Just like Senator Obama, Sen Clinton, and Sen Biden in 2006. What's your point exactly?

I wonder how much those nay votes will hurt their re-election chances? Probably not much, but wouldn't be surprised to see one or two lose their seat over it.

You mean the same Sen Reid who voted no in 2006? Why do you all get sucked into these games by these fuckers on both sides? They don't care about you it's all a game to get reelected and it works.

whoa whoa hold your horses here-I was just making a joke, not a political statement. Everybody in the world expected him to vote no.

I wouldn't be surprised to see some Yay votes leave office feet first at this point. And it'd be richly deserved afaic.

Fair enough. But none of these votes are shocks, all playing to their voters.

Yes if anything it will be the yay votes but most likely it will be neither. The 18 nays know exactly what their voters wanted them to do. Just like Sen Obama back in 2006. It's not about the global economy it's a political game over who gets the bigger share of the kickbacks. Looks like two billion is headed to KY. McConnell is the hero right? :)

I guess most people are unclear on the concept of representational government. If 80% of your constituents (for example) want you to consistently vote a certain way on an issue or to fight for what most in your district believes in, that is what is purposed in the Constitution. But I guess they get demonized if they really act like representatives of their people.

I believe this is pretty fair.

You'll note that I'm not particularly critical -- in that respect anyway -- of the D's who voted the way they did today. They did what they were sent to do, and they didn't do anything other than what was expected of them.

The R's on the other hand ... there's nothing that comes close to my feelings for them that would be legal to say nor wise to express publicly.

So, the only moment of drama was post vote, when apparently, someone went nuts.

Jake Sherman ‏@JakeSherman 7m
An official house court stenographer took to the microphone & was screaming about God. She was saying in the hall you can't serve two masters.

Interestingly, Ron Johnson is taking it from the right too.

Kind of fun to watch.

Floor1.101612.WAV by @toddzwillich on SoundCloud - Hear the world’s sounds

audio of the stenographer ranting and raving. Freemasons, etcetera.

Ted Cruz out bright and early welcoming people back to Washington. I feel so comforted :)

Cruz stages photo op outside Capitol greeting visitors after government reopens | The Raw Story

Looks like lesson learned:

Robert Costa ‏@robertcostaNRO 40m
McConnell to NR, looking ahead to Jan and Feb showdown: "A government shutdown is off the table."

Robert Costa ‏@robertcostaNRO 38m
More McConnell on prospect of another shutdown: "We’re not going to do it," says other GOP leaders agree

So, is this the end of the Tea Party's influence over the GOP?

No, it's the calm before the 2014 midterm storm. They're going to try to primary as many "moderate" GOP members as they can.

SI

I look forward to more Democrats being elected.

Hard to do when districts are so gerrymandered as to make safe D and safe R districts. I'd say you end up with more left and more right leaning districts but the left continues to just eat paste so you don't have a lot of really lefty folks in Congress (Bernie Sanders aside, and he's a Senator so districts mean nothing).

SI

Harry Reid probably would have lost in 2010 if he hadn't been going up against a nut like Sharron Angle. Moderates getting primaried by Tea Party candidates can only help the Democrats.

I agree for the senate, all bets are off for the House. I could see many seats in the House going to the tea party - dep on demographics. The senate is always going to be more moderate than the house, though, because of the larger voting block.

I suppose it's true. We saw the same dynamic in 2012 when the Tea Party cost the GOP Dick Lugar's seat. But we also saw Todd Akin give Claire McCaskill back her seat in almost identical circumstances with similarly stupid rape comments. But he wasn't a Tea Party favorite, he was just a moron.

Also, we just used 3 purple states in Nevada, Missouri, and Indiana to make this point. There just aren't that many purple House districts any more.

SI

I sure hope you're right, except there is no try, there is do or do not.

Sending pseudocons to DC is accomplishing nothing worth a damn, and I'm not even a Tea Party guy consistently (i.e. they've backed a low-end nut job or two more than once in these parts).

In other words, a Tea Partier.

{shrug} Call it what you will, I've long been a consistent commenter that hardly anybody knows what the hell that term actually means at this point beyond their own personal definition. I'm not sure that I have a hard & fast definition myself.

Some stuff I'm with 'em on (insofar as things they get associated with), some stuff I think they miss the mark on. All I know at the moment perhaps is that I trust them -- or the people who get labeled as "them" -- more than I trust a generic (R) right now.

What's interesting about Nevada is how the state is split. Southern Nevada is overwhelmingly Democrat, Northern Nevada overwhelmingly Republican. Adds another layer to the whole UNLV/UNR rivalry.

In Europe for the week. Watching RT channel and their analysis on American Exceptionalism.

The woman reporter just needs to give up her citizenship and go live somewhere else.

She does spread it out between GOP and Dems pretty evenly. its like the Fox News version of anti-American.

Well it is RT. It can't be too much of a surprise.

In Soviet Russia, RT... aw, hell. Fox News? That's selling Russian journalism and even Fox News short. They're more like Coast-to-Coast

SI

Kudos on...ya know...actually providing a reasonable source.

The below is shamelessly taken from another website to point out that this "controversy" is another ginned-up talking point that's been covered already.

