hospitals are only taking certain companies on the exchange or none at all. this means if you get your plan through the exchange there is a good chance that you are going to be paying out of network costs.
doctors are even worse. i would have to look again but i think 70% of the doctors interviewed were not going to take exchange insurance.
only about 22% of the 500+ doctors said they would take it and other doctors are thinking of dropping all insurance.
they are basically tired of getting screwed.
As a person who works with several medical entities and has a lot of family in medicine, I'll back this up - the vast majority of good doctors and hospitals in my area are backing away from exchange insurance. At best, a few are approaching it cautiously.
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hospitals are only taking certain companies on the exchange or none at all. this means if you get your plan through the exchange there is a good chance that you are going to be paying out of network costs.
doctors are even worse. i would have to look again but i think 70% of the doctors interviewed were not going to take exchange insurance.
only about 22% of the 500+ doctors said they would take it and other doctors are thinking of dropping all insurance.
they are basically tired of getting screwed.
As a person who works with several medical entities and has a lot of family in medicine, I'll back this up - the vast majority of good doctors and hospitals in my area are backing away from exchange insurance. At best, a few are approaching it cautiously.
They're lying if they're saying THEY are. They're not allowed to pick an choose policies they participate in and networks within a company that exist in the exchange must have a non exchange policy they overlap with.
If they don't want to take UHC exchange plans, they can't take ANY UHC plans, etc. And every insurance company is required to offer exchange plans (3 minimum I think?).
Now on the reverse though many insurance companies are slimming the range of their networks which means the average doctor will accept fewer. (Although out of network claims are required under the ACA - but out of network is annoying and generally more costly even after reimbursement)
They're lying if they're saying THEY are. They're not allowed to pick an choose policies they participate in and networks within a company that exist in the exchange must have a non exchange policy they overlap with.
Umm, that doesn't make sense. Helathcare providers (not the insurance companies -- the doctors) don't have to take any patients they don't want to, as long as they aren't discriminating based on a protected class and aren't an ER.
Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
If they don't want to take UHC exchange plans, they can't take ANY UHC plans, etc. And every insurance company is required to offer exchange plans (3 minimum I think?).
[Citation]?
There may be contracts between the insurance companies and the providers, but there's no law that I'm aware of that requires a healthcare provider that takes one plan to take every plan from that insurance company.
They're lying if they're saying THEY are. They're not allowed to pick an choose policies they participate in and networks within a company that exist in the exchange must have a non exchange policy they overlap with.
Umm, that doesn't make sense. Helathcare providers (not the insurance companies -- the doctors) don't have to take any patients they don't want to, as long as they aren't discriminating based on a protected class and aren't an ER.
Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
If they don't want to take UHC exchange plans, they can't take ANY UHC plans, etc. And every insurance company is required to offer exchange plans (3 minimum I think?).
[Citation]?
There may be contracts between the insurance companies and the providers, but there's no law that I'm aware of that requires a healthcare provider that takes one plan to take every plan from that insurance company.
Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
In fact, Obamacare seems to have incited quite a few doctors and medical centers to go "concierge," taking cash payments up front for services rendered and backing off their standard practice proportionally. (BMJ, sadly paywalled)
As more and more doctors offer concierge-type services, it'll be the new free market of healthcare, and cash customers will want this service. Meanwhile, non-cash customers will be competing for ever-smaller shares of medical practitioners' time, creating queues. The prediction is that Obamacare is basically going to result in a health system that is as bad as Canada's if you're poor (multiple-month waits for non-emergency care) but like the plot of Elysium if you're rich.
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Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
In fact, Obamacare seems to have incited quite a few doctors and medical centers to go "concierge," taking cash payments up front for services rendered and backing off their standard practice proportionally. (BMJ, sadly paywalled)
As more and more doctors offer concierge-type services, it'll be the new free market of healthcare, and cash customers will want this service. Meanwhile, non-cash customers will be competing for ever-smaller shares of medical practitioners' time, creating queues. The prediction is that Obamacare is basically going to result in a health system that is as bad as Canada's if you're poor (multiple-month waits for non-emergency care) but like the plot of Elysium if you're rich.
this is why my system of a massive HSA system works and works well.
i wish i could talk my company into just giving me the amount of money it spends on insurance into an HSA every year.
plus my own contribution. i have 0 premium to pay and can put in whatever i want.
the account would just grow and grow + interest.
a simple 10% tax 5% by you and 5% by the company + whatever else the company wanted to contribute tax deducted.
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Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
In fact, Obamacare seems to have incited quite a few doctors and medical centers to go "concierge," taking cash payments up front for services rendered and backing off their standard practice proportionally. (BMJ, sadly paywalled)
As more and more doctors offer concierge-type services, it'll be the new free market of healthcare, and cash customers will want this service. Meanwhile, non-cash customers will be competing for ever-smaller shares of medical practitioners' time, creating queues. The prediction is that Obamacare is basically going to result in a health system that is as bad as Canada's if you're poor (multiple-month waits for non-emergency care) but like the plot of Elysium if you're rich.
While our system may get glorified by plenty of idiots our system is far from "bad"
They're lying if they're saying THEY are. They're not allowed to pick an choose policies they participate in and networks within a company that exist in the exchange must have a non exchange policy they overlap with.
