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Health Insurance
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Yes Tim, some good. I have a few pre-existing conditions so if I were to be shopping on the open market I could get coverage now thanks to the ACA. And I have two kids in their twenties who will only get covered if the government puts a gun to their head as they are now doing. And the poor are now covered, technically.
However…in the middle class world I inhabit, when you back out the corporate types covered by work, all I know who were forced onto ACA policies are very, very, VERY unhappy. They got dropped by their current carrier and what was replaced was higher premiums but what’s worse: Higher deductibles, co-pays and this new co-insurance thing. My own bro can’t see the doctors he’s been with for years and remember, that was the mantra: You will still be able to keep your doctors. Uh Uh. New term: Narrow Networks. And my bro is a staunch (rabid) Democrat. Not happy. I suppose it makes one have healthier habits???
In sum, yes you are technically covered but…God forbid you come down with something expensive, THAT’S when you find out what the real cost will be, and I hope that doesn’t happen to you. It has happened recently to members of my extended family of various ages who tend to all be self employed.Tremendous sticker shock even though they are “covered”. I’m glad my wife is in a strong union but we were told just the other day the next school year will have a 6% premium increase. I suppose I should be thankful it ain’t the usual 10%? Hmmmm…I thought inflation was 1.8%? Glad the poor are now covered but they are now using the ER even more because less doctors are now accepting Medicaid. Unintended consequences:
https://www.wsj.com/articles/u-s-emergency-room-visits-keep-climbing-1430712061
Ned Miller
Chicago Videographer
http://www.nedmiller.com -
Here is what it comes down to. Everyone wants everything to be fair. Life it not fair. Some amateur has a top Sony/Arri/RED camera, because his family bought it for him as a toy (to keep him out of trouble) while some hard working pro is still trying to pay off his Betacam package loan, and can’t afford a new system.
Doctors are charged a TON of money to go to med school, and pay for malpractice insurance, and there are only so many smart guys (there are only so many good editors, graphics guys, DP’s, motion graphics artists, etc.) But everyone wants this to be FAIR, and it’s not fair. The doctor has to say at some point – “I owe 1 million dollars between my school loans, and malpractice insurance, and I must have 2 people doing my insurance billing – I have to charge at least XXX”.
And the poor demand the same medical treatment that everyone else gets. It’s not fair, but it’s impossible – the doctors are not going to go bankrupt, just to be fair. Now, are the hospitals, insurance companies, and pharma companies taking advantage of this – OF COURSE THEY ARE. We (the editors, the graphics people, the audio guys) are the doctors (I know – it’s a stretch !)- and the networks, ad agencies, etc. are the insurance companies, hospitals. They want their huge profits for “nothing” (hey, they found the clients) – and “we” (the working guys) have to keep lowering our rates, and finding ways to buy equipment, so we can keep making a living.There is no way to make it fair. The poor (you know, the indi film makers) will always suffer – no matter what the plan – because WE are not going to work for almost free, so they can make their indi movie, that no one will go see.
Bob Zelin
Bob Zelin
Rescue 1, Inc.
bobzelin@icloud.com -
Whether you approve of it or not, we’re headed for single payer or “Medicare for all.” The lobbyists are probably already pivoting toward that world, trying to politicize the Medicare system.
The reason: no part of the economy can grow at these rates for long.
There are some great things about the ACA, but the real issue is not “who pays,” but rather, “how much.” And at the rate of increase in health care costs, it will be over 100% of our economy. Not going to happen. It will be fun to see the lobbyists start to fight each other over their share of a limited “pie,” once they realize they can’t keep gouging the rest of us.
So – “Medicare for all” – unless Google (or Amazon or Apple) drops all that driver-less car nonsense, and gets to work on something that really matters.
It’s bad. But it can only get so bad, before it starts to get a whole lot better.
I hope.
Bob C
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[Bob Cole] “There are some great things about the ACA, but the real issue is not “who pays,” but rather, “how much.””
AMEN.
(full on rant ensues)
The ACA got my family back in the system after 10 years of my wife being totally un-insureable because a decade ago, she was mis-diagnosed with Lupus. After Obamacare made pre-existing denial unlawful, she got into the Mayo Clinic for a checkup test which indicated she’d never even had LUPUS to begin with! It was stress from caring for her Mother during a long slide into Alzheimers kicking my wife immune system. Never “Lupus”
Thanks a lot medical industry knee jerk actuaries at the time.. She’s SICK with something we don’t really understand from one soon to retire doctor – that we suspect we can’t “fix” cheaply – so get her OUT of our insurance system and make sure she NEVER gets back in.
On my side, I’d had my Blue Cross ExecuCare policy for 20 years without a single claim, and saw nothing but constantly increasing premiums. Regular as clockwork.