This all sounds very ominous until you consider that the naturally high turnover rate associated with the individual market means that it's highly unlikely that individuals would still be enrolled in plans from 2010 in 2014. In fact, the Obama administration publicly admitted this when it issued the regulations in 2010, leading Republicans like Sen. Mike Enzi (R-WY) to seize on the story in order to push for repeal of the grandfather regulations. Here is a story in The Hill from Sep. 22, 2010 pointing to this very same 40 to 67 percent range. [...]
The debate was widely covered in the press, so it's unclear what exactly the NBC investigation unit has uncovered.

Isn't the article specifically talking about the INVOLUNTARY loss of insurance plans and the administration's knowledge that that would happen, despite its "if you like your plan, you get to keep your plan" rhetoric? I remember people rolling their eyes at that line even back then. Nobody really believed it, so in that sense it's not a big deal. And isn't kind of the point of the new setup to get people into higher quality plans, and to bring about the net societal gain of getting more people insured, at the expense of more pricey plans for some who had insurance anyway? I think they just felt like they needed a little deceit to get that idea rolling in the beginning.

That's the key part. They never said "Everyone will get to keep their plan". The plans that are kicking people off aren't meeting the minimum requirements of the Act. In most of the cases, the new plans available for the people who are being kicked off are cheaper and provide more coverage with a lower deductible than their existing plans.

But a lot of them aren't cheaper, is the point of the article (and I think a few posters here have gone through something similar). As a policy, there's nothing inherently wrong with that, a few people pay a little more for other people to have coverage in the first place, but the catch phrase, as utilized, was misleading.

I still want to see a case where it's

a) Not cheaper for an equivalent level of care (provided that the equivalent level of care meets the minimum standards)

AND

b) the person doesn't qualify for subsidies to make it cheaper/in-line.

I think a lot of the people who are finding it not-cheaper were in plans that don't meet the new minimum standards/aren't profitable for the insurance companies under the new regulations, so they're being discontinued.

All this hand-wringing over "OMG I MIGHT HAVE TO CHANGE MY DOCTOR!!!!"
I dropped my last doctor at the drop of a hat and switched to a PCP I'd never met before because my old one wouldn't give me a referral to the specialist I wanted to see and the new guy would. Really what's the big deal???

I'm sure that some people might end up paying more, I have no doubt of that. But from the hullabaloo being raised you'd think that was going to happen to everyone, which just flat-out isn't true.

We're still awfully early in the implementation of this new system (if it ever even gets fully implemented). We're going to have a multiple year wait before we see if it actually works.

This article does a good job of spelling out just what is happening with the notices.

This is why Obamacare is canceling some people’s insurance plans

But you've told us for years that it is a disaster.

I like this part


People are upset about losing access to these types of "insurance plans?" For real??

These are (I imagine) the people complaining their new plans are going to "cost more" when the reality is yes, they will cost more up-front, but they will cover a lot more and result in less overall total cost of healthcare and healthier individuals.

And I believe it will be in the end. I've seen nothing from personal experience to minimize my opinion in that regard.

I forget what our age difference is off-hand so I can't completely speculate as to why that might not be as big an issue for you but that's an enormous -- often a #1 -- fear for many people who have had the same PCP for years. In some cases, their entire lives.

In other instances, a change could mean going from a doctor with relatively easy appointments to one that takes weeks to see. Or in some areas it could mean a choice between one of only two doctors/groups in manageable distance which would mean significant travel or being stuck with a doctor that you've had a previous bad experience with. For others it means abandoning a level of trust & familiarity with a doctor who is familiar with your medical history & situation in exchange one that may or may not give the slightest damn about you versus the one that may have kept you alive through some tough situation.

Point being, lots of reasons that people consider that problematic at best, outright traumatic at worst.

I would venture to guess that the above scenario where someone has a multi-year relationship with a particular doctor and can't continue to see them after a change in insurance is quite rare in the group where only 17% purchase the same plan for two years running.

So you can't call it a success for years, but it's okay to call it a disaster before it starts?

I'm 34. I had the same PCP since puberty and dropped him like a hot pan over the course of like 3 days last year, AND got an appointment with a new PCP to get a referral to the specialist I wanted AND got a flu shot from them while I was there (which they suggested), AND got a physical scheduled for 7 months out. AND my new doc emailed me on their secure email system they have to give me the results of my blood test and tell me to take Vitamin D supplements and that everything else was normal. Yeah...I'd say switching docs is no big deal (but then again I freely admit I live in a city that is a worldwide leader in medicine, so my experience may not mirror what somebody living out in the 'sticks has).

I get that it might be an issue for some folks, but I think it's being oversold as some traumatic issue when in reality, most people see their PCP on average what...every 18 months (figuring in the "see me in 2 years" vs. "see me every year" people). You see your damn dentist more often, and you don't hear people panicked about that.

No, I said I believe it will be a disaster. I don't think you can definitively say either at this point, no?

Fair enough, I honestly just couldn't remember.


