from the sign-this-form-and-we-can-cure-the-hemorrhage-with-a-money-extraction dept.
The Affordable Care Act (ACA) open enrollment period for US Soylentis has ended. The website was plagued by problems from its launch and even had issues on the the last day.
So, did any Soylentis actually use healthcare.gov to sign up and how has your experience been with the Obamacare system so far?
For those that don't know, from Wikipedia:
The ACA was enacted with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. It introduced a number of mechanisms - including mandates, subsidies, and insurance exchanges - meant to increase coverage and affordability. The law also requires insurance companies to cover all applicants within new minimum standards and offer the same rates regardless of pre-existing conditions or sex. Additional reforms aimed to reduce costs and improve healthcare outcomes by shifting the system towards quality over quantity through increased competition, regulation, and incentives to streamline the delivery of healthcare. The Congressional Budget Office projected that the ACA will lower both future deficits and Medicare spending.
(Score: 3, Interesting) by Anonymous Coward on Sunday April 06 2014, @10:47AM
Let me start by saying I was in favor of the concepts behind the ACA.
Did it work for me? I don't know yet, which I guess means "no" until it does. I've signed up on healthcare.gov. I've filled out a lot of information. Lots of site errors, getting logged off, "too busy, try again later" crap, etc. They ask for your email so they can send you a notice when the site is less busy, but it comes in the middle of the night and is worthless when trying to access it when you actually see the email.
I've had phone calls with them, I've got the recording "we're too busy now, call again later" that hangs up on you, they've called back in the morning while I was at work even though my selection for callbacks was "evening".
I tried submitting the forms for business insurance, but they never worked. It's taken since Nov and I couldn't get the forms to work, or they weren't working on their end, and the insurance companies I spoke to directly couldn't help because I had submitted stuff to the government website, etc, etc, etc.
I finally gave up and started an application to get individual insurance. Still have the endless loop of errors, requests for resubmissions, you must call (phones were too busy), and everything else I dealt with before.
Right now I am waiting on my identification to be verified. They ask you to download a sheet with verification options, but don't provide any way to upload your scanned documents (even though uploading is the first option they list on the PDF). I've called but couldn't get a person (I left my number again). I will try again, but I have to say it has been a disappointing experience and a sinkhole for time. My confidence in the process is zero, and I can only hope that the insurance coverage that I "may" get is worth the effort and the high cost.
(Score: 2) by VLM on Sunday April 06 2014, @11:11AM
My opinion is they don't want it to work, so we'll "have to" fix it with a version 2.0
(Score: 3, Informative) by The Mighty Buzzard on Sunday April 06 2014, @11:21AM
My rights don't end where your fear begins.
(Score: 3, Insightful) by VLM on Sunday April 06 2014, @12:18PM
LOL I would imagine from the perspective of those casinos and businesses it is indeed a tax, just not one you're paying (assuming you don't run a casino / business)
I don't mind paying taxes for healthcare. I pay prop tax, so they build a fire station about 5-10 minutes from my house, cool, I like that deal. I pay prop tax, so they build a police station more or less across the street from my subdivision (its a major arterial road, and being next to the airport is not really suitable for residential, so..), cool, I like that deal. I could go on and on about the local school district that often makes it to the nationals of the academic decathlon, or public works does a pretty good job of pothole filling and plowing snow, blah blah blah. I think I generally get my money's worth. But, supposedly, I should get pissed off if I pay my taxes so they operate an emergency room and ICU about 7 blocks from my house. But try as I might I can't get pissed off about it, I kind of like being a 4 minute ambulance ride away from an ER, if I really need one. Would take a lot more PR lies to change my opinion than they've provided so far...
(Score: 4, Insightful) by Anonymous Coward on Sunday April 06 2014, @01:32PM
There's more to healthcare than the supplier and recipient of benefits, and it's the amount of bloat that has causes healthcare prices to rise to the point where action is necessary. The pharmaceutical industry (spends more on advertising than research), hospital administrators (one of the biggest growth sectors in terms of profit, yet with no value-add compared to their role in healthcare thirty years ago), formerly marginal health-services providers like scooter manufacturers and MRI centers, and *tada* insurance companies have, in financial terms, wholly eclipsed the simple, Norman-Rockwell image of the doctor-patient transaction. The doctor gets little of what the patient pays, especially if he's a frontline general practitioner working for some healthcorp conglomerate.
The more middlemen and profit centers and gluttonous maws of corporate greed got added to the system, the more expensive healthcare became, at a rate outpacing CPI and even education inflation.
And similar things are happening in your local school district. It used to be far cheaper to build and run a school, and the old schools sufficed to produce fine statesmen and generals and all the glory of the flowering Republic. Now you need a $50M facility, loads of extraneous teachers to teach PE and wood shop instead of literacy or math or science, and a host of subsidy programs in the form of massive textbook, techno-gadget, and breakfast/lunch budgets. It's the construction and corporate-subsidy programs that are growing the most: textbooks are often over $100, even in high school, and the plethora of wholly unnecessary iPad-for-education programs that don't actually help literacy are appalling. Meanwhile, student-teacher ratios suck and the core functions of education are getting neglected.