So after the ACA we switched over. We’re ALL INSURED again! The whole family! We’re paying in and able to access care. It was WONDERFUL. So I went to get the mild tinnitus that had been bothering me checked out. Oops, Cat Scan says Acoustic Neuroma (benign tumor on the acoustic nerve) not threatening but possible annoying if it keeps growing. Good news, they can zap it with outpatient Cyberknife nuclear medicine. Sounds, AWESOME. fine. Did it. Dealing with insurance was the usual nightmare of nine foot bills, scary numbers six months later during some additional insurance back and forth that I actually SAW, and WAY too many hours of the phone getting things pre-cleared, cleared, and post cleared so they would pay. But 6-8 months later all the bills were covered. Felt bad I’d showed up in a new system and had a significant claim, but figured my loyalty over the coming years would generate premiums to offset much of it. Plus, it FELT GREAT to have my loved ones INSURED again at terms I could meet without starving.
Anyway the real kicker is that here in Arizona, we’d signed up with a brand new CO-OP built directly in response to ObamaCare. I like co-cps in general because they don’t typically have $$$$$ executives and rich owners sucking profits out of the system, right? Lets try it. Worked PERFECTLY for me. So imagine my surprise when our enlightened state legislature GUTTED the co-op and pushed everyone back into traditional Insurance Policies last year. It was WORKING – I was PROOF! The co-op had recently announced they could meet the claims AND still make a profit. What they couldn’t do was meet the arbitrary RESERVES the legislature mandated.. So suddenly we’re on notice the Exchange is DEAD – and we now need to buy on the regular insurance market. OK, did our due diligence went BACK into the ACA system and low and behold, one of the BIG insurance companies is suddenly there with decent plans. OK, lets try that. Last year we had increasing incomes so could stand that my costs would TRIPPLE over-night as our CoOp Policies lapsed at the end of the year but it was better coverage, so oh well. I chalked the increase up to the state killing the Co-Op.
Now we learn that THAT huge insurance company (the monster who’s name rhymes with True-Ninted) is pulling out of the state suddenly and I’m suddenly remembering the local news coverage about all the money they spent back during the Obamacare debates to scare seniors with stories about SOCIALIZED MEDICINE – Seriously, I read they even payed for BUSSES to transport those same riled up Sun City Seniors into town hall meetings where they yelled parroted all that crap about the DEATH PANELS. Remember that?
So who knows what will happen next year.
But suddenly, I see wall to wall ads on TV every night for Candidate John McCain about how “Obamacare has FAILED Arizonans.” Well, yes, it did, BECAUSE the Insurance company toadies at the legislature EXECUTED it. Then screwed it into the ground. I’m not paranoid usually, but I’ve honestly started wondering if the whole exercise in AZ was a long con creating talking points for the coming election. Honestly.
The entire US insurance industry, is, IMO, a massive scam. Don’t get me wrong, within it are plenty of decent people siting at reception desks, working as nurses and therapists and even insurance company agents. They are largely doing their best to try to help people and do their jobs, but ALL their efforts are bought and paid for by huge forces sitting on top of the system who’s central purpose is to suck the maximum return out of every premium dollar and pay out as little as possible, however that’s legally possible – and if that’s enough, they have legions of lawyers and tame legislators to change the rules. And the folks at the top could ABSOLUTELY care less if that results in pain, bankruptcy or suicide on the human care end of things. They’ve hit the JACKPOT. Fear of medical cost bankruptcy and fear of real honest to god PAIN drives customers into their system on the sales side – and their proven to cavalierly DENY that relief from any or all their customers of that sits on the customer facing side. Profit trumps compassion virtually every time. And when it doesn’t – you can bet the PR machine goes into high gear about how the photogenic kid was SAVED by some transplant. The counterbalance to consumer abuse in healthcare used to be Government – with state “insurance boards” providing consumer protections. HA! Check who’s sitting on YOURS. Likely some industry lobbyist IF you even have ANY advocacy at all. Those “SMALL GOVERNMENT” fanatics? Guess who they cut out of the system first thing? It’s disgusting.
IN US medicine today Nobody actually knows what anything costs. Nobody know whats fair or stupid. Nobody explains a policy term or regulation unless it’s in the process of denying a claim. And nobody in the industry cares as long as the premiums keep rollin in and the profit lines on the reports keep going up. The bill you get after medical services is idiot fan fiction at best and systematic way to bring back individual financial indentured servitude for anyone with the temerity to get ILL! without an industry approved insurance card.
Connecting the suppression of pain and human heath into a system of PROFIT is about as stupid as the human race has ever gotten. And the many, MANY countries that have decoupled those things should be cheered. This is one of the very, very few things that makes me ashamed to be an American.
