Something people don’t seem to understand about Obamacare
I’ve noticed this before, and I noticed it again while reading this article in the Washington Examiner about Obamacare. Here’s the quote that caught my attention:
Former New York Lt. Gov. Betsy McCaughey, a Republican who is now a health care advocate, said Obamacare’s lack of first-class hospitals is a big problem.
“It’s not just the number, but who they are. You’ll find under the Obamacare exchanges that the academic hospitals have declined to participate, along with the specialists who practice at those hospitals. The same is true of cancer hospitals,” she said.
“People who are seriously ill need to stay away from these exchange plans,” McCaughey said.
But what McCaughey doesn’t appear to understand—and what my research so far has told me is true (although Obamacare is so Byzantine there’s always the possibility of error)—is that in the individual market there is almost no way for people, seriously ill or otherwise, to “stay away from these exchange plans.”
For those with employer-based insurance, they can stay away (for now—we’ll see how that changes next year). Employer-based plans still have good networks. But people without employer-based insurance who must seek individual policies don’t for the most part have access to those networks, they only have access to the more narrow Obamacare networks.
You might say, “But what of people who buy individual insurance off the exchanges? Can’t they circumvent the problem?” After doing a lot of research (including phoning insurance companies), everything I’ve read and heard points to the fact that the entire individual health insurance business has restructured itself to conform with Obamacare, and that individual policies off the exchanges are the exact same policies as those on the exchanges.
That includes the narrow networks. The only difference is that off the exchanges you can’t get a subsidy, although the plus side is that off the networks you don’t have to deal with the healthcare.gov website and its perils.
As an alternative, you can buy temporary catastrophic insurance that allows you to go to any doctor. But temporary insurance is just that: temporary. It is limited to one 6-month period or at the most two, depending on the state. Then you are not allowed to buy it anymore.
So the only way a person buying individual insurance could act according to McCaughey’s suggestion is to not buy insurance at all. If you’re paying out-of-pocket, then you can go anywhere you want. Most people can’t afford to do that, of course, especially the “seriously ill,” the ones McCaughey was addressing in her statement.
If anyone has done research that contradicts what I’m saying, please let me know. Obamacare is a maze of complications, arcane rules, and contradictions, and it’s much like an iceberg, the bulk of which is invisible.
McCaughey is a very sharp woman, and knows more about the ins and outs of Obamacare than almost anyone I’ve seen.
I suspect her suggestion was more of an emotional appeal motivated by shock. If your critique were pointed out to her, I’m sure she’d agree.
This is the statist rat-maze we’ve been reduced to.
It would seem to me that insurance companies could offer low cost bare bones catastrophic policies for sale to individuals and employers who are willing to risk paying the fine. Those policies could include more hospitals and doctors. As a practical matter the fine can be avoided if you do not have an IRS refund coming. That can be managed.
Given that we have not seen this suggests to me that big insurance companies are fearful that Obama would be pissed off and would cut them out of subsidies and bailouts.
I can only speak for Illinois. Blue Cross of IL offers the same doctor/hospital network for “non-marketplace” 2014 individual plans that they offered in 2013. I sell Blue Cross of Illinois non-marketplace individual plans in my insurance agency but I refuse to sell Obamacare Marketplace plans. It’s partly out of disgust with the whole thing. But mostly because I sincerely feel that my clients are much better served by non-marketplace Blue Cross plans. The main downside is that the subsidies are not available unless you go through the marketplace. So, if you need/want the subsidy, you have to go through the marketplace. Which means you won’t have access to some of the better hospitals. And you’ll be subject to the plethora of problems in the marketplace.
So what meeting did this person go into and how long did it take to zombiefie that person into an Obama supporter?
If all it took to convince that person to back ObamaCare was to say to them that individuals could just buy some other insurance plan…
Neo,
After reading your article something odd occurred to me.
1) The entire market has been conformed to fit Obamacare.
2)Also you are allowed to purchase temporary catastrophic insurance.
So say for instance you get brain cancer. What is preventing you from simply purchasing the catastrophic insurance AFTER your diagnosis and then going to the non network specialists?