The fire departments seem relatively less bloated, although the police are starting to bloat up with the latest MIC subsidies for new tactical gear and SWAT armored personnel carriers that never get used for anything because America is not Somalia. Still, I mind the fire and police less, because they're still focused on core functions.
Health care and education need serious reform: cutting out a ton of profits being made by players on the sides. Obamacare didn't do that for healthcare, and probably just made it far worse by forcing the young and healthy to assume some of the costs of caring for the unhealthy, socializing risk while ensuring insurance profits. Note that I didn't say anything here about paying taxes to build ICU's: actually nationalizing health care itself, not just mandating its insurance, might help build ICU's, but Obamacare won't. Nationalizing the entire healthcare industry might help, but it won't happen. Eliminating insurance and middlemen and government subsidies and letting markets determine rational and far-lower pricing for healthcare is, frankly, a pipe dream that will never happen. I don't see a way out -- all I see is a looming financial crisis in which aggregate demand for all products and services dies out as a small number of middlemen and marginal actors, most of whose profits will go to a very few people, suck the discretionary spending out of a populace that can't find adequate employment.
(Score: 1) by tirefire on Monday April 07 2014, @08:05AM
You've touched on a lot of my favorite subjects to get pissed off about, but for now I'll just focus on one. iPads, $100+ textbooks, and PE teachers only form the latest wave of "education" pork barrel spending. Read John Taylor Gatto on schooling's transformation in the post-WWII period:
"... a long-term propaganda campaign which radically redefined good education to include football stadiums with lights, band uniforms, huge cafeterias, bus systems large enough to meet the needs of a small city though used only a couple hours a day, costly standardized testing, and many similar additions which once would surely have appalled ordinary citizens with both their high cost - and bizarre irrelevance." (emphasis mine)
Source: https://www.johntaylorgatto.com/chapters/17i.htm [johntaylorgatto.com]
There's a whole book available there for free, by the way. I highly recommend it.
---------------
Personal Story: Right around 2006, the school board in my home town in Iowa wanted a new, larger middle school. The existing building had about 24 students in each classroom when I was a student there just a couple years prior, and enrollment projections showed there would be fewer students 10 years in the future. What was their justification? It was that 6th grade was currently taught in elementary schools, and that some study from California said it was best to put 6th grade in middle school (never mind that 6th grade in the elementary schools had already been run like a middle school for a decade).
Result: A new middle school was built only a quarter mile from the city limits, at a cost of tens of millions of dollars. Nearly every student had to be bussed in or driven; no one lived within walking/biking distance except about a thousand college students in an uber-cheap off-campus apartment complex directly across the street. A lot of them liked to get wasted on their balconies every Thursday/Friday afternoon right about when the middle schoolers got out. Shortly after the new middle school was opened, perfectly good neighborhood elementary school buildings were closed because declining enrollment, coupled with the loss of 6th-grade students, put every elementary school way under capacity. The K-5 students were consolidated into the remaining elementary schools; I remember seeing a lot of shiny new school buses rolling around town soon afterwards.
Bonus: The old middle school was re-purposed into the "administrative headquarters" for the school district. Since then, I've never seen more than 20 cars in the parking lot of a building that once warehoused 500+ students at a time. On a warm day last week, I went for my first bike ride of the year, and when I rolled around the corner expecting to see the old building and maybe eight cars in the lot, I saw... nothing. The building had been demolished, the parking lot torn up, the dirt raked, ready to be seeded with grass. Until I hear otherwise, I'm going to assume that some time last winter all the administrators held a meeting where they decided to get real jobs and then left town as pariahs. It's easier for me to bear than checking the local newspaper to see a photo of the groundbreaking ceremony for the NEW! PEDAGOGICALLY-SOUND! COMMON-CORE-COMPLIANT! ARCHITECTURAL-MASTERPIECE-ERRMAAGUUUUD! building that is no doubt under construction somewhere else.
(Score: 0) by Anonymous Coward on Monday April 07 2014, @09:38PM
We'll, the ACA does put a ceiling on how much of revenue can be spent on non-care-giving activities: 20%. That means that slice of the pie is going to wind up being squabbled over between administrative salaries and owner/investor profits, instead of growing unbounded at the expense of care and/or premiums.
(Score: 1) by khallow on Sunday April 06 2014, @03:08PM
What happens when you're paying for this stuff and not actually getting those services? That's the end game with the continual increase in extent and cost of government services without growing the underlying economy fast enough.
(Score: 2) by VLM on Sunday April 06 2014, @03:27PM
Fire the mayor? I guess that's kind of my point, if taxpayer funding works awesome for a "putting out fires" service, I'm not sure why we cannot consider it for medical services as a class? Why can we have garbage collection as a city provided service but not bandaids?
Or rephrased surely big business middlemen are corrupt and inefficient at getting in the way of medical services. As is the government. So, especially since they've merged and one purchased the other, whats the difference? Other than the existing medical system is corrupt and a replacement will surely, however temporarily, we superior until its corrupted?
(Score: 1) by khallow on Sunday April 06 2014, @03:34PM
I'm not sure why we cannot consider it for medical services as a class?
Because private services do a better job at lower cost?
Or rephrased surely big business middlemen are corrupt and inefficient at getting in the way of medical services.
That didn't happen with Obamacare. Instead, they're attempting to force everyone to take on an insurer as a middle man and requiring a considerable degree of required services in that insurance.
