Countries that have mandatory health insurance also have NO DEDUCTIBLES

[Lydia Leftcoast]

Affluent people may not understand what's wrong with deductibles. They may think that deductibles are "necessary" to keep the hypochondriacs from living in the doctors' offices (as if this includes vast numbers of people).

But here's my situation, which illustrates the problem with deductibles.

As many of you know, I dropped my health insurance this past spring.

Why?

Here's why. When I moved to Minneapolis in 2003, I enrolled in an affordable health insurance policy that had a $1000 deductible and a 20% copay for the next $5000 for a total of $2000 in out-of-pocket costs.

This was a worse deal than I'd had in Portland, $250 a month with no deductible and a $25 copay for all office visits and tests at the local branch of Kaiser-Permanente, but I could live with it.

However, the premiums continued to rise by at least 10% per year, with an additional quantum leap when I reached one of those milestone birthdays (one that ends in "0" or "5.")

I was forced to raise my deductible twice so that I could keep affording the premiums.

By the beginning of 2010, I had a $5000 deductible with a 20% copay on the next $10,000 (the next $25,000 for out-of-network treatment), for a total out-of-pocket cost of $10,000.

I did not go to the doctor, except for one urgent care visit when I sprained my ankle in 2009, because my monthly premiums, withdrawn automatically from my checking account (it was either that or pay a whole year's premiums in advance) cost more than an office visit.

When I looked at the proposed insurance and subsidy levels under the Obama administration's plan, I saw that they continued two evils of the current system: age-based premiums and deductibles. I argued about that frequently on this board.

Anyway, in January 2010, I slipped on a patch of black ice during the twilight hours and broke my elbow.

The total bill for my treatment came to a little over $1100. I was offered physical therapy and refused it, partly because of the cost, but partly because I felt that I hadn't suffered any loss of function.

After 6 years of faithfully paying premiums adding up to about $18,000, what did I get from the insurance company?

Letters explaining in bureaucratic detail why my injury wasn't covered. Which I already knew.

My finances were at their lowest point in 15 years early in 2010. I was barely able to pay for food, rent, and utilities, and that useless insurance company was still pulling money out of my bank account on the 5th of each month.

Then, in April, I received a letter telling me how much they "cared" about my health and how my premiums were going up another 20%, 10% for my new age bracket and 10%, well, "just because," I guess.

Business was starting to come back by that point, but I had debts from the bad months, not including the medical bills, and I saw no way of repaying them AND continuing to have the vultures deduct hundreds of dollars a month from my checking account.

I also realized that if I had put that $18,000 in the bank, I could have easily written checks for the treatment of my broken elbow, and I could have had those physicals and age-appropriate tests that I have not had. A little more math convinced me that if I ever actually had to pay that $10000 out of pocket, I would be bankrupt anyway, so why not save bankruptcy, if it became necessary, for something BIG?

So I took a deep breath and dropped my insurance.

It feels great. It feels liberating. Yes, I might develop a serious illness, but like a lot of self-employed people, I've been through bankruptcy before, and it's unpleasant and a real hassle, but it is survivable.

(Some of you are going to start telling me how wonderful HSAs are. I looked into them, and my insurance policy didn't qualify, because the deductible was too high. :wtf: If I had wanted to start over with a qualifying policy, which would have a much higher monthly premium, I would have had to apply all over again TO THE SAME INSURANCE COMPANY, even though they had all my health records for the past 16 years. Furthermore, all an HSA really does is prepay your deductible, and so it would have meant 1) Paying a higher premium than the one I was already struggling with, and 2) Paying an extra $200 per month. HSAs are great tax shelters for affluent people, for me, not so much.)

Getting back to the title of this post, I cannot support any health care bill that retains deductibles (otherwise known as "the insurance companies' license to print money").

I know of other countries that have modest copays (Japan, Germany) and others that provide medical care free at the point of service (Canada, the UK, despite their very different systems). I have not been able to find ANY country that charges deductibles.

Two other features of other countries' health care systems that are worth noting:

1. Premiums, if charged, are based on INCOME, not on age or pre-existing conditions.

2. If there are copays, they are capped. In Japan, you apply for a refund from the government if the copays exceed a certain amount, and certain chronic or catastrophic conditions are fully covered from the first yen. In Germany, you simply don't have to pay the copay if you have already paid a certain amount that year.

I think that some of the provisions in the current legislation are great, but tacking on a requirement for private insurance with no public option, very few restrictions on the companies, and a millionaire Senator's notion of what is "affordable" turns the legislation into an abominable bit of corporate welfare that is going to cause real hardship for people on the margins, the ones who are too well-off to qualify for subsidies and too poor to really afford the insurance. (I would be one of those. The deals available to me would be WORSE than the one I dropped.)

