Some very ugly truths about what is coming in 2014:

[truedelphi]

http://www.nakedcapitalism.com/2013/05/why-are-people-with-health-insurance-going-bankrupt.html#comment-1236790

[truedelphi]

1. The comments in the above link are well worth the read.

I was enheartened to hear others expressing the same beliefs that i have expressed -that when a person has to pay X amount per month, times 12 months, and then has to have a certain amount as a deductible before the insurance exchange will kick in, it is logical to state that you' re therefore paying some huge amount of your yearly income before you get a single penny of benefit from the insurers.

It also was a relief, in terms of my sanity, to find out that I am not the only one who has had to struggle with getting insurers to pay for the thing their policies tell you would be covered.

Also, "Anthem" gave me such a hard time several years back; it was always: we don't want you to send the claim; you must send the claim to the doctor's office and they will send it to us and then we will process it. And then Anthem told the Doctor's office not to send the claim; they told the doctors' office that it was the patients' responsibility to send the claim in to them. And guess what? This lovely Anthem company will be in charge of the state of California's exchange program, I have been told!

[HiPointDem]

2. it's going to be a nightmare in more ways than one but we must not say so.

[uponit7771]

7. You forgot to add death panels too

[Ms. Toad]

5. The article is more fiction than fact.

Especially since the plans that are offered are not yet fixed so the premiums, benefits, and deductibles are not yet set, some services must be provided without charge if you have insurance (so there are some benefits even if you never hit your deductible) - and 30% of something really big is capped by the out of pocket max - so it is not an unlimited spend once it kicks in.

Not to mention that if you didn't have health insurance, you would be paying 100% of all expenses, at 1.1 to 10 times more than if you had insurance. (I have been closely tracking bills over the past 2 years, the insurance discount on labs is about 90 cents on the dollar, on office visits it is about 10 cents on the dollar. Other bills are in between, but cash patients are always billed more than insurance patients.) Don't you think you would go bankrupt even faster if that same serious illness struck and you had no health insurance (meaning higher bills and no cap)?

Insurance companies are a pain to deal with - I agree with you 100% on that. Make sure you understand your benefits. Make sure you follow the rules to the letter. Don't take "no" for an answer if you are right, and even if you are wrong - appeal.

Our bills run $60-$80,000 a year. With Kaiser, about 20% of those were rejected incorrectly - one infamous group took me 100 hours to straighten out. with Medical Mutual I have only had one real challenge, and it turns out it was the doctor's screw-up (he didn't understand how to obtain authorization for a step therapy drug). But I have never lost a battle I chose to fight, even when they were technically correct (e.g. I didn't get a new referral which Kaiser required every 6 months for a specialist). (In 20 years of dealing with at least 6 different insurance companies I have chosen not to fight one battle, that I recall.) It should not be that hard, and part of the reason I fight all those battles even when I'm investing way more time than it is worth is to force them to follow their own rules so that at least the people I come in contact with will know, for the next person, how to do it correctly.

I would much prefer a single payer system - BUT - we were never going to get there, and guaranteed issue for every person, at an average premium cost (rather than one based on health), with subsidies or free insurance for low income people will be a significant improvement.

[truedelphi]

10. Pretty please, I think you need to go back to the site and read the comments. Several of them

Detail exactly what you are saying. So you are disagreeing with your own experience? How exactly does that work - you will defend Obama care by detailing your experience which is exactly the same experience as that of those who are disgusted by what all of this will mean. And you indicate you are disgusted by your experience... Illogic abounds when people are in denial.

Let me know when you have read the article and all the comments. Remember, once the new Obama Care gets in full operation, the American public will still be told that procedures are not available. The spouse or children will still be spending precious time on the phone arguing with claims' people when they should be spending time with the dying loved one, who might not even be dying if there were procedures in place that penalized these insurers from denying our claims./Please read the comments. the nightmare will continue.

I already know for certain that "Anthem" will be the company in charge of the California exchange. That fact was announced in mainstream media newspapers.And Anthem makes it totally impossible for a sick person to resolve payment. I detailed that in my OP or first comment here. You have to ask them to accept your claim. Then Anthem people tell you that you the patient cannot submit the claim. That you have to have the doctor's office submit the claim. Then Anthem staff tell the doctor's office that they are not to submit the claim. So the doctor's office staff people won't do it. Catch 22. Their hope is that you give up.