Other than the existing medical system is corrupt and a replacement will surely, however temporarily, we superior until its corrupted?
Easy thing to say. But how do you fix a government, single-provider system? At least in the current system, you can switch health care and insurance providers, including moving from one hospital to another.
(Score: 3, Insightful) by VLM on Sunday April 06 2014, @03:58PM
"At least in the current system, you can switch health care and insurance providers, including moving from one hospital to another."
Hows that work if I get into a car accident and later decide I didn't like the plan my employer provides, and how do I tell people which hospital to take me to if I don't have any data?
Basically you can't run a market or expect the advantages of a market if one side of the market is unable to make any choices by the inherent nature of the market?
(Score: 2) by khallow on Monday April 07 2014, @07:43AM
Car insurance costs injuries from car crashes in the US. If you don't like your employer's health insurance, you can always buy your own.
Which is a different matter. You would have the same problem anywhere else in the world with the same situation.
(Score: 2) by tathra on Sunday April 06 2014, @06:27PM
citation needed.
(Score: 1) by BasilBrush on Sunday April 06 2014, @07:15PM
Because private services do a better job at lower cost?
But they don't. The US spends 2.5 times the money on healthcare that the UK does, and yet still doesn't have the universal coverage that the UK does. Ask any American that's lived in the UK which they prefer. The ACA does something towards addressing the huge problem of Americans without access to proper healthcare, but it's still far short of what the UK state system provides.
That's not to say if you are rich you can't get better private care than the UK NHS provides. Of course you can. Whether you are in America or the UK. But that doesn't make it a better heathcare SYSTEM.
Hurrah! Quoting works now!
(Score: 2) by khallow on Monday April 07 2014, @07:41AM
The US spends 2.5 times the money on healthcare that the UK does
The US isn't going to magically spend 60% less just because it goes to single payer. Keep in mind that Obamacare was the government fix for health care and it just made the various problems worse.
The ACA does something towards addressing the huge problem of Americans without access to proper healthcare
Not at all. It helps to some degree people with large, costly health problems. It makes the plight of people who don't have those problems worse. It's a wealth transfer from healthy people to sick people. And it does nothing to control health care costs aside from making Medicaid even less effective than it already was.
(Score: 1) by BasilBrush on Tuesday April 08 2014, @06:43PM
Magical overnight improvements are rare indeed. But I'm just showing that your claim that private services do better at a lower cost is false. The US problem is their leaving heathcare to private services that ponly exist to profit their owners. Public sector does far better for health.
As to "a wealth transfer from heathly people to sick people" - a more reasonable thing is hard to imagine. Those with a lot of money SHOULD be paying for those without money whose health would otherwise suffer.
Hurrah! Quoting works now!
(Score: 2) by khallow on Tuesday April 08 2014, @07:22PM
But I'm just showing that your claim that private services do better at a lower cost is false.
How? None of the other national services have to provide what private insurance in the US has to provide. Keep in mind that private insurance doesn't have control over costs (and the ability to deny people health care without legal consequence) like a nationally run health care system.
As to "a wealth transfer from heathly people to sick people" - a more reasonable thing is hard to imagine.
How about not doing that? Healthy people do things other than generate consumable wealth while merely waiting to become one of the sick. Ultimately, you should be responsible for your own health care since it is your decisions which greatest effect your life. And your personal self-interest which cares the most about your life. The process of shifting the onus of health care onto others who had little control over consumption of health care created the overly expensive system that is in place now in the US. Note that while other countries are not near as bad, they are all getting worse with their health care consuming more of their overall economic activity.
(Score: 1) by BasilBrush on Sunday April 20 2014, @05:15PM
"How?"
Again by showing you other countries that do better. US healthcare is by far the most expensive in the world, and yet still leaves many people without necessary medical treatment. What's not to understand about how poor that is. And Again, the reason is that it's run mostly for profits, not for the good of the people.
"Ultimately, you should be responsible for your own health care since it is your decisions which greatest effect your life."
What about children? What about those born with physical or mental handicaps that mean they are never in a position to earn money to pay for their healthcare. And why on earth do people who have become rich through the many abusive business possibilities deserve better health treatment than people who do worthy jobs that don't earn much money?
Your belief that people should finance their own healthcare, such that those without much money don't get treatment, is indefensible. In fact it's evil.
Hurrah! Quoting works now!
(Score: 2) by khallow on Tuesday April 22 2014, @01:04AM
They don't do what US health insurance does or covers. They don't have the political problems to the same degree either, at least not yet.
So what fraction of the population is that? Here, they're claiming that the percentage of people in the US who are "children" (people under 18 in age) is 24% and dropping. And most of those are covered by parents' health insurance. Physical and mental disabilities at birth are fairly rare too. And what has the person with the "worthy job" done to deserve the level of health care you think he deserves?
So who's paying for your moral certainty? One of the big universal problems with health care is that it is trivial for everyone to collectively consume more than they put in via taxes. All those other health care systems attempt to fix this by limiting the health care they give to people - like the worker with a "worthy job" that doesn't earn very much money. A lot of people will pay any price (especially, if someone else is paying!) to stay alive just a little bit longer. But that doesn't have much value to society and so it doesn't happen.
