Supreme Court upholds Obamacare subsidies

[The Colorado Kid]

The Health Care Industry Needs to Operate As a Free Market, not as a Monopoly.
- There's no reason my insurance rates should go from $450/month in 2007 to $1,400 in 2015.
- There's no reason I should be able to buy a script in Egypt for less than $900, but have to pay almost $90,000 for the same script in the United States.
- There's no reason Americans should be forced to embrace Medical Tourism as a viable alternative to filing for Bankruptcy.









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[LunaTEKKE]

As someone who lost medical coverage for my autoimmune condition after switching jobs from the corporate to the nonprofit sector, I was very much in favor of healthcare reform. Unfortunately, the new system is a complete cluster.

I believe everyone should have access to affordable health care, and I don’t have a problem with some of my tax dollars going to help families that really need it. But the people who are bearing the brunt of the costs are those like me who have to purchase an individual policy without a subsidy.

The government is bragging about how many new people were able to purchase insurance on the new system, but with extremely high deductibles and narrow networks*, we will no doubt see a huge increase in bankruptcy filings in the coming years. And if the patients can’t pay their bills, this affects the ability of the providers to stay in business.

*High deductibles and narrow networks are an extremely bad combination if you need surgical care, as I found out last year. Even if your hospital and surgeon are in network, providers that you have no control over (surgical assistant, anesthesiologist, pathologist, etc.) can be out of network.

For those who want an interesting read on healthcare in the rest of the developed world, check out T.R. Reid's "The Healing of America." The systems used in other countries all have flaws, but ours is far and away the worst in terms of both expenditures and outcomes.

 

[Diamond45]

The Affordable Care Act (ACA, aka Obamacare) has been and will always be a mixed bag because of the unique predicaments that the United States is in. Health insurance as we know it started in the US in 1930 with Blue Cross. It predates most (if not all) countries where they provide coverage. For example, Britain's National Health Service (NHS) started in 1948, so they were able to learn from an existing program and improve upon it. As often stated, there are always advantages and disadvantages to each health care system.

The Health Care Industry Needs to Operate As a Free Market, not as a Monopoly.

I tend to agree with this. However, it makes ACA almost impossible since it's such a CF. In that case, single payer makes more sense.

- There's no reason my insurance rates should go from $450/month in 2007 to $1,400 in 2015.

Agreed. ACA forced insurance companies to drop low end premiums, which I felt was a big mistake.

- There's no reason I should be able to buy a script in Egypt for less than $900, but have to pay almost $90,000 for the same script in the United States.
- There's no reason Americans should be forced to embrace Medical Tourism as a viable alternative to filing for Bankruptcy.

Part of that problem is who pays for the R&D for new drugs. Guess who gets to do the bulk of it? You guessed it, the good ole US of A. That's why other countries can get it so cheap. Two questions - Does it really cost that much to develop these new drugs? Can other countries chip in for their fair share of the R&D costs?

Unfortunately, the new system is a complete cluster.

That is the understatement of the century.

The government is bragging about how many new people were able to purchase insurance on the new system, but with extremely high deductibles and narrow networks*, we will no doubt see a huge increase in bankruptcy filings in the coming years. And if the patients can’t pay their bills, this affects the ability of the providers to stay in business.

I've felt that the ACA is more of a "get well" plan for the insurance industry, not for the people who actually need insurance. The ACA could have destroyed the insurance industry and have gone to a single payer system. However, doing so would have sent a ton of people to the unemployment office and nobody would have wanted that.

Going to a single payer system (i.e. the US government) would have its own problems. As a government weenie for over 20 years, I would NOT want the government to handle my insurance claims. I've seen way too many things go wrong with other government departments (Social Security for one) that makes all the bad problems with health insurance seem like nothing.

For those who want an interesting read on healthcare in the rest of the developed world, check out T.R. Reid's "The Healing of America." The systems used in other countries all have flaws, but ours is far and away the worst in terms of both expenditures and outcomes.