[Ms. Toad]

11. The gist of the article is that people are going to go bankrupt on health insurance.

As an isolated statement that is correct. There are people with health insurance now going bankrupt, and there will continue to be after 2014. BUT there are a lot more people now going bankrupt because they do not have access to insurance at all, and every single bill is at least 10%, and as much as 1000 percent higher than it would be if they had health insurance AND had to pay 100% of every bill until they hit an out of pocket max (as I do currently). Moving people who had no insurance to insurance cuts the bills significantly, even if insurance never pays a penny of it.

Just so you know how significant the insurance discount is - so far this year, the providers have billed our family $38,225. That is what we would have had to pay if we did not have any insurance. Because we have insurance, the providers were required to accept $16,174. So just by having insurance, I saved 58%. By moving people from no insurance to insurance, every family will realize that kind of savings immediately - even on the 60/40 plan. That means fewer people, not more, will go bankrupt.

Beyond that,in the comments people are saying things which are not true,and no I am not going to plow through each and every comment when the gist of the comments are clear from the first couple of cozen. For example, someone said people receiving subsidies are ONLY offered the 70/30 plan. Not true. They are free to purchase a different plan - but they will have to cover the difference between the subsidy and the better plan.

The article also sserts that ahaving to pay 30% for a really serious illness is “Lose your house” territory. - which demonstrates the person who wrote the article fundamentally does not understand the plans. If you have a really serious illness, it doesn't make a bit of difference if you have a 90-10 split, or a 60-40 split. Your costs (above the premiums) are going to be $6,350 for 2014. Period. In that case, you (or more specifically our family) would be better off buying the cheapest plan out there - which will be a 60-40 plan with a high deductible. That plan will cost significantly less than a 90-10 plan.

What the ranges do (90-10, 80-20, 70-30, 60-40) give you a variety of ways of juggling your cash outlay up to that out of pocket max,which is the same regardless of which plan you choose. You can pay more for insurance, and get a low deductible, have the plan kick in sooner, and stretch out how long it takes to get to $6350. Or you can pay less for insurance, get a high deductible, and a 60-40 plan and get your spend out of the way fast. Because we know we will max out our out of pocket every year, a 0-100% plan with a deductible which equals the out of pocket max is the cheapest plan. Our family pays 100% of everything (at the insurance adjusted rates) for the first few months of the year. Last year we hit the $3000 max January 20 for one family member, and in April for the family as a whole. This year we hit the family max by the end of February. There is absolutely no economic reason for our family to pay more in premiums for the illusion that we're getting something back for our money early on. The platinum plan is not better for us - the plan which is being ridiculed (60-40) is the best option for us. The numbers may crunch differently for people who don't have hefty expenses.

So that's the economics of it.

As for the hassles of dealing with insurance companies - those hassles will be there whether we have private insurance, or single payer. Someone has to administer it, and someone will make mistakes. I had similar hassles when we were on the equivalent of a single payer plan (the sCHIP plan) - although those has more to do with them not being able to follow their rules to determine whether my daughter was eligible, and I had very similar fights with them over that - and once they started administering that plan through a third party insurance carrier, I had the same insurance hassles.

Unless you have a pot-o-money, someone will be standing between you and access to health care - either an insurance company or a government servicer. I'd prefer a single payer government servicer, but I have had enough experience with those to know that they don't make all the problems vanish.

Like I said - know your plan. No matter who is between you and paying for care, you need to know how your plan works. Not to pick on you, but somewhere in your plan documents, there are guidelines as to how the forms have to be handled. Once you know how it is supposed to work you're in the driver's seat. They have to comply with the plan. They get away with running you ragged because you don't know which one of them is right. Doesn't mean it is fun, or that you should have to - BUT single payer is not a solution to that particular problem. Competent administration is.

So - to summarize - from a people are going to go bankrupt on standpoint (the headline of the article) that will happen less rather than more because everyone (of the more) who have insurance get the insurance discounted rate lowering their costs. And there is a stop-loss for everyone who has insurance. You will spend (for 2014) no more than $6350. That's no walk in the park - and for families like mine where that is an every year expense it is lousy. But for most people who have that $6350 expense once in a decade or less it is much more manageable than having a $100,000 or more expense (without insurance) once in a decade.

From a management standpoint it stinks. It stinks now, and it will stink in 2014, and it will stink if we ever get single payer. The best solution for that is know your plan and fight every single screw-up so they know people are watching.

[truedelphi]

12. I learned quite a while ago that people in your income bracket are

Getting relief from some aspect of one of Obama's programs. But what is troubling is that you don't udnerstand for a minute what it is like to not be part of the upper 8%.

My household already suffered a medical bankruptcy. I voted for Obama for two reasons: One) I believed he would step aside from what Bush had been doing, and fix the economy. I fully believed (Silly Naive Me) that he would understand what even a lay person like myself understands about the economy - we needed to re-instate Glass Steagall, so banks could no longer be gamblers, insurance companies and financial croupiers.

and Two) I saw the need for Universal Single Payer HC.

As far as the economy, here is part of the big problem on why people need help so badly, and it illustrates that Obama did not move away from what happened under Bush: We saw this coming with the defeat of cramdown in Chapter 13 bankruptcy cases. During the campaign, Obama claimed he supported the idea, and the senior Senator from Illinois, Dick Durbin, was an early and vociferous supporter. But the banks didn’t like the idea that homeowners could negotiate a fair price for their homes under the supervision of a bankruptcy judge. Obama didn’t lift a finger, probably too busy worrying about how to cut Social Security and Medicare to balance the budget.

As far as his version of health insurance, it put no brakes on the Big Health Insurers. All because he and Rahm Emanuel were too tied into their buddies at the Big Health insurance Companies. The Big Insurers and Big Pharma and Big Hospital Money People are continuing to cost as much as 40% of the health care money equation. Their staff and their executives eat away at our health care monies so that depending upon what expert you look at, the per capita spending on HC in the USA is 1.7 times to 2.5 times what it is in other countries.

And we get Nothing for this expenditure. MY MIL was just hospitalized in Utah. She had a heart attack scare and the doctor wanted to stabilize her. Within 24 hours of being admitted, she had a technician put an IV into her arm incorrectly so all the drugs went not into her system but into her arm. This would not have been so bad if any of the four staff on that hospital floor had paid attention to her when she told them her arm was hurting unbelievably. But they ignored her for two hours; then relatives showed up and noticed immediately her arm was the size of a football.

All this is happening because the hospitals are allowed to have the least experienced, least well trained staff and very little in the way of any type of compliance, standards, etc. And yeah there are laws on the books, but those laws are not followed.

We recently saw that some 26 people at Sandy Hook got killed by a single gun men, so now there is all this energy thrown at the gun control issue. (Never mind that the CIA has been releasing assault style weapons into the ghettos for the last three decades!) But there are tens of thousands of people who end up depleted of their savings, because of hospital visits, and because of the poor quality of care that occurs in those hospitals. Over thirty thousand people die each year because of not being insured, and probably an equivalent number die who have no ability at all to meet the co pays and they don't want their house and their retirement to be yanked away from them so they suffer till it is too late.

NONE OF THIS WOULD MATTER in terms of Obama IF PRES OBAMA HAD NOT MADE THIS A CAMPAIGN ISSUE. BUT HE DID: AND HE FAILED.

[graham4anything]

3. malarky. another smear Obama piece in the alt-media. How quaint.

[djean111]

6. What is being "smeared" is our corrupt and greedy private health insurance industry.

You can't paste a picture of Obama on it and change it from a rapacious pig into a swan.

Actually, if forcing people to buy health insurance works as badly as it sounds, Obama himself may be responsible for 2014 and 2016 losses.

I don't think "malarky" is a really reasoned opposite view - but then again, no one knows what will happen.

[egold2604]

8. This is why we need single payer

It is a known fact that 40% of what is paid to insurance companies goes to overhead such as dividends and high executive salaries. The overhead for Medicare is about 4%. This is the real reason the right wing is fighting Romneycare. Their corporate leaders will not profit off the sick.

In the ideal situation, there are no forms, no administrative costs, and every bill gets paid at at predetermined rate.

[truedelphi]

9. Very well stated, egold2604. And

Once there was an articulate young African American guy running for the Illinois Senate, and he said the very same thing. He said it with passion and conviction, as though the lives of his fellow Americans depended on it, (and those lives really did depend on Single Payer Universal HC.) I have no idea what happened to him - he doesn't remotely resemble the man that told all of us, Summer of 2009, that the public option is "only one tool in an entire tool box of tools" by which to bring the American people health reform.

Realizing how that young man simply disappeared, now totally off the political radar, I guess alien abductions are a possibility.