This is a common problem in the US. For example, Medicare recipients are promised something like 3-4 times as much spending on their medical care as they put into the system. The health insurance markets created by Obamacare have, despite the tax/fine penalty of the individual mandate, strong incentives for health people to stay out of the market and for sick people to get in. That ultimately means that more health care costs will be paid out than insurance premiums paid in and yet another drain on the US federal government finances.
Another is that a lot of health care is theater - it does provide a measurable increase in lifespan (especially early and midlife medical care), but in the last part of life not one commensurate with the money put in. And at some point, death is the predictable short term outcome no matter how much money you throw in. Yet those times at least in the US are also the most expensive health care periods of a person's life. Similar issues happen in other health care systems. They generally solve this by doing a certain amount of theater to provide the illusion of caring.
A third problem is why should we value someone's health more than they do?
By paying for your own health care, you neatly solve all these issues. You can't get more health care than you pay for. You can get health care theater, if that's what you want and have the money for. And you can choose to value your health as you see fit.
But by inserting our dubious morality into this game, we lose the upper bound on health care costs and these other restrictions. All of the developed world health care systems suffer from huge health care inflation - the US just happens to be the worst case, not the only case.
Ultimately, I see the current US health care scheme and similar giveaways as bribes to coax voters in going along with the current corruption throughout the developed world. The corporate world gets their squeeze and you get yours. Everyone is happy and the powers-that-be stay the powers-that-be.
(Score: 1) by BasilBrush on Tuesday April 22 2014, @07:33PM
You're waffling. Overtreatment and undertreatment are identifiable issues in all healthcare systems, but probably the worst in the US system.
It's really simple. The US has the most expensive healthcare in the world, yet it is the only developed nation that doesn't insure everyone. And the outcomes in the US are far from the best in the world. It's impossible to believe that the US way is the best.
By paying for your own health care, you neatly solve all these issues.
You don't solve ANY problems that way. Need for medical treatment and ability to pay is terribly ill-matched. In fact it's closer to an inverse relationship. It's the worst way of making a healthcare provision.
Hurrah! Quoting works now!
(Score: 2) by khallow on Wednesday April 23 2014, @01:07AM
Ok, who in this thread believes US health care is the best? You?
Obviously, the US health care system has huge problems that recently grew even more under Obamacare. But it's the people who value universal coverage over cost effective health care who dug this hole deeper. I'm not set to give them another opportunity to make matter even worse than they already are.
I stated three such problems. Just because you choose to ignore them, doesn't make them go away. First, need for medical treatment and ability to pay is an excellent match and much more simple than your "really simple" and irrelevant observation (just because the US system is much more broken than other health care systems doesn't mean that private insurance or a mostly free market can't operate better than what we currently have).
The fundamental problem with every national health plan and one which the US system has in spades is that they encourage demand by insulating the consumer from the consequences of their consumption. It's the classic collective check problem. A group can decide to pay for a meal in two ways. First, each person pays for their food separately or second, they pay a fixed portion of the collective check. The latter results in higher consumption. For example, if ten people orders meals separately, then every dollar a single person reduces their meal cost by becomes a dollar saved by that person. But if everyone pays a share of the total, then that person only saves themselves $0.10. There is less incentive to control consumption.
If we just pay for everyone's health care with one single check, then there is only a microscopic incentive for anyone to reduce their health care consumption. Note that this lesson was completely ignored by Obamacare which among other things fixes the cost of health insurance for subsidized purchasers to a percentage of income. Outside of the one-time deductible, there is no connection between consumer and the cost of the health care services they consume. If the cost of health insurance goes up, the subsidized person pays no more.
And we already have a preview of how the US would deal with single payer in the combination of Medicare and Medicaid. The former pays out 3-4 times what it gets. The latter is becoming the new uninsured with reduced health care coverage from even a few years ago. Combined the two programs threaten the future of the US even though the US doesn't yet have universal coverage.
And finally, the costs keep growing as the moral obligations do. Every developed world country has health care costs growing faster than GDP. What will control costs? What will provide health care when the system breaks from attempting to provide health care below cost?
(Score: 1) by BasilBrush on Wednesday April 23 2014, @05:11PM
Hurrah! Quoting works now!
(Score: 2) by khallow on Friday May 02 2014, @04:40PM
I apologize for the lateness of the reply, I've been away from the internet for a couple of weeks.
"Work better" than one of the worst developed world health systems is such a ringing endorsement. I stand by my previous statements. Everyone's systems are bad and growing worse, the US just happens to be digging the hole far faster than the other ones.
First, people can't choose not to eat. Even if we didn't grant that, you don't bring up a relevant point. The dynamic remains the same whether it's a restaurant or health care consumption. Second, you assert that things like smoking increase the demand for health care. But so does living longer. The only thing that reduces the demand for health care is killing the people who would get sick. Or if you're economically practical, killing them once the present value of their expected future health costs exceed the present value of their expected future labor. That incidentally also favors rich people. It also indicates that smokers may be a lot cheaper than you claim for a health care system.
It's interesting how much of today's health care problems can be traced to perception. You think that "access to health care" (whatever that is supposed to mean) is important. But what's the quality of that health care? Who is paying for it? And will these attempts to improve coverage even work to improve your hypothetical metric over the next few years? For example, the proponents of Obamacare radically scaled back their expectations for 2014-2015 enrollment and they're including a lot of people who got dumped on Medicaid.