Fortunately, by the time the insurance mandate takes effect, I will be close enough to qualifying for Medicare that I will just pay the fine and cross my fingers.

We all ought to do the math and not just accept the idea that we MUST have private health insurance, especially when we are in a position that makes it extremely difficult to pay for. A person may have ongoing medical expenses, but are they really more expensive than the out-of-pocket costs of insurance? That is something that each of us has to decide for ourselves.

Insurance companies are only part of the problem with the American health care non-system. Drug companies gouge us because we're the only Western country that doesn't either regulate or negotiate prescription drug prices. Our fee-for-service model encourages the less scrupulous practitioners to prescribe unnecessary tests and surgery and to rush as many patients through their offices in a day as possible. The expense of medical education and the grueling life of a resident make doctors feel entitled to lavish compensation. Hospitals have overpaid administrators and wards understaffed with nurses, who are also required to complete picky paperwork after each interaction with a patient.

If a foreign power tried to impose this system on us, we'd consider it an act of war. If non-participation in insurance causes this horrid system to collapse, I say "It's about time!" I hope that all of you who have single-payer advocacy groups in your state are supporting those groups and lobbying your legislators.

With the Obama administration and Congress co-opted by corporate interests, state-by-state action is our only hope for a humane, universal, lower-cost medical system in this country: one with required participation but with premiums geared to income rather than age or state of health, truly affordable caps on out-of-pocket expenses, and NO DEDUCTIBLES.

[onpatrol98]

1. Good Post!

[zipplewrath]

2. By 2014 I can't see healthy people buying insurance

The fine isn't all that big, compared to the premiums. Ultimately they won't be able to refuse you insurance, so you'll just be "out" any short term costs of getting covered. As your experience shows, you can negotiate for retail for many procedures and probably "save" money as oppose to paying premiums. Now, if you develope a chronic condition, then you'll go get the insurance.

They never should have dropped the public option, but kept the mandate. And they never should have agreed to no drug price negotiations.

And you can't compare our system to other countries because they have UNIVERSAL health CARE. We still don't have that at all.

[Lydia Leftcoast]

3. That's right--all that wrangling and media propaganda, and we STILL

don't have universal coverage.

[bvar22]

32. In 2014,

when 40 Million Americans are herded into the Exchange Pens and forced to BUY "Insurance" they won't be able to afford to use (high Co-Pays, High Deductibles),
the Democrats will be unelectable for a generation.
Over 70% of ALL Americans opposed Mandates without a Public Option.

ALL the Republicans have to do is sit back and say, "Yep. We opposed it."
This was handed to The Republicans by the "sensible, centrist" "Democrats".


"If we don't fight hard enough for the things we stand for,
at some point we have to recognize that we don't really stand for them."
--- Paul Wellstone

[obxhead]

53. I completely agree

This will sink the Dems and in hand our country.

[raccoon]

4. ITA! I think the US needs a national health plan with a modest copay.

Sounds like Japan and Germany both have a good idea.

"2. If there are copays, they are capped. In Japan, you apply for a refund from the government if the copays exceed a certain amount, and certain chronic or catastrophic conditions are fully covered from the first yen. In Germany, you simply don't have to pay the copay if you have already paid a certain amount that year."

[Lydia Leftcoast]

6. There are three basic models found around the world

1. Single payer (Canada and a few other countries)

2. National health service (the UK and a few other countries)

3. Mandated private insurance (Germany, Switzerland) with STRICT regulations on the companies. For example, they cannot refuse payment unless they can PROVE fraud, and they must pay up in 14 days.

Japan's system is a hybrid of #1 and #3. People either get insurance through their jobs, with the premiums deducted from their paychecks, or sign up for the public option. Both have similar costs and benefits.

[BlancheSplanchnik]

58. You forgot the 4th basic model...

4. Rape and Pillage (US of A)

[bvar22]

61. Thats the "Uniquely American Solution!"

:patriot:

[leftstreet]

5. K&R

[Mimosa]

7. EXCELLENT OP!!!!

And if the 'Affordable Health Care Act of 2010' legislation survives unchanged until 2014 and afterwards I doubt our situations will be much improved.

Lydia, why wasn't your accident covered?

[Lydia Leftcoast]

8. If the proposals stand, I will be worse off

than I was with my existing crappy insurance. Higher premiums and copays.