Sounds like maybe you should have made a change sooner ;)


We must know a lot of different folks. I'm an extreme exception, I get that completely. I honestly can't tell you the last time I've been treated by a doctor for any reason. I don't have one here & we're going on 8 years since we moved, I saw one only twice in the decade prior to that in the previous town. But on the whole, I sure know a lot of folks (under 65) who make multiple visits a year, particular with ongoing issues. Even moreso those with children dealing with that doctor/pediatrician. That doesn't say it isn't still "most" just as you said, but it certainly doesn't seem like an inconsequential number simply based on day to day evidence.

Bear in mind that if you have a plan from Insurance Company X through your employer, and then your employer drops coverage, forcing you into the exchange, there's a very high likelihood that Insurance Company X will also be offering a plan there, since it would be market suicide not to do so (unless you're talking about a very small health insurance company).

In such an instance, if your PCP was in-network with your previous plan, due to the way provider networks are constructed, there's a very good likelihood he'll (she'll) be in-network on the Exchange plan.

So while it's a fear, and while in some cases such a change will have to happen, it's probably being overstated.

I'll see if I can do this...

In 2009, I started a BCBS catastrophic plan with a $6,000 out of pocket maximum per year at a little under $100 per month. This plan now costs $161, in major part due to Obamacare requirements that took effect in 2011.

That insurance is insufficient, for reasons I'm unsure about. I've been told I can select another BCBS catastrophic plan that does meet the requirements. It costs $186 per month for 2014, but it carries an $8,500 out of pocket maximum in network, and a $17,000 annual maximum out of network.

A bit of hit in terms of what has value to me, but I could live with it. A slight extension of the middle finger to government for a near-100% increase in five years, plus a higher maximum. But, hey, I get a free physical.

But, for those of us who had insurance and are self-employed, the true fuck-you comes in 2015, when BCBS has been told to dump everyone on an individual plan into the exchange.

My exchange quote is $303 for a bronze plan roughly equivalent to the BCBS plan. And it carries only a $6,350 out-of-pocket maximum in-network. So far, pretty much equal to what I have today at only three times the cost I paid five years ago.

But... there is no out-of-network maximum with the bronze plan. In fact, there is no maximum for gold or silver, either. It simply isn't covered. You must stay in-network. And, the only doctor I've seen this year isn't even in the BCBS network.

So far, according to reports, doctors operating outside of a hospital where their contracts require them to support Obamacare simply aren't going in network. We won't know the score for a few months, but this is a real problem for anyone who wants more than the most basic care.

I don't know what I'm missing, but so far Obamacare seems every bit as bad as it did when the Senate rammed 2,000 pages of lobbyist-written bullshit through a vote without even reading it because it would have been blocked once Scott Brown took his seat in the Senate.

Again, please reform health care. It desperately needs it. But this is bad legislation that makes a serious problem much, much worse.

You are the first self employed person I've heard say anything negative about this. I'm sure there are many others, but this is the first I've heard.

I am self employed with insurance through BCBSNC. I pay $625/mo for rather average coverage. I have a $5000 deductible, a $60 specialist co-pay which actually matters now that I see specialists about 5 times a year. I have a $500 prescription deductible, and $1500 max coverage on prescriptions per year... so I pay the first $500 of prescriptions out of pocket, then once they start covering things, once they've paid $1500 for prescriptions, I'm back to paying full price for everything for the rest of the year.


My plan is grandfathered in, I can keep it if I want with no changes, though I got a notice that the rate is going up to $690/mo next year.


I've applied for coverage under the new system, My new coverage with BCBSNC under Obamacare will be $375/mo, will have a $1000 deductible, a $30 copay for specialists, no prescription deductible and no max coverage for prescriptions. Co-insurances for MRI's and stuff or hospital stays should I ever need them are the same in both plans. The network of doctors I can see is exactly the same.


My story is as anecdotal as Jim's so it shouldn't carry much weight in the overall conversation... but my understanding from talking to a number of friends that work as consultants is that self employed folks who didn't have access to group coverage were being screwed royally and that this is a huge change for the better to level the playing field. Perhaps the High Deductible/Catestrophic plan only folks like Jim are seeing something different, I don't know.

Another caveat for a sample size of 1 here, but this is exactly how its working out for me staying with BCBSNC but switching from a personal plan for self employed folks vs a plan through the exchange. The provider network is the same.

As another self employed person the biggest difference to me is that, should my union insurance lapse again, i actually CAN get coverage. I was denied for 4 years over what turned out to be a misdiagnosis so I was living off of expensive catastrophe only insurance and thankfully I'll never have to go back to that.

Which of these is more typical? Is it just that Jim has an insanely inexpensive plan (my share of the plan I get through my company is about $210/mo for family coverage; I do not know what the company is paying, but I assume it's something) and costs overall are evening out? Obviously that sucks for Jim (and those like him -- regional thing?) but I'm not sure that proves anything about the plan overall.

I can think of a pretty sizable portion of the population that would prefer policies that don't offer maternity care.

Not that I don't believe the results, but I am surprised by Jim's offer of an 8.5K out of pocket -- I thought cost sharing needed to be limited to HSA limits, which are around 6K. Also, did the deductible change?

I don't know the global answer. I know here in Maine the situation for self-employed people, as I've said earlier in the thread, is much more like Radii's. The Affordable Care plans are much much better than what was currently available.