It's worth noting that a number of people were able to buy insurance even though they had preexisting conditions, say via health insurance provided as part of a spouse's employment. And once, you're on such insurance, it transfers.
Second, what's broken about it? Insurance is for things that haven't happened yet. A preexisting condition already happened. And I imagine that if the person with the preexisting condition were actually willing to pay the proper insurance costs for having that preexisting condition and were able to legally buy insurance at that price, then they'd be able to buy health insurance. Or they could self-insure. But that gets to your unwillingness to base health care on peoples' ability to pay.
Look, I already know that at some point, my health care costs will exceed my ability to pay for those costs even as insurance. I am comfortable with only getting a certain level of health care that I can afford. I'll die anyway, and I'd rather die at a point which doesn't bankrupt myself, my family, or my society.
(Score: 1) by BasilBrush on Wednesday April 23 2014, @05:27PM
I think this sums it up pretty well. Health care systems ordered according to how good they are by the World Health Organisation.
US is 37th on the list whilst being the most expensive.
UK is 18th whilst being the 26th most expensive.
http://en.wikipedia.org/wiki/World_Health_Organiza tion_ranking_of_health_systems_in_2000 [wikipedia.org]
(Note it's quite old, so you can't blame Obamacare.)
"Socialist" single payer state healthcare works so much better than the many-payer commercial insurance route.
Hurrah! Quoting works now!
(Score: 4, Insightful) by The Mighty Buzzard on Sunday April 06 2014, @04:13PM
My rights don't end where your fear begins.
(Score: 2) by VLM on Sunday April 06 2014, @11:13AM
Note that there's a pretty intense self selection of commenters, combined with a blind men discussing an elephant effect. So other than blowing off political steam I don't think there's much to discuss.
I can't think of any way it currently affects me other than macroeconomic.
Feels nice that if I got a new job, I'd have coverage for preexisting conditions.
(Score: 2) by aristarchus on Sunday April 06 2014, @08:09PM
Nothing to discuss, since the prompt was allegedly about the tech of the sign up process, not the politics of health care. I mean, why should I have to pay taxes just because _you_ have a sucking chest wound? What ever happened to personal responsibility? Why cannot the poor just not get sick, and save us lots of money? "Mit der Dummheit kämpfen Götter selbst vergebens" -Schiller
(Score: 0) by JohnnyComputer on Monday April 07 2014, @02:33AM
Why should the public foot the bill to cure you of tuberculosis? Take care of yourself, you blood sucker. You're the one who has that disgusting, painful, but miraculously now curable disease. I don't have it. At least not yet. Oh yeah, forgot that part. You mean, if you have it, you can give it to me? You arse hole! Don't we have places we can put you? Jeez!
--
People forget that the public's health is a frequency-dependent phenomenon. My getting immunized for the flu, helps you not get the flu, even were you not to get immunized (free-rider!).
As for the website, well I'm fortunate enough to already have healthcare. But I liked the Medi-Cal when I had it, before I got this job.
(Score: 4, Interesting) by cmn32480 on Sunday April 06 2014, @11:37AM
I don't think it really worked for anyone. The whole thing was rolled out before it was ready. The insurance companies aren't sure if they are going to get paid. Maryland is totally scrapping a website that they spent $180 million in federal money and an additional $125 million of state money on. the whole thing has been a clusterf**k from the beginning.
There was a hearing a few days ago where the health secretary from Maryland was asked how many people signed up (answer: approximately 60,000), and how many people lost their insurance due to cancellations (answer: approximately 75,000). On it's face, it looks like this cost 15,000 people their healthcare, but no one can seem to come up with a number for those that skipped the exchanges and went straight to the providers. I think that this is the number that really matters.
In the end, my premiums are going to go up another 10-25%, and my insurance will be of a significantly lower quality then it was a few years ago.
From a political perspective, it has been an absolute disaster, particularly for those of us in the middle class who will end up being the ones that really pay for it. There should be no exemptions, not unions, not Congress, nor anybody else. If it is such a great thing, we all ought to have to go in on it.
"It's a dog eat dog world, and I'm wearing Milkbone underwear" - Norm Peterson
(Score: 1) by opinionated_science on Sunday April 06 2014, @12:29PM
it worked for me. While the complete disaster with the initial rollout does seem a touch disappointing, they did provide phone access so I was able to enroll, even though the IT was not ready. Essentially once was enrolled, it became less of an issue.
The message, however, was overcomplicated. The 4 "metals" give the ratio of patient/insurance coverage, and also define the doctor pool. This was not made clear.
Once have the doctor you want, then you can pick the plan in that pool which suits you. In this way you "can get the doctor you want". Just don't expect all the good doctors to be in Bronze....
I am insured in the "I don't need much care" way, so I'll use the diagnostics etc...
But there are families out there who might be crippled by disease and the debts that come with it, I would not be so quick to dismiss the system as the removal of preexisting conditions has greatly changed the perception of the system.
(Score: 3, Interesting) by Anonymous Coward on Sunday April 06 2014, @01:41PM
But there are families out there who might be crippled by disease and the debts that come with it, I would not be so quick to dismiss the system as the removal of preexisting conditions has greatly changed the perception of the system.