[sinkingfeeling]

11. Please explain how.

I went here and used a wild-ass guess that your age would be 62 and your income would be $40,000 in 2014 and here are the results.

http://healthreform.kff.org/SubsidyCalculator.aspx

Projected income in 2014 $40,000
348% of poverty
Unsubsidized health insurance premium in 2014 adjusted for age $10,172
(Based on an age factor relative to a 40 year-old of: 2.26)
Maximum % of income the person/family has to pay for the premium if eligible for a subsidy 9.50%
Actual person/family required premium payment #3,800
(which equals 9.50% of income and covers 37% of the overall premium)
Government tax credit $6,372
(which covers 63% of the overall premium)
Out-of-Pocket Costs
The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium) is $4,167. Whether a person or family reaches this maximum level will depend on the amount of health care services they use. Currently, about one in four people use no health care services in any given year.
The guaranteed plan for the person/family will have an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. Specific provisions like deductibles and copayments may vary from plan to plan, and out-of-pocket costs for any given individual or family will depend on their health care expenses. Preventive services will be covered with no cost sharing required.

[Lydia Leftcoast]

12. No, it will be a wash in the best-case scenario

The premium will be about the same (since the current bill allows age-related premiums), and the alleged out-of-pocket will be $4,167, and the fine print says,

Specific provisions like deductibles and copayments may vary from plan to plan, and out-of-pocket costs for any given individual or family will depend on their health care expenses. Preventive services will be covered with no cost sharing required.

In other words, I would have to pay nearly $8000 before receiving any benefits. At $40,000, an income level that I achieve in some years and not others, $8000 may as well be $10,000 in terms of being unaffordable.

[sinkingfeeling]

15. You don't have to pay the entire $4167 in copays before you receive benefits. You would pay

the $3800 in premiums with the government paying 63%. That is better than most on Medicare. My 90 year-old mother pays the monthly $96 premium plus her supplement and drug plan runs about $400 a month.

[mudplanet]

46. You can calculate it any way you want according to the formula but

the simple fact is that my 82-year-old neighbor lives on approximately $8500 a year, from which Medicare of approximately $75 a month is deducted. She can't afford to pay $400 a month for a supplemental deductible plan. Fortunately the state is also giving her Medicaid to cover her Medicare deductible or she'd be SOL. And of all of that Medicare and Medicaid money that gets paid for medical care something in the neighborhood of 45% of it (still) goes into the pocket of the fucking insurance companies and the fucking people at the hospital that have to work full-time to wrestle with the insurance companies and not to doctors, nurses, and medical technicians. It often takes two or three trips to the pharmacy to get just her diabetes test strips for which the drug companies are charging Medicare a fortune because the insurance company the state contracts the Medicare business to requires the pharmacy to fax them the then wait and wait before they will tell them, yes, you can give this little old lady some test strips.

It escapes me how people can blithely talk about paying $400 a month, or $1200 a month for medical insurance as though it were virtually a negligible cost and an inescapable necessity. THE MEDICAL INSURANCE INDUSTRY IS A FUCKING RACKET that is responsible for killing tens of thousands of people in America every year. In my best year I made $40K yet I see people posting here who are paying nearly half that in medical insurance ALONE! And some fucking politician is running for office on the idea that the deductible for Medicare services should be $2000! That's fully 25% of my neighbor's income. Only a person that has never had to do without and has never missed a meal except through choice could suggest something like this.

By instituting National Health we could cut medical costs from 20% to 40% while providing medical care to every American. Every bit of real world evidence indicates this and points to the fact that, rather than containing the cost of medical care, the private medical insurance industry is driving the cost of medical care out of the reach of the average person. And if this doesn't concern someone then I'd suggest that someone is the average American's mortal enemy. This is nothing less than a matter of life and death for tens of thousands of people every year.

If a giant scam designed to benefit rich people and kill poor people is the American Way then, Fuck America and all those who sail in her.

[Admiral Loinpresser]

47. Thank you. n/t

n/t

[BlancheSplanchnik]

59. Hear Here. n/t

[subterranean]

17. The maximum deductible will be $2000.

So assuming subsidized premiums of $4,000, you would only have to pay $6,000 before receiving any benefits, although preventive care will supposedly be free. Beyond that, the copayments would kick in.

[Lydia Leftcoast]

29. ONLY $6000? ONLY $500 a month?

Well, I should start celebrating now.

My point is that in other countries, that amount of premium entitles you to NO deductible.

[Mimosa]

30. God bless da chile dat's got his own!

Most on Medicare couldn't afford the high priced supplement insurance unless they've got pensions. These days few have.

[subterranean]

34. I understood your point.

If I'd had health insurance for the past 10 years (which I haven't), I would have spent almost $40,000 and never been able to use it because I wouldn't have hit the deductible in any year.