Man I love that line, it has everything. It is the best example of an anecdotal proclamation of truth I've ever read. For me, I will start using "Isnfpetmmoitr" in posts.

Probably somewhere in between. I got dinged for weight when I first signed up. I had no other options but BCBSNC (all commercial payers like United/Aetna/Humana declined to offer me coverage) and BCBSNC made it clear I was being charged a premium. When I first signed up I paid ~$425/mo. Over the last 5 years its gone up every year to the current $625.

For income tax purposes, I do get to deduct 100% of my premiums, so the effective cost is a little lower as a result.

Catastrophic plans have tended to be complete and utter shit in two ways.

The first is in benefits offered, but that's OK since most who buy a catastrophic plan don't intend to use "regular" benefits. This, however, is bad for society (see below).

The second, however, is in the ways the company that offers the plan tends to have to get out of actually living up to your expectations should you actually need catastrophic coverage. Kinda sucks to be on your way to the hospital and find out you're not going to be covered, at all, because of some fine print.

At the private health insurance company I worked at until recently (one of the 5 largest in the United States), the doctors who ran the Care Management division hated catastrophic plans. The reason was that those with these plans tended to avoid treatment for anything for so long that by the time they showed up, they cost a fortune to treat, usually in a losing cause as well.

So basically the existence of catastrophic plans enables (and even encourages) the misuse (through non-use, then overuse) of medical treatment options. In addition, many with these plans will cost the taxpayer a lot of money should they (and they are) dropped from coverage once they have an expensive condition (see: lawyers).

The irony is that even private insurance companies want you to use your benefits. Using your benefits means you tend to cost a lot less in the long run, which is better for everyone, not just the docs and nurses in Care Management, but the C-Suite looking at the margins.

(I'd like to note that I'm not accusing Jim or anyone else here who may have had catastrophic plans as being part of the problem. I'm going to assume all FOFC people are smart people who keep themselves healthy and seek treatment in a timely manner when necessary.)

I'll leave you with an anecdote about this. When I worked for this company, we took on an employer group in an urban area who had a very large blue collar staff. These employees, by and large, had never had private health insurance before, but the employer wanted to finally offer it to them.

The concern we had, as a company, was how we would get these folks, who were used to, at best, using the ER for any and all medical treatment, to actually use the benefits they were going to have, which included preventative care, checkups, wellness, etc....

In the end they decided to use part of the budget to hire several nurses who lived in the area, and task them with calling, educating, explaining, etc... these new members on how to use their health benefits, including everything from finding a PCP (including explaining what a PCP was), how to schedule an appointment (and for what), etc.... Having done the research on similar populations, it was an easy decision to approve, as it was clear the short-term cost would be far-less than the long-term cost of not getting these folks to use their benefits.

It's frustrating to read that my decision, which is to pay for the medical treatment I need, is somehow selfish or un-American or utter shit. I haven't been to an emergency room for a long time. It's not something I'd use except in an emergency.

If you have low-level insurance, by the way, it's a fairly stupid way to handle health care anyway - you still pay until you reach a deductible, and emergency rooms are more expensive than a regular doctor visit.

What is insurance? Budgeting an amount of money to protect you from bankruptcy should something bad happen. We don't have home insurance to pay for, let's say, a new water heater when your old one breaks down. We have it for the small percentage chance of a fire or a tornado or something along those lines. We don't expect our auto insurance company to cover us for an oil change every 5,000 miles.

We can educate people on the value of having a physical exam every year or so. Some insurance companies, on their own, even added this to catastrophic plans as it can save them money in the long run.

But that's not even what this debate is about. It's about the government taking over health insurance and turning it into something different.

I have my selfish un-American utter-shit insurance. Obviously, I'd like one of those employer-paid packages with concepts like co-pays, but that's an expensive benefit and that kind of insurance isn't available for self-employed people - at least not at less than $1,000 a month. Sure, my utter-shit insurance doesn't pay anything if I get pregnant, but I think I can handle the risk of pregnancy on my own.

My insurance is there to ensure that I get decent medical care in the event of a serious illness.

With Obamacare, I will pay three times as much to get an inferior product. With Obamacare, if I have a serious illness, I can only receive treatment from in-network doctors. And, really, there's no guarantee that there will be any in-network doctors for many specialties. That's my biggest concern. With Obamacare, I cannot keep my old insurance and I cannot chose my own doctor. How many people would have supported this plan had they known that Obama's campaign promises were utter bullshit? There's a reason even unions are against Obamacare now that some of the problems are being exposed.

Obviously, selfish utter-shit insurance wasn't available everywhere. There are many states where regulations have kept high-deductible plans out of the marketplace for the self-employed. So this has some value, though real health care reform would have been a better solution.

And, of course, if you qualify for the subsidies, which means other people pay for your health care, then it has more value. But don't forget that real costs are still being incurred and someone else is paying for them.

I haven't been a part of these debates very frequently so I don't know what's been discussed in here before... but I am curious if you are aware of how much of our nation's insurance is already "taken over by the government" ? I work for a healthcare technology company with services in a few hundred medical offices around the country from hospitals to primary care offices to specialist offices. Our software manages patient check-in's, so every appointment goes through our system. Last time I checked, 38% of our volume was for Medicare patients. I think another 10-15% are Medicaid. Government *already* runs at least half the healthcare in the country. No one but the heaviest tea partiers or libertarians even want to reduce that. We love the government being involved in our healthcare.