I'll have to check that out. Not surprised that the US system is the worse of them all, but unfortunately we've been down the path that we can't really get ourselves out of unless we do some very drastic things and go the single payer route.

 

[freakchylde]

As someone who lost medical coverage for my autoimmune condition after switching jobs from the corporate to the nonprofit sector, I was very much in favor of healthcare reform. Unfortunately, the new system is a complete cluster.

I believe everyone should have access to affordable health care, and I don’t have a problem with some of my tax dollars going to help families that really need it. But the people who are bearing the brunt of the costs are those like me who have to purchase an individual policy without a subsidy.

Agreed. I've been in the individual market for years as a self-employed person. It was bad enough when Anthem decided to jump my premiums up for not using my plan for anything that I switched to Humana. But my premiums more than doubled and I don't make enough to qualify for a subsidy or a tax credit (since it's now no longer a tax deduction for me).

I have no issue with base care being provided for those who need it. But I don't see why I should be forced to pay for anything other than catastrophic insurance (and I shouldn't be forced to do that either, just wish it was available now - but I can't get it because I'm not under 30, wtf?).

The government is bragging about how many new people were able to purchase insurance on the new system, but with extremely high deductibles and narrow networks*, we will no doubt see a huge increase in bankruptcy filings in the coming years. And if the patients can’t pay their bills, this affects the ability of the providers to stay in business.

*High deductibles and narrow networks are an extremely bad combination if you need surgical care, as I found out last year. Even if your hospital and surgeon are in network, providers that you have no control over (surgical assistant, anesthesiologist, pathologist, etc.) can be out of network.

My only saving grace is that I have a POS, not an HMO. So they'll pay something regardless, and we already know that none of my surgical team is in-network because they're not in anyone's network. Seems that is the direction of some of the medical field.

But I think most folks were blinded by the "I have insurance!" bling and don't realize that if it comes down to it they'll be paying their premium and then the deductible, and then the co-pay and any overage. I have money set aside for this, but I feel for anyone who finds out the hard way.

 

[Yippee38]

Unfortunately, the U.S. government (and maybe all governments in this era) will continue to do as they have always done, and put a bandaid on the cut rather that removing the reason for the cut. They go after the symptom, not the cause. The Affordable Healthcare Act attempts to provide healthcare to those who cannot afford healthcare, but it does absolutely nothing to reduce healthcare costs, which is the real problem. In fact, it most likely raises cost across the board.

 

[The Colorado Kid]

This is interesting.​

 

[MeTuLHeD]

The Affordable Care Act notwithstanding, US Debt now stands at $18,152,809,942,589 and rising exponentially. If we don't do something to reign in spending and pay that astronomical amount down, we are headed for an economic collapse that will make The Great Depression look like a picnic. Sooner or later that kind of indebtedness becomes unsustainable. At that point questions about healthcare become moot. That's not political. It's not Left or Right. It's reality.

 

[Palabra de Dios]

It's the companies that only care about lining their pockets with money that inhibit our ability to actually have low-cost healthcare. Capitalism's evils are shown most nakedly when it comes to healthcare - these companies don't give a shit about how healthy or sick we are. As long as we're buying their products, they'll continue to gouge us for every dry cent we have. The Affordable Care Act is a convoluted mess, but it at least attempts to address some of the issues that we have. I supported a public option in 2008; I think that an option that directly competes with the private companies could prove to keep prices down, to keep that monopoly from extorting thousands of dollars from us every time we need some procedure or some prescription.

 

[freakchylde]

Aetna bids for Humana and Anthem considers Cigna

This is the future of the insurance industry. We won't get competition unless the gov't forces non-monopoly (but the smaller companies will go out of business by selling their policies to the larger companies if they do start going under water). Eventually, it will be a single payer option, just under the private market.

As to a gov't option, go look at the mess going on within the VA. That is the gov't option and they're not doing a spectacular job at the moment.

