feuervogel: (godless liberal etc)
Donna received the letter canceling her insurance plan on Sept. 16. Her insurance company, LifeWise of Washington, told her that they'd identified a new plan for her. If she did nothing, she'd be covered.

A 56-year-old Seattle resident with a 57-year-old husband and 15-year-old daughter, Donna had been looking forward to the savings that the Affordable Care Act had to offer.

But that's not what she found. Instead, she'd be paying an additional $300 a month for coverage. The letter made no mention of the health insurance marketplace that would soon open in Washington, where she could shop for competitive plans, and only an oblique reference to financial help that she might qualify for, if she made the effort to call and find out.

Otherwise, she'd be automatically rolled over to a new plan -- and, as the letter said, "If you're happy with this plan, do nothing."

If Donna had done nothing, she would have ended up spending about $1,000 more a month for insurance than she will now that she went to the marketplace, picked the best plan for her family and accessed tax credits at the heart of the health care reform law.

"The info that we were sent by LifeWise was totally bogus. Why the heck did they try to screw us?" Donna said. "People who are afraid of the ACA should be much more afraid of the insurance companies who will exploit their fear and end up overcharging them."

Donna is not alone.

Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies' own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces -- which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

Ain't capitalism grand?
feuervogel: (godless liberal etc)
Ron Paul:
I practiced medicine before we had Medicaid, in the early 1960s when I got out of medical school,” Paul said. “I practiced at Santa Rosa Hospital in San Antonio. And the churches took care of them. We never turned anybody away from the hospitals. And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves, our neighbors, our friends; our churches would do it. This whole idea — that’s the reason the cost is so high. The cost is so high because we dump it on the government. It becomes a bureaucracy. It becomes special interests. It kowtows to the insurance companies, then the drug companies.

The first statement is full of the ignorance of someone who hasn’t practiced medicine in a very long time. Hospital emergency rooms (at least those that benefit from any federal funding, which is pretty much all of them) cannot turn away sick people. They are required at the very least to stabilize a patient and find a safe, suitable transfer. In reality, the hospitals usually admit any sick patient and eat the cost of any unfunded care. There is no magic coalition of churches to take care of an uninsured patient who wanders into an ER bleeding. They are cared for and the hospital and we as a society eat the cost. Hospitals that take care of a certain number of poor patients receive federal monies to help defray the costs, but this hardly covers it. This system is easily strained. There are a number of infamous cases, especially in Southern California, where hospitals simply dump patients on the street. But in general, hospitals care for the ill who wander in.

Read the whole thing. It's short.
feuervogel: (godless liberal etc)
1. One way capitalism can make health care worse and more expensive from those wacky Marxists at The Economist in response to disingenuous shit David Brooks' column about how there's no way government-run efficacy reviews could constrain costs (widely ridiculed already).

But beyond the added expense [of marketing campaigns], why would anyone think that a system in which marketing plays such a large role is likely to be more effective, to lead to better treatment, than the kind of process of expert review that governs grant awards at NIH or publishing decisions at peer-reviewed journals? Why do we think that a system in which ads for Claritin are all over the subways will generate better overall health results than one where a national review board determines whether Claritin delivers treatment outcomes for some populations sufficiently superior to justify its added expense over similar generics? What do we expect from a system in which, as ProPublica reports today, body imaging companies hire telemarketers to sell random people CT scans over the phone?

2. The illusion of high taxes

As I've said before, and evidence (NYTimes) suggests, if the US government funded a single-payer national health plan via increased taxes, the amount of money out of the (already insured) average American's pocket would not change much, because the money they pay (both directly as a premium and indirectly as lower wages) for insurance is about equal to the amount taxes would have to go up.

It's a common scare tactic of the American right (and one I saw with my own eyes in an anti-single-payer leaflet produced by a drug company 6 years ago) to say, "Your taxes will go up to oppressive levels and you'll have no money left to pay your bills!" That's patently untrue.