The families crippled by disease are a very small minority. The healthy are a majority. Insurance companies can only stay in business so long as their profits (income minus expenditure) stay positive, much as a casino only stays in business so long as its customers in the aggregate continue to lose, even if a small minority of gamblers are lucky enough to win more than they bet.
Obamacare ensures that the casino (oops, I mean insurance industry) stays in business. Nothing more. A minority of very ill people benefit, and the financial risk of caring for them is, in effect, socialized among the healthy majority, but with the addition of some vig for the bookies (oops, I mean profit for the insurers). You could actually socialize medicine -- nationalize it and eliminate the casinos -- without that added profit, and it would be cheaper all around.
(Score: 3, Interesting) by opinionated_science on Sunday April 06 2014, @02:21PM
As you are an AC, I will give you the benefit of the doubt. However, statements such as "a very small minority" are not quantifiable. I have no quarrel with the idea that the insurance industry may have been close to the implementation plans. But then I consider that they are basically on the hook to either insure everyone, or go out of business. It is that simple. There is no magic font of information on the implementation, industries know "what's what" in their interest.
As a goal for the US society it would, however, be preferable to use the actuarial calculations to produce better healthcare outcomes, rather than profits. This is being attempted by the Mayo Clinic and others to produce a "best working practices" report. There is a great deal of research into genomic medicine which might also help bring down costs.
There is no magic here. Even if the insurance companies made $0 profit, there would still be a problem with the cost of unfunded legally mandated medical treatment i.e. emergency rooms etc.. .
One possible goal of the ACA, is to optimise provider/patient interactions by making more of them. By widening access to the healthcare system, there is a very real chance that new things will be discovered that will help us all.
(optimistic tag) One opinion I will venture (I have no evidence, see how this works?) is that perhaps the removal of all the "we pretend to cover you but never pay out" plans, may really focus the insurance companies on how to treat the 50,000,000 people who did not have regular access.(end optimistic tag)
(Score: 2) by VLM on Sunday April 06 2014, @12:54PM
Something I've never understood about how websites supposedly save money, is in your example, the cost of providing service via website is in excess of 5K per signup for only one year.
Yet, if they used foreign call center drones, that means you could hire a call center drone for an entire year per signup. You'd have a personal butler for an entire year doing nothing but processing your signup. Of course a real drone could handle more than a case per year. Lets be generous and give them an entire day per case. That would only save 30000% percent of the website cost although it leaves a lot on the table for later scheduled performance target increases.
Or, I've had work done with local lawyers (admittedly nothing complicated or stressful) and you can write a heck of a lot of sales contracts and wills and handle the execution of a will (is that the right term?) for $5K. So it would appear to be cheaper to just hire a lawyer and sue the companies until they provide service.
Yeah yeah, I know, the whole point of the websites is massive .gov contractor corruption and all that, so its a feature if it costs a quarter billion not a bug.
Still if they just went all medieval DMV style on them it, would be almost infinitely cheaper.
(Score: 2) by M. Baranczak on Sunday April 06 2014, @01:43PM
The ACA has no "exemptions" for Congress. It's a blatant lie that was repeated so often that it became the accepted truth.
On the technical side: yeah, mostly a disaster. Worked for me, since I used the New York State exchange not the federal one. Then again, I haven't actually used my insurance yet. When I get some expensive disease, we'll see how it goes.
(Score: 1) by khallow on Sunday April 06 2014, @03:11PM
What Congress has is a very plush lifetime health care plan provided for them by their employer - themselves. That employer-provided plan is quite compatible with the Obamacare law. Yet at the same time, they're immune to the consequences.
(Score: 1) by Qzukk on Sunday April 06 2014, @11:51PM
no one can seem to come up with a number for those that skipped the exchanges and went straight to the providers.
At least one here. As a single guy I make too much money to qualify for any subsidy so I just went to the local BCBS and signed up for a plan that was $50/mo less than what my employer and I were paying BCBS, then asked for (and got) the $200/mo contribution my employer was making. The plan even has a lower deductible than the plan the company had been providing.
(Score: 3, Insightful) by kaethy on Sunday April 06 2014, @11:51AM
I don't need it for myself. Being the go to tech person in my circle, I helped two people sign up. Had minor problems with the first one. We had to call in, but that one call took care of the enrollment, and the agent was helpful. Second person we completed the process in one session with no problems at all. Both people are happy to have insurance now, both very affordable, $22 for the first one and $25 for the second.
So from my point of view, it's a success.
I know 2 people who are out of work, both estimated too high for their situation, and got payments they couldn't afford. They didn't understand that they could estimate low income and go back in later to raise the estimate if they get a job. But these two people didn't know me well enough to ask for my help.
(Score: 4, Insightful) by Thexalon on Sunday April 06 2014, @01:27PM
I had a bit of fumbling going through the sign-up process, but in the end found myself a reasonable policy at a reasonable price. So did my mom and a couple of good friends of mine that would otherwise have nothing at all.
There's a much bigger benefit though: Because I no longer have to prove that I'm not sick in order to get health insurance on the individual market, I could actually get an individual policy relatively easily, which made the decision to stop being a full-time employee and go independent much easier. And if I do well enough as an independent contractor, then I might just have to start building a small business, and isn't that what many politicians claim is the most virtuous economic role on the planet?
