If people can't afford an insurance premium and must be subsidized...

[OneTenthofOnePercent]

How are they suppose to afford the copay and deductible? I have good insurance and would still struggle if any illness struck.
The deductibles and copays are the real killers... and if you can't pay them no insurance policy in the world will help.
Plus, many good policies are only 80% coverage for anything major - even with a insurance... a $5000 ER bill hits HARD.

No annual limits, No lifetime limits, and no preexisting condition screening allowed by law...
The deductible on such policies is going to be scary.
This bill won't solve anything. It will bankrupt people forced to buy insurance but who cannot afford to USE the insurance.
At best, general preventative checkups become affrodable. Just hope they don't actually find a problem. :eyes:

Health Insurance =/= Health Care
Having Health Insurance =/= Having Access to Health Care
You've got to be able to AFFORD to USE your insurance to benefit from it.

[Cronus Protagonist]

1. At this time, I cannot afford the cost OR the fines, never mind actually USING it.

I'm about to be raped by my own party. I wish I had options.

[havocmom]

2. Some cannot afford to take time off from work to get to a doctor to begin with

We are not addressing reality with this 'reform', are we?

How many middle class bankruptcies due to medical care costs? And lots of those folks had insurance.

[abelenkpe]

10. That is so true!

I never leave work for a doctors appointment or dentist appointment unless it is something really dire. If I miss time at work I have to make the time up so doctor appointments have to happen during vacation.

[Oregone]

3. It doesn't matter what you think. The fix is in

4 decades of lobbyists fighting for this, and now it has come to pass.

[laughingliberal]

52. Yes. This fix was in long before most of us realize. nt

[sandnsea]

4. The co-pay and deductible is turned over to the credit bureau

But at least you get to see the doctor when you're sick. And you get free preventative check-ups.

If you don't want that, don't use it. Let the rest of us get the only health care we have a prayer of getting in our lifetime.

[ipaint]

8. Yes all of you being sent to the poor house or worse. Eat shit and die.

You must sacrifice so others can get theirs.

Never the other way around. We wouldn't want the I"m getting mine folks to say "not unless the least of us get what I get". That's unamerican.

[Hello_Kitty]

15. The least of us are getting Medicaid.

The slightly-above-the-least are getting subsidized insurance they can't afford to use.

[ipaint]

37. Medicaid...

As Medicaid Payments Shrink, Patients Are Abandoned
By KEVIN SACK
Published: March 15, 2010

http://www.nytimes.com/2010/03/16/health/policy/16medicaid.html


States Consider Medicaid Cuts as Use Grows
By KEVIN SACK and ROBERT PEAR
Published: February 18, 2010

... A survey released Thursday by the Kaiser Family Foundation found a record one-year increase in Medicaid enrollment of 3.3 million from June 2008 to June 2009, a period when the unemployment rate rose by 4 percentage points. Total enrollment jumped 7.5 percent, to 46.9 million, and 13 states had double-digit increases.

Because Medicaid enrollment often lags behind unemployment, this year’s increase could prove even greater.

The options are limited by several realities. To qualify for Medicaid dollars provided in the stimulus package, states agreed not to tighten eligibility for low-income people. And any time a state cuts spending on Medicaid, it loses at least that much in federal matching money.

Despite the ban on restricting eligibility, hard-hit states like California and Arizona are considering proposals by their governors that would remove hundreds of thousands from the rolls once the federal financing ends. Gov. Jan Brewer of Arizona, a Republican, has called for eliminating Medicaid coverage for 310,000 childless adults and ending the Children’s Health Insurance Program to help close a two-year budget gap of about $4.5 billion.