The best insurance you could get as an individual was $1000/mo that wasn't a catastrophic plan? See my above posts where I am deemed a health risk and originally got insurance for less than half that a few years ago, I have my problems with it for sure, but because of my health risk it was worth it to pay, so I did. It wasn't for you, so you didn't. But I'm calling a very high level of bullshit on this.


Have you researched this for yourself? You get to do that before you commit to anything. The people who are freaking out about in network providers are typically ones that have long term relationships with specific providers and are afraid of their network being slightly smaller than it is today. It sounds like you've taken good care of yourself and have been lucky to not need a lot of care, I wouldn't have thought you were in the group impacted by this. The articles I've read talk about some payers limiting some provider networks by 10-20% to help keep costs down for patients, in some plans (but still offering more expensive plans with the same options generally). Are there serious concerns that "my plan forgot to contract with a cardiologist in my region, so I guess I'm screwed" ???



This is of course the big political question, and I'm clearly on the other side of it, but I'll remind everyone here that we are already doing this in a monumental way, and if anyone seriously suggested we stopped, most of us, even those who violently oppose Obamacare, would absolutely lose their shit.

So, why not just eliminate health insurance entirely? Why continue to create winners and losers?



Yes, there's a heap of bullshit you can place on a straw man. Always is. That's why people create straw men.

The value of many employer-paid plans is over $1,000 in the private market. That's not even available to the self-employed in many states. Let's say you're a teacher. The average cost of insurance for teachers, nation-wide, is more than $700 per month - as part of a very large group. It's certainly not a stretch to say that many individuals would have to pay $1,000 for that level of coverage, since the self-employed don't get the benefits of being in that large a group. I'm sure there's a level of insurance out there I would have to pay $1,000 to receive. The Gold plan would cost me $480. But again, that has no out-of-network coverage.


We don't know what will be in-network and what won't be under Obamacare. There are plenty of doctors who aren't in-network today. Their payments in many cases will be lower under Obamacare, so it stands to reason that more will refuse to participate. Under Obamacare, you're not covered out of network, period. That's a real, tangible reason that it's a lower level of coverage than the high-deductible plans so many here are calling utter shit.

And, yes, I've discussed this with the company I use to price insurance. Their advice is to stay out of the exchange as long as possible unless I qualify for Medicaid, which I don't (Of course, if FOF7 fails, I will, but let's hope it doesn't come to that).



Who would turn down free medical care for everyone, anywhere?

As I pointed out a few pages back, we're spending too high a percentage of GDP on medical care. If we could just reach the international average amongst the higher-developed nations, we could probably take a bigger step. Unfortunately, Obamacare does very little in terms of real health care reform.

Holy shit, motherfucker, can you read?



1. I explicitly said I didn't think the situation applied to you or other FOFCers (and their ilk) who use these plans.

2. I didn't use the words "selfish" or "Un-American".

3. I was expressly making an explanatory post on the way medical benefits were used.

:banghead:

It's unlikely that the increases were due to ObamaCare. Health care costs have risen 196% since 1999, with worker contributions rising 182%. Attributing an increase to ObamaCare simply neglects the reality of the historical ever-increasing health care costs.

FYI, for those of us with families, the cheapest catastrophic $6k deductible plan would run about $600 back in 2009. I know, I looked. Those plans covered virtually nothing more than a wellness visit and picking up anything in excess of the $50 copay on prescriptions. And that didn't even cover maternity costs. So either your plan was extremely unusual, or...


...your plan didn't cover hardly anything. And since your insurance is now "insufficient", this confirms that your plan didn't amount to much at all. That's not an insult, but you must have had a very unusual plan.


So your near 100% in 5 years isn't much above the historical rise in costs for the last 14 years and you have added benefits. That sounds about right.


Are you still living in MI? On Michigan health insurance exchange: your state’s marketplace the lowest cost plan is $222 a month, not $303. Also, by your own admission, the new plans offer benefits that you do not currently have so you're not comparing apples for apples. Also note that MI chose not to launch it's own health care exchange and is riding off the federal one. States that launched their own have seen reduced costs.

We do agree that health care needs to be reformed. I'm not a big fan of Obamacare because it doesn't fix the fundamental economic issues of health care. Goods that carry an inelastic demand typically don't work well without major government intervention. Unless we're willing to let people die on the street because they don't have access to health care, this is one of those industries that simply don't work well in a laissez faire marketplace. So unless we're willing to do that, there is no free market solution that fixes health care. Which is why that every other industrialized nation has gone to some sort of a single payer solutions, which provides roughly equal care (some things better, some worse - depending on the system) at far less of a % of GDP, which is good for everyone (except those who are raking in huge profits).

Huh?

Blue Cross Premier Gold, which is BCBS's Gold plan on the Exchange in Michigan, costs $308/mo if you're under 50 for an individual plan or $525/mo if you're over 50 (prices lower for silver & bronze), includes a $150 in-network deductible and $300 out-of-network deductible with a $10,200 out of pocket maximum.

