Obamacare, Healthcare, etc.

[kuronosan]

If you have a limited choice it's not forced. Gotcha.

[jmc]

How does that work, exactly? If you're uninsured in MA, you get smacked with a tax penalty, so I don't get how "dumping" a policy is doable, let alone viable.

And that tax penalty is no fucking joke either.

Went one year without insurance, due to being laid off and got hit by a $600 penalty for not having health insurance.

[hey]

If you have a limited choice it's not forced. Gotcha.

You could choose D) none of the above.

[SwampdonkeyPLD]

So question about pre-existing conditions.

My insurance law book said the clauses all follow something similar to this: If treated in previous 6 months, excluded for a year.

Does that mean coverage is only excluded for a year and then your covered? Or, every time you receive treatment, the 1 year exclusion starts over? As to the latter it would look like this. Treatment in January. Apply in February, thus condition isn't covered. Then you receive treatment in June. Does your year still start from February, or does it now change to June?

The book doesn't get that specific.

[Salodin]

So question about pre-existing conditions.

My insurance law book said the clauses all follow something similar to this: If treated in previous 6 months, excluded for a year.

Does that mean coverage is only excluded for a year and then your covered? Or, every time you receive treatment, the 1 year exclusion starts over? As to the latter it would look like this. Treatment in January. Apply in February, thus condition isn't covered. Then you receive treatment in June. Does your year still start from February, or does it now change to June?

The book doesn't get that specific.

Probably done like that on purpose? I thought that was the point, and why people are fed up with insurance in the country.

[Drex]

And that tax penalty is no fucking joke either.

Went one year without insurance, due to being laid off and got hit by a $600 penalty for not having health insurance.

I'm not in Mass so feel free to correct me if this is a misleading/incorrect statistic, but most sources I'm reading cite around $14,300 as the median annual cost of family health insurance in Massachusetts. Compared to that, the penalty is kind of a joke. Even employer-provided health insurance is listed at around $3500-4000 a year.

As for the problems with the Mass healthcare, this article does a pretty good job summarizing how people "game the system" (#2), how the inflation of healthcare costs is masked by subsidies (#1,#3), and how the heavily subsidized government plans encourage individuals to abandon employer coverage and private coverage to hop on the government bandwagon, meaning costs will keep rising at increasingly fast rates (#5). The whole idea that people could keep their private insurance if they didn't want on the government dole was always a joke to anyone with a clue, and the experiment in Mass proves it was a BS assurance: you can keep the plan, but you'll have to pay 2-3x as much as before because government mandates force the insurers to keep the premiums on public customers down (eating a loss on every one), so there's nowhere to make up for the shortfalls except by jacking up the rates on private customers.

Of course, to the consumers it's great because someone else is paying the costs to keep their premiums down. But if it's applied to every state, there isn't anyone left to pay for it except the consumers. And if the costs start rising even faster than 10-12% per year, hold on to your butts.

[Ragnus]

Even employer-provided health insurance is listed at around $3500-4000 a year

I'm in MA and my employer provided health insurance costs me $1400 a year which includes vision and dental. I was paying your quote as a single payer through Blue Cross with no vision or dental.

Reasons #1-#5 of that website all point to what I've been saying all along. Romneycare is a half assed attempt at universal healthcare. On top of that #4 is ridiculously misleading. The author spent a decent amount of time bashing how families in MA need to spend upwards of 14k/year in MA for health insurance but now its absolutely atrocious that they have to spend $2400/year for the whole family while maintaining a net increase of 11.5k/year for the household. He further tries to demonize it by calling it a tax instead of a premium like he would talking about a private plan. I'm not sure what he's bitching about since the family would still be in the hole 1000/year if they had to pay his hypothetical 14k/year in insurance making them have a 107% "tax rate" on a 13k/year increase in income.

[Acturus]

So question about pre-existing conditions.

My insurance law book said the clauses all follow something similar to this: If treated in previous 6 months, excluded for a year.

Does that mean coverage is only excluded for a year and then your covered? Or, every time you receive treatment, the 1 year exclusion starts over? As to the latter it would look like this. Treatment in January. Apply in February, thus condition isn't covered. Then you receive treatment in June. Does your year still start from February, or does it now change to June?

The book doesn't get that specific.

PreX is usually dependant on the insurer's policy on what defines pre-existing. Does your book speak to a specific context of PreX?

[jmc]

I'm not in Mass so feel free to correct me if this is a misleading/incorrect statistic, but most sources I'm reading cite around $14,300 as the median annual cost of family health insurance in Massachusetts. Compared to that, the penalty is kind of a joke. Even employer-provided health insurance is listed at around $3500-4000 a year.