[bread_and_roses]

40. Really, people are acting like this is "affordable?"

it boggles my mind. In truth, there will be no such thing as "affordable" while the vampire insurance cos have us in their grip. Not to mention that those "subsidies" people celebrate go right into the vampires' profit maws - such a good use for "our tax!" I can't believe people are still trying to make a silk purse out of this far-less-useful-than-a-sow's-ear "reform."

[dflprincess]

50. What we were told was that we'd get "affordable" insurance

No one (outside of those who want single payer) ever talked about reform that would give us access to health care - and that's the reform that was needed.

This whole scam is nothing but a gift to the insurance companies.

[Melissa G]

54. Amen! n/t

[bvar22]

62. They are not just arguing that it is "affordable"...

They are calling it "historic reform",
and demanding that we be jubilant with gratitude for this great gift!

AND, the worst parts of this Sell Out will not hit until 2014.
Tar & Feathers is too good for the people responsible.

[Admiral Loinpresser]

49. Is there any cap on premiums?

If not, I expect the premiums to go up faster than before. BigHealthInsuranceInc will rationalize even more rapacious premium increases because they have to cover "pre-existing conditions." This is like the cost plus contractor treason (er, uh, excuse me "contracts") in Iraq.

I am screwed by HCR. I will have to buy insurance I can't afford to utilize.

[pnwmom]

55. Something you're not accounting for is that your insurance company

was calculating your rates both on age and on preexisting conditions. In 2014 there will be a narrower range of increases based on age alone (the difference between youngest and oldest will be less than it is now)-- and none based on preexisting conditions. Both factors should make a difference for people in their fifties, most of whom do have some preexisting conditions.

[Lydia Leftcoast]

68. I don't have any preexisting conditions except nasal allergies

I was getting the best rate for my age group, according to the company's charts, and it was still a significant expense.

And lest one think that this is just a problem for us over-fifties, that same chart says that a person under 30 pays $99 a month for a $5000 deductible.

OK, now the right-wingers like to blame young people for not buying insurance, but say you're a graduate with loans to pay off, but the only job you can get pays $8 an hour. That's $1280 a month before taxes and deductions. You're living in a 2-bedroom apartment with three other people, cycling to work, and buying your clothes at thrift shops. So having $99 automatically withdrawn from your checking account every month for something you are unlikely to need is going to be a priority?

[pnwmom]

73. To answer your question: no. Which is probably why they made it mandatory. n/t

[Alcibiades]

48. Is that actual income?

In running the numbers in the little tool thing, I found that if I make $93k in 2014, I would be liable for a premium payment of $8,835, plus $8,333 out of pocket. (I am assuming a 100% chance of a worst case scenario, as we have hit the catastrophic level for three years running).

If, on the other hand, we make a little more money, say $94k, we would be required to pay a $17,766 premium and $12,500 out of pocket.

In other words:

$93,000 = $17,171 to private insurance company
$94,000 = $30,266 to private insurance company

The insurance company gets to keep $13,095 more of my family's money if we make $1,000 more. Where's that supposed to come from?

My god, no wonder they love this.

[Lydia Leftcoast]

10. It wasn't covered because I hadn't met my deductible

The policy has no exceptions.

There are now new policies that offer somewhat better coverage, but when I called to ask about switching, they said that I would have to reapply from scratch, even though they have all my medical records for the past 16 years (the 6 years I was with them plus the previous ten years when I was insured with Kaiser).

Someone who used to work for an insurance company told me that it was because they hope that there will be a discrepancy between the person's two applications so that they can use it as a reason to deny the application on the basis of "fraud."

[Kat45]

14. "Fraud" if the applications aren't an exact match, huh?

Wow! I'd be in big trouble if I ever had to fill out an application for insurance because my memory sucks and I can't remember details of my medical history, conditions, years, meds, etc. I hope I won't have to. I'm in MA, currently on the plan for low income folks through the state. Currently I'm paying no premium and low copays because I have no income; when I did have some income last year, I had low premiums and slightly higher copays, as they do go by income. If I get a job that pays too much for the state plan but not enough to purchase a plan, then I'll be in trouble.

[Mimosa]

21. Uh oh. That could happen to anybody with a high deductible

I have a $10,000 deductible.

[Hello_Kitty]

9. Outstanding post!

:thumbsup:

I honestly believe some people would accept any plan so long as it forced people to buy insurance.

[Lydia Leftcoast]

45. Actually, they're inclined to accept any plan, no matter how lousy, as long as

it's labeled a "Democratic" plan.