 

[J-Dubya 777]

As to a gov't option, go look at the mess going on within the VA. That is the gov't option and they're not doing a spectacular job at the moment.

I can speak to this. My dad is 92 years old, missing a leg, and due to astronomical costs for home care, and nursing home care, he has run out of cash, he is now in a VA. While his care has been decent, probably because he is physically healthy, the backstage shenanigans there concern me greatly. A while back, I almost climbed the clock tower (seriously!) because they dropped his disability from 80 to 70%. I still to this day do not have a satisfactory explanation as to why, his mental state isn't great, or any better, probably worse since he was admitted there, and his leg hasn't grown back, so why the change? Part of me wants to rock the boat, part of me doesn't care about being arrested doing so,, but because I'm adverse to any prison situation, and the fact that it's run by our bloated government, always makes me think twice, or at least carefully choose what to bitch about. It really sucks. If he goes under 70%, then we lose funding for his care there. I feel bad for US vets, they gave so much, but so many are getting shit care.

 

[TheLongshot]

As to a gov't option, go look at the mess going on within the VA. That is the gov't option and they're not doing a spectacular job at the moment.

The problem with the VA is an indirect result of being at war for over the past decade, and not dealing with the aftermath.

That being said, my conservative father is very much in favor of government run single payer health care, because that's what he had in the military, and it worked well for him.

While I'm not thrilled with everything the ACA stands for, it is at least an attempt to do something and it does seem to be effective for a certain percentage of the population.

 

[freakchylde]

The problem with the VA is an indirect result of being at war for over the past decade, and not dealing with the aftermath.

That being said, my conservative father is very much in favor of government run single payer health care, because that's what he had in the military, and it worked well for him.

While I'm not thrilled with everything the ACA stands for, it is at least an attempt to do something and it does seem to be effective for a certain percentage of the population.

One thing I've found, is that when things work for you, you don't want to change them till they stop working for you.

The problem I'm experiencing is friends thinking things are great because they work for them, and dismiss my issues because I "should just get a better policy."

We really have to look at how bad things are at the bottom. There will always be a bottom, but when the bottom can at least take enough care of you that you can walk out the door in the best shape possible given your circumstances then it's not bad. I've seen some of the bottom at the VA, and watching my 37 year-old friend be in worse shape than my 90 year-old gram because the VA screwed up, not so cool. If a system can't take care of those with long-term chronic issues in a manner that is satisfactory for the private sector, then it is failing.

 

[TheLongshot]

One thing I've found, is that when things work for you, you don't want to change them till they stop working for you.

The problem I'm experiencing is friends thinking things are great because they work for them, and dismiss my issues because I "should just get a better policy."

We really have to look at how bad things are at the bottom. There will always be a bottom, but when the bottom can at least take enough care of you that you can walk out the door in the best shape possible given your circumstances then it's not bad. I've seen some of the bottom at the VA, and watching my 37 year-old friend be in worse shape than my 90 year-old gram because the VA screwed up, not so cool. If a system can't take care of those with long-term chronic issues in a manner that is satisfactory for the private sector, then it is failing.

I don't think anyone is saying that there aren't problems with the VA. IMO, the VA has serious management issues, partially because of the massive influx of patients from being at war for over a decade.

That being said, the VA does not define everything government run healthcare is. Medicare/Medicade is government run healthcare. Tricare is government run healthcare. Both serve their subsection of the US population reasonably well. Yes, the VA can do much better, and as a son of a vet, I certainly think they should. But, let's not reach the conclusion that the government can't be the solution, particularly when the private sector is doing what it can to squeeze as much as they can from their customers.

 

[freakchylde]

I don't think anyone is saying that there aren't problems with the VA. IMO, the VA has serious management issues, partially because of the massive influx of patients from being at war for over a decade.