Gov. Phil Bredesen of Tennessee, a Democrat, is proposing the largest cuts in the history of TennCare, his state’s Medicaid program. To trim 9 percent of the TennCare budget, he would establish a $10,000 cap on inpatient hospital services for nonpregnant adults and would limit coverage of X-rays, laboratory services and doctor’s office visits.

http://www.nytimes.com/2010/02/19/us/politics/19medicaid.html


30% of doctors don't take it or aren't taking new patients, over 40% of specialists. Waiting times are up to 4 months in some states to see a doctor. Medicaid is a purposely underfunded disaster. The long term unemployed number over 6 million. An additional at least 15 million under the income level americans are estimated to enroll. That number is a low ball estimate. Add them to the almost 60 million on medicaid today.

It's a massive dumping ground for the poor. Approved of by the ever pandered to middle class that has a history of not giving a shit when medicaid was systematically cut to the bone. The poor must sacrifice so the middle class can get theirs. The mantra of the new conservative liberal and just another version of the 30 year old right wing bootstrap meme.

[Hello_Kitty]

38. I'm in AZ, unemployed, and supposedly eligible for Medicaid.

I applied but my friend who works for AHCCCS (our Medicaid system) says they've shut off new enrollments even though they're technically not supposed to. We're that broke. And the Medicaid expansion in the HCR bill (which is theoretically a good thing) will only fund 80% of it in the states. Arizona absolutely cannot afford hundreds of millions in an unfunded mandate, no matter how worthy a goal extending coverage to more low income people is.

[sandnsea]

49. They can't shut off Medicaid enrollments

Get a lawyer.

[Greyhound]

62. You don't understand AZ.

Just because something is illegal doesn't mean anything, the various AG's simply "decline to prosecute" when the state or big money is involved.

This is the state that major corporations have repeatedly told was not suitable, no matter how many tax breaks they give, because we have no educated workforce. For decades we've rank in the basement in education spending and results, so we get "charter schools" (churches sucking the education budget dry) and deep cuts for public schools.

[sandnsea]

64. That's why there are lawyers

She needs to get one -- the way we do when we need to defend our rights in blue states. Do you think everything just operates perfectly in blue states? No. We fight when things aren't right, over and over and over again.

And we have charter schools too. Some great ones that are doing things like foreign language and cultural immersion, arts, science, etc. We've got them even in good districts, because it seemed like a good idea to introduce some new educational models and learn from them.

[OneTenthofOnePercent]

9. But you're not getting HEALTH CARE.

You're getting health insurance. There is a finite difference.

Doctor visits and regular check-ups could be handled without exploiting every american into paying insurance companies.
Open free clinics and provide free care to people at or under 150% poverty threshold & reduced cost care for other patrons.

Trust me, this isn't the health CARE you've been praying for your entire lifetime. Insurance is a scam.

[sandnsea]

48. Cured Hepatits C, diabetes, heart, back

How much health care would you like to have?

[Lyric]

12. The preventative checkups don't help much

when you can't afford to follow up on them if something is found. Your credit bureaus comment doesn't make sense either, because most doctor's offices simply do not provide service PERIOD unless you have the co-pay up front. I suppose hospitals and emergency rooms could report you to the credit bureaus, but that's how it is NOW...so what's the difference?

As for your rather sickening last comment, allow me to translate that into plainer language: "I got mine. Tough shit for you."

Welcome to the NEW Democratic Party, ladies and gentlemen--as represented above. Jesus effing wept.

[sandnsea]

47. But you can follow it up

As I said below, this horrible terrible SUBSIDIZED INSURANCE cured by husband's Hep C, pays for all of his heart medication, has helped get his diabetes under control, and has paid for several procedures to try to treat his back pain.

Yes there is an occasional co-pay turned over to a credit bureau, but since the insurance pays the majority of the bill, THEY KEEP SEEING HIM.

Most of the time, they just write off the portion we can't pay.

[Occulus]

57. My doctor's office will no longer even see you if you don't provide the copay up front.

They have a big, big sign stating as much right when you walk in the door.

[Hello_Kitty]

13. Did you just lose that good coverage you've bragged about having here?

I don't know what you're doing with this "only health care we have a prayer of getting" stuff but people on DU have memories.