(Additionally, US total tax rates are at a 60-year low. Yeah, I think the 250k+/year earners could afford higher taxes.)
feuervogel: (godless liberal etc)
While pro-market conservatives like to say that high deductibles keep costs down because people will "think harder" about asking for expensive, potentially-unnecessary tests, the main effect is to keep people who need treatment but can't afford the up-front out-of-pocket payments from going to the doctor to get that little thing taken care of before it becomes a huge thing, or for routine preventive care.

Via the Mad Biologist comes a story from the New York Times about people foregoing necessary care because they can't afford to meet their deductibles.

For someone like Shannon Hardin of California, whose hours at a grocery store have been erratic, there is simply no spare cash to see the doctor when she isn't feeling well or to get the $350 dental crowns she has been putting off since last year. Even with insurance, she said, "I can't afford to use it." Delaying care could keep utilization rates for insurers low through the rest of the year, according to Charles Boorady, an analyst for Credit Suisse. "The big question is whether it is going to stay weak or bounce back," he said. "Nobody knows."

High deductibles also can be daunting. David Welch, a nurse in California whose policy has a $4,000 deductible, said he was surprised to realize he had delayed going to the dermatologist, even though he had a history of skin cancer. (emphasis mine)

Mike: I understand the need to cut down on unnecessary spending--and many plans' 'unnecessary' ER deductibles are low, especially in the People's Republic of Massachusetts--low for me, anyway*. But for some people, they can't even afford a $100-$200 deductible. That is what poverty means. This 'efficiency' is going to get people killed. (emphasis mine)

So all you folks blithely saying that high deductible plans are great and that health insurance ought to be only for unforeseen catastrophes, not routine care or prescriptions (or even things like physical therapy and psychotherapy, because those aren't, like, CANCER or a broken leg), what you're actually saying is that the poor deserve to die from completely treatable medical conditions.

If you want more transparency of costs, I'm with you, but when someone has food poisoning or a heart attack or is involved in a car accident, they're not going to be shopping around for which hospital has the best rates. They're going to go wherever's closest, or wherever the ambulance takes them.

(This is why medical care cannot be likened to buying a washing machine. Aside from the disparity of information (doctors vs patients), someone in an emergency situation is NOT going to do a little comparison shopping before getting in the car/ambulance. For elective care, like knee replacements, sure, but price isn't the only factor.)
feuervogel: (black haru)
So, I called Duke Sports Medicine today and got an appointment for next Thursday. Fine.

I get the online checkin email and go to the site to go through it. Insurance is right, agree to pay for shit, hit the second to last page and find a box filled with $250 that I'm expected to pay, rather than the $30 copay that's in my benefits booklet.

Oh, it's a HOSPITAL-based service, and subject to my deductible before anything else. It had better fucking NOT be $250 each fucking time. Hospitals can choose whether to have outpatient clinics, and they can choose whether to bill insurance as facility-based (and get the patient's full deductible) or as a free-standing clinic and just get their copay. Of course they'll choose the higher bill. Profit über alles.

And the BCBS-NC website has no option to find a physical therapist in their "find a doctor" area. It's not an option on its own, and it's not under specialties, so I can't "shop around" as free market fellaters would have me do to find one that isn't hospital-based and thus only subject to my $30 copay.

Update: I called the clinic back to see if that would be an every-time thing or just this once, and the guy who answered didn't think that sounded quite right (like it hadn't been billed to insurance yet, which they do the day before the appointment), so he transferred me to the person who handles insurance, who was either away from her desk or on another line. I left a slightly rambly voicemail asking whether I'd be paying the deductible or a copay or if it'd be $250 every time or what.

Update 2: The person who handles insurance called back. I met my hospital deductible already (that sinus CT back in October, which was clean and bought me the neurologist referral), and I'll have to pay nothing for it (until fall, if I'm still going in, when I pay the $250 again). Because it's hospital-based, not clinic-based, I don't even have to pay the $30 copay. Which is better, I suppose, but still unexpected to see "yes, you will owe $250 for your appointment. Please pay $100 in advance, and you'll be responsible for the balance upon arrival." (There's an option to skip payment, which I did, because it sounded entirely wrong, and I figured I'd pay it when I got to the appointment if I had to.)