That being said, the VA does not define everything government run healthcare is. Medicare/Medicade is government run healthcare. Tricare is government run healthcare. Both serve their subsection of the US population reasonably well. Yes, the VA can do much better, and as a son of a vet, I certainly think they should. But, let's not reach the conclusion that the government can't be the solution, particularly when the private sector is doing what it can to squeeze as much as they can from their customers.

Medicare/Medicaid and Tricare are gov't subsidized insurance. In Medicare/Medicaid's case, they are paid for by the citizens directly through taxes then distributed not according to what you've paid in. With Medicaid, the state will recoup their money through taxes to the individual or through the estate (this is one reason why States that don't have the supplemental funds to cover what the Medicaid coffers can't pay out didn't accept the Fed money because there is a time limit on that money). All 3 are actually run by 2cd party health insurance companies (Humana is one, as noted by the article I linked to above).

Tricare is also run as a health insurance company. Those who can pay premiums like any other health insurance customer, those who can't are treated through the VA system.

There is a vast difference between health insurance and health care. One does not equal the other, and me personally - not on board with the idea that the gov't knows best, or could even manage mediocrity. The Fed gov't has more than enough cases of ideas that were good on paper but only good failures in execution. Setting aside tax money to fund basic care for everyone (meaning, minor emergencies and Dr visits for those who can't afford it and basic catastrophic care for everyone), good luck with that. Congress has done such an awesome job on spending and budgeting, I'm sure they'll find some spare change somewhere, after the lobbyists have their way.

 

[TheLongshot]

Sorry, but I realize that we are talking about two different things, and that's kinda on me. What I meant to say is that in general I'm for a single payer system managed by the government. I'm not in favor of the government taking over the role of running hospitals or doctor practices, tho I don't think anyone in this country is arguing for that. It is why I said that the VA does not define "Government run healthcare" because I don't see that as a system anyone would implement to cover everyone. To be honest, the VA is kinda beside the point in this argument.

Course, I have a hard time believing that someone will implement a single payer system because too many people have too much invested in the current system. There is also a lot of fear that changes will affect the individual negatively. That being said, it seems things get more expensive every year and benefits shrink. This happened before Obamacare and Obamacare unfortunately won't change it in any big way. Until we can remove much of the profit motive from health care, it will continue.

 

[The Colorado Kid]

My family rates and deductible will reach over 20k this year. A few years ago I had better coverage and my total oop expenses were 8k. Insurance companies are gouging the hell out of us. The ACA is an excellent 1st atep, but we still have a ways to go.

 

[J-Man]

Tricare is also run as a health insurance company. Those who can pay premiums like any other health insurance customer, those who can't are treated through the VA system.

Not entirely true, I will say it is run as a HealthCare insurance there are 4 Tricare regions 3 regions cover the US proper and 1 region called overseas, each region is administered by a Healthcare Insurance provider: North - Health Net, East - Humana Military, West - Unitedhealthcare Military, Overseas - International SOS.

Tricare is a 3 tier system for Active Duty, Retirees and their dependents.
There are 3 levels:
Standard, Extra, And Prime (all of them have different levels like Prime Overseas, Prime Remote), then there is Tricare Young adult(for dependents over 23 who are still in Undergrad, grad school, Law School, Med School or any other school that takes them past age 23 to age 26) and Tricare for life(This is after the sponsor turns age 65 and is eligible for medicare, at this point medicare becomes primary and Tricare becomes secondary.

Here's how Tricare works: As an active duty servicemember you are automatically enrolled in Tricare Prime and so is your Family members, cost $0, you receive treatment at military hospitals, clinics or satellite clinics. Now if you are REFERRED to an outside civilian medical facility the cost is $0, if you go on your own Tricare will pay 80% and you pay 20%.
For retirees, Prime cost $495 a year plus deductible and co pays. You have a primary care manager and need referrals to see a specialist

Extra is free the only difference is the deductible and co pays. You can be seen at a military hospital or clinic or Satellite clinic at no cost

Standard is also free, a little high deductibles and co pays but no referrals needed. You can still be seen at a military Hospital, clinic or Satellite clinic.

