Monday, April 19, 2010

The Ups, Downs and Surprises in Obama's Health Plan


The Plan that recently passed is hardly perfect.



I mean that in both a good and a bad way.


That's the good news.






Bucksome said...

Grace, I just posted yesterday about three family members that benefit from the health insurance reform bill.

I didn't know about this benefit loss. My employer never did allow us to submit claims for over the counter drugs so it doesn't impact me personally but it makes me wonder what else don't we know?

Morrison said...

Hold onto your wallets folks. It's going to be a bumpy ride.

We already have an Obama-like plan here in NY. Everyone must be accepted when they apply for health plans-no pre-existing clause. The result? Well people don't get coverage till they get sick which has been costing the rest of us (who hang onto the health care) plenty! In the HMO alone that I am under, there used to be 132,000 insured. Now, there are only 23,000 and the rest of us are paying dearly with higher premiums to make up the deficit. The fee penalty that Obama will impose is way less than the coverage costs, so quess what? Most other Americans will be doing what these NYr's have been doing-they wait till they get sick, like cancer or heart disease and then sign up and drain the system.
Last week, after 160 years in business, St. Vincent's Hospital, which served the downtown areas, closed it's doors for good. Why? because of NY's amnesty position (they accept all illegal aliens and do not report them to INS) For decades, this hospital took care of the uninsured till it bled the hospital to death (no pun intended) Despite billions and billions of both federal and state aid, the hospital closed and laid off 3500 employees. Now, downtown NY, right in the World Trade Center area has absolutely no hospital.
Where are the citizens to go now? Where????

I believe that all Americans are entitled to universal health care: 100%. But at what costs? NY govt sponsored health care, which I pay dearly for, covers less and less each and every month. I can only get an annual physical every 3 years. Last month I went for my yearly gyn visit and was asked to leave by the nurse! Why? Because I was 1 week shy of a full year between visits and my insurance would not cover it. I had to come back. I went to a heart specialist and his bill came to $4040. My insurance only paid him $723. How is this doctor to stay in business?

It's only going to get worse and worse and worse. It is NOT going to get better. DH and I have been going to get all our tests done NOW because under the new health care, most procedures (like hip & knee replacements) will stop at the age of 55. I'm 59 and I have severe arthritis. For me (and DH) our futures don't look to bright because Obama care will be cutting medicare to pay for the younger citizens.

Yup! Hold onto your wallets and hope you can afford airfare-to fly to another country to get the care you need. Because it won't be here in the good old USA.

Grace. said...

I have to say I don't buy these doomsday scenarios, Morrison.

Insurance companies who fail to cover pre-existing conditions are not worthy of our pity.

I'm not thrilled that my OTC medications will no longer be covered by pre-tax dollars, but it is a small price for me to pay to allow everyone to have health coverage.

velvet jones said...

Actually, over-the-counter drugs (and insulin) will require a prescription to be reimbursed through FSA, HRA, and HSA beginning 1/1/2011. So it's not like you can't get the OTC's with your FSA, etc., you just have to get your doc to write/call-in a script for it. A hassle, to be sure.

Morrison said...

Grace, I didn't tell you what was going to happen in the future. I am telling you what is going on now, today, immediately: St. Vincent's Hospital closed last week, my govt run insurance plan pays my doctors less & less (how are they to survive?) and I keep paying more and more for less and less coverage.
Will Obamacare make this better? Only time will tell, right?

Personally, as it stands now, I'm only worrying about myself. You may think you are paying a small price now, but as I said, only time will tell. It's easy to be an armchair moderator, till it happens to yourself. Then, all bets are off.

As for pre-existing conditions-it's like auto insurance. What would be the status of companies if, only after someone is in an accident, they call the car insurance company and demand coverage and force the company to pay for the repairs? How long can insurance companies stay in business?

Exactly-they will go out of business. So, in effect we already have universal single payer health care under Obamacare because eventually all the insurance companies will go out of business. Technically, Obamacare now dictates to the insurance company, who they will cover, how much they will pay the doctors (BTW-none of my doctors are American born-they all come from India, Pakistan etc. etc.)and what medications we will take.

It is what it is.

I am, however, extremely committed that ALL American citizens are entitled to health care AND receive it. I'll do my part and pay my way but alas, Grace, I can't save the whole, wide American world.

Anonymous said...

I too think this is a much needed step in the right direction. There are simply too many people (I could start sharing personal anecdotes here but the response would be too long) who CANNOT get health insurance. A lot of people are denied for pre-existing conditions or are priced out. I have a personal policy that I hang onto as tight as I can with my two little hands, even though I've had little benefit from it (it's high deductible & pays for nothing until I hit the deductible, though I do get the PPO discounts) and the company raises the premium EVERY STINKING YEAR until I'm afraid that eventually I won't be able to afford even this policy. (To have a well-woman exam costs me over $600.00, so I stretch out the time between them as long as I can). Still, I consider myself lucky. At least I'm insured. I have friends who can afford insurance but can't get it. It's a scary way to live and it's maddening.
Yes, I foresee problems. We don't have enough primary care providers now, and that will only get worse. I'm sure there are other -- as you say -- not so pleasant surprises, but I'm convinced it will be better than what we have now -- at least in this state (Texas, the home of the free and the uninsured).

