The absolute maximum yearly out of pocket allowed under the ACA is $6700 iirc. So your insurance company is required to cover 100% of any bills once you've hit that cap.
The best way to understand the ACA is that your maximum of (premiums + out of pocket) is ~$8,000 for an individual. So whatever crazy policy you gamble on, your worst case is $8,000/year.
Key difference is that your premiums would have been adjusted upwards or policy canceled whenever your health has deteriorated.
Which is what happened to Brandon Boyer.
http://boingboing.net/2014/03/...
Humana screws Brandon Boyer for $100K worth of cancer bills - help him pay them
Cory Doctorow at 12:00 pm Fri, Mar 7, 2014
Our good pal Brandon "Offworld" Boyer has cancer. Lucky for Brandon, he signed up for medical insurance with Humana not long before he was diagnosed. Unlucky for him, Humana has decided unilaterally not to cover his cancer treatments and has stuck him with with a $100,000 bill.
Insurance is supposed to be there for EMERGENCIES, not to run you $10 copay for routine Dr. visits. That needs to be something you save and pay for, just like any other necessity of modern life, like utilities, food and gas.
That's one of those ideas that sounds good but doesn't work when you try them out in the real world. Most other developed countries have health care systems that pay 100% of costs (although non-American Slashdotters may be informative on that). Health insurance isn't car insurance.
The biggest problem is that once people have to pay for "routine" visits, they don't go on routine visits. Obviously you are one of those people who can afford to pay for a $200 doctor's visit out of pocket. Maybe half of Americans are in your category. The other half aren't. Doctors have no end of stories about people who didn't get routine care because they couldn't afford it, and wound up with preventable, fatal diseases. http://www.nejm.org/doi/full/1...
The other problem with "emergency" care is, "what is an emergency?" If I have to pay $100 for a doctor's visit myself, but my insurance pays for my $2,000 ER visit, I'm going to have a lot of emergencies. That actually was the problem in the Swiss health care system, which was mostly a catastrophic system which didn't kick in fully until you had passed a certain amount (It might have been $30,000). Once you reach $30,000, the insurance company has to pay for everything, 100%, so the doctors give them CAT scans, tests, specialist consultations, etc., and bill it all to the insurance company.
This is the type of policy and situation that is usually perfect for healthy younger folks that don't need tons of coverage for routine things.
Think about it. Any policy is perfect for healthy younger folks who never need coverage. The only people who need health insurance are the ones who get sick. If you develop multiple sclerosis or lupus, you can live a much more normal life if you can afford to get a lot of health care. There are drugs that can save your life and keep you out of a wheelchair for $50,000 a year.
I knew a young, libertarian Republican who had severe psoriasis, which put him in the hospital once or twice a year. The drugs he was taking were damaging his liver and kidneys. There were new, more effective, safer drugs -- but they cost $100,000 a year. What did he do? Government handouts. His wife was a government employee, and he was covered on her policy.
Depending on where you go, a "routine" doctor's visit can range from $50 to $200. Still, it's much cheaper for both you and an insurance company to cover a once a year "wellness" visit and catch anything early on than it is for you to skip the yearly visit since it costs an extra $50, and then suddenly learn you've had a slow growing tumor in your ear and now you're going deaf.
Your main point is right. Co-payments are terrible health policy.
Actually, the most common example is people with asthma. If they use their controller medication, they won't get asthma attacks, but the controller medication can be expensive. There were health insurance plans that covered 100% of medication costs. Then they shifted to co-payments. Even with small co-payments, people stopped taking their controller medication. They got asthma attacks, and wound up in the hospital. One ER trip will cost as much as several years of controller medication. So the plans wound up paying more under co-payments as they did with 100% payments. Same with co-payments for blood pressure medication -- more heart attacks and strokes. If you want to look this up, to make sure I'm not repeating an urban myth, it was reported in the New England Journal of Medicine by Amal N. Trivedi, who published a few other studies like that. Also see the Rand Health Insurance Experiment on Wikipedia or elsewhere.
Here's what Krugman had to say. If you say you did the math, you might be right, but there are a lot of BS health care stories out there. The big benefit of Obamacare is that it limits your (pemium+copayments) to ~$8,000. One big weakness of Obamacare is that when you find an "affordable" plan, it might have a small pool of doctors, it might not have a doctor that you've been using, and it might not have an competent doctors at all. Single payer would have been better, but, as Uwe Reinhardt says, the American political system is too corrupt for that.
http://www.nytimes.com/2014/02...