[sandnsea]

43. Nope. I still have it

And I'm still going to the doctor and so is my husband. His Hep 3 is cured, his heart is in great shape, his diabetes is at normal levels. I'm thrilled beyond words.

[Arkansas Granny]

35. Oh, right. The part you can't pay is turned over to the credit bureau and what?

Do you think it just goes away? They get a judgment against you and garnish your wages. The last I heard, they could take up to 25% of gross wages to satisfy a judgment. Not only that, but most doctors want money up front for office calls if your insurance won't cover the visit.

[sandnsea]

45. Get a bettter doctor

The clinic here takes everybody, money or not. Maybe you better make your nonprofits in Arkansas do the same.

Do you know Baptist is a nonprofit? It is. They sure don't act like it.

[Cleobulus]

41. So now you have debt collection agencies on your back, and you declare bankruptcy...

Problem solved, right? :eyes:

[sandnsea]

44. No you don't.

Anybody at the bottom of the pile knows better. And being able to get medical care is worth working out a $100 payment plan here and there. A damn site better than dying, which is all any of you are offering.

[Cleobulus]

53. Oh please, I have to pay for my MRI before I can even get surgery...

and then I have to come up with the money for that, so, using the deduct offered by my insurance, I'd have to pay 100 extra dollars I don't have for 20 months before I can even get treated.

[sandnsea]

55. Oh please. I have a $500 deductible

Because the subsidy pays enough of the premium that I can afford to do that. If I'm sick enough to need an MRI, the $500 deductible has been ate up long before the MRI rolls around. If you're being charged for an MRI instead of your insurance, then you either need a different hospital or a different insurance company.

One of my sons walked around with an injured back for months because he had no health insurance and we couldn't afford a $500 visit to a doctor or an $800 MRI. With our insurance, my husband hasn't had to go through that and has gotten all kinds of treatments to try and resolve his disc and arthritis issues. I know the difference between insurance and NOTHING and I'll take insurance every single time.

[Cleobulus]

61. My employer offers a deduct that's 4 times that, with a 5,000 dollar maximum...

annual out of pocket expense. Making 10 bucks an hour, I simply cannot afford to pay that. Its great that you are so lucky with your insurance, not all of us are that lucky.

[walldude]

51. "If you don't want that, don't use it"

Well I wouldn't except it's FUCKING MANDATORY. Or are you saying I should be forced to pay a premium and not be able to use the "insurance" and that is an improvement over the old system? :rofl: :rofl: :rofl:

And BTW you aren't getting "health care" you are getting insurance.


Normally I have to go to Freeperville to see the level of "I got mine, fuck you" I have been seeing on DU today.

[dflprincess]

5. It doesn't matter.

The point of this bill was to keep the insurance companies going by handing them a group of "mandated" customer and transfering billions of tax money into their pockets in the form of premium subsidies.

This bill was never meant to actually improve Americans' access to care.

[havocmom]

18. And it is also a gimme to Wall Street. Insurance Companies play the casino

They do NOT put our premiums in a coffee can in their offices.

[OneTenthofOnePercent]

6. One good anaolgy is GIVING a very poor person a house...

It won't save them poverty or from homelessness. To live a house they still have to pay for taxes, utilities, and upkeep.
They'll be back on the street twice as poor as ever.
They need a program that would give them shelter/housing with ALL the costs accounted for or controlled.

[EFerrari]

23. I was thinking in the same terms only using a car.

:)

[librechik]

7. guess what? looks like the public option is IN

and I doubt they will make poor patients pay high deductibles. What's the motive? It's NON PROFIT.

[OneTenthofOnePercent]

11. If there is no verbatim restriction on high deductibles and copays...

You can bet your ass it will be happening EVERYWHERE.
Not only that, but every loohole in the document is going to be handling more traffic than the Brooklyn Bridge.