Can you tell that the past 30 years of my experiences with the insurance and healthcare industries as a self employed small business guy has nearly always involved a MASSIVE hassle? It’s the stupidest run business system in America unless it’s judged on a SINGLE metric. Extracting money from the many to give to the industries ownership class. And there it is stunningly WORLD CLASS.
It’s an EVIL system, IMO supporting, I’ve come to believe, astonishingly EVIL sociopaths at the top who will stop at nothing to kill any regulation that will make things a tiny bit better for the humans they are supposed to serve – at least if that means they lose one one-thousandth of a hundredth of a point off their profits.
Pisses me off.
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Wow. Very illuminating and poignant comments. Thanks for sharing.
Bob C
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[Todd Terry] “I personally want nothing for free”
It’s not free though anymore than public roads, public schools, the police and the fire department are free.
Are people going to game the system? Sure. People gamed the old system, they’ll game this system, and they’ll game the next system that comes down the road. I’m less worried about the guy that you described getting the knee surgeries (which after a quick Google search appear to be around $30,000 per knee) than I am about the higher-up that games the system for millions, if not billions of dollars, annually.
My quick 2 cents to this whole thing. I’ve bounced between being freelance and staff with benefits a few times over the last 15yrs and anytime I’ve paid my own way for health insurance it has always gone up (FWIW I’m healthy and beyond checkups I don’t go to the doctor). In the mid 2000’s I had a plan (can’t remember with who) and after a year it went up around 20%. The next year it went up another 20%. I ended up changing providers and started the whole dance again.
In the mid 90’s I broke my arm and went to the ER. They had to knock me out to set the bones (snapped both bones in my forearm) but I was in/out in just a few hours. The medical bill was around $8,000 IIRC (all covered by insurance). In 2000 I was in London and broke two bones in my hand. They had to do surgery (insert 2 metal pins) which meant a two day, one night stay in the hospital. I later had a couple followup visits as well as a couple of physical therapy treatments. Since I was just visiting, as opposed to being a resident, only the x-rays and initial examination in the ER were covered by their public healthcare. Everything else I had to pay out of pocket (eventually I got my insurance to reimburse me). My bill? $1500-$2000 (can’t remember exactly). The Brits even used a more advanced procedure than what was allowed in the US at the time which enabled me to start rehabbing within days instead of weeks.
Every system is flawed, but I’m kinda tired of the US, when compared to other 1st world countries, being ranked near the top in cost but ranked near the bottom in quality of care.
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[Bill Davis] “Profit trumps compassion”
Funny 🙂
EDIT: The funny part being trump running for president and profits and compassion all in one little bit of irony.
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I actually think this “Executive Team compensation numbers are PEANUTS compared to the money that flows out of these organizations. These guys are really just well payed figureheads. I’d bet dollars to doughnuts that behind the curtains, hundreds and hundreds of millions of dollars a month if not a week flow through dozens and dozens of these insurance systems.
And if we know anything, we know that whoever’s ACTUALLY in charge of that kind of cashflow has long since figured a million ways to divert, tributaries, streams, heck whole RIVERS of cash toward whoever they believe will help them keep the flood going. Rationally couldn’t happen ANY other way.
I’m old enough to remember a time when most of the largest buildings in any major American City had a huge brightly lit Insurance company logos on top. Those logos all came down in the 1970s and 80s. Always wondered why. Today, I think it’s because they didn’t want their customers knowing they owned so much of every downtown and certainly not easily able to find where their operations are based. You can find the payment acceptance buildings, of course. And some vanilla operations centers. But not much else anymore.
They probably still own the buildings. Probably multiple ones in eery city now. But they’ll never make it too obvious again. Mustn’t look TOO successful, when you spend all day running teams workers trained to look for reasons to deny claims.
Might piss too many people off. And NOTHING can ever be allowed to rock this particular boat.
Bitter? Sure. But from looking back on years of shoveling money at that industry, and the few times I’ve needed them – NOTHING but hassles. My preference now is single payer – AND auditing every one of the legacy companies. And if if they haven’t paid out at least 95% of their premiums in actual benefits to actual breathing customers,, I’d make the entire executive teams spend a year or two caring for the sick for every basis point above that they sucked out of the sick, hurt, or damaged humans they were supposed to support and protect.
But that’s just me.
Creator of XinTwo – http://www.xintwo.com
The shortest path to FCP X mastery. -
To Todd the OP’s question: Small Business Owners will be more screwed in 2017. This is why I never wanted employees! See today:
https://digitaledition.chicagotribune.com/launch.aspx?pbid=3e7227b1-e3b7-4fac-aa07-5f943e58b4c5
Ned Miller
Chicago Videographer
http://www.nedmiller.com
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