[subterranean]

13. Thanks for posting this.

I think Americans who have never lived outside the U.S. (in other words, most Americans) still have little knowledge of how other countries' health care systems work. They can't conceive of health insurance with no deductible that doesn't cost a fortune. By the same token, people in other countries could not imagine paying for health insurance, and then having to spend an additional $2,000 or more out of pocket before they could actually use it.

[SoCalDem]

16. I am shocked when I hear people talking about other countries' medical plans when we have NEVER

even had "that conversation".. When have we had a series oif panels of "real people" sitting around comparing how their country handles things?

It would be the easiest thing to do, yet no one seems to have ever done it (to my knowledge).

Imagine couples.. German, Swiss, Canadian, Korean, Japanese, British, etc.. all with similar incomes & families ...and each one detailing how their family health care is handled and laying out the out-of-pocket/payroll/income tax costs..

Followed by frank discussion.comparisons by those same countries' health-ministers...laying out how it works in more detail.

Americans might take to the streets... and that's why the whole issue is always discussed in our media the way it is...

We are never given facts, because we are naughty children who do not deserve to know facts.. we are to be pacified with myth & fairy tales about long waits, denial of services & skewed statistics.

[subterranean]

20. Americans, especially Republicans, tend to tune out

when someone talks about how other countries do things. They're not interested. They are emotionally invested in the idea of American exceptionalism, and don't believe we can possibly learn anything useful from other countries. Tell them that a good idea has worked well in France, for example, and they will automatically reject it. On the other hand, if they hear that someone's friend's aunt had a bad experience with the Canadian health care system, they'll believe that and use it to condemn the whole system.

A few people in the media, such as T.R. Reid and Bill Moyers, did a good job of showing how health care works in other countries, but their message reached a limited audience of PBS viewers and was largely drowned out by the right-wing echo-chamber.

[truedelphi]

24. Actually Michael Moore comes close to that in his movie SICKO

And most people I know who saw it loved the way that the French have their medical care, though Great Britain also scored high.

And Mike edited out his findings on Health Care in Norway, as the situation there is so fabulous he thought that the RW nutjobs would think that he made it up. (For a while, Mike Moore's interviews with folks in Norway were on YouTube.)

[SoCalDem]

25. MM & PBS are the ONLY ones who tell us the truth, but they have a tiny footprint

compared to the BIGFOOT media that reminds us hourly that we are NUMBER ONE..:(

[truedelphi]

27. No one in this household spends much time watching the Major Media.

Life is too short to spend time listening to LIES.

And believe me, they are feeling the brunt of many households like ours. Cable channels
are so much better - you learn more in a night of Jon Stewart than you'd learn in six months of watching ABC news.

[SoCalDem]

28. preaching to the choir here..

I even watch the UCTV channels and have most of the crap channels blocked :rofl:

[dixiegrrrrl]

18. You are correct in your thinking.

( but you know that)

We have done the same thing.
dropped all insurance, put the premium costs into our own savings fund.
That means NO Medicare B, NO D plan, just A plan.
Keeping in mind that for years we both paid Medicare taxes.


Mr. d. had to be in ICU for 4 days last month, due to an injury.
He fortunately now has Medicare A.
His deductible for that is 1,100.00. ( inpatient costs) per year.
Hospital billing dept says they go up every year, they were 800 a couple years ago.
Medicare A picked up 5400.00 of the hospital bill, wee had to pay the deductible.


His out of pocket expenses related to the problem is another 1,000. ( outpatient bills)
Monthly Medicare B premiums would have been over 1200.00 per year times 4 years
if he had taken that option.

We are paying what we owe from the fund we set up. The fund still has money left in it.

the question comes down to:
Do we take care of ourselves as best we can physically, to stay healthy, and
create a nest egg for medical bills
or
do we stay healthy best we can and give a HUGE amount to the insurance companies
which are rigged so that we get very little in return?
Which option is more dependable, reliable,trustworthy?

[old mark]

19. We really don't have a healthcare "system" here - we have a patchwork of

private insurers making tons of money and offering the least coverage they can legally get away with. And it's mainly available to people who are healthy enough to work steadily. I had bad health much of my life, and spent most of my life with no health insurance at all. The few times I had employer coverage, I was told the illnesses I had seen my doctor for were "pre existing conditions" and they would not pay for treatment. One time I was out sick, lost my job and my health insurance because I had no money to see a doctor and my insurance did not cover my "pre existing" allergies.

So I was sick, unemployed and broke at the same time.

What a wonderful country - and we get called socialists brecause we want to improve it.