Health Care Horror Hooey
Paul Krugman
FEB. 23, 2014
(Right-wingers convinced Americans that farms are being broken up to pay "death tax" estate liabilities, but there is not one single example. Now the Republicans are creating Obamacare horror stories, which don't hold up upon fact checking. In the GOP response to the State of the Union address, Rep. Cathy McMorris Rodgers claimed "Bette in Spokane" had lost her good insurance and was forced to pay $700 a month more. Local reporters found the real Betty, and found out [Bette Grenier had a catastrophic plan, and she refused to look on the ACA web site.] In Michigan, Americans for Prosperity, funded by the Koch Brothers, is running an ad about Julie Boonstra, who has leukemia, saying that her new policy will have unaffordable out-of-pocket costs. But Glenn Kessler of the Washington Post found that she will be saving more than she will be paying in out-of-pocket costs. [The Obamacare out-of-pocket maximum is $6,350. Her premiums were cut in half, from $1,100/mo to $571/mo.])
[T]he true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.
Also, I work in the medical field. You know what Insurance companies are doing?
CLOSING THE FUCKING LOOPHOLES!
For example, physician owned labs are being phased out due to abuse. Doctors would urine screen every patient monthly, rather than random or via risk stratification. For this reason, the practices like ours who do have a random policy will be killed in the process. But they are STILL CLOSING THE LOOPHOLES.
The insurance companies aren't doing a very good job. I went to a physiatrist last year who gave me an unnecessary knee x-ray, and if I had let him he would have given me an unnecessary and dangerous cortisone shot. My insurance company didn't care.
As long as you give doctors financial incentives to do something, most of them will do it. The insurance companies gave us a song and dance starting with the managed care days about how they would impose quality standards, but they botched that up. They usually let Medicare set the standards, and follow along. If you want doctors to follow evidence-based guidelines, then put them on salary. They don't do unnecessary urine tests (and CAT scans) in the VA or in the UK NHS. If you're going to let lobbyists (like the ones at the American Academy of Orthopedic Surgeons) influence government standard-setting bodies, then of course you're going to have waste, fraud and abuse. We missed our chance with Donald Berwick.
But back to the original question, I suspect that the fraud in the food stamp program is well under the fraud in the private health insurance industry.
On the general question of redistributive programs, Paul Krugman explains it better than I can.
http://www.nytimes.com/2014/03...
Liberty, Equality, Efficiency
By PAUL KRUGMAN
MARCH 9, 2014
Almost 40 years ago Arthur Okun, chief economic adviser to President Lyndon Johnson, published a classic book titled “Equality and Efficiency: The Big Tradeoff,” arguing that redistributing income from the rich to the poor takes a toll on economic growth.
(Income inequality varies greatly among advanced countries. This difference is primarily the result of government policies.)
primary income — income from wages, salaries, assets, and so on — is very unequally distributed in almost all countries. But taxes and transfers (aid in cash or kind) reduce this underlying inequality to varying degrees: some but not a lot in America, much more in many other countries.
(2 studies by economists at the International Monetary Fund found that (1) nations with low income inequality have more sustained economic growth. (2) redistribution has benign effects on growth.)
(Incentives vs. resources. Aid to the poor reduces their incentive to work, and taxes on the rich reduce their incentive to get richer. But in an unequal society, the poor have fewer resources. The slogan that we should seek equality of opportunity, not outcomes, is a joke. 40% of American children live in poverty or near-poverty, and don't have the same access to education and jobs.)
So what? Out of 47 million people on food stamps, you'd expect that a few of them cheat.
Those stories show that the USDA is policing the system and catching people when they do cheat. They're doing their job.
That doesn't show that a large number of people cheat the system. You need statistics for that.
I don't think the cheating on food stamps is any worse than the cheating in the private sector, and maybe less. Doctors perform unnecessary procedures, like CAT scans, and bill the private insurance companies for thousands of dollars. And I do have statistics for that.
A rich person might have taken your job away, and sent it to India or China.
The top 1% made about 24% of the income. http://www.slate.com/articles/...
So it's totally appropriate for them to pay 37% of the taxes (if they did -- I don't know if those figures don't include FICA payments, which conservatives sometimes exclude from the definition of "tax").
Paul Krugman has explained why income inequality is bad for everybody. http://www.nytimes.com/2014/03... Those American billionaires could get along perfectly well at Swedish levels of taxes, and the rest of us would be much better off. It's actually bad for everyone to have 20% or 40% of the population in poverty.
The rich pay most of the taxes and pay a higher percentage of income on taxes than everyone else.
I know that right-wing talking point and I've checked it out before. Don't forget the footnote:*
_________
*Footnote: "Taxes" are defined to exclude FICA, which is the largest payment most middle-class and working people pay.
Percentagewise, the rich pay roughly 30%, the same as the middle-class, although those that can put everything into investment income like Mitt Romney pay about 15%.
That's why Warren Buffet pays less than his secretary.