MasterPo said...

MasterPo agrees with Morrison.

There are many decent gov programs out there now people in need of health care and qualify for but are just too figg'n lazy! MasterPo knows 2 mothers off the bat who definately qualify for Medicaid but just haven't done the forms, even with social worker help!

MasterPo and Mrs. MasterPo worked DAMN HARD all our lives to be able to have it good, including a generous health plan. Let others do the same.

It's the "step in the right direction" thinking that perpetuates the false concept that Americans lay gasping and dying in the streets while people in suits walk around them! Totally false!

In ever single case MasterPo has ever heard of in terms of insurance denial if you look at the details there is a good, legitmate reason for the denial.

They didn't pay the premiums as required.
They didn't get pre-approval for a non-life threatening procedure or test.
They didn't understand (or more likely didn't want to understand!) their policy has limits on this or that.

Something along those lines.

MasterPo has NEVER seen a case of a person in good standing is denied all benefits for an accident or illness just because the insurance decided to say "no".

Urban myth.

Anonymous said...

I, too, have worked DAMN HARD all of my life to have a good health plan. I am thrilled that my niece, who survived cancer when she was five years old, will now be able to have a good health plan in spite of her "pre-existing condition" which some people apparently think is a good, legitimate reason to deny her coverage. Shame on you greedy people.

Anonymous said...


Morrison - Can you tell me where in the new health care bill it says this?


Sharon said...

Wow Grace, you sparked some interesting comments. I, however, will not comment on this subject....yet....

MasterPo said...

"Shame on you greedy people."

While MasterPo is pleased to hear the good news about your niece, so now it's "greedy" that one person should not have to pay more so someone else has coverage?

By what right on Earth or in Heaven do you stake a claim on someone else's paycheck for your own benefit?

The fact remains as a cancer survivor your niece has a high risk of re-developing cancer than someone who never had cancer at all. And for that she is a greater risk to insurance. Period.

It is disgraceful that people like you (and MasterPo has met quite a few!) believe others have an obligation under force of law to pay for someone else.

MasterPo said...

Anon - Obamacare clearly spells out a "formula" for determining benefit vs. costs of treatment where "benefit" is subjectively quantified as how much you are expected to contribute to society.

IOW, a cost/benefit analysis: It will cost $20,000 for a hip replacement on a 60 y/o who will be retiring in 5 years and no longer being a significant, productive contributor to society.

In the words of Obama himself "Maybe a pain pill would be a better treatment".

MasterPo said...

ps- MasterPo is still looking for an example of a person with paid-up/good-standing coverage who was denied treatment just because the insurance company said "No!".

In fact, MasterPo had dinner this evening with a woman who works in a doctor's office and was asked this very question. The woman had to admit that MasterPo was right in that in all cases she has ever seen (10 year+ career in a MD's office) of denial of coverage was due to some issue with the premium payment, lack of pre-approval, exceeding policy limits, etc. and not because of "mean" and "greedy" insurance companies wanting people to die and keep the profits.

Anonymous said...

Master PO,

My husband and I have also worked DAMN HARD, as you put it. My husband was the first in his family to graduate high school, much less college, much less law school. And I put him through that law school. And then finished college myself, the first in my family to do so.

Now that we have that out of the way, we can get to the healthcare part. My daughter's daughter was born with an inherited disorder that was expected to kill her by age two. She's outlived all expectations, but she has required nutritional, occupational, physical and speech therapy. She has a malformed kidney, is deaf, and has an underlying metabolic disorder that makes her prognosis unknowable. My daughter, a single mom working fulltime at the time of her daughter's birth, had to give up her job to take her daughter to said therapies and to basically keep her alive. Her metabolic disorder meant she kept crashing and going into what's known as decompensations. Due to her efforts, my granddaughter is now alive, mainstreamed in kindergarten and well on her way to being a productive member of society.

However, we had to support this little family for a while and that included replacing the health insurance that my daughter and her older daughter no longer had since she wasn't employed. It was mega expensive, but that wasn't the problem. My daughter kept getting turned down for private insurance, as did her daughter. ACCESS is the problem. We are all intelligent, driven people who searched and did all we could and finally found an insurance policy that my daughter is basically afraid to use. Not a lazy bone in any of our bodies. Not a greedy one, either, as my husband is the go-to guy in both our extended families if anyone needs help, financial or otherwise. But you just plain don't know what you're talking about.

