Obamacare: in the real world

[iamwhatiseem]

I needed to go to the doctor - so yesterday I called to make an appointment.
"I see your insurance changed...did you change employers or did you get a policy through ACA?"
"Same employer, we switched it to my wifes payroll"
"I need the policy number and the individual holder number as well please"
"I have a card, won't you just scan it tomorrow when I come?"
"We will, but I need both numbers before I can confirm the appointment - this is a new policy"
[I'm thinking..new policy...mm mmm you are going to verify the policy before I can come]
[gave her the numbers]
"Thank you..please hold while I verify your policy is active through Anthem."
[La la la la]
"Thank you Mr. #### your policy is active we will see you tomorrow then"
++++++++++++++++++++++++++++++

I have went to this same specialist for over 20 years, I helped him setup his office network about 15 years ago so I know him on a personal level..his practice now has 6-7 doctors and it's own surgery center.
Anyway - so I had this conversation:
"I see you guys are verifying insurance is actually active before you accept an appointment"
[scowl on his face]..."unfortunately yes, we have had to change a number of things."
"Obamacare eh?"
[settles in his chair...]
"We have injections we give patients where Medicare gives up LESS payment than what it cost us, and now we are having people showing up with Medicaid as well...try running a medical office where you have to put cost over care. It is ridiculous, everything is now about reducing cost. There will be people we will have to tell they can't get an operation because we can't afford to do it for what Medicare/aid pays, I have never turned a patient away in 27 years till now"
"I am going to have to find ways to cut cost as well...something else I haven't had to do in 27 years either"

 

[waltky]

Granny says it ain't gonna work out `cause nobody gonna be able to afford it...

Obamacare At ‘Significant’ Risk of ‘Death Spiral,’ Economist Warns
January 17, 2014 – Economist John Goodman, who warned last October that Obamacare could plunge into a “death spiral” if not enough young, healthy people signed up for coverage, says that danger is now “significant” following news that the Obama administration failed to hit its young adult enrollment target.

“I think there is a significant problem here,” Goodman, president and CEO of the National Center for Policy Analysis (NCPA), told CNSNews.com. “I think the insurers are worried. I think the administration is worried. “Remember, everybody is facing the wrong price. And sick people are facing a price that’s well below the cost of their care. Young healthy people are being overcharged. And so they need lots of young healthy people to join so they can get the money to pay the bills for the sick people. And the younger people just aren’t buying it. “Part of the problem, I think, is that it’s been so difficult for people to sign up, and so the only ones who’ve persevered – sometimes trying a hundred times – are people who really have serious health problems.”

A death spiral - the insurance pool equivalent of bankruptcy - occurs when too many older and sicker people sign up for insurance relative to the number of younger, healthier people, Goodman explained, forcing everybody’s premiums up. But as premiums rise, even less young people sign up for coverage. “That’s what we’re seeing so far,” Goodman told CNSNews.com. “Over half of all the people who enrolled are above the age of 45, and older people are more expensive [to insure]. We’re also seeing 20 percent of the people who are enrolling are going for the gold or platinum plans. Those people tend to be sick. They’re buying the more comprehensive plans because they plan to use a lot of health care.”

According to figures released this week by the U.S. Department of Health and Human Services, only 24 percent of the 2.2 million people who have already signed up for Obamacare are between the ages of 18 and 34, just a little more than half of the 40 percent the administration admitted it needed to keep premiums affordable. When CNSNews.com asked Goodman how Americans would know if the system was crashing, he replied: “Well, there won’t be any neon signs that say ‘Death Spiral Underway,’ but what you’ll see is premiums keep rising, and if premiums keep rising, then fewer healthy people will buy in and we may get to a point where you need government subsidies to prop the whole thing up. By that I mean government subsidies to the insurance companies.”

MORE

 

[LoneLaugher]

I needed to go to the doctor - so yesterday I called to make an appointment.
"I see your insurance changed...did you change employers or did you get a policy through ACA?"
"Same employer, we switched it to my wifes payroll"
"I need the policy number and the individual holder number as well please"
"I have a card, won't you just scan it tomorrow when I come?"
"We will, but I need both numbers before I can confirm the appointment - this is a new policy"
[I'm thinking..new policy...mm mmm you are going to verify the policy before I can come]
[gave her the numbers]
"Thank you..please hold while I verify your policy is active through Anthem."
[La la la la]
"Thank you Mr. #### your policy is active we will see you tomorrow then"
++++++++++++++++++++++++++++++

I have went to this same specialist for over 20 years, I helped him setup his office network about 15 years ago so I know him on a personal level..his practice now has 6-7 doctors and it's own surgery center.
Anyway - so I had this conversation:
"I see you guys are verifying insurance is actually active before you accept an appointment"
[scowl on his face]..."unfortunately yes, we have had to change a number of things."
"Obamacare eh?"
[settles in his chair...]
"We have injections we give patients where Medicare gives up LESS payment than what it cost us, and now we are having people showing up with Medicaid as well...try running a medical office where you have to put cost over care. It is ridiculous, everything is now about reducing cost. There will be people we will have to tell they can't get an operation because we can't afford to do it for what Medicare/aid pays, I have never turned a patient away in 27 years till now"
"I am going to have to find ways to cut cost as well...something else I haven't had to do in 27 years either"

Anecdotal.