Fuck all rightwingers everywhere.

mark

[Mimosa]

22. Darlink, the democrats screwed us over on 'health care reform'

The insurance companies can get away with whatever they want today. And 2014 won't be much different.

[bvar22]

63. 2014 will be worse.

In 2014, bending over for the Insurance Corporations becomes MANDATORY.
After 2014, the Democrats will be unelectable for a generation.

[truedelphi]

23. Sorry for your situation. Until we get the Corporation Control out of the Preisdency,

The Senate and the House of Representatives, things are not going to be any better.

[Desertrose]

26. I'm in the same boat as you Lydia.

It makes no sense for me to pay insurance that I can't afford anyway...with a high deductible for care that wouldn't be covered by health insurance anyway.

We need Medicare for all. Its that simple...or it could be.

[maryf]

31. Thank you, your post perfectly explains why we need Medicare for all

I'm sure Healthcare Now or PNHP would like your story...K&R

[bvar22]

33. "Medical Bankruptcy" is a term unknown in civilized countries.

Even after ALL the provisions of the "historic" Health Insurance "Reform" kick in,
Medical Bankruptcy will STILL be Big Business in the USA, possibly even BIGGER than now.

Thanks for this "Uniquely American Solution."

[Blue Owl]

35. K&R

K&R

[Vinca]

36. Great post. I realize I'm about the crankiest person here about the

health INSURANCE reform bill and I'm beginning to realize I might as well give it up and accept my - and your - fate. It's apparent nothing truly affordable will happen for the average person. In 2014 I'll be eligible for Medicare, too. Nothing is going to save me between now and then since I'm still too well off for Medicaid and too poor for the pre-existing condition pool, so either I live to see it or my husband will post my obit for you all to read.

[reggie the dog]

37. what is a deductable???

i have lived in france since i finished my ma in the states where i was born, the only insurance i have ever had for myself has been in france and i dont understand the concept. from where is the money deducted?

[Sentath]

38. simple version

the deductible is the portion of the cost of the qualifying medical care that the individual must pay before the insurance company becomes involved.

[Lydia Leftcoast]

43. A "deductible" is the amount of money you are required to pay

before you receive any benefits from your insurance.

I had a $5000 deductible, which meant that I had to pay any expenses up to $5000 on my own before I received any benefits from my insurance.

The higher the deductible, the cheaper the insurance.

[reggie the dog]

75. we have that in france

when i go to the doctor i have to pay 22 euros and am only refunded 20 euros so each time i go to the doctor i have a 2 euro deductible

[Lydia Leftcoast]

77. That's a co-pay, not a deductible

If you had a $5000 deductible, you would have to go to the doctor over 200 times before you received ANY money back.

[reggie the dog]

78. good grief!

[Fumesucker]

39. K&R, thanks for posting, LL..

[ThomCat]

41. Deductibles and Copays are a scam to force poor people

to never use insurance, so that insurance companies can keep the money you give them and provide absolutely Nothing in Return.

Isn't that a great business model? Wouldn't every business love to be able to charge you money and provide Nothing in Return?

Only the insurance industry has mastered this. And our government has not only made it legal, Obama has made it Mandatory! We all have to give the insurance industry money, with no guarantee or expectation of ever getting anything in return. Ever. Because insurance costs are still allowed to rise, and copays and deductibles are allowed to be astronomical, and the total cost is allowed to be up to 22% of your annual income! Which means that it will always be exactly 22% of your annual income, because insurance companies aren't going to miss a chance for every dollar they can get out of you.

We are already seeing insurance companies maneuver to get out of covering people so that the "benefits" of the supposed health care "reform" won't hinder them or hurt their profits in any way. The health care reform was written to benefit THEM, not us, and has so many loopholes in it for them that we won't ever know all the ways that we're screwed until after they're done taking all our money. :(

Was this the change you voted for? Was this what you remember Obama promising us during the campaign?

It seems to me that this is McCain promising us. :(

[harun]

42. Great post. Health Insurance != Health Care. Just because people have insurance doesn't

mean they will have get even one penny of their expenses covered. People just don't get this, it is tragic.

[TexasObserver]

44. Our system is designed to overcharge and bleed patients.

That's why our health care system costs over 16% of our entire economy. They overcharge, then they take every last dollar from their patients, then they chase them into bankruptcy court.

Until we regulate fully hospitals and health care, they'll continue to be the tail wagging the dog in this country. Our health care system is run for profit, and those who run them want that much more than they want to deliver quality health care at reasonable costs.

[dflprincess]

51. Fantasic post!

:applause:

[glinda]

52. K & R n/t

[myrna minx]

56. Excellent essay, Lydia.

:applause:

[area51]

57. +1

Each day, 273 people die due to lack of health care in the U.S.; that's 100,000 deaths per year.