And this morning, I read about an insurance company that immediately flags any woman who has been diagnosed with breast cancer and looks for a reason to cancel her policy.

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

Do you plan to collect Social Security or Medicare? If so, you will be "staking a claim on someone else's paycheck for your own benefit." Do you plan to pay for your medical care out of pocket once you reach the point that your costs exceed what you have paid in?

In a civilized society we all pay for things we may not personally use but acknowledge are for the common good: schools for children who are not our own; roads we personally never drive on; libraries we never utilize; and, yes, health care.

People who care about only themselves ARE greedy and they are the ones who are a disgrace. If the shoe fits, MasterPo.

Morrison said...

To the Anon with a v. disabled child, and to other commenters, please read this article:

Rahm Emanual's brother, Dr. Ezekiel Emanual, a bioethicist, has been the main adviser to Obama regarding our new health care. Dr. Ezekial specializes in end of life issues and euthanasia. His actions and recommendations apply to both the elderly AND children. The Dr. doesn't believe that life begins till after a child is 2 years old. So, if a child is born with any deformity, that child will be subject to medical denials. Dr. Ezekiel has put several policies into play in the new heath care bill: the policy to deny coverage to the elderly and disabled for the greater good of the country. The elderly with dementia and the young with neurological disorders should be sacrificed for the good.

Don't want to believe this? Fine BUT it is well documented. Just google him, read and weep. Any child born with an inherited disorder will be eventually terminated. Same for the elderly. Dr Ezekiel has determined that 55 years of age is the turn off point for elderly care. This practice is already in practice in UK. They have a formula in place that takes the cost of the operation, i.e. hip or knee replacement, divided by your age and number of years left to live and if it doesn't make financial sense, the operation procedure is denied.

Still don't want to believe this? Fine. I guess we will all find out when we reach our late fifties and discover our future is a wheel chair. By then, it will be way too late.

In order for all the masses to be insured, there must be some cuts along the way. The new Obama care is well documented that severe cuts have been made to Medicare (Obama wants the broke states to pay the difference. Duh?) in order to insure the middle youth. The knife cuts both way: the elderly and the newborn.

BY the time Obamacare goes into effect by 2014, both Grace and I will be eligible for Medicare. We both won't even benefit from Obamacare and will be subject to whatever Medicare will be doling out at that time. My advice: get yourself in tip top medical condition right now and try to live out the rest of your life as healthfully as possible.

Ain't nothing wrong with that advice. Nothing.

Grace. said...

Whoa, Morrison!

You do know that you are entirely incorrect as to the UK, right? In fact, I'm thinking that's where you got your statement about Obama's health plan not allowing knee or hip replacement after age 55. Some idiot congressman said that the UK did not allow replacements after age 55, and that's what you get with socialized medicine. As it turns out, 60% of all replacements done in the UK are for folks over 55, well into the '80's and '90's.

I admire your passion, worry about your fears, and really, really wish you'd check your facts.

MasterPo said...

Morrison is 100% correct regarding Dr. Emanual and his philosophies.

Frankly, it's a thought that MasterPo has had as well in so far as if medical treatment can be denied for the very old, why not the very young? Scary isn't it! But it's out there whether you choose to believe it or not.

SS is a very poor example because MasterPo pays into the system as well as MasterPo's employer. Plus (in theory) there should be some element of investment growth on the funds (bogus as it is). Therefore, when MasterPo get's SS (IF SS is still around) a large portion is what MasterPo paid in and is now getting back. The difference is "insurance".

"Insurance" is pooled risk meaning that it is expected some will draw on the coverage and some won't. For example, in all MasterPo's years of driving never had an insurance claim on auto damage yet still pays for collision insurance. And because of no claims MasterPo pays a lower rate. However, someone with several accidents, while may have same coverage, pays a lot more because they have shown a greater risk for having accidents and therefore is more likely to draw on the pool of coverage.

What's so evil about that?

Reality check:

Something like cancer can cost tens of thousands $$$ or more to treat.

Where is the "fairness" in someone paying a mere $2,000 now and the other policy owners having to shell out $50,000 or more immediately in treatment? (and maybe more later) Talk about a ponsio scheme!!

In any other financial transation that involves some kind of payment in for a possible payment out later, the sooner you take a payment out then the more you pay now or the less the payment is (ex: a lump sum payment into an immediate life annuity pays much less than a lump sum payment into a life annuity 20 years before retirement).

Let MasterPo leave you with this thought:

If you're so sure that MasterPo and others are "greedy" for taking care of our families first and foremost, then would you go up to a stranger on the street and DEMAND money from them because you think that appear to have some extra $$$ and they are greedy for keeping it?

If you would do that to MasterPo face-to-face then MasterPo concedes your point.

But if you wouldn't get your hands dirty and instead want the government to take MasterPo's hard earned money then it is YOU who is greedy and a disgrace.

Not racist.
Not violent.
Just not silent any more.