Umm, that doesn't make sense. Helathcare providers (not the insurance companies -- the doctors) don't have to take any patients they don't want to, as long as they aren't discriminating based on a protected class and aren't an ER.
Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
Yes and no - they can refuse people on X insurance but if they're refusing people on X insurance they have to refuse them for that insurance company on their standard non-exchange policies as well as their exchange policies.
They can't parse out just some from within a providers packages. The only way they could do that is if some of the providers start going EXCLUSIVELY exchange - which I'm not aware of.
There might be some weird corner cases where it can happen - but overall it can't ON THE PROVIDERS SIDE - the insurers side is definitely narrowing network sizes though, which does have a similar net effect.
But it's chicken and the egg - where we know the insurer is the one starting things.
If they don't want to take UHC exchange plans, they can't take ANY UHC plans, etc. And every insurance company is required to offer exchange plans (3 minimum I think?).
[Citation]?
There may be contracts between the insurance companies and the providers, but there's no law that I'm aware of that requires a healthcare provider that takes one plan to take every plan from that insurance company.
[/quote]
Citation on which part? Every insurance company that wants to provide something requiring an exchange offering (or multiples) is part of the ACA and pretty well publicized.
On the other half that's stuff I've known since '90 or so when I was working in the medical records for the doctor's office way back when - they can try to find another excuse to refuse a patient - but if you say "I'm refusing you because you have Y insurance package managed by BC/BS" that's illegal unless that office is refusing ALL BC/BS packages.
It's similar to EOE that way - you can find secondary reasons to get around it - but the overt version is not permitted unless EVERY package managed by the company is also refused.
[But I don't know the law to cite, it's possible it's a MD only thing as that's the only state I did records for, although we did have some PA patients pretty sure PA laws don't apply for such cases]
Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
In fact, Obamacare seems to have incited quite a few doctors and medical centers to go "concierge," taking cash payments up front for services rendered and backing off their standard practice proportionally. (BMJ, sadly paywalled)
As more and more doctors offer concierge-type services, it'll be the new free market of healthcare, and cash customers will want this service. Meanwhile, non-cash customers will be competing for ever-smaller shares of medical practitioners' time, creating queues. The prediction is that Obamacare is basically going to result in a health system that is as bad as Canada's if you're poor (multiple-month waits for non-emergency care) but like the plot of Elysium if you're rich.
this is why my system of a massive HSA system works and works well.
i wish i could talk my company into just giving me the amount of money it spends on insurance into an HSA every year.
plus my own contribution. i have 0 premium to pay and can put in whatever i want.
the account would just grow and grow + interest.
a simple 10% tax 5% by you and 5% by the company + whatever else the company wanted to contribute tax deducted.
Technically speaking if you're trying to echo Singapore you're missing a few key points that effect a handful of people although that is how it works for the majority of people. [Also I believe the government collects the interest for themselves, that it goes towards the "overflow" costs when someone ends up costing the system money when they need care over what they've paid in and the government eats the bill]
They're lying if they're saying THEY are. They're not allowed to pick an choose policies they participate in and networks within a company that exist in the exchange must have a non exchange policy they overlap with.
If they don't want to take UHC exchange plans, they can't take ANY UHC plans, etc. And every insurance company is required to offer exchange plans (3 minimum I think?).
Now on the reverse though many insurance companies are slimming the range of their networks which means the average doctor will accept fewer. (Although out of network claims are required under the ACA - but out of network is annoying and generally more costly even after reimbursement)
I thought accusing people of lying wasn't something you did. Tsk tsk.
As has been noted, it's an all or nothing approach and the reality as documented here is that an overwhelming majority of doctors are either refusing to take anyone in the exchanges or are tiptoeing around a final decision on it.
All the way back to 09 and the healthcare debates doctors were saying these very things, as well as talking about retiring instead of attempting to ride this out of control and toxic bull. Sure Obama had his press conferences with doctors as props backing him up saying that everything was great and it was supported across the board but those were schills and direct employees for those who lobbied for this.
There's the Romneycare example that shows exactly where this is going to go. The reforms and policy changes spoke of in the article are not going to stop the flow of doctors and providers out of the system, at some point it comes down to a simple "who wants to deal with that kind of headache for so little gain?" game.
It's amusing the acidic attacks from Democrats and their media on this entire thing. The patchwork demands to force every doctor to take every patient no matter what they have, Medicaid/Care or whatnot shows the attempted strongarm tactic to make up for the fact that the entire law and everything it is about just doesn't work, but as I've mentioned several times we can get past the point of saying it was designed to work.
Pay attention, there's calls for single payer hitting the media everyday, only to escalate as this thing blows up.
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Right and that's another example of how they can by sidestepping the actually discriminating against exchanges which is a lie. (And I don't call people in Debate liars, people secondhand are a different story...)
It's perfectly acceptable to say "Oh, we're not accepting any new patients" to prevent ALL new patients, exchange or otherwise. With the only exceptions made being obvious logical extensions (i.e. family members of existing patients).
And it's not an "overwhelming majority" overall - it does seem that way in a handful of states however since some people are quoting its par for the course some places, while others its unheard of. (Any network shrinking here is entirely on the insurance side of the equation in MD - and have thusfar heard of literally ONE