Going to VA is a choice made by service members who feel or were told that their medical problems were service related and they need to try and get a percentage of VA disability(portion of any military retirement that will be deemed tax free due to disability) Once in the VA system all your healthcare is handled at VA clinics and VA Hospitals unless it is a life threating emergency then if the Military Hospital is available and the needed specialty is there you will go there, if not, the nearest civilian facility, or you can request transfer or the attending Dr. may decide to send you to Brooke Army Medical Center, Bethesda, Walter Reed but only in the direst of health problems ie Transplant.

So you see it's not based on whether you can pay or not it is based on what your choice is. For our family Myself and my wife we have Tricare Standard, and purchase a Tricare supplement, and we have just purchased Tricare Young Adult for my daughter who turns 23 next month and will be in Graduate school. Next year we go to Tricare for life as I will be 65, and I will also have Medicare, but I have to purchase part B. We get all of our care at either William Beaumont Army Medical Center(emergencies or weekend Quick Care) or the Vista Del Sol WBAMC satellite clinic(our primary care Dr is there). My oldest daughter has Tricare Prime as she is the wife of a Soldier.
Okay that is TRICARE at a glance.

 

[freakchylde]

Not entirely true, I will say it is run as a HealthCare insurance there are 4 Tricare regions 3 regions cover the US proper and 1 region called overseas, each region is administered by a Healthcare Insurance provider: North - Health Net, East - Humana Military, West - Unitedhealthcare Military, Overseas - International SOS.

Tricare is a 3 tier system for Active Duty, Retirees and their dependents.
There are 3 levels:
Standard, Extra, And Prime (all of them have different levels like Prime Overseas, Prime Remote), then there is Tricare Young adult(for dependents over 23 who are still in Undergrad, grad school, Law School, Med School or any other school that takes them past age 23 to age 26) and Tricare for life(This is after the sponsor turns age 65 and is eligible for medicare, at this point medicare becomes primary and Tricare becomes secondary.

Here's how Tricare works: As an active duty servicemember you are automatically enrolled in Tricare Prime and so is your Family members, cost $0, you receive treatment at military hospitals, clinics or satellite clinics. Now if you are REFERRED to an outside civilian medical facility the cost is $0, if you go on your own Tricare will pay 80% and you pay 20%.
For retirees, Prime cost $495 a year plus deductible and co pays. You have a primary care manager and need referrals to see a specialist

Extra is free the only difference is the deductible and co pays. You can be seen at a military hospital or clinic or Satellite clinic at no cost

Standard is also free, a little high deductibles and co pays but no referrals needed. You can still be seen at a military Hospital, clinic or Satellite clinic.

Which would make sense, as this is an "employer paid" policy, if you will. Not sure if you've ever dealt with employer provided health insurance, but some companies pay varying portions of the policy premium, and in some cases all of it (though that's rare these days). And I would sincerely hope the gov't covers the entire premium of active duty service members.

Going to VA is a choice made by service members who feel or were told that their medical problems were service related and they need to try and get a percentage of VA disability(portion of any military retirement that will be deemed tax free due to disability) Once in the VA system all your healthcare is handled at VA clinics and VA Hospitals unless it is a life threating emergency then if the Military Hospital is available and the needed specialty is there you will go there, if not, the nearest civilian facility, or you can request transfer or the attending Dr. may decide to send you to Brooke Army Medical Center, Bethesda, Walter Reed but only in the direst of health problems ie Transplant.

So you see it's not based on whether you can pay or not it is based on what your choice is. For our family Myself and my wife we have Tricare Standard, and purchase a Tricare supplement, and we have just purchased Tricare Young Adult for my daughter who turns 23 next month and will be in Graduate school. Next year we go to Tricare for life as I will be 65, and I will also have Medicare, but I have to purchase part B. We get all of our care at either William Beaumont Army Medical Center(emergencies or weekend Quick Care) or the Vista Del Sol WBAMC satellite clinic(our primary care Dr is there). My oldest daughter has Tricare Prime as she is the wife of a Soldier.
Okay that is TRICARE at a glance.