If the insurance companies cannot prevent you from purchasing policies for per-existing conditions. Is there anything you have seen that would prevent this?
Mythx:
In most states, temporary insurance excludes pre-existing conditions. That may even be true in ALL states (not sure because I don’t know about all states).
You are absolutely right about the complexities and twists within O’Care. One thing that hasn’t been mentioned recently is the funds removed from Medicare over the next decade to fund Obamacare. I believe that most of the reduced funding came from reducing reimbursements to providers (that’s my guess but try to find out). Linked to this is an apparent capping of future Medicare costs. Now think about this (If I’m right) – Provider fees are reduced; total costs are capped – what happens to the ability to obtain quality health care in the future?
Two additional points – there is no capping of the remainder of health care costs. Second, a chunk of Medicare funding reductions comes from a reduction of payments to Medicare Advantage plans so what happens to those plans?
All of this could have been avoided with so many lower cost options!!!
God help this country.
Sangiovese:
I’m glad to hear Illinois still provides that option. From the research I’ve done so far in California, California does not. I wonder how many states are like Illinois (and for how long), and how many like California?
Perhaps New York is more like Illinois than like California? That would explain why McCaughey said what she said.
It’s really hard to find this stuff out. To do so, you have to call each insurance company in each state and ask the question, and even then you don’t necessarily get the right answer.
As one should expect from Central: you can have any plan that you want as long as it’s an 0-care plan — Black, with running boards, hand-crank, gravity fed fuel, planetary transmission, no chrome, and a rag top.
Bold print makes it plain: ALL plans are 0bamanations.
From where the cartel sits, that’s not a bad outcome, for then all of those nasty competitive wrangles are set aside. Eventually, no-one is embarrassed by mis-pricing coverage.
BTW, at the end of the day, 0-care is coming after the medical-pharma cartel. The halcyon daze of cost-plus price-push have reached the end of the yellow brick road.
Wall Street has yet to adjust to the destruction of the currency — and the economic merits of the medical-pharma cartel’s swan song.
Having reached 1/6th of the national economy… this pyramid project is complete.
I get McCaughey- she’s perhaps reasonably visible/audible, though the Wash Examiner is likely not much read in NY State. She’s trying to get some more uncertain fence-sitters to fall off in the right direction. But Neo’s site? Probably 99% of those reading are already very antiObamacare.
More entrail-reading just gets me more depressed about the hopelessness of our dependency-driven LIV future. We may elect a few Scott Browns in 2014, but to what net effect? Brown was not particularly an asset while a Senator. OK he was better than Warren is today, but not by a heck of a lot.
AIB says…
Yes, provider fees are indeed now capped by Medicare. I was informed of this personally by one of my doctors. Not only have they been capped but they’ve been reduced by, what I believe, is about 20%. In my experience the Medicare drug formularies are also changing.
AIB: “Two additional points — there is no capping of the remainder of health care costs. Second, a chunk of Medicare funding reductions comes from a reduction of payments to Medicare Advantage plans so what happens to those plans?”
I have a friend who has been fighting COPD for the last ten years. Up to now his care on Medicare Advantage has been very good. Since 1 January things have changed. His doctor has now become reluctant to continue to treat him aggressively. He lives in Spokane, WA so I don’t see him very often. I received a heart breaking e-mail from him three days ago. He’s in despair because of the change of policy. This sounds very much like the use of Obamacare to let old people die more quickly. It’s disturbing!
Two ways out from under Obamacare’s policies, both of which give you the benefit of “cash networks” while giving you the wherewithal to weather the unexpected better: MediShare and Samaritan Ministries, both of which are exempt from Obamacare’s requirements, significantly cheaper, and are worldwide.
From my personal experience I was (eventually) able to sign up for a Humana Platinum plan in Georgia with a national POS network that seems pretty extensive. It certainly includes Emory.
The Platinum plan while expensive has very low deductibles (good for us as my wife has a pre-existing condition) and is substantially cheaper than a similar employer based plan I had a few years ago in NY.