Bear in mind those premium levels are without subsidies, but I'm going to assume you don't qualify for subsidies (though you might, if your ongoing FOF income is low or sporadic).

It covers a variety of services out-of-network (see here).


Yeah you do. Again, in Michigan, just using Blue Cross as an example, the benefits are listed here (and those are the exchange plans, so you can buy them on the exchange or from BCBS direct), and you can look up individual providers, based on your plan here.


Edit: Again, straight from the website, the Blue Cross Premier Silver Plan, which is available for $434/mo on the Exchange if you are over 50 and not eligible for subsidies, is a PPO with out-of-network coverage for most services: http://www.bcbsm.com/index/plans/mic...emier-ppo.html

As Blackadar noted, the increase is most likely due to rising health care costs, but let's look at those requirements that took effect in 2010 and 2011. They are:

2010

•Coverage for children with pre-existing conditions

Not applicable to you, probably didn't impact your plan, since your plan was individual-only (and thus so was its risk pool, presumably).

•Coverage for young adults under 26

Not applicable to you, probably didn't impact your plan, since your plan was individual-only (and thus so was its risk pool, presumably).

•No more lifetime limits on coverage

Did you read your fine print? Did you have a lifetime limit in your beloved plan? Because this was reason #2 why catastrophic plans tended not to work if used as intended.

•No more arbitrary cancellations or rescissions

And this is reason #1 why catastrophic plans tended not to work if used as intended. I am interested - did you ever use your plan for a catastrophe? What was your experience.

•Right to appeal health plan decisions

Related to the above. Again, what did your fine print say?

•Consumer Assistance Program

Not applicable to your plan.

•Small business tax credit

Not applicable to your plan.

•Temporary coverage for people with pre-existing conditions

Not applicable to your plan.

•Community Health Centers

Not applicable to your plan

2011

•Prescription drug discounts for seniors

Not applicable to your plan.

•Free Medicare preventive services for seniors

Not applicable to your plan, although arguably it should have made your plan (if used by seniors) cheaper.

•The 80/20 Rule (Medical Loss Ratio)

Not likely to apply to your plan, since catastrophic plans are typically a very small part of an insurance company's revenue. They may have raised the premium to help their overall MLR, of course, but that's more an argument for the rising cost of health care causing the increase.

•Rate Review

This could affect your premium if they decided to start pricing in future increases in current years. I would expect this, plus, as you said, they are preparing to discontinue the product (maybe for the Exchange catastrophic product?) means they now it's either actuarially unsound now, or it will be soon. In which case, ironically, it's the market working as intended.


The brokers you are buying your insurance from are BS artists, Jim.

This is a relief. The web site indicates the premier plans have caps out-of-network. The file my agent sent me shows the opposite - calls them all HMOs. That concerns me. I definitely want to remain in a PPO.

Remember that one of the complaints about the Obamacare web site so far is that the generic quotes are for over 50 and under 50, the under being if you're in your 20s. I am 48. Premier Silver would be $398. Premier Gold would be $481. Premier Bronze, which now does seem quite close to what I have (plus, apparently, maternal benefits) is $303. Is 300% over five years equivalent to what we see in health care costs?

As for the motherfucker bit, if you were reading, you'd realize that paragraph was combining your words and others here. There is a definite mantra that people who have catastrophic plans are somehow gaming the system (yet Silver and Bronze are fairly close to catastrophic anyway). You may be right that they don't work as designed - I've never come close to the deductible. But they have helped in that there is a card and doctors have to filter their bills through BCBS. So I get a better rate than I would if I had no insurance.

I was trying (and failing) to channel my inner Samuel L. Jackson. I apologize.

You realize most liberals would like nothing better than that? The ACA is more of a compromise (heck, it was originally created by Republicans to begin with).

Hey - I'm just glad we could help Jim see that he was receiving erroneous (to be kind) information from his insurance agents and that Obamacare might actually save him money, and certainly isn't going to cost him an obscene amount more.

Just goes to show though (I think we can all agree) that if you take the time to look at the reality yourself (all snark aside about how that's difficult since the website is apparently shite and all), it can actually be a positive thing for a lot of people.

I'd be first in fucking line to signup for universal single-payer, just out of principal.

And I have a damn nice Tufts package I'd be giving up (I think my copay on office visits is like $25?)

And it's one that makes the insurance companies more, not less powerful. I never understood how that's a step towards single-payer, to have more private industry in healthcare. Sounds more like a Republican plan, which make sense because, ya.

The bill we have now is a monumental piece of shit, whose full repercussions will not be felt for a couple more years. We're already seeing some of the cracks, and I seriously doubt it's going to improve.

*I'd* even wholeheartedly back a true universal single payer system...if it were not chock full of loopholes, partisan bullshit, fairy-tale costs, etc (much like the ACA). Unfortunately, our government incapable of such things. Even if a GOOD system could be proposed, it'd be heralded as the end of days by (insert party that didn't propose it here), and the ensuing war in Congress over it would turn it into...something like the ACA.

"We have to do something" are the five most dangerous words one can hear from a congresscritter.

How will it save me money? In 2015, when I get dumped into the exchange, I will be paying in at least $1,400 per year more than I will in 2014. While I'm glad to find I can still go out of network, I would like to keep my existing plan.