As for the problems with the Mass healthcare, this article does a pretty good job summarizing how people "game the system" (#2), how the inflation of healthcare costs is masked by subsidies (#1,#3), and how the heavily subsidized government plans encourage individuals to abandon employer coverage and private coverage to hop on the government bandwagon, meaning costs will keep rising at increasingly fast rates (#5). The whole idea that people could keep their private insurance if they didn't want on the government dole was always a joke to anyone with a clue, and the experiment in Mass proves it was a BS assurance: you can keep the plan, but you'll have to pay 2-3x as much as before because government mandates force the insurers to keep the premiums on public customers down (eating a loss on every one), so there's nowhere to make up for the shortfalls except by jacking up the rates on private customers.

Of course, to the consumers it's great because someone else is paying the costs to keep their premiums down. But if it's applied to every state, there isn't anyone left to pay for it except the consumers. And if the costs start rising even faster than 10-12% per year, hold on to your butts.

On average of not having health care you sound about right.

However, most don't have health insurance because they can't afford it either because of not working, or making minimum wage non-full time. So the tax hit of a few hundred dollars does not really help out a already stressful situation.

[SwampdonkeyPLD]

PreX is usually dependant on the insurer's policy on what defines pre-existing. Does your book speak to a specific context of PreX?

It says nearly all contracts define it as something you were treated or diagnosed for and some take it further and say something a reasonable person would have sought medical care for.

[archibaldcrane]

The preX problem is that insurers will refuse to insure lots of people period under the pre-obamacare system.

What you're talking about is likely more applicable to employer plans where you won't be denied, they'll just not treat preX for a set period of time.

[Acturus]

It says nearly all contracts define it as something you were treated or diagnosed for and some take it further and say something a reasonable person would have sought medical care for.

That's still very vague. Not surprising, if it's coming from a textbook, but because it's a textbook, you have to acknowledge that it's going to be general in order to provide basic information to the reader, not specific examples that are used in contracts today.

I don't study member benefit contracts nearly as much as I study health care provider contracts, but the concept of pre-existing conditions are better defined by what happens when one exists instead of simply what one is. Insurance companies pre-Obamacare would routinely deny coverage under the category of pre-existing for reasons other than a truly pre-existing condition.

i.e. My wife was under her parents insurance until she and got married. Shortly after I added her to my plan, she had a medical stay and the stay was denied for pre-existing. Now, there was no way for the insurer to know that whatever medical care she sought was because of a preX condition, but the fact remained that they could deny because of the unknown. It turned out that all they needed from us was proof that she had coverage prior to switching to my plan. Not that any previous coverage acknowledged whatever she presented with as a covered benefit or a treated condition, but simply that before marrying me, she had coverage.

PreX is still defined based on how the insurer chooses to define it. Academically, PreX is supposed to be denied coverage due to injury or illness that occurred prior to the policy implementation for reasons consistent with the fact that such coverage would significantly negatively impact the risk pool expenditures.

However, PreX became a catch-all for denials of coverage by insurers, not just for denials for documented illness or injury that pre-dates policy coverage. It became a way for insurers to deny payment for services of their members. Providers can't control the benefit plans of customers, and if an insurer denies a claim for pre-existing condition, providers have a very hard time getting paid. Unfortunately for the member caught in the middle, they still pay their premium dollars, and the insurer keeps those payments. This is why one of the key provisions of Obamacare is the elimination of denials for pre-existing.

The idea of acknowledging pre-existing conditions within a health benefit plan is not abhorrent within the context of contractual relationships. But the company who writes the contract does not benefit from upfront disclosure, and the person who agrees and signs the contract is left in the dark to defend against vague contract language and member policy.

[kuronosan]

Welcome to modern business, where all they give a crap about is getting your money. What else is new?

The only way something like this will ever work is if everyone does it for the good of all.

It amazes me that the majority of people won't balk about their tax dollars being wasted on politician health care, which is miles above anything you pay for privately, yet they'll balk about their tax dollars potentially going towards (and being wasted on) another human being.

[Cantih]

I recognize that the only way to truly and permanently make things better is rational discussion and patience (lots, and lots, of patience). Any other path only leads bad places, I'll never deviate from that path any further than a few harsh words.