How much do the injections cost him? How much do they cost to produce? That is where the problem lies.

 

[iamwhatiseem]

Anecdotal.

How much do the injections cost him? How much do they cost to produce? That is where the problem lies.

Yes this is obviously anecdotal...it is a story of one medical office. Having said that, would you argue it is isolated? Didn't think so.
As to the cost of pharmaceuticals etc. being the problem - you may be right. However, like most problems in our healthcare system - it was not addressed by Obamacare.

 

[LoneLaugher]

Anecdotal.

How much do the injections cost him? How much do they cost to produce? That is where the problem lies.

Yes this is obviously anecdotal...it is a story of one medical office. Having said that, would you argue it is isolated? Didn't think so.
As to the cost of pharmaceuticals etc. being the problem - you may be right. However, like most problems in our healthcare system - it was not addressed by Obamacare.

Addressing it would have required GOP cooperation. It requires GREATER government involvement in the health care industry. Which is, as you know, kryptonite for any GOP politico.

The continued existence of a problem that was not addressed by the ACA cannot be blamed on the ACA. Your doc's problem is the high cost of the medicine that he needs to provide his patients. It is not the low Medicare and Medicaid contributions.

It can be blamed on the policies/leaders which/who allowed it to exist in the first place.

 

[iamwhatiseem]

Anecdotal.

How much do the injections cost him? How much do they cost to produce? That is where the problem lies.

Yes this is obviously anecdotal...it is a story of one medical office. Having said that, would you argue it is isolated? Didn't think so.
As to the cost of pharmaceuticals etc. being the problem - you may be right. However, like most problems in our healthcare system - it was not addressed by Obamacare.

Addressing it would have required GOP cooperation. It requires GREATER government involvement in the health care industry. Which is, as you know, kryptonite for any GOP politico.

The continued existence of a problem that was not addressed by the ACA cannot be blamed on the ACA. Your doc's problem is the high cost of the medicine that he needs to provide his patients. It is not the low Medicare and Medicaid contributions.

It can be blamed on the policies/leaders which/who allowed it to exist in the first place.

uhh...no.
Apparently you know no one on Medicaid...there is a reason people with Medicaid get secondary insurance. It doesn't pay for a plethora of procedures/medicines/devices - you name it.
Medicare/Medicaid is terrible coverage. It pays less for all medical costs, not just pharma.
As the doctor said - he has never turned away a patient because medicaid paid so little for AN OPERATION. Because he recuped the loss by insured patients.
His trouble is with the increased number of Medicaid/Medicare patients - the scale has been tipped over and he doesn't have enough insured patients to cover the losses.

 

[rdean]

Just saw two doctors on Morning Joe talk about a woman charged $25,000 to get a white spot scraped off her skin. When asked about Obamacare, they said this kind of thing would be much less common because of the forced transparency.

 

[Luddly Neddite]

Gee, this is almost the same thing that happened to me -

Except that I now don't pay any co-pay for doctor's office visits,
My scrips cost less,
We got two refunds because of the 80% mandate,
And our premium is less.

Betcha I know why the difference ...

Note to OP - Don't blame ObamaCare for your insurance company's and/or your doctor's requirements when you change your situation.

 

[Rozman]

The evidence is out there.
More and more every day.
ObamaCare suks!

How many of the 48 million that did not have insurance before ObamaCare have now signed up?
Would like to know the answer.Last I heard 2 million signed up. Over 5 million dropped.

So we are still at the point where more people have been dropped from their plan then have signed up.

 

[Rozman]

Went to pickup 2 prescriptions yesterday.
It used to cost $7.00 each.
Yesterday they were $20.00 each.

Reason.My plan through the company was dropped by the provider.
We had to sign up with the same provider for a plan that is supposed to cover us through February 2014.Then we have to find a new provider.This one that we had for the last 5 years will no longer cover us past next month.
The plan that we now have has higher prescription costs,the same premium,higher co pay at the doctor's office,higher co pay for procedures at the doctors office like EKG and the like,$1,500.00 for a trip to the ER,$6,000.00 deductible for hospital stay.

I have no idea what plan we will end up with but all of us in the company are sure it will be more expensive.
Probably similar to what we now have.

 

[billyerock1991]

I needed to go to the doctor - so yesterday I called to make an appointment.
"I see your insurance changed...did you change employers or did you get a policy through ACA?"
"Same employer, we switched it to my wifes payroll"
"I need the policy number and the individual holder number as well please"
"I have a card, won't you just scan it tomorrow when I come?"
"We will, but I need both numbers before I can confirm the appointment - this is a new policy"
[I'm thinking..new policy...mm mmm you are going to verify the policy before I can come]
[gave her the numbers]
"Thank you..please hold while I verify your policy is active through Anthem."
[La la la la]
"Thank you Mr. #### your policy is active we will see you tomorrow then"
++++++++++++++++++++++++++++++