How do I make up the $1,400? That's a lot of money (especially when you haven't released a new game in several years).

Of course I realize that.

The logical conclusion to the concept that health care is a right is a government absorption of the health care industry.

I'm torn on that. I'm a social liberal, so I want people to have freedom to become whatever they work hard enough to become. But I'm a fiscal conservative, so I want to reform government.

I think the practical solution is to reform health care, as monumental a task as that will be. Obamacare isn't just an expensive compromise; it refuses to even look at real reform in health care.

Unfortunately, due to extraordinary mismanagement of the budget, we are not in a position to add entitlements. At some point, we have to pay for them. And our ability to pay is being reduced right now because of other unsound policies.

i'm jealous of you folks who can use the website. it still has not worked for me - even to browse available plans (NJ)

Again, what do you mean by reform healthcare? You, and a lot of people on the right say that, but there are rarely any specifics.

Another way to look at it is that the ACA merely brought forward your eventual (and inevitable) day of reckoning. The fact of the matter is that BCBS would have refused to renew your catastrophic plan at a point where you got old enough that you became an actuarial risk. Or, your day of reckoning would have been when you had a catastrophe and went backrupt.

On the question of money, again I don't know how much you make (nor do I need to), but if it isn't a lot, you may qualify for a partial subsidy, especially if you look at coverage not from a single, but from a family (you got married, right?) standpoint. There are options, is what I'm saying.


Well, I think you answered your own question there.... :p

And you have to name 3 things that aren't tort reform or shopping across state borders.

SI

The notion of "healthcare reform" is one that has a really ugly truth: somebody somewhere is going to get royally fucked.

You can't "fix" it without dramatically reducing costs ... but there is little (or no) legitimate means for the government to get involved in that beyond what they negotiate for the patients the taxpayers are paying the freight for.

Hypothetically, you can't just wave a magic wand & say "okay doctors, you can only charge $5 for service X" ... because they've invested (by incurring debt) based on the notion that there was a reasonable ROI.

The problem with healthcare is that we've got too many people needing it, not enough money to pay for it and no legitimate or justifiable way to fix that.

It is a royally fucked situation that likely has no "solution" that truly corrects that basic problem. The only "fix" will be when it collapses completely (likely moving things considerably toward solving that basic problem).

If by 'fucked' you mean curtailing the profits of the large health corporations which are milking the system presently - then yes I agree, however considering Americans pay out 2x the costs of most other modernized countries and receive less in return* I fail to see why individuals should be worse off if the reform is undertaken sensibly ... with regards to the ACA, its far to early to judge if its going to be a success at present in my opinion, we'll see in 5-10 years time how its viewed (I've seen a few interesting articles regarding how Medicare was initially viewed which mirror much of what has been said about the ACA today).



*By 'less' I mean not all the country is covered and there are higher out of pocket costs and far more red tape than is present in many other countries.

other countries have managed to come to some kind of solution (even if it's at the risk of lower quality) that has lower costs, so it must be possible. when you're the worst, it's hard to say that it can't be improved.

In my defense I did say "might" - I hadn't crunched the numbers. $1,400 a year is not nothing, but it's better than you thought, right? So maybe "won't cost as much more as you thought" is the more accurate phrase I should have used.

I'd agree that bringing costs down radically now would screw over a lot of people, but we really don't have to do that. As bad as costs are now, they are sustainable if the growth rate in medical inflation is brought down significantly. We don't need to cut medical spending now, we need to reduce the amount of growth in medical spending over the next two decades. That can be done without very many people feeling they have gotten screwed.

The number one precursor to any health care reform is to change what we view healthcare as in this country. Healthcare coverage is not the right to free prescriptions, $10 doc visits and $1000 out of pocket maximums. Health care coverage is catastrophic coverage to ensure a bad medical event doesn't bankrupt you. I propose changing this by doing the following:

1. Through a Private set of companies, have a bare-bones "catastrophic" $6Kish deductible plan highly subsidized for all users through tax incentives. If you want to have it fully covered for people under 60K, I'm fine with that. But, it should be subsidized for all users. I don't care if you make $20K or $200K, everyone should be able to buy this level of coverage. This is the extend of the government interference. This coverage does not cover office visits, prescriptions, ... Just catastrophic coverage. There aren't 20 different levels with 9 different copays - it's one plan that everyone has fairly cheap access to.

2. Allow the purchase of an additional private plan that would add in doc visits, ER trips, prescription coverage,... Since everyone would have this initial "catastrophic" plan, the rates here shouldn't be outlandish. But, these plans will be expensive for people without employer provided coverage as health care IS EXPENSIVE.

3. Promote the crap out of the idea of health/medical expense account that is pre-tax. If you are a small business owner, maybe you go with the bare bones coverage of 1 and the cheapest option for 2 and set aside $3-4K a year in medical expense savings accounts. This would allow you to have a smaller monthly premium but still be able to go to the doc a handful of times a year and buy prescriptions with your pre-tax money. If you don't like that idea (or expect to have higher costs than normal), go with a better private plan with higher premiums.