But there are days when I want to forget that, and take any person who argues for the merits of employment or income dependent healthcare, and repeatedly scream FUCK YOU whilst slapping them in the face.

http://www.atlantamagazine.com/featu...spx?ID=1648804

She walks through the emergency-room doors sometime in the early morning. In a plastic bag, she carries an object wrapped in a moist towel. She is not bleeding. She is not in shock. Her vital signs are okay. There is no reason to think that she will collapse on the spot. Since she is not truly an emergency patient, she is triaged to the back of the line, and other folks, those in immediate distress, get in for treatment ahead of her. She waits on a gurney in a cavernous green hallway.
The “chief complaint” on her chart at Grady Memorial Hospital, in Downtown Atlanta, might have set off a wave of nausea in a hospital at a white suburb or almost any place in the civilized world. It reads, “My breast has fallen off. Can you reattach it?”

...

We admit Edna Riggs into the hospital, to get the tests done and to start antibiotic treatment of the infected wound. We could have done the workup without admitting her, but I fear that she will leave the system as abruptly as she entered. Psychological and emotional support are legitimate reasons for admittance, though most insurance companies and Medicaid would disagree.
As she starts to trust me, Edna tells me how frightened she was when she found a lump in her breast. Right away, she knew it was breast cancer, and in her experience, everyone who got breast cancer died quickly, painfully. Insurance problems kept her away from the doctor, as did the fear of dying. She knew she would die after going to the doctor. Several of her friends had.
Early on, Edna had some insurance, which didn’t do her any good. Her employer wouldn’t let her take just two or three hours of sick leave to go to the doctor. If she needed to take sick leave, she had to take it in increments of one day. This guaranteed that an employee would exhaust all the leave quickly. If Edna had been fired for taking time off after exhausting her sick leave, her three kids, too, would have lost support and insurance.
Acknowledging the physical problem and facing the consequences became increasingly difficult. Edna tells me that she feared the disease, but she also feared the system. Would the doctors scold her? Would they experiment on her? Would they give her drugs that caused nausea, vomiting, hair loss? Would the hospital kill her?
Edna’s decision to stay out of the medical system was about fear: fear of breast cancer, fear of the medical profession, fear of losing the roof over her kids’ heads. Fear intensified after her employer started to require copayments from workers who wanted to be insured. This extra $3,000 a year made health insurance too expensive to keep.
Payment for medical services and sick-leave policies determine the quality of service we receive. Several years ago, my research team at the American Cancer Society published data showing that people diagnosed with cancer who had no insurance or were insured through Medicaid were 1.6 times more likely to die in five years as those with private insurance.
In breast cancer, patients with private insurance were more likely to be diagnosed with Stage I breast cancer than those who had no insurance or were receiving Medicaid.
I have seen poor breast cancer patients choose mastectomy (surgical removal of the entire breast) over a lumpectomy (removal of the tumor) because of employer sick-leave policies. A woman who chooses a lumpectomy must also receive radiation, which has to be given daily, Monday through Friday, for six to eight weeks. The treatment requires fifteen minutes in the clinic, but it’s done only during business hours. Unfortunately, this less disfiguring treatment is hardly an option for a woman who knows that longer postoperative treatment will cause her to lose her job.
Much of the problem is that poor people don’t get care that would be likely to help them. The reasons for this are complex. Perhaps they can’t get care, or don’t know where care is available, or haven’t been offered insurance or steady access to care by their job or social services.


...


Early on, Edna ignored her tumor. She accomplished this easily during her busy days, but not when she was alone at night.
The disease progressed relentlessly. The lump grew. Then the tumor broke through the skin, causing a gaping wound, which became infected. The odor caused problems at work. Edna tried to conceal it with body powder and cologne, which worked at first. Her kids started trying to get her to come in and get help several months earlier, after a powerful, relentless stench finally set in.
Since Edna couldn’t pay for private insurance and have enough money left over to provide for her family, she had to come to Grady. Our doctors are good, but free care comes at the cost of time lost waiting for appointments, waiting for tests. You can spend an entire day waiting for a service that a private doctor’s office provides in fifteen minutes or less. People like Edna, who need every day’s earnings and who can be easily jettisoned from their jobs, can afford time away from work even less than professionals, who may have some savings and job security. So people like Edna wait until it’s impossible to wait any longer; they come to see us when it’s too late.

This is one of those days.

[kuronosan]

Well, I agree that it's a huge problem... but I think waiting until a tumor starts growing through your skin is fucking retarded.

Seriously. At that point you're probably going to die so now there's no chance she will survive long enough to take care of the children she was trying to protect because she will die and no one will be bringing any money in.

