Can you expand on this please? I find it extremely hard to understand how an ACA-compliant health care plan could "not cover" a hospital stay for myocarditis. Unless you're on a high-deductible plan and the entire stay was less than your deductible?
I suspect the maximum annual out of pocket.
Try being hospitalized without insurance. You'll find out really fast. (I was, twice, circa 2010. I was unemployed and uninsured)
However when going through the annual election process it generally makes it very clear how much you are paying out of each paycheck and what the employer contributes. Now whether people pay attention at all I can't say.
I think Obama-care (as much as I still support it in contrast to just letting private healthcare continue as-is) actually made things worse in the US by letting insurers and providers use the government involvement as a justification for their BS.
When you compare US costs to countries like the UK, France, Germany, Japan, and similar it is indeed true that US is significantly more expensive.
It is also true that over time US costs are rising significantly.
However, the ratio of US costs to the costs of other countries has stayed roughly the same over time.
In other words, the rest of them are having the same problem of rising costs that the US is, and their costs are rising at roughly the same rate. We pay a lot more than they do now because we paid a lot more than them a long time ago.
This is worrisome, because it suggests that even if we can lower our health care costs to be in line with the rest of the developed world we are still heading for unaffordable healthcare--all we'd be doing is making so we reach that when the rest of the world does instead of a few years before they do.
Here's some comments from earlier discussions with numbers and a link to the data [1] [2].
There is certainly some inefficiency in the US healthcare system but mostly it reflects the poor health of the population. Switching to some form of socialized medicine won't fix that problem. Other developed countries are doing a little better at the moment but they're on the same trend line and will inevitably hit the same crisis. At some point if we want to prevent a systemic collapse we're going to have to get serious about emphasizing prevention over treatment.
As a personal anecdote when I lived in the US there were three months in a row where I paid 10/pill, 3/pill and 1/pill (I also had earlier paid 0/pill when I qualified for VT medicaid) for the same medication[1] as I was 1) initially uninsured 2) covered by the "cigna preferred rate" but otherwise had no drug coverage 3) had regular drug coverage. As a bonus a few months after that run a generic for my medication came out and I paid .10/pill for the brand name because the generic existed but they didn't have it in stock.
Please explain how that makes any sense at all.
1. Concerta - the 54mg version now apparently retails for $545 per 30 here's a weird website talking about it (I now live in Canada and while there isn't Pharmacare in my province the drug is free with some cheap insurance) https://www.singlecare.com/blog/concerta-without-insurance/
Actually no, you still won't. Because the hospitals send out fraudulently inflated/overitemized bills to help their negotiating positions.
To know how much medical care actually costs, you need to have "insurance" and read through the itemized bills and explanations of benefits. The top line large number is the fraudulent amount that has no basis in reality, there is an "adjustment" based on the rates the "insurance" company has actually agreed to pay, there is the amount the "insurance" company pays them, and then there is your portion. Adding the last two, or taking the first minus the second, is as close to knowing how much something costs as you can get in this fucked up system.
Also it bears repeating, never pay a medical bill unless you're damn sure you're responsible for the amount [0]. Even if you have "insurance", often you'll get sent the fraudulent bill right away, and it will take a month or two for "insurance" to bother doing their job. Also billing departments have no problem blatantly lying to you about your (non) responsibility for the fraudulent bill, since it might get them more money.
[0] Of course some times they have you over a barrel like ongoing care getting denied if you have an unpaid balance. In which case you just have to eat it and then hassle your "insurance" company for half a year to get your money back.
In practice how do you do this? I've never got a medical bill that made complete sense to me and when I did argue it went around in circles for so many months that it was not worth my time so I just paid it.
Then, you need to know your general deductible and copayment schedule. The bill should show original charges (fraudulent), "adjustments" to those charges to make them line up with what your "insurance" company has negotiated to pay, and then payment by the "insurance" company. The part remaining that you need to pay should line up with your deductible.
If you've got a large deductible (common) and this is one of your first bills, then the "insurance" company won't have anything to pay, but there will still be an adjustment. If you think that is off, you can contact your "insurance" company to check if it matches their negotiated rates. In my experience, their customer service departments haven't been totally gutted yet.