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 1) by Beldin on Sunday April 06 2014, @01:03PM
I am insured through my employer. Nothing changed for us, and we still have exactly what we did before. I know quite a few that did enroll, most had no problems and are happy with what they got. Only 2 people I know had issues. I think it has to do with the state you're in, in New York everything seemed to work pretty well.
(Score: 2, Interesting) by JoeMerchant on Sunday April 06 2014, @01:33PM
I am insured through my employer, but have had a couple of employment lapses during the last few years.
No direct experience with Obamacare, but I will say that "Florida Kid Care" offered an excellent experience from the user perspective, while we were a "qualified" (zero income) family. Zero premiums (for kids only), used all our same doctors, cheaper easier checkout and payment experience. Less administrative hassles than I've had with Aetna / Blue Cross / Humana.
🌻🌻 [google.com]
(Score: 4, Interesting) by SlySmiles on Sunday April 06 2014, @02:11PM
A quote: a total of 40% of Americans ages 18–64 have inadequate access to health care, according to the Consumer Reports study [wikipedia.org]
For the richest nation on earth, and the richest nation in history this is a truly disgusting figure.
Trying to mend this rotten system will take more than basic legislation and a website, it will take removing the huge money syphon going from taxes to corporations and the collusion between care-givers and payment centres.
By all measures it is a failed experiment, I know not if the ACA will help one little bit.
(Score: 1) by MikeVDS on Sunday April 06 2014, @03:20PM
Out in California I have only heard good things from people who used the system. We have https://www.coveredca.com/ [coveredca.com], so they get to go around the federal website. I have not use it myself, as I am covered by my employer, but I even know of a few people who found the same coverage through coveredca for less than their employer would offer it.
In all seriousness, what is with the "open enrollment"? I seriously do not know. Why limit it in this way? I understand a cut-off for getting hit with the uninsured-tax-penalty but why not let people sign up year-round.
(Score: 0) by Anonymous Coward on Sunday April 06 2014, @09:28PM
Well, you didn't talk to me. I tried to sign up for the expanded Medi-cal, the California version of Medicaid, with the CoveredCA web site a couple days before the 2013 deadline and the web site was quite broken. I couldn't get past the login screen. I have a screen shot of the result to use as proof in case the IRS wants some money from me. As of the beginning of February I am theoretically covered but have not received anything in the mail from Medi-cal. I will be calling them on Monday.
Now, I tried signing up a friend of mine who doesn't use Internet a few days ago just before the final deadline and, despite the last-minute crush, the web site worked splendidly other than being understandably slow. But when we got to the final page, where it takes a digital signature, the site would not take it and sending instead an error message. It was hopelessly broken at that point.
A couple days later we tried it again. The web site lost all the information we'd previously entered so it had to be re-entered. However, we were able to get it all re-entered and I set him on his way in ten minutes. It worked well.
So, the moral of the story of the California health care exchange is this: Don't use it when it's very busy.
Incidentally, based upon some of the error messages that were generated, the website seems to be an unhealthy mix of .NET and Java J2SE. Ugh!
(Score: 1) by khallow on Sunday April 06 2014, @03:25PM
Currently, I'm on employer provided health insurance. Something weird, which I won't talk about, happened last year to indicate to me that they are telegraphing a plan to drop the insurance benefits or at least making them harder to obtain. If they do that and I'm still earning enough to avoid Medicaid, then I don't know what I'll do. I'd rather not pick up a subsidized bronze plan since I don't want to be a burden on society, but self-insured is unusually risky in the US due to the sky high health care costs and the individual mandate penalty.
(Score: 3, Insightful) by MikeVDS on Sunday April 06 2014, @03:51PM
The idea behind the subsidized plans is that having uninsured people is a burden on society. If, as a society, we give people coverage to get preventive care, it costs a lot less than when you are in an ER with a major problem that has been neglected for months or years. That is the theory anyway. I do not think you should turn down subsidized coverage as it is probably better for everyone if you accept it.
It sounds like it may be your employer who is "abusing" the system, which is probably the same thing their competitors are doing.
(Score: 2) by khallow on Monday April 07 2014, @07:53AM
That is the theory anyway.
I don't buy in to the theory. The problem is that health care is not a bit flag you set. There's no set amount of health care that gives you the true, near universally desired outcome - living indefinitely with a mind and body that are healthy and a life that is at least mostly free of suffering and bodily decay. So when the only limit to consumption of health care is how much of other peoples' money you can spend, the end result is going to be ugly whether in the US or elsewhere.
It sounds like it may be your employer who is "abusing" the system, which is probably the same thing their competitors are doing.
Not from their point of view. And from my point of view, the "system" is self-inflicted injury on society which may lead down the road to much worse health care than the US has presently - "abuse" of it may end up being the only moral good involved.
(Score: 1, Interesting) by Anonymous Coward on Sunday April 06 2014, @03:54PM
Shouldn't all of the references be for the Affordable Care Act, which is the appropriate name? The "Obamacare" name is used to paint it in a negative way, especially by a particular news organization.
(Score: 1, Interesting) by Anonymous Coward on Sunday April 06 2014, @04:47PM
The "Obamacare" name is used to paint it in a negative way, especially by a particular news organization.