It would change America's mindset. If suddenly the "freeloaders" and system "cheaters" couldn't extract cash from an ATM with their foodstamp card, then they would have to go about it a different way.
There are plenty of cases where people live in gov't funded housing, get food stamps, slang drugs and have more than I do as professional. Take away the gov't funded housing, and suddenly they have some skin in the game... makes fuckin' sense to me. Maybe they find other avenues of illegitimate income, but maybe they don't. Either way, if we keep closing loopholes, eventually they have to do it the way I am.
Yeah, let's get rid of the freeloaders and cheaters.
From FTA:
http://news.investors.com/0310...
The 1% Handouts
Instead, a surprisingly large amount of federal money is handed out to wealthy Americans through Social Security, Medicare, farm subsidies, unemployment benefits, conservation programs, disaster payments and other programs.
An IBD analysis found that the richest 1% of Americans, in fact, receive roughly $10 billion each year in federal checks.
Outgoing Sen. Tom Coburn, R-Okla., who exposed these vast payment programs available to the rich, said "this reverse Robin Hood-style of wealth distribution is an intentional effort to get all Americans bought into a system where everyone appears to benefit."
How many? Do you have stats on this? Furthermore, how much would it cost to fix this? Would we actually end up saving money?
There are plenty of stats on the subject, and the amount of pervasive abuse is also apparent.
But you can't cite any stats.
Therefore, many of us would conclude:
1. There are no statistics.
2. You're full of shit.
We're paying roughly twice as much for our health care as the Canadians do.
If we want to cut our health care costs, all we have to do is compare our system to Canada's and see what we're doing wrong.
Most of the drugs they use to treat AIDS and cancer come from NIH research (although usually the pharmaceutical companies managed to squeeze in and get a patent for them).
The one I was thinking about was AZT https://en.wikipedia.org/wiki/... Government-funded researchers developed AZT, tied it up in a package, and handed it to Burroughs-Welcome. Burroughs-Welcome did have some expertise in retroviruses, but they weren't indispensable.
FYI, only about a quarter of all drugs were invented with public funding.
I'd like to know where you get that figure. And I'd like to drill down to see how much of that is new classes of drugs vs. me-too drugs that just stick on a methyl group somewhere.
In most cases academic research greatly informed the development of new drugs (as intended), but there's a huge gap between "this mutation causes bowel cancer, maybe if we inhibit that protein it will stop progression" to "this drug stops bowel cancer". (Huge gap = many years, at least hundreds of millions of dollars.)
There's a problem with the term "invented." Most drugs are the result of a long chain of efforts from basic research to drugstore. The drug companies contribute to parts of that, usually in the later stages of human research and industrial production.
But government agencies are quite capable of doing the human research. The VA for example has often done the best studies of drugs used in cardiology and other conditions that are common among their patient population.
And many of the drug companies now contract out their actual drug production to factories in China and India. The FDA does inspection and quality control.
Alexander Flemming discovered, or invented, penicillin in a university lab. He refused to patent it, because he wanted to give it to the world. During WWII, the British gave all their penicillin research to the U.S. government, who gave it to Pfizer, who worked out the commercial development. Pfizer, in contrast, patented everything they did and kept it to themselves.
In the case of AIDS, academic research has been focused on vaccines, whereas the current best-in-class anti-HIV drugs really have been mostly the work of the drug companies.
I'd have to look that up, but AZT was developed as I described. I'll give the drug companies credit where it's deserved, but they have always been supporters of NIH funding.
Whenever the Wall Street Journal had an editorial demanding that the government shut down NIH funding and unleash the creativity of the free market in its place, even the right-wing conservative corporate executives in the pharmaceutical industry came to the NIH's defense.
The Social Security tax rate is 12.4% up to a maximum of $117,000.
If we were to eliminate the maximum, and charge everyone 12.4% of all their income, that would solve any problem the Social Security system had.
Because of the way income is distributed, people with income over $117,000 in the aggregate earn about as much as everybody else put together. So that's where the money is, and they can easily afford it.
People may be living longer now, but they also have a higher level of disability. For example, I saw in a recent issue of the Journal of the American Medical Association that 20% of people over 50 years of age have mobility problems such that they can't walk a mile. So they couldn't do a job that required walking.
Over the age of 65, peoples' abilities decline and their handicaps increase significantly. There are people who can continue working, but they're exceptional. For example, I know an actor who made a good living but he had to stop working in his 70s because he kept forgetting his lines.
Most other developed countries have a retirement age of 60-65 (sometimes younger) https://en.wikipedia.org/wiki/...
Is the American economic system so inefficient that we have to force people to work longer than they do in other developed countries -- even socialist countries?
I put up my thumb... and it blotted out the planet Earth. -- Neil Armstrong