Calling the provider's billing department is generally pointless unless/until you know exactly what you're talking about. Once, a phone rep (at a small place even) called me to nag me about a bill. I told them that their charge was above the Medicare limit for a service, and that it needed to be corrected before I could pay. In response, they insisted harder that I "owed it" and I "had to pay". I told them they were wrong, ended the conversation, and just waited. Lo and behold 4-5 months later they finally billed the "insurance" and sent the correct bill. I think they were just hoping I'd fall for their fraud so they could pocket a few extra bucks.
I'm certainly not an expert on this subject in particular, just generally experienced at cutting through the avalanches of paper that psychopaths try to bury us with.
The parent poster likely benefits from the following items on https://en.wikipedia.org/wiki/Affordable_Care_Act:
> Annual and lifetime coverage caps on essential benefits were banned.
> Insurers are forbidden from dropping policyholders when they become ill.
> All policies must provide an annual maximum out-of-pocket (MOOP) payment cap for an individual's or family's medical expenses (excluding premiums). After the MOOP payment is reached, all remaining costs must be paid by the insurer.
Obama was a sellout.
’Eat the food as you would a loaf of barley bread; bake it in the sight of the people, using human excrement for fuel.’ ... I said, ‘Not so, Sovereign Lord! I have never defiled myself.’ ‘Very well,’ he said, ‘I will let you bake your bread over cow dung instead of human excrement.’
We could be dealing with worse shit, however shit remains shit.
Sorry to hear that.
One of the massive negative side-effects of ACA will come to the national forefront in a few years. We now have tens of millions of people enrolled in Medicaid. What most don't understand is that, after 55 years of age, this isn't insurance at all, it's a loan you are required, by law, to repay.
Don't take it from me, here's a summary directly from the Medicaid website:
https://www.medicaid.gov/medicaid/eligibility/estate-recover...
I looked into this a while back. The State can place liens on your estate and your children could be stuck with a bill because of that. For example, if you have a home it is very likely that 100% of the value of your home will be consumed by your healthcare bills if you needed what I am going to call a normal level of care for that age group from 55 onwards.
In other words:
People were told they they were getting health insurance through Obamacare. In reality, they agreed to receive a credit card using their estate as collateral. If this isn't fraud, I just don't know what is.
Obamacare might just be the largest private-property grab by any government in the history of this nation, if not humanity. I wonder how many people actually understand they will not be able to leave anything to their children. Or worse, leave them a huge bill owed to the State.
These are the things that really rattle me: Politicians selling pushing programs in the most dishonest ways possible. How many people would have supported ACA had they were told they would have to sign-over their estate to pay for their after-55 medical bills? Very few, if any.
What really sucks about this is it affects the low to middle class portion of the population in a disproportionate manner. They are the ones who end-up on a Medicaid plan, not people who can afford to pay for something else. Once again, politicians claim to be for the little guy and, instead, they royally shaft them every time they are able to. All they care about is their votes.
Medicaid expansion is also just one portion of the ACA.
The low premium option is the least cost option if you don't use much healthcare, or if you use a lot; but there's a range somewhere in there where the higher premium plan may lower your total costs. Of course, if you're getting a premium subsidy, the calculation changes.
But yeah, Obama promised access to healthcare and delivered access to healthcare insurance. It's not unuseful, but it's not really enough.
If it were up to me, I'd lower the medicare eligibility age every year, and gradually grow the system, a couple decades later we'd have Medicare for All (ish, not all seniors are eligible).
An Obamacare Bronze plan is like the bank extending credit - they carry the umbrella after you when the sun is shining, but at the first drop of rain they disappear.
Of course, paying the hospital is usually sort of optional. They're most often happy to bill you later and send you to collections, and you can let it accrue. It's not great, but if you're so sick you can't work, what are you going to do about a debt you can't afford to pay? Better to not pay it.
These days, because of the ACA all plans are "emergency only", except without the lower premium.
They were cheap for a reason. They're back in force, if you want to grab one. I don't advise it. https://www.propublica.org/article/junk-insurance
These days all coverage is emergency only coverage, because of the insanely high deductibles. Except without the benefits of lower premiums.
I am aware that some things improved, but not for the average low risk person.
I do. My wife and I went bankrupt with it, via $90k in copays and coinsurance.
We had good insurance, but back then insurance could have uncapped costs of this kind. As a bonus, they could a) set a maximum annual and lifetime amount they'd pay and b) decline to renew our coverage, leaving only high-risk pools (4-5x as expensive for premiums) available.
I have a zero-deductible ACA plan. There are plenty of them.
How much does that cost? And which state?