No, it's used by everybody now, including MSNBC and Nanci Pelosi. Get over it.
(Score: 2) by tathra on Sunday April 06 2014, @06:25PM
its Mitt Romney's healthcare plan anyway, implemented in his state and favored by republicans... until democrats got behind it.
if you wont call it by its proper name (Affordable Care Act), call it by its proper roots - Romneycare, not Obamacare.
(Score: 2) by mendax on Monday April 07 2014, @01:03AM
The irony is that when the ACA and the state and federal health care exchanges finally get all the bugs worked out of them, the Obamacare label might eventually contribute to it's being the greatest legacy of his presidency. I'm sure the fascist Republicans will be choking on that word then. Granted that the ACA is not the best way to provide a national system of health care, but it will eventually become popular and then will be easier to fix.
It's really quite a simple choice: Life, Death, or Los Angeles.
(Score: 1) by number11 on Sunday April 06 2014, @04:11PM
Doesn't apply to me, I'm on Medicare. But my neighbor is a retired (due to a dispute with her employer) teacher in her 50s who couldn't afford to pay for COBRA (continuing the insurance she had at work, but paying for the whole thing herself). With much trepidation, she signed up and since her income is low enough so that she gets a subsidy, it turned out to be way cheaper than COBRA, so she's happy. And this is in a state where the state website has been just as incompetently done as the federal one. And several other people I know who have "preexisting conditions" are no longer chained to their current employer (imagine what having had bladder cancer did to your prospects for finding medical coverage before).
IMHO they should have just expanded Medicare to cover everyone and cut the insurance companies out of the picture. but no pol has the spine to try that. Medicare has an overhead of only 1-2% (6% if you include supplemental insurance provided by private companies). Insurance companies have an overhead that's more than 3X that (after all, they spend money on advertising, and obscene bonuses for the CEO, and dividends to investors), plus hospitals etc. have large costs dealing with the administrative paperwork that they require (different for every plan). US physicians and hospitals spend 5X as much on billing and office expenses as do those in Canada.
(Score: 1, Interesting) by Anonymous Coward on Sunday April 06 2014, @04:50PM
Pay the fine, if they can force you. Only buy an insurance policy if you have a need for treatment - they cannot deny coverage, even if your arm is hanging off.
Since they're destroying the insurance industry anyway, it's not in anybody's self-interest to play along.
(Score: 2, Insightful) by gishzida on Sunday April 06 2014, @05:56PM
No if they wanted to destroy the insurance companies they would have made this single payer... Instead we have exactly the system the Insurance companies, hospitals, and big Pharma wanted. So unless you are someone that is supposed to get paid by the insurance company... or get service from them... you'll be just fine. The point is they couldn't deny you assistance before the ACA if you walked into a public facility...
As for the penalty... they will grab you by your tax return and squeeze. Never give the IRS a reason to want to squeeze anything... ever. You won't like it.
We had trouble with the sign-up. The insurance that the insurance company signed us up for was not the one we signed up for on healthcare.gov. We ended up having to cancel and start over. We happen to fall in the government assistance bracket and the insurance company essentially deducted the government money right off the top so we paying about $77 a month for my wife and I.
The main issue we have had is finding doctors / providers that accept this insurance... its government sponsored but we happen to live in one of the "don't want no 'bama care" states [i.e. the state hates its citizens and refused to create a state exchange and refused the Medicaid expansion] even tho' it ain't costing them a dime.
For us the copay is reasonable... but even so the deductible for major medical is steep... $4000... when you are making $12000 like we did last year we can only hope that we don't have any major issues.
What the insurance companies have done is gamed the system to raise their rates on those that are not getting government assistance and made it hard for those that are getting assistance to actually get decent care.
When I last had insurance [three years ago] I was paying something like $500 a month for a plan that now costs something like $900 a month.
So yes we now have insurance that we did not have before...but no the insurance companies are screwing us all... And I image that it is only going to get worse if the Republicans decide they want to dismantle the ACA... to please the people that will never miss the money then my wife and I will be without insurance again.
(Score: 0) by Anonymous Coward on Sunday April 06 2014, @06:25PM
I signed up with on the site Washington had. Everything seemed to work correctly, but I was dark patterned into actually signing up for a plan. I'm still trying to find out what exactly it covers and what the deductibles are and such. All I've found out so far is it covers Naturopathy, which made me a little bit upset
(Score: 2) by xlefay on Monday April 07 2014, @01:11AM
... I'm not American, you insensitive clod!
(Score: 0) by Anonymous Coward on Monday April 07 2014, @01:31AM
My wife and I live in Connecticut, which set up its own insurance exchange. The upside: she was covered under the state's high-risk pool (she's had cancer) for ~$435/mo. Now she's under the ACA for ~$135/mo. Major win for an unemployed couple.
Caveat: It was an odyssey getting there. No one knew what was going on, she got conflicting answers, and it finally took an insurance broker from the next county (we weren't in his territory) to get us signed up.
Massive win: Two days before she was to go in for her first chemotherapy treatment, her previous insurer canceled the policy, claiming the cancer must somehow have been ``pre-existing''. After twenty-four hours of terror, and a call to our state senator, it got straightened out. Under the ACA, no one will have to go through that again.