Look, I understand that the problem with insurance is that you can't afford it so you're scared to go in because it will be too much. Take a few hours off to see a doctor? Ooh, evil employers. If she knew it was breast cancer she knew it was serious and should have thought of her children instead of being retarded.

Would this have been avoided if health care was universal? Probably. It also would have been avoided had she just went to the fucking doctor and bit the bullet. Bankruptcy, even in cases of "fuck you this system sucks", is a lot better than death.

[Milkster]

http://abovethelaw.com/2012/04/the-r...rt-appearance/

Be in debt, bankrupt or go to prison. Yay American Healthcare system.

[Kohan]

Ordinarily, when I color my posts with curse words and other vibrant bits of vulgar language, it's because I enjoy writing that way. The raunchy emphasis brings a greater degree of excitement or derisiveness, depending upon the context, and makes for a more thrilling read.

There are times, though, when I am legitimately angry, and on the Internet, those times are rare. I have better things to worry about, and will either avoid what's going to devolve into an uninteresting conversation or eventually walk away from someone I've been baiting with little to no amusing results.

One of the things that I can be legitimately passionate about is marijuana legalization. Another is this.

Well, I agree that it's a huge problem... but I think waiting until a tumor starts growing through your skin is fucking retarded.

Seriously. At that point you're probably going to die so now there's no chance she will survive long enough to take care of the children she was trying to protect because she will die and no one will be bringing any money in.

Look, I understand that the problem with insurance is that you can't afford it so you're scared to go in because it will be too much. Take a few hours off to see a doctor? Ooh, evil employers. If she knew it was breast cancer she knew it was serious and should have thought of her children instead of being retarded.

Would this have been avoided if health care was universal? Probably. It also would have been avoided had she just went to the fucking doctor and bit the bullet. Bankruptcy, even in cases of "fuck you this system sucks", is a lot better than death.

If I could punch you in the face for your arrogant idiocy, I would risk the jail time for the chance. If you read the article, you did so with such a callous, short-sighted, uncaring mindset that you could only believe in the end that the woman was "retarded," and this is coming at you from someone who lovingly throws that word around, as if it were an everyday greeting.

You legitimately think this woman did not have her children in mind, despite the fact that it's what kept her from going to the doctor. To her, diagnosis meant death, but not only that—she knew that, if she were to be put through treatment, she would lose her job. It wouldn't help her family, and so, working herself to the death was the only option. As much as it frightened her, it was the logical choice.

You criticize her as if it's as simple as, "if only she went into debt, she would surely be cured, and therefore able to take care of her children for years more," as if it were that easy. As if she were guaranteed an extended lifespan. As if the debt would be surmountable in the coming years, and not a burden left behind.

I seem to recall gambling as being the least trustworthy approach to things. In her mind, she wasn't gambling with doctors that could or could not help her; instead, she was working toward what was a sure bet: bringing in money till she inevitably died. You may want to say, "well, she was gambling with her life," but if she already believed that cancer equaled death, there wasn't any gambling going on. She knew exactly what the outcome would be, and she planned to work herself to the death till it came.

From a poor person's point of view, it's more sensible. The debt incurred from burying a loved one is significantly cheaper than what you'll spend to treat life-threatening illnesses. Cremating them is even cheaper. They may as well work themselves to the bone till they're worth nothing, and then the death that they expected will come, and it will all be over for them. Having left their loved ones with the least amount of debt possible, they can die as peacefully as they can.

That you can't understand this earns you a punch in the mouth, as far as I'm concerned. That you and thousands of others can't understand this is why universal health care isn't taken seriously, and that's despite the fact that you personally support it. This is why I consider you a reprehensible person in general, as you claim to stand behind relatively progressive ideas, but your viewpoint on some of the issues involved with them is so offensively flawed that I can only view you as a bastard.

Are you going to be in California anytime soon? My arms are weak, and I doubt it would hurt you, but I really would delight in delivering that punch I promised. Until then, go fuck yourself.

[archibaldcrane]

If you think being diagnosed with cancer is what kills you, you're retarded.

Retarded people can still get sympathy, sure....


...but they're still retarded.

[Salodin]

If you think being diagnosed with cancer is what kills you, you're retarded.

Retarded people can still get sympathy, sure....


...but they're still retarded.

This...pretty much hits it on the head.

[kuronosan]

Kohan, you continue to be an inspiration for militant man-hating feminists everywhere. Go fuck yourself with your taking-shit-out-of-context bullshit.

P.S., thinking that someone working themselves to death is selfish because it leaves her children without a caregiver isn't arrogant.

P.P.S. You're still an over-emotional fool.