I have went to this same specialist for over 20 years, I helped him setup his office network about 15 years ago so I know him on a personal level..his practice now has 6-7 doctors and it's own surgery center.
Anyway - so I had this conversation:
"I see you guys are verifying insurance is actually active before you accept an appointment"
[scowl on his face]..."unfortunately yes, we have had to change a number of things."
"Obamacare eh?"
[settles in his chair...]
"We have injections we give patients where Medicare gives up LESS payment than what it cost us, and now we are having people showing up with Medicaid as well...try running a medical office where you have to put cost over care. It is ridiculous, everything is now about reducing cost. There will be people we will have to tell they can't get an operation because we can't afford to do it for what Medicare/aid pays, I have never turned a patient away in 27 years till now"
"I am going to have to find ways to cut cost as well...something else I haven't had to do in 27 years either"

in the past it was you had to be able to pay the cost or nothing at all ... then when you were very sick and need health care, you got canceled by the policy holder ... Just because you had a wart on you ass in 1969 removed and didn't tell them ... whose problem is it now ??? yours !!!! where you had the choice cough up the money or die ... now these Big babies doctors are complaining that they don't get enough money for their 10 min. service give me a break ... what did these doctor do when the insurance company said they won't pay your bill ... even though you had a policy and they say your canceled because you lied on your policy, you did what ??? Filed bankruptcy... how did that work for your whiny doctor friends ...

 

[billyerock1991]

it amazes me about how some doctor hate the ACA not the majority but some ...when many more embrace it ... I have real bad knees from a fall broke them both, the caps I walk like frankinstein ... we were talking and it was his opinion that he felt that everybody should have medicare ... that way all doctors know they will get paid something for their services... he felt that nobody should not have health care ... his statements not mine... he felt the employees should be taxed each month ... then have a tax deduction from their income to offset the cost of your plan ... where the employer wouldn't have to cough up any cash for your health care any more... i thought it was a good Idea ...

 

[billyerock1991]

Went to pickup 2 prescriptions yesterday.
It used to cost $7.00 each.
Yesterday they were $20.00 each.

Reason.My plan through the company was dropped by the provider.
We had to sign up with the same provider for a plan that is supposed to cover us through February 2014.Then we have to find a new provider.This one that we had for the last 5 years will no longer cover us past next month.
The plan that we now have has higher prescription costs,the same premium,higher co pay at the doctor's office,higher co pay for procedures at the doctors office like EKG and the like,$1,500.00 for a trip to the ER,$6,000.00 deductible for hospital stay.

I have no idea what plan we will end up with but all of us in the company are sure it will be more expensive.
Probably similar to what we now have.

Ive seen this happen to others ... what I found out is you will have higher prescriptions cost here's where it comes into play ... even thought you migh have a drug that doesn't cost a lot I have a friend whose on a long term of OxyContin this drug alone will cost you personally with out health care 2000 dollars a month.. why??? I don't know ...but it does ...his prescription cost is 40 dollars a month to get this drug under medicare with the new laws he pays 20 dollars a month ... now he can buy some of the other drug he need to live .

 

[iamwhatiseem]

it amazes me about how some doctor hate the ACA not the majority but some ...when many more embrace it ... I have real bad knees from a fall broke them both, the caps I walk like frankinstein ... we were talking and it was his opinion that he felt that everybody should have medicare ... that way all doctors know they will get paid something for their services... he felt that nobody should not have health care ... his statements not mine... he felt the employees should be taxed each month ... then have a tax deduction from their income to offset the cost of your plan ... where the employer wouldn't have to cough up any cash for your health care any more... i thought it was a good Idea ...

 

[billyerock1991]

Yes this is obviously anecdotal...it is a story of one medical office. Having said that, would you argue it is isolated? Didn't think so.
As to the cost of pharmaceuticals etc. being the problem - you may be right. However, like most problems in our healthcare system - it was not addressed by Obamacare.

Addressing it would have required GOP cooperation. It requires GREATER government involvement in the health care industry. Which is, as you know, kryptonite for any GOP politico.

The continued existence of a problem that was not addressed by the ACA cannot be blamed on the ACA. Your doc's problem is the high cost of the medicine that he needs to provide his patients. It is not the low Medicare and Medicaid contributions.

It can be blamed on the policies/leaders which/who allowed it to exist in the first place.

uhh...no.
Apparently you know no one on Medicaid...there is a reason people with Medicaid get secondary insurance. It doesn't pay for a plethora of procedures/medicines/devices - you name it.
Medicare/Medicaid is terrible coverage. It pays less for all medical costs, not just pharma.
As the doctor said - he has never turned away a patient because medicaid paid so little for AN OPERATION. Because he recuped the loss by insured patients.
His trouble is with the increased number of Medicaid/Medicare patients - the scale has been tipped over and he doesn't have enough insured patients to cover the losses.

what it doesn't pay is the outrages price your doctor whats to charge ... I'm in good standing with my doctor ... we both play guitars I own a recording studio ....on Occasions we record ... he's a great Mandolin player too ... he things Medicaid and medicare are fine ... he feel that its better then nothing at all ... which many use to have... nothing ... and the doctor didn't get paid the hospital didn't get paid ... but now they will ...if its not enough money for them, fine, sue them...