ObProSinglePayer: Because clearly, the government couldn't be any LESS efficient than having an entire department that deals with the ins and outs of the dozens of insurance providers and their dozens of plans.
feuervogel: (godless liberal etc)
Pop quiz: Who said the following?
Behind this plush curtain of tax and spend, three sinister spooks or ghosts are mixing poison for the American people. They are the shades of Mussolini, with his bureaucratic fascism; of Karl Marx, and his socialism; and of Lord Keynes, with his perpetual government spending, deficits, and inflation. And we added a new ideology of our own. That is government give-away programs….

Click the link to find out.

Do Republicans really oppose making health insurance cheaper?

Short answer: apparently. They argue that if we have either Medicare for all or some sort of pool/exchange, people will quit their jobs and decrease the labor supply, which disingenuous tits like Paul Ryan equate to killing jobs. Um, if people who want to remove themselves from the labor pool, through early retirement or otherwise, do so (because the only thing preventing such is concern about purchasing health insurance on the "free" market (which is in truth a monopoly)), their job will not disappear (most of the time). Job seekers (aka the unemployed) will be able to take the newly-opened position, and -- stay with me; I know this is mind-blowing -- unemployment will decrease.

The only way you could consider people voluntarily leaving the labor pool (to homeschool a child, to retire early, whatever) to be increasing the unemployed is if you're a) a disingenuous liar like Paul Ryan or b) if you consider all people who don't work, whether or not they're actively seeking employment, unemployed, which isn't the standard definition of unemployment.

Also, from the irony department, Medicare recipients are still against government handouts.
feuervogel: (godless liberal etc)
In fact, it's a hundred, a thousand, times better than the system that killed Melissa Mia Hall, who had no insurance, as a freelance writer, and began suffering chest pains due to a heart attack and died in her home because she couldn't afford to go to the doctor, let alone the hospital.

To those of you who believe the free market can and should sort everything out, this is what you're advocating. If taxation is theft, free market health cover is murder.

Do you wonder why I, as a tenuously employed person with no health benefits of my own who aspires to be a freelance writer (as all novelists are) -- a job that almost never has health benefits -- would rather move 4400 miles, a 9-hour flight, and a 6 time-zone difference to a country that mandates health coverage and provides it for those who can't afford it themselves through taxation?

Germans aren't afraid of the social contract or of helping out those in need through vile governmental muggings in dark alleys taxation. Fucking American selfishness needs to die in a fire.
feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
I've been saying that for years, and finally there's some evidence.

Atul Gawande, via Ezra Klein:
The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, tests, and procedures -- make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise -- climbing almost ten per cent each year. The company was baffled.

Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions -- in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.

The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late.

If you're young and generally healthy, or if you have a high enough income to support putting away $5000 or more a year, a HDHP + health savings account may work for you. If you're the other 80% of the population, chances are it won't.
feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
After 10 years of my dentist wanting me to get one, and 4 denied authorizations from Blue Cross, the note from my neurologist recommending a bite guard got the fuckers to do their job.

They wanted evidence one time that I grind my teeth. The broken teeth weren't enough? The fact that I have 4 crowns (which cost, each, twice as much as a bite guard) isn't enough? The visible wearing down of the points of my teeth isn't enough?

Free-market health insurance sure works great and manages costs effectively, doesn't it? Good to know that BCBSNC's logic goes like $650 < 4x$1300, so let's deny the $650 thing. Because that's sure cost-effective.


24 Mar 2010 03:24 pm
feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)
OK, so in comments to GRRM's post on the health care reform law, some fellow named saxster busts out with the Mars-logic:
This opens the door to pure Socialism, which I firmly believe is the intent of the bill and especially of Obama and his handlers. This will push us towards a Global government one more step.