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, bankrupts and kills people. Republinazi '93 plan:

"Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."

"We will never have real reform until people's health stops being treated as a financial opportunity for corporations."

[gtar100]

60. K&R - higher than a premium!! Excellent write-up!

[cyclezealot]

64. We live overseas most of the year..

We mostly rely on the French system, which our visa allows us to subscribe to. It's an incredible system. going bankrupt over medical concerns is not a concern.. we have friends in the UK, Switzerland.. They share in your ideas that deductibles are controlled and kept in check..
I've been googling to confirm your assumption.. Wish I could find one. My only experience with your view is personal. Not the result of any comparative study of the various systems, outlining the cost of deductibles.
Wish I could find one. Here, the only deductible is 2 euros, when we go to a doctor's office. that's it.. There are some costs related to dental care. The cost of dental care here. Who cares.. Compared to the horror stories we'd have in the US.. My wife is presently facing 8 dental visits, for a new bridge, root canal . It would cost us over $3,000 in the US .. Here, about 200 euros..

[subterranean]

74. Just curious...is dental care covered by the French system?

Or do you have to take out supplemental insurance for that?

One thing I liked about the national health insurance in Japan, besides having no deductible, was that it covered dental care. That's one thing I actually used it for!

[Lydia Leftcoast]

76. What kind of visa do you have?

Inquiring minds want to know.

[SOS]

65. Excellent post

A few thoughts on this topic...

I think the insurance bill was a preemptive bailout. There are studies (available on the net)
which predict a total collapse of the private system by 2018.
They know damn well the system is unsustainable, so they force everyone to participate in the Wall Street rackets.

An MRI in Tokyo is (by law) $98.
In NYC an MRI is $2,500.

:wtf:

It is wise to use the premiums for routine care rather than hand the cash to the vampires.
It is also wise to judgment-proof yourself.
Place assets into the name of a trusted person with insurance or run all your income through an S corporation.

It's terrible that we have to think in these terms, but that's what this system forces us to do in order to avoid destitution.
That's how the rich do it. We regular folks need to get hip to their ways.

[Lydia Leftcoast]

66. It was always obvious to me that the primary concern was corporate welfare

for the insurance companies, especially after Obama met with them in closed-door sessions and refused to even talk to the single-payer advocates.

[Mimosa]

79. Obama's family MD of 20+ years was a single payer advocate

He wanted to meet with Obama. Obama wouldn't. :(

[Lydia Leftcoast]

80. Wow, just wow

The corporations have really gotten to him.

[Mimosa]

81. Here's a link to a video and transcript of interview with Dr. Scheiner

Lydia, my BFM is a medical professor and he had told about it way back when the HCR bill was being discussed.

http://www.democracynow.org/2009/7/22/president_obamas_longtime_physician_opposes_white

[Starry Messenger]

67. k & r

[w4rma]

69. Yup. As far as I can tell bankruptcy is the best choice for critical and expensive health care. (nt)

[Jakes Progress]

70. Shhhh. Hush up. Don't you know we have the bestest hcr in the world.

[mwooldri]

71. Deductibles are a way of making sick people pay more.

Ideally, there would be no deductibles.

I am covered by my employer for health insurance. It has a "high deductible" but we are given money that essentially covers 60% of the deductible ($2300 deductible). As a family who meets the total "out of pocket" expenses in the first quarter of the year, it was extremely rough the first year we switched over from the co-pay based program to the deductible based one, however we wised up and toughed it out and after year 2 it got far easier. I simply on top of what I pay for my share of the insurance have to contribute extra to the HSA.

The good news in this is that I know how much the health insurance will cost each paycheck and as a family we can see any in-network doctor we need to and be assured that the bill will be paid for. Out of network doctors are a big problem though, as they bill one amount and the insurance processor will only approve a far lower amount (if any). The bad news is that if we compare our family to healthy families who only need to see the doctor once a year and are in good physical shape, we don't get to benefit. The healthy guys get their HSA, get to put the company contribution to the HSA and let it sit there and get another contribution the next year and so on. Us sickos have to pay much more than the healthy people - yes we use health care providers much more than healthy people... but of course we pay more for it. Call it a no-claims bonus if you like, but the healthy people don't have a "crash" and essentially have the "no claims bonus"... the sickos like us have frequent crashes and can't earn a "no claims bonus". Fortunately the company I work for only discriminates the premium on whether you smoke or not, and treat you as a non smoker if you promise to quit within that enrollment period.