The end result here is to get people onto a "car insurance" style health care plan as their main plan and then allow them to pay more privately or get employer-provided plans for "premium" coverage.

The main difference here is to have the government only involved in subsidizing (not providing, key difference) the high deductible catastrophic coverage plan. Once nearly everyone has that, a lot of things become more manageable. To really reduce costs, people would actually have to negotiate directly with doctors and hospitals to pay for services. Maybe some higher level private insurances would get you a discount, but you would still be paying for what you use in some capacity (no different than taking your car to the shop and the warranty covers some of the parts while you pay for labor and other parts on a negotiated price). But, we are a LONG way from that point. There's simply too much entitlement in the idea of health care in the US to get there anytime soon.

Are you keeping Medicare and Medicaid in roughly their current format or changing/cancelling those programs?

But wouldn't having the first items highlighted made available to more people help prevent having to claim the catastrophic insurance? Instead of heading issues off at the pass, they get ignored until you have to go in for catastrophic insurance. Going the route you are suggesting here seems penny-wise/pound-foolish.

Everything is on the table if you are seriously trying to impact costs. Obviously, any change there would have to be phased in - but I don't see a big problem with telling people in their 30s and 40s to start saving for health care costs when they get north of 60. No matter how you slice, the elderly will be a big portion of the cost, but I see no reason why a similar plan as outlined above couldn't work for the 50+ with some planning and tradeoffs. People will probably have to work longer to keep cheaper care and you can maybe focus on reducing the cost of preventative care for the 50+ (ie, the main plan gives one free physical a year plus a discount on prescriptions for 50+ members). But, I do think both programs would need to be changed to make all this work.

Also, more preventative care results in less catastrophic coverage so you really should be promoting the former if you want to lower costs on the latter (though to really cause a sea change in reducing costs, delinking health ins from employment would be huge, because then the real costs would be seen of health care).

Even if you assume that the catastrophic plan pays for everything after the 6K deductible, that's a huge amount of money to ask people to pay if they are below the poverty line. There are a whole lot of people that aren't poor because they didn't save enough, they're poor because they don't make enough money to pay all the bills. That group is only going to get larger as machines replace more and more workers. How will your plan cope with these people?

Not to mention the "moving goalposts" issue of his first paragraph. "Healthcare coverage" is whatever we decide to define healthcare coverage as, not what YOU Arles think it should be.

I think for the pre-50 crowd, it wouldn't matter a ton. Most will be working with employer based coverage and have options to cheaper prescriptions/wellness visits. What do you think those things do now for 20 and 30 year olds? How many people under the age of 40 do you actually think get yearly physicals now?

What preventative are would you like covered (that isn't now) for people between the ages of 20 and 40? Rarely do these people get full phyisicals now and they are often free.

Yeah, this plan incentivizes waiting until medical problems are a catastrophe. Aren't most medical costs in the US either chronic disease management or end of life/trauma care? Will this plan even save a considerable amount of money? Certainly providers can adjust costs so that the cheaper stuff is even cheaper and the more expensive stuff is more expensive, thereby getting the government to pay more of the costs.

There is more to it than just annual physicals. It is going in to get something treated at the doctor's office before it turns into a hospitalization event.

Someone gets their car totaled tomorrow and has to pay $3-4K to get a new one - that's a lot of money. Someone has a house and their AC unit goes out in the summer and they have to pay $2K for that - that's a lot of money. Yet, people don't think that stuff should be 90% covered. Yes, there is a chance that a $6K healthcare bill could really hurt you. With that in mind, you may want to get a better private plan to supplement that or set aside some money in a pre-tax savings account to plan accordingly. How is this "not fair"?

I don't know why death panels get such a bad rap. I say, bring 'em on!

You can shop around for a car at the price you can afford - or you can go without (sucks, but possible).

You can shop around for an AC unit at the price you can afford - or you can go without (sucks, but possible).

You can't shop around for the drugs or medical equipment you can afford, and in life threatening instances, you can't go without.

Are their numbers on our overhead, i.e. how much of our health care spending goes to actually collecting and distributing the money, as opposed to directly providing care?

And getting people away from going to emergency rooms as their primary basic care will help a lot with costs.

What kinds of things are we worried about here? A burst appendix? Cancer? kidney stones? What the people who take this argument are essentially saying is that if someone has something that is really bothering them (ie, appendix) but won't go visit the doc if it's $50-70 but will if it's $20. Either the person feels like they need to see the doc (or even ER) or they feel fine. If they feel fine and get cancer, the only thing that will prevent that is yearly physicals which are often free right now and few people use them.

So, what conditions are we afraid people won't go to the doc for if they elect a cheap private plan with $50-60 doc visits as opposed to $20 ones?

Not every health situation is life threatening and if we instituted the things I said in the above post - you would be buying more health care services directly without having the ghost of insurance to hide it all from you. That will great a new economy for services that will reduce cost. If all I get is a $10 copay for every doc visit, I don't know if it really cost $50 or $500 - and I don't care.

I, for one, welcome our new death panel overlords.

What we are afraid of is if they elect to only go with the catastrophic plan, and not also one the cheap plans, which is an option you are providing. That changes nothing from how things are today, and part of the reason the ACA mandated minimum coverages for the plans.