Considering I just watched a terrific German-made film, 'The Lives of Others', just last night, which shows in stark terms how life was in Eastern Germany before The Wall came down, I am disgusted by what I see happening in this country. The will of the PEOPLE was ignored. The vast majority of Americans came down against this bill and the Democrats ignored their constituents in every case.

(I should point out that I'm vaguely offended this person likes a movie I loved.)

Scrolling down, we get
However, we might very well end up with a Feudal society again at this rate. The sword on my wall is a constant reminder to me that I'm not a slave and never will be.

East Germany is hardly that much of a leap from where we are heading right now. History is rife with leaders run amok. There is a reason why this Congress has the lowest approval ratings in United States history.

And some appeals to states rights (he lives in Texas, and invokes unconstitutionality of federal control over health insurance. Which of course totally existed in 1776.)

These are the wackaloons that make me cringe when I hear the word "libertarian."

Oppose the law ON ITS MERITS. Don't just make shit up that's just scaremongering and knee-jerk reactionism and Mars-logic. oh noes, Socialism! It's the USSR! We're gonna go back to a feudal society! (Seriously, I don't get that one. Anybody? In the thread, someone called him on it, and he never responded. I don't know if it's because he didn't have a good response or if GRRM froze the thread first.)

National health insurance will not take away your right to vote. NHI will not invalidate the first amendment (or any of the others.) NHI will not destroy the market economy. NHI will not move into your house and tell you what to eat. It won't even pay for fucking abortions, thanks to women's health being used as a political football YET AGAIN.

It will, however, make it easier to compare insurance plans. It will make it easier to find out how much a procedure costs. It will (oddly enough) make restaurants put calorie information on their menus. Yes, it also expands federal regulations, and if you think that's a bad thing, so be it. But to equate it with the fucking Deutsche Demokratische Republik (which was neither democratic nor a republic) isn't anything founded in Earth logic.

(I worked in county government for 2.5 years. I know there's a lot of waste, incompetence, and nepotism. I think waste should be minimized and competence maximized, for maximum efficiency. I'm very Teutonic in that respect. Ordnung muss sein! und so weiter.)
feuervogel: (godless liberal etc)
As a goddamned pinko leftist, I don't think it goes quite far enough. Being swamped with Life and trying to get this damned novel edited, I haven't had as much time as I'd like to sit down and read the shit. But I do know that Republican obstructionism and outright lies (death panels, say) are basically that.

Also, they said Medicare would destroy the American government, ruin American health care, and many of the same things they're saying now. Possibly even with the tinge of race-baiting and scaremongering they've got going on.

I don't understand, either, Republican insistence that this goes against the will of the people. Let's see. We've got Democratic majorities in the House and Senate (59/100 is still a majority, regardless of what those who want 60/100 to be a majority say) and a Democrat in the White House. Seems to me the People want Democratic reforms.

Opposition to the actual content of the bill, based on personal philosophy, is all well and good, as long as it has a basis in reality (ie, the actual content of the law), as opposed to the wild-eyed rantings of Michele Bachmann or Rush Limbaugh. (Who said he'd move to Costa Rica, if I recall. Pony up, Rush.)

I can't really fit my opinion on what a health care system should look like into an essay on the internet, and boiling it down to a soundbite is dangerous and inaccurate. I've discussed it at length elsewhere in the past. Some of the things in this bill are things I see as good. For example, insurance companies not being allowed to drop your policy based on some bullshit reason after you get sick. If insurance is supposed to cover your medical costs (that's what you pay fucking premiums for, right?), then it ought to damn well cover your medical costs when you get sick.

I understand the libertarian argument that insurance hides the costs of care from the consumers, and that if we don't know how much full body scans cost, we don't care, and we get them anyway. I take issue with the idea that medical care should be thought of in the same way as buying a washing machine (if you're having a heart attack or have just been in a head-on collision, you're not going to google which hospital has the best prices), BUT. But. The new law will increase transparency. Drug companies will have to disclose payments to physicians. Hospitals will have to post prices.

