Barry! How's That ObamaCare Thing Working?

[Captain FT]

Because really for the next 15 years it's all about my kids coverage, after that I'll worry about how fucked up everything is. No Fortune 500 company is going to royally fuck their employees near term.

 

[mrplunkey]

So someone like me who has no primary care doc, has an Aetna family plan through work and when I rarely get sick go to Patient First with my $1000.00 pretax healthcare savings Visa card, why should I fucking care?

I'm guessing here, but you're probably buying a minimal Aetna plan for your catastrophic coverage and handling the small stuff through your HSA.

Soon (if not already) your employer will need to add contraception, mental health care and wellness visits to your plan -- it now needs to meet BarryCare standards. That should drive your premiums up soon (unless they have already). One way they might have slowed-down the increase by slipping-in a $10,000 deductible.

So how will it ultimately effect you personally? Your employer will have to offer a "qualified" plan that has at least a 60% medical payout. Plus, it can't cost more than 9% of your pay.

But when it comes to spouses and children, there will be a catch there too. None of the restrictions mentioned about apply to children and spouses. Typically spouses run 50% more than employees (on a per-enrollee basis, not in aggregate). So you might get coverage for yourself at something like $12 per paycheck, but that might jump to $200 or even $400 (or more) when you try to add your spouse. And if your spouse has access to their own employer, you might get out-and-out denied coverage for her (i.e. the UPS change they made a while back).

UPS to drop 15,000 workers' spouses from insurance, blames Obamacare - Aug. 21, 2013

 

[mrplunkey]

Because really for the next 15 years it's all about my kids coverage, after that I'll worry about how fucked up everything is. No Fortune 500 company is going to royally fuck their employees near term.

Don't think of it as a royal fucking when it comes to kids coverage.

Picture this scenario:

With no pre-existing conditions and no lifetime caps, every new employee is a potential surprise. Imagine hiring a $30,000 per year to do unskilled labor in a factory and then learning they have a child on dialysis with other complications that will now cost you $15,000 per month forever. You don't have a $30,000 employee now -- now you have a $210,000 employee.

Setting aside the debate about the morality of preexisting conditions and lifetime caps, it doesn't take too many of those enrollees to dramatically increase the cost of care to an employers' children. And when those costs go up, they'll show-up in higher premiums for spouse and child buy-ups on employee plans. This isn't greedy employers or greedy insurance companies -- this is just the risk pool getting a lot riskier.

So when the buy-up for spouse and child insurance becomes 40% of your paycheck, you'll finally get frustrated and turn to an exchange. That then worsens the profile of the government pool, but that's the subject of another post. So you, the primary employee, may get better-than-BarryCare coverage, but your wife and kids will be on Medicaid (essentially).

It's not really "fucking over". It's just cause-and-effect economics.

 

[billfred]

We have a tiered system right now:

Private Payers (roughly at cost x 1.60)
Medicare (roughly at cost x 0.90)
Uninsured/Under-insured including Medicaid (roughly at cost x 0.20)

We're moving toward a two-tier system:

Concierge Level / Elite Private Payers (cost unknown)
Obamacare/Medicare/Medicaid (cost unknown)

We managed access to the third tier before (which yes, is a nice way of saying we denied or limited care). Emergent care was paid by the hospital absorbing the cost, but even then that tier was managed.

Let me give you an example: If you presented to an ER with a marginally-stable fracture and had no insurance, you most likely got a plaster or fiberglass cast if at all possible -- they didn't even know if you'd ever return. But if you had insurance, you probably got plates and screws (a secondary, costly surgery). Providers rationed care based on your ability to pay.

Let me give you another example: Here's a real-world one. Our nanny/housekeeper's husband is marginally employed. He does "odd jobs" and probably makes less than $10,000 per year. He's at least 350 lbs and has a blood sugar that routinely runs over 300 and often spikes to over 400. He's a complete train wreck. She buys him glucose meters and test strips -- he refuses to use them. She tries to modify his eating habits -- and he sneaks food. He's told me point-blank that he doesn't care and that if they need to cut something off (referring to an amputation), so be it. In a BarryCare world, this guy is a vein of pure gold to a provider. They could easily rack-up $50,000 per year in bills for him, but A) He's not going to exercise, B) He's going to maintain his 350+ lbs body weight and C) He's not going to modify his diet. That $50,000 per year is going to come straight from taxpayers.

So what's the incremental cost of BarryCare to taxpayers through measures like I described? I'd guess for the first few years it will only be around $200-$400 billion dollars. Past five years and more like ten years away, we're talking trillion+ dollars of new entitlement costs. And yes, that's on top of our existing Medicare and Medicaid burden -- this is money spent beyond that.