No, that's not the case at all. We had to negotiate with the hospital and settled for this amount. The ACA covered none of it or a very small portion. I don't remember the actual bill, my wife dealt with all of it (she is a doctor and knows how to discuss such things with hospitals).
The ACA is not an insurance plan, so I assume you are using "ACA" as shorthand for "ACA-compliant insurance coverage".
It is simply not plausible that an ACA-compliant plan would wholesale "not cover" a hospital stay for myocarditis, absent extremely niche and bizarre circumstances.
Given that you don't seem very familiar with the specifics, I have to assume that your information is either missing some very important details, or incorrect.
Suppose the insured did use a non evidence supported vaccine or whatever, the vaccine itself would not be covered by insurance, but the healthcare needed by the damage caused by the use of unsupported medicine would be covered.
Similarly, health insurance has to pay for your healthcare if you get into a car accident and do not have sufficient auto insurance to pay for your healthcare costs. Technically, you are sort of buying redundant insurance if you buy PIP.
Falling while skiing is not FDA approved. A woodcutting axe applied to the hand is not FDA approved. Drinking bleach is not FDA approved. And yet, health insurance will cover medical complications arising from any of these actions.
As a lifelong heart patient, I've had many post-operative stays not covered, past a certain duration regardless of my current condition and I've always paid for the highest tiers of health coverage (for over 2 decades now). I find it very likely that ACA would not cover" a hospital stay for myocarditis.
I'm of the personal political opinion that almost always when the government steps in to fund things on the demand side of the market equation it leads to massive growth in costs and burden for consumers. Universities are another great example of this. If they do step in, they also have to regulate the supply side as the free market is effectively broken at that point, and people who...say want to pay their own bills or for their own education by working or don't qualify for whatever government program is helping others, are screwed by the system.
Government intervention always seems to rake money into companies' pockets rather than helping consumers and tax payers.
> almost always when the government steps in to fund things on the demand side of the market equation it leads to massive growth in costs and burden for consumers. Universities are another great example of this.
I agree with all the points you make in your comment. I'll just add that the problem is far more complex than this. And, yes, it is all, 100%, caused by government intervention.
Without diving too deep, the problem starts with substandard education in the US all the way down to K-12 level. From there it goes to the insanely high cost of university education due to the government being involved in guaranteeing loan. Nobody in their right mind would give an 18 year old a $300K loan or $120K loan for a bullshit degree with no prospects of repaying it in their lifetime. Then we have heavy, expensive regulatory frameworks and horribly slow and bureaucratic processes to build or make just-about anything. And, finally, lawsuits.
When someone is laying on an operating table in the hospital, they are surrounded by a team with somewhere in the order of three to five million dollars in student debt. The same team likely spends somewhere close to a million dollars a year in liability and other licensing and insurance.
Each and every manufacturer of the equipment in that room and the tools used for the surgery, employs people with student debt in the range of $100K to $300K per person. Hundreds of them. Thousands of them. The companies has huge regulatory, legal and insurance costs.
The hospital is in a similar situation. Millions of dollars per year in legal, insurance and other costs and a workforce that owes millions of dollars in student loans. Not to mention the various laboratories and services that make the hospital run.
If you follow the various tentacles and construct financial cost model showing what it takes for a person to be on a table in an operating room, the resulting number will be massive.
That's the key to our broken healthcare system and why no socialist utopia is going to fix it.
Until we fix the underlying cost structures driving the system, it is impossible to pass laws to truly control such costs. The "single payer" idea is, in this context, in a range between utopia and demented.
Why is it demented?
here's an analog: We take out one credit card with zero interest for a year. The intent is to use it to pay off all of our other credit cards within that period using this card by transferring the balance. People do this all the time.
Here's the problem: They don't change their spending behavior. Instead of ending-up with no credit card bills after twelve months, they wake up one glorious Monday now owing more money and having one more card to pay off.
You have to fix the underlying cost structure first. The problem can't be solved without this important first step.
This means getting the government out of education, student loans and a bunch of other areas. It also means demanding that the government be efficient and effective in doing the work we hire them to do.
The problem with this concept is that the people need to understand reality in order for them to vote appropriately. We don't have an informed citizenship. Not even close. We have clans fighting against each other and a few of us in the middle yelling "the emperor has no clothes!", and nobody listens.
Simply because they can and no one is going to stop them, so why not? This is the system working as intended.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...