I can't speak for my friend, now, but she had a medical discharge and was always treated at the Atlanta VA without co-pay or anything, for everything (including the sniffles). So obviously there is a loophole in there, somewhere for disabled vets who are, in effect, unable to work or afford health insurance and care.

That said, the VA is still working through some serious kinks with their referral service, especially in the Atlanta area (can't speak to other areas) as I have several friends who got stuck in that cluster. But as with everything, your experience is going to vary based on location, severity of issue, and ability to pay. The VA still has issues taking care of what could be referred to as the "bottom" segment - who is either too sick to work or otherwise cannot find gainful employment, and that segment is what the ACA is supposed mediate - and it does not (because not only can that segment not afford to pay, but it's not subsidized either).

 

[J-Man]

Yes a medical discharge(service related) under honorable conditions you will get lifetime VA care. The VA has problems every where. Here in El Paso we have a veteran population of over 100,000 and the wait time at the VA clinic did I say clinic? Yes Clinic, is the longest in the US, in two years WBAMC will open their new US ARMED FORCES MEDICAL COMMAND MEDICAL CENTER, a 400 bed all specialty medical center and Level 1 trauma center, it will also have a wing devoted to pediatrics, a rehab wing, and a medical and biological research center. That will leave the old WBAMC vacant, the plan is to expand the current VA clinic into the old WBAMC build thus becoming the first VA medical center. That is the plan. By the way my wife just started working for US ARMED FORCES MEDICAL COMMAND as a Clinical Lab Scientist(Blood Bank and Hematologist).

I worked 18 years for RAYTHEON Corp so I know about employee paid insurance. When I first started we paid 1% per year of before tax income as a health insurance premium, then it went to 1 and a half %, then in 2000 was when the shit hit the fan, my premium for a family of 4 was $26,000 a years with the company paying $21,460 and I paid the rest, but there were at least 30 different options including opting out in favor of Tricare (if eligible) and receiving a one time payment per year of $1300. Of course I opted out. Now, talking with some friends who still work at Raytheon there are only 5 plans to choose from and they vary in cost from $500 to $1450 a month with varying deductibles and co-pays.

 

[freakchylde]

Yes a medical discharge(service related) under honorable conditions you will get lifetime VA care. The VA has problems every where. Here in El Paso we have a veteran population of over 100,000 and the wait time at the VA clinic did I say clinic? Yes Clinic, is the longest in the US, in two years WBAMC will open their new US ARMED FORCES MEDICAL COMMAND MEDICAL CENTER, a 400 bed all specialty medical center and Level 1 trauma center, it will also have a wing devoted to pediatrics, a rehab wing, and a medical and biological research center. That will leave the old WBAMC vacant, the plan is to expand the current VA clinic into the old WBAMC build thus becoming the first VA medical center. That is the plan. By the way my wife just started working for US ARMED FORCES MEDICAL COMMAND as a Clinical Lab Scientist(Blood Bank and Hematologist).

My friend said the Salt Lake City one was awesome, Atlanta....yeah, it'd be better if they'd just say it was a clinic. I'm glad El Paso's will be improving.

I worked 18 years for RAYTHEON Corp so I know about employee paid insurance. When I first started we paid 1% per year of before tax income as a health insurance premium, then it went to 1 and a half %, then in 2000 was when the shit hit the fan, my premium for a family of 4 was $26,000 a years with the company paying $21,460 and I paid the rest, but there were at least 30 different options including opting out in favor of Tricare (if eligible) and receiving a one time payment per year of $1300. Of course I opted out. Now, talking with some friends who still work at Raytheon there are only 5 plans to choose from and they vary in cost from $500 to $1450 a month with varying deductibles and co-pays.

I know you worked for Raytheon, I just wasn't sure if you had dealt with their insurance or not.