Yeah - here is my point. I don't have a GP. Never have really as I rarely get sick. See a Doc maybe once every 5 yrs. Pull my back - thought I was dying - legit. Go to emergency room for two hours of scans, X-rays and generic scrip. Cost me $8,500. I guarantee I was the only one there who paid a bill so I paid my bill and everyone else's. Insurance paid about half so the rest was out of my pocket. I protest the bill my credit gets fucked so I take one for my Hispanic team.

Shit has got to be fixed. I would rather these fucks have to have some sort of insurance even if it is getting subsidized. Everyone needs some skin in the game.

Not saying I endorse the current cluster fuck but do endorse some effort to change.

 

[ismaele00]

So have you all became commies yet?

BTW, socialised comes from society, not from socialism. Just saying.

 

[mrplunkey]

Yeah - here is my point. I don't have a GP. Never have really as I rarely get sick. See a Doc maybe once every 5 yrs. Pull my back - thought I was dying - legit. Go to emergency room for two hours of scans, X-rays and generic scrip. Cost me $8,500. I guarantee I was the only one there who paid a bill so I paid my bill and everyone else's. Insurance paid about half so the rest was out of my pocket. I protest the bill my credit gets fucked so I take one for my Hispanic team.

Shit has got to be fixed. I would rather these fucks have to have some sort of insurance even if it is getting subsidized. Everyone needs some skin in the game.

Not saying I endorse the current cluster fuck but do endorse some effort to change.

The whole system has to be fixed. There's no doubt about that.

The reason you got all those scans and x-rays was because you had good insurance (but it sounds like you had a large deductible).

In our current system, private insurance massively subsidizes government insurance. Picture this:

- 40% of a hospital's business is Medicare (which covers only 90% of cost, with the 20% copay)

- 20% of a hospital's business is indigent / Medicaid (which only covers around 20% of cost)

So here's who makes-up the difference: Private payers. They need to be paying at 160% or 170% of cost just to keep the hospitals even.

Now look at the big picture: The government-side of health care receives a massive subsidy from federal taxpayers (Medicare runs at a deficit) and massive subsidy from state taxpayers (Medicaid programs also suck-up tax dollars) and a massive subsidy from private insurers (1.65 mark-ups versus 0.90 mark-ups).

How anyone in their right mind could come to the conclusion that we need to make government even the slightest bit more involved in this mess blows my mind. They shouldn't have even let BarryCare leave conference committee until Medicare and Medicaid were fixed.

Under BarryCare logic, we need to give Casey Anthony a new baby and get George Zimmerman a new gun. I bet they'll do much better on their do-over.

/rant off

 

[samoth]

Shit has got to be fixed. I would rather these fucks have to have some sort of insurance even if it is getting subsidized. Everyone needs some skin in the game.

I tend to disagree with this, but that's based off of a view that everyone (theoretically) pays for what they receive; no different than walking into a retail store with an intent to walk out with something. If someone goes into a hospital and doesn't have the money/insurance, they're asked to leave. Why is this not the case?

 

[mrplunkey]

I tend to disagree with this, but that's based off of a view that everyone (theoretically) pays for what they receive; no different than walking into a retail store with an intent to walk out with something. If someone goes into a hospital and doesn't have the money/insurance, they're asked to leave. Why is this not the case?

That sort of happens now. Our existing health care system has self-organized into something that is flawed, but has some common-sense measures built into it.

Let's say I show-up to an emergency room and tell them I've got a little bit of clicking in my shoulder when I lift heavy. I'm uninsured, but think it would be just great if they'd refer me to Dr. Andrews down in Alabama, because he did such nice work on Drew Brees a few years ago.

That's never, ever, ever, never going to happen.

But if I go into the same emergency room with blood gushing out of my shoulder via my subclavian vein, they'll save my life and stabilize me -- even with zero insurance at all.

We really have two systems: A non-emergent and an emergent system. We don't have people dying in the streets (who don't have alternatives).

There is absolutely, no-doubt, 100% for sure people in dire financial circumstances who have chronic conditions who genuinely want them treated or even cured. But it's very difficult to separate that group from the 450lb Walmart crowd who thinks it's funny who can grow their bellybutton the deepest over the holidays. There are people who just don't care. Remember: 20% of Americans still smoke. What kind of rock would you have to live under to not know smoking is bad for you? But with their BarryCare card, they'll become walking, breathing ATM machines for a health care system designed to rack-up charges against patients with insurance.

The private sector might be able to sort-out the Helpless from the Clueless, but it's absolutely certain that the government won't be able to do it.

This thing is going to be a train wreck. We're 15% into the mess, at best.

 

[Captain FT]

After reading that reply I suddenly have an urge to see how deep my bellybutton is.

 

[miplank]

76% of statistics are made up on the spot.