance rejects to pay until you wait out their required refill period.
Also, uninsured go to ER to get their very expensive medical services. Often times, if the health was maintained when the issues first came up, the demand for ER services would be less.
These are initial startup pains. Yes, the government site was not ready and they should have done better job there. But, insurance plans are still run by private sector with some minimal standards set by the government. Other than sign-up you really do not have any interaction with goverment in the administration of those plans.
Once the dust settles, I expect it will be more good than bad.
I'm genuinely curious how this is at all negative for big pharma and insurance co's. I agree with you that these companies don't do what they do for the good of humanity, but all I see are benefits in their favor from this - why do they have to lower their prices? If this actually works, they just get a lot more customers. If not, the government gets $$$ in penalties.
Insurance companies have more reporting requirements now; and they are required to spend 80-85% of premiums for medical services and improving health care quality (thus restricting the amount left for overhead and profits).
While hospitals will have to handle fewer uninsured patients, the government subsidies they were receiving to cover these costs are being cut somewhat commensurately. Here's a good Q&A on those two programs (Medicare and Medicaid Disproportionate Share Hospital payments), and how they're affected by ACA.
Ultimately if this doesn't work, the government winds up a net loser in $$$. The premise is that rates won't rise much even with guaranteed issue requirements, because the pool will be much larger, including more healthy people. If those people opt out of the pool, it is very likely that the rates will rise so high (and the government subsidies with them) that the "shared responsibility" (penalty) payments the government collects won't be adequate to cover that additional rise in premiums.
IMHO, that's the biggest risk created by the fed's technology "glitch". Too many people may not sign up - not because of a failure in ACA's design, but because of a transitory implementation issue that turns people away.
ACA policies also push better life style and pre-screening methods that could reduce the need for their medicines. How would that affect pharmaceutical profits? I don't think it's all negative for pharma, but they may see a net loss from where they are today.
And here is a nugget from a Barron's article which describes a drawback for insurance companies, which I believe msf also mentions: Also saw an interesting blog that stated ..."Insurance companies are also worried about non-profit insurers. Some big companies like Aetna, Cigna, Humana and UnitedHealth Group are not planning to participate in many of the marketplaces... it’s because they know they cannot be competitive and still satisfy the profit expectations of their shareholders."
What's good for Americans isn't always what's good for big companies I guess. And they have a lot of money to make this difficult.
http://www.forbes.com/sites/rickungar/2012/06/25/busted-health-insurers-secretly-spent-huge-to-defeat-health-care-reform-while-pretending-to-support-obamacare/
I do hope I'm wrong about ObamaCare. I have seven members of my immediate family who are intimately involved in the medical field . . . so for for their sakes, I hope ObamaCare is an unambiguous success, and it does not destroy America's health care system, the best in the world.
But . . . time will tell, won't it? Not me. Not you. Time. Empirical evidence will tell. ObamaCare is here to stay ("it's the law of the land"). It will work or it will not work. Simple as that. For the life of me, I don't know how it can possibly work, but, hey . . . it won't be the first time I'm wrong.
Please check back with me in a few years, and we'll compare notes.
Remember, the 100% of ObamaCare does not kick in until . . . aaaah 2017 . . . conveniently after the next presidential election. That's on the assumption it does not implode first. (It may take us that long to read the 27,000 pages, and growing by the day, of regulations which "spell out" how ObamaCare will be implemented.)
Cheers!
You say, yet your original post is about and giving nothing but political talking points as your facts. Well, it just might implode if it has to go through a war to reach it's goal. But as you said, time will tell.