Although I am probably a winner here please don’t mistake that for support for ACA.
Also oddly the Platinum plan was actually cheaper than the Gold plan.
JJ, if a person does not have political connections, they are worth less than Obama’s dog at the national and favor connections level.
Anybody who thinks that their access to health care will not depend on their political connections is a damn fool.
It’s just another way to “winnow out” opposition by attrition. That’s a feature, not a bug. They are going to weaponize the health care system against anyone who opposes them.
These people are pure, raw evil.
The only difference is that off the exchanges you can’t get a subsidy
Agreed.
We bought the exact same plan off network that we would have bought on network.
The only difference is that on network they would have forced our kids to be on Medicare.
Neo, question in follow-up to a discussion a few days ago: You pointed out that when we hear that a bronze plan, for example, pays 60% of medical expenses on average, this means that the entire cohort of insureds within that pool pays 60%. So my question is, if the whole risk pool is only paying 60% of their medical costs, who’s paying the other 40%? Shouldn’t the aggregate contribution of an entire risk pool be 100% of that group’s medical costs (actually > 100% taking into account administrative expenses and costs)?
Momo…
Any kids would have go on MEDICAID… not Medicare.
Medicare is aimed at those over 65 AND those who’ve been put on SSDI — and stayed there for 24 months. It’s at that time that they are transitioned from MEDICAID to Medicare — age no longer being an issue.
%%%
BTW, one of the reasons for the explosion of SSDI is that the administration is not at all averse to getting semi-seniors off of the labor market.
In particular, African-Americans age faster than European Americans. This taboo reality shows up all over the statistics.
Barry’s intent is to permit Black America to tap into the SSDI trust fund before they leave their mortal coils. As it stands, the net, net, effect of SS is to shift payroll exactions from Black America to White America. This flow is ENTIRELY due to the longer, more drawn out, retirement years that European Americans achieve. (Talk to Darwin about it. It’s an ancestral legacy from surviving the Ice Ages. Africans simply skipped that ordeal. Instead, they had to stay one-step ahead of the carnivores so common to that continent. )[ No wonder humanity decided to take a trek across the Red Sea to Yemen.]
With Barry, you have a political animal that wants diversity in DNA and uniformity in outcomes.
(He ‘choomed’ his way through biology… hence, spliff dreams.)
In Oregon, at least, there are many more individual plans than Exchange plans. The example that I’m most familiar with is my own insurance provider, Providence.
See their list of plans for the details.
That said, the Oregon exchange has been a disaster…
My IT consulting takes me all over the country and into parts of Canada. None of the plans offered on the exchange will cover me when traveling outside of my home “area” in north Texas.
Also, I tried to see if my son (in his mid-20’s) could sign up for a different plan than the one which least poorly fits my needs. Can’t do it– ge must sign up on my selected plan even though it’s a waste of money for him. If he tries to get his own plan (subsidized by me) he can get a cheaper plan, but he has to lie about his income to quality
The Freelancers Union plan I signed up on in NYS is the old deal (i.e., the same as it’s been the last couple of years), and pays much better than Zerocare.
And it’s still in existence thanks to the grace and favor of Dem. pitbull, Sheldon Silver. Which means he can retract that exemption any time. (Silver really runs New York, not whoever happens to be the mayor.)
blert said:
As it stands, the net, net, effect of SS is to shift payroll exactions from Black America to White America. This flow is ENTIRELY due to the longer, more drawn out, retirement years that European Americans achieve.
While that may be true of retirement benefits, it may not be true of survivor and disability benefits.