Increasing the information consumers will have access to in order to make informed decisions is a good thing, isn't it? Yet medical care isn't like getting a washing machine. Sure, you can use ratings to decide which primary care doctor to see, or which orthopedic surgeon to go to for the knee replacement, or any sort of non-emergent (to use the medical jargon) situation. I'm all for that.

But when your doctor says he wants to run a test because that could be cancer, most patients will say "OK," then go wherever the doctor sends them. The situation is not completely analogous to going to Consumer Reports for their opinions on the best washing machine.

I generally like [livejournal.com profile] leora's post on the topic, but this comment in particular stood out:
It is going to encourage people who use different plans to rate them, and make those ratings publicly available. Most people really don't know how good or bad their health insurance is. They often get it through work or school, and unless something goes wrong, they just assume they're okay. Their employer may or may not have really looked into what the company has to offer, or may have just gone with something cheap to be able to say they offer health insurance as a benefit. This is hoping to make for more transparency and awareness, while also setting minimum limits so no health insurance can be bad beyond a certain level of bad.

The principle of the free market that many people like takes as a requirement perfect information. You never have perfect information. But the more you strive toward pretty good information, the better competition works. So, there will be competition among different health care plans, with an attempt to make it so that how good a plan actually is is clearer, and thus better plans actually will be more popular.

I'm willing to make concessions to the free market, but only if there are regulations to keep the people from being fucked over.

(Also, DrugMonkey's post made me giggle. It's probably not *nice* of me to have giggled, but with all the right-wing talk about the impending end of the worldAmerica as we know it, it was a nice sarcastic antidote. From another person on the front lines of health care who's actually had to deal with jerkwads on the other end of the phone at the insurance companies, who know as much about medicine as the guy stocking shelves at 2 am.)

This was *supposed* to be quick. Oops. Now I need to eat lunch before my hands start shaking more.
feuervogel: (godless liberal etc)
Who said this?

[...]the actual complaint of the worker is the insecurity of his existence; he is unsure if he will always have work, he is unsure if he will always be healthy and he can predict that he will reach old age and be unable to work. If he falls into poverty, and be that only through prolonged illness, he will find himself totally helpless being on his own, and society currently does not accept any responsibility towards him beyond the usual provisions for the poor, even if he has been working all the time ever so diligently and faithfully. The ordinary provisions for the poor, however, leave a lot to be desired [...].

Just the founder of the German welfare state, that noted leftist* populist* Otto von Bismarck. His motives were so altruistic*, weren't they?

feuervogel: (writing)
Today's word count: 1024
Total word count: 61275 (nuked another scene)

I have an opinion on the health care reform ♥law♥ but I don't have time to elaborate. It's not perfect, but it's a lot better than it used to be. I'll make a real post on it ... sometime. Maybe.
feuervogel: (wtf?)
Insurance company: You can get a temporary policy, but if you want to continue it, you have to reapply. And if you use the temporary insurance, you've got a pre-existing condition, for which we'll deny you. That sounds fair. Sure.
The coverage my friends were able to purchase for their daughter was a 180 day policy. The terms of the policy required that, if they wanted to "renew" it, in effect, they had to reapply for it all over again. At which time, the insurance company was free to take into account any "pre-existing conditions" as a cause for denying coverage. "Pre-existing conditions", in this case, included any conditions for which the policy holder sought treatment for during the 180 days of coverage for which they had paid for.

Read also this post, about one of the victims of the health club shooting: a recent college grad without health insurance who can't afford the bill for the surgery (necessitated by some sick fuck who wanted to take revenge on all women for merely existing and not fucking him, apparently) so her friends & neighbors held a CAR WASH. A fucking car wash.

These are two examples of why this country needs universal coverage, like every other civilized nation on the planet.


feuervogel: photo of the statue of Victory and her chariot on the Brandenburg Gate (Default)

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