I personally would love to see a health care system that is free at the point of delivery to all people in the United States (or with a very small copay and definitely NO DEDUCTIBLE). Also payment will be according to ones means. I'm also up for supplemental insurance that people who have the means can purchase to cover "medical procedures" that the "public insurance" would not cover (e.g. elective cosmetic surgery).

[happyslug]

72. You pointing out what Krugman pointed out, this is to help the Insurance Companies

What has happened since Clinton's administration has been slow, but steady drop in the number of people willing to pay for Health insurance. This has been buildings since Clinton's failed attempt to get Universal Health Insurance in 1993-1994.

Worse, from the insurance companies point of view, is the people who actually USE insurance (Such as myself, with almost $1000 a month in pills to fight high cholesterol) tend to pay whatever is charged, for it is cheaper then paying for the medication/medical treatment themselves.

Krugman points out Health Insurance, like any insurance, is an attempt to spread out the risk of danger over a group, on the grounds the group can better pay for it then an individual. A house will burn down once every 1400 years (Given the standard exclusions in such fire insurance, arson, war etc), but if it is your house it is a huge loss. Thus you buy insurance, not that you think you will ever need it, but the cost is so low (do to how rare house fires actually are) it is cheap AND if fire occurs you will be covered.

The same when it came to Health Insurance, it was cheap when it first became popular during WWII (When big industry was forbidden to offer higher wages, do to the severe shortage of workers do to WWII, but could and did offer benefits including health insurance). This was expanded in the early 1970s as Congress made Health insurance 100% deductible if provided to workers.

The problem is, no one ever put on any controls. Without Controls, the more money you put into something, the more people will use that object. Price is the ultimate Control, sooner or later it will raise is its head and impose a control on how high a price can go UNLESS something else acts as a control (i.e. Government restricting what it will pay and forbidding anyone to out bid it).

The problem is the US system had no control so the price will go up and up until price will act as a control. i.e. people will STOP paying for the service for they can NOT afford it. The health insurance industry found this out over the last 15 years and been trying to figure out a way to get that 30% of the population to pay for health insurance even as the price goes up (And the price going up INCREASED the percentage of people WITHOUT health insurance). Krugman pointed out that the Insurance Industry was in a death spiral, as it raises prices to cover those who are sick and need coverage, the number of people who are NOT sick dropped buying health insurance. That forced prices of the people who stayed on to go up, which forced even more people to drop health insurance. This was a death spiral.

Obama's plan, and it is clear what we ended up with was what he wanted for that is what the Health Insurance Industry wanted, is to force everyone to buy health insurance, thus spreading the risk of those who are sick BUT also keeping the Health Insurance industry Financially healthy (i.e. get them out of the Death spiral). I suspect it is unworkable, but it is the only way for the Health insurance industry to survive (And for that reason it was adopted, NOT that it is unworkable, but it is the only way for private health insurance to survive). Your case is the classic situation, you paid for health insurance until you could no longer pay. That is the death spiral. Under Obama's plan this death spiral will stop, for he forces EVERYONE to pay for health insurance. People who can NOT afford to buy (or refuses) will be assigned to a health plan AND force to pay an additional fee when filing Income Tax (I have NOT read the actual law, but I suspect this is called a fee NOT a tax, and given that the way to avoid paying the fee is to have private health insurance is it a tax?).

If this fee for NOT have insurance a fine or a tax? The court may dismiss that argument as meaningless, but the Court may make it the basis for a decision striking that part of the law down, on the grounds that all taxes MUST be universal and can NOT be used to force people to pay private individuals. In the debates this was dismissed on the grounds that States have for years demanded people to have insurance to drive a car, but people tend to forget Driving a motor vehicle is NOT something EVERYONE must do (i.e. you can opt NOT to own a car and thus avoid paying auto Insurance, you can NOT opt out of health insurance mandate). It is will be interesting to see if the Health Insurance industry can convince the Supreme Court that the fine for NOT have Health Insurance is the same as NOT have auto insurance, even through you can avoid Auto Insurance by NOT driving, while they is NO way to avoid Health Insurance mandate.

Side note: The Supreme Court has long taken notice that there is NO right to drive a car, it is a privilege granted by each state, that each state can abolish at any time. Unlike the right of movement which is absolute, because people can WALK anywhere on the public roads (except those roads built for non-pedestrian traffic, i.e. the interstates) as opposed to upgrading of existing roads (i.e. US Highways can be limited access, provided an alternative way to preserved for pedestrian traffic). I make this point to show that Auto Driving is NOT required of everyone in the Country, but the right of movement does NOT require the right to use an automobile for such movement.

[Mimosa]

82. K&R n/t