I keep reading about these new, narrow networks, and it’s got me wondering: will a smaller number of patients be receiving care from these newly-excluded hospitals and providers? Are there going to be empty beds and laid-off technicians? A shifting of personnel from urban to rural areas? We’ve known for some time that patients will be dislocated thanks to these new networks; will there be any significant dislocations for providers themselves as well?
i can stitch up my own wounds..
as my grandfather did
i can set a broken bone…
cut an infection…
i was raised by depression era / war survivors…
save extra meds… ie. if you get antibiotics, put them in the freezer. if someon dies, try to get what they have… you may need this to live… a few cipro tablets can make a big difference in an infection the system wont treat as your rationed.
find people who know this…
(immigrants will do better than most)
whether it gets fixt or not, you can be sure that this is now killing people, and will kill a whole lot more before it gets adjusted.
mao did similar things..
great plans that ended up killng people.
sound familiar?
easy out…
claim your a christian jewish muslim…
then have them say you aint…
then….
ie. they insured that those that convert to islam can get around the issues..
not bad…
stay jewish, or christian, your second class disposable
convert to islam, and…
and Renegado set this up… too funny
Faceless Commenter:
I addressed that question in a different post a little while ago (don’t have time to find it right now, though). The gist of the answer is that at the moment the vast majority of people in the US still have employment-based insurance where the networks are broader. As long as that holds up (plus a smaller percentage of private pay patients, very rich people who will go to the best hospitals even if they must pay out-of-pocket), there will be no problem for the “excluded” hospitals (who for the most part have excluded themselves voluntarily because the reimbursement from Obamacare is just too low). Over time, though, if and when more and more employment-based insurance either is dropped or payments go down and networks become more and more restricted, then those hospitals may end up having some trouble getting enough patients and may come to have to accept the lower rates or go out of business. The goal probably is getting government control of the whole shebang.
In addition, in some states (California) the networks are quite narrow for individual insurance. In some other states it’s not so bad. It’s a state by state thing.
Wait till people start to wonder if the state will use obamacare to retaliate like the IRS and so on…
think for a second (ladder of evil)…
the nazis did the same thing…
people worried if they needed care, that the system woudl “take care of them” in a way that they did not want…
this is common in socialist states like germany, and russia, the medical industry became an important part of the control of people.
in a few years, they will declare adorno to be right, and start putting people away who have ever written online about conservative princippals…
this is a very vengeful political system modeled after the past systems that were most successful
which is why germans murdered whole families..
for the same reasons that the UK royalty did
for the same reasons that the arab states did
for the same reason that islam did
for the same reason that feudal japan did
and even the romans, greeks, athenians, etc..
for the same reason sicilians did
(for the same reason in the Godfather script!!!)
in the other thread neo mentioned 1000…
heck
she should read more
Kragujevac massacre
“He who pays the piper calls the tune”
some names you can read about:
Sergei Pisarev
Pyotr Grigorenko
Viktor Rafalsky
Joseph Brodsky
Valery Tarsis
Evgeni Belov
Alexander Esenin-Volpin
Yuli Daniel
Viktor Fainberg
Valeriya Novodvorskaya
Natalya Gorbanevskaya
Zhores Medvedev
Andrei Sakharov
Viktor Nekipelov
dont think its just the soviets…
USA did it. Canada did it (Duplessis Orphans)
China, nazi germany, and more
how different was Dr Donald Ewen Cameron from joseph mengele? (do you even know the name?)
It was found, according to Munro, that the involuntary confinement of religious groups, political dissidents, and whistleblowers had a lengthy history in China. No deviance or opposition in thought or in practice was tolerated. The documents told of a massive abuse of psychiatry for political purposes during the leadership of Mao Zedong, during which millions of people had been declared mentally sick
INDIA 2012
It was reported in June, 2012, that the Indian Government has approached NIMHANS, a well known metal health establishment in South India, to assist in suppressing anti-nuclear protests regards to building of the Kudankulam Nuclear Power Plant. The government was in talks with NIMHANS representatives to chalk up a plan to dispatch psychiatrists to Kudankulam, for counselling protesters opposed to the building of the plant.
Japanese mental institutions during the country’s imperial era reported an abnormally large number of patient deaths, peaking in 1945 after the surrender of Japan to Allied forces
In Nazi Germany in 1940s, the abuse of psychiatry was the abuse of the ‘duty to care’ in enormous scale: 300,000 individuals were sterilized and 100,000 killed in Germany alone and many thousands further afield, mainly in eastern Europe.[27] For the first time in history, during the Nazi era, psychiatrists sought to systematically destroy their patients and were instrumental in establishing a system of identifying, notifying, transporting, and killing hundreds of thousands of “racially and cognitively compromised” persons and mentally ill in settings that ranged from centralized mental hospitals to jails and death camps.