Non-Profit :rofl: :rofl: :rofl:

[librechik]

17. big if--can you wait a few days to rain on the democracy parade? n/t

[kestrel91316]

14. This bill will pass, with THAT problem. And when it becomes apparent that

large numbers of people are STILL going without medical CARE, or are being bankrupted by medical CARE, there will be added impetus to the drive for single payer.

That's how I see this playing out.

[Mari333]

16. yeah that really worked out well with NAFTA didnt it

[kestrel91316]

25. Apples and oranges.

[OneTenthofOnePercent]

26. you're overlooking a HUGE factor though. This is a DEMOCRAT bill.

If there enough problems AFTER this bill is implemented that major HCR needs revisted again - then democrats lose.
Good luck getting the much needed fixes without democrats in power.
All the republicans need to say is "We told you so. We tried to save you guys from this."

Game over.

[OneTenthofOnePercent]

27. double post (n/t)

[Marr]

40. No, this bill was meant to lock the insurance companies firmly into place.

The problems you mention are the reason national healthcare became such a huge issue in the first place. The Obama Administration essentially stepped in and rescued the insurance industry by grafting it onto the government, just as the crisis they created was threatening to destroy them.

Very similar to the bank bailouts.

[Gman2]

19. Question, are any of you going to SHUT UP after the bill passes?

No? Neither will I. So, they are hounded to speed things up, make them more inclusive and promoting early detection and preventative care.

Lets roll.

[ShortnFiery]

22. LOL, yes, it's worked so well for NAFTA and the Iraq Invasion?

Nothing can go wrong here too? :crazy:

[Gman2]

24. HCR aint nafta. Not even close. Nafta nibbles at us. HC is an immediate need, and always will be.

[ShortnFiery]

28. The result will be THE SAME. The poltical elites will NOT act and we will be stuck with

mandates and absolute servatude to the Insurance Cartel. Many of us will go bankrupt if we get dx with Cancer or get into a bad accident.

Congrats for making even more people die and/or go into debt.

"The road to Hell is paved with good intentions."

We'll all be part of the abject poor thanks to the Insurance Cartel.

[Gman2]

31. As of now, I cannot ever work again, cannot get HC ins, was turned down for SS dis

The fight ever goes on. Must I youtube Teddy?

[ShortnFiery]

20. Yes, we could opt to go bankrupt like many. Heaven knows the cost will not be contained ...

without, at a minimum, a robust public option.

Be careful what you wish for? Abso-fucking-lutely!

[OneTenthofOnePercent]

30. "Abso-fucking-lutely!" - best line in Sex In the City. (n/t)

[DesertFlower]

21. i have coverage from hubby's employer. they

cover him for free, but i pay $121 a month for my coverage. however, we are both subjected to co-pays and deductibles that go up every year. our deductible for this year is $900 for each of us.

[ShortnFiery]

29. It's going to go up again and again. We'll be bled dry before any of the meaningful

changes for working class Americans will take effect.

[DesertFlower]

33. i agree. i've been eligible for

medicare for a few years, but hubby's plan is better.

[yurbud]

32. yep, and I'm uncomfortable with subsidies WITHOUT price controls

[Spike89]

34. Ignoring the death spiral effect of current coverage

I'm not thrilled that we're getting only a start, but I'm more than a little dismayed to see so many people either ignorant or willfully ignoring one of the problems with the current system and how mandated coverage can and should actually help. It isn't complicated--when buying insurance is expensive, healthy people are less likely to opt-in. This skews the pool of insured people toward those with illness, this causes the rates to rise. The rising rates tip the scales even further until eventually, only the people with catastrophic/chronic illness would continue to pay the premiums.
Mandating coverage averages out the pool. Is it the only or even the best cost containment strategy, obviously not. However, those that say mandates are not part of the solution are not being honest. I would prefer government run single payer, but that requires a mandate too, funded most likely by withholding taxes.