Psychiatrists played a central and prominent role in sterilization and euthanasia constituting two categories of the crimes against humanity. The taking of thousands of brains from euthanasia victims demonstrated the way medical research was connected to the psychiatric killings
n Romania, there have been allegations of some particular cases of psychiatric abuse during over a decade
United States
Drapetomania was a supposed mental illness described by American physician Samuel A. Cartwright in 1851 that caused black slaves to flee captivity
[so the assertion above as to nazi germany being first is wrong… ]
In the United States, political dissenters have been involuntarily committed. For example, in 1927 a demonstrator named Aurora D’Angelo was sent to a mental health facility for psychiatric evaluation after she participated in a rally in support of Sacco and Vanzetti
[notice that these all happened in the century of totalitarianisms births… ]
When Clennon W. King, Jr., a black pastor and civil rights activist attempted to enroll at the all-white University of Mississippi for summer graduate courses in 1958, the Mississippi police arrested him on the grounds that “any ni**er who tried to enter Ole Miss must be crazy.”
“The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater.” This led to the banning of diagnosing public figures when you have not performed an examination or been authorized to release information by the patient.
In the 1970s, Martha Beall Mitchell, wife of U.S. Attorney General John Mitchell, was diagnosed with a paranoid mental disorder for claiming that the administration of President Richard M. Nixon was engaged in illegal activities. Many of her claims were later proved correct, and the term “Martha Mitchell effect” was coined to describe mental health misdiagnoses when accurate claims are dismissed as delusional
[this is a major plot in childrens shows. adults dont listen to children…etc]
15,000 pages of documents received from the CIA via the Freedom of Information Act that there have been systematic, pervasive violations of human rights by American psychiatrists during the recent 65 years – see The C.I.A. Doctors: Human Rights Violations by American Psychiatrists.
The book covers the history of the 1960s Ionia State Hospital located in Ionia, Michigan and now converted to a prison and focuses on exposing the trend of this hospital to diagnose African Americans with schizophrenia because of their civil rights ideas
http://en.wikipedia.org/wiki/The_Protest_Psychosis:_How_Schizophrenia_Became_a_Black_Disease
neo-neo,
Thanks for the response. I also suspect that many of those folks who are rich enough to afford out-of-pocket treatment in the best hosptials will be foreigners, putting a new twist on medical tourism: middle-class Americans head for India and Mexico while our own hospitals treat sheikhs and ChiCom millionaires.
Funny, a lot of California hospital jobs prefer (or require) “bilingual” nurses or admins. This might continue, but the preferred languages would change.
The reason why Canada and others come to the US is because even if they had money, they aren’t allowed to purchase medical resources for private use at home. The NHS is a monopoly for Britain, etc.
Once the US is under this system long enough, there won’t be any resources left for medical treatment, even if a person has the money. Other countries will offer blackmarket backdoor care, of course, as always. But the quality is… not perhaps that high.
The US medical resources are designed to dry up and be preserved solely for the political elite. Solely, and that includes the future life rejuvenation therapies and limb regeneration treatments.
Conrad:
If I understand your question correctly, I think you’re confusing the money the insurance company gets from premiums (which are not figured into cost-sharing) and the patient’s contribution (cost-sharing) which consists of deductibles, co-pays, and co-insurance. See this.
An insurance company has to get enough money from purchasers (or purchasers subsidized by the government) to cover its payouts and make a profit. But a lot of that money comes from premiums. The 60%, 70% etc. figures in Obamacare are the amount the patient pays of covered expenses.
Pingback:Schiff: Destroy This Monster That Threatens Us All | Paradoxical Convergence
Pingback:neo-neocon » Blog Archive » Another Obamacare surprise coming… | SCWilliam Insurance