[Hello_Kitty]

39. 86% of Americans have coverage now. Are they all in poor health? eom

[Spike89]

54. Not 86% of the self-employed/unemployed

Most people are currently insured in mandated circumstances, i.e., their employer MUST cover everyone (or not provide insurance). Another chunk of the 86% are on medicare (again, not optional).

[Hello_Kitty]

59. The only mandatory health coverage in existence today is on members of the military.

No one is forced to accept insurance from their work or sign up for Medicare/Medicaid.

[Spike89]

63. Sure, you're not forced to use it

But I'm pretty sure no one asked if I wanted medicare/medicade costs coming out of my check. Likewise, refusing insurance at most places that offer it as a benefit doesn't mean that you get more money, so in effect, you're still paying. It is common for some businesses no to ask a small contribution toward insurance, but I've never heard of the employer's contribution being returned to the employee. Also, most employer plans must sign up a significant percentage of the workforce to get competitive rates and to qualify for tax breaks.

Anyway, this is all semantic games. The reality is that for insurance to work, its costs to be spread around and the risks assumed somewhat equally--otherwise it simply becomes a personal medical savings account, i.e., pay as you go. I'd personally like to see insurance become optional the government take over the providing of basic healthcare. However, that would be essentially universally mandated insurance. The only difference (and it is a huge difference) is that the government would be non-profit.

There are tons of things wrong with our health care system, insurance is just a part. This bill doesn't even pretend to fix all of healthcare, it doesn't even attempt to fix insurance much. However, it is trying to get coverage to many of the 14% that don't have it. Doing that without a mandate is sadly, not realistic. That the mandate isn't coupled with a nationalization of the insurance industry is a shame, but it doesn't change the economic factors that make mandates inevitable.

[laughingliberal]

50. Mandated health insurance can & will help the insurance & hospital industries

Us? not so much. A public option would have provided this basis for improvement we keep hearing about. Without it you guys will spend the next 30 years fighting to change it. Me? I'll be here for part of it but I'm old and won't make it for 30 more. There were options between this and single payer.

Too bad we didn't have anyone who ran on a plan to give people a choice to buy into a public plan.

oh...wait...WTH happened to that guy.

[uppityperson]

36. It depends. I had subsidized ins for a while, was very appreciative of it

Co pay of $15 to see a doc in the clinic was fine with me. When I had surgery, it cost me a couple thousand, which was difficult to come up with. But without insurance, it would have been much much much more.

I do hope you aren't saying that because I had difficulty paying the $2000 deductible, that I should not have any insurance coverage at all.

[Cleobulus]

42. Its not just deducts its also maximum out of pocket...

For the insurance offered at my work, its 5,000 dollars, considering I need surgery, I can't afford that, so I do without. I can't afford the premiums, even after HCR even if my premiums are subsidized, I'd still do without. I'll be insured on paper, but not in practice.

[sandnsea]

56. You won't have to have a $5,000 deductible

You'll be able to afford a better plan when your premium is subsidized. And, iirc, I don't think they're going to be able to charge that kind of deductible anymore either. Yes the out of pocket will probably still be too high, but once everybody is in this system, we'll have more moderate income people to get together and scream about these things. If we just leave it the way it is, there will be no hope to make the system any better.

[Cleobulus]

58. No I won't, because that is what my employer offers...

hence I would have to accept it, by law. In addition, that 5,000 dollars maximum out of pocket, the deduct is 2,000.

[uppityperson]

65. Now that I am paying for insurance, that is what I have also, thinking of it as catastrophic vs usea

useable. I find it odd that my state subsidized insurance (WA) made it more likely I was able to use it where my private insurance makes it less likely.

[JVS]

46. It's supposed to enrich the insurance companies, not get health care to poor people.

[Kitty Herder]

60. That is what I keep thinking about, too.

We need meaningful healthCARE reform, not an insurance-care bill. But how do we get there from here? This is the best chance we're likely to have for a generation. And it's been blown. Healthcare won't come up again for years. And in the meantime, how many people will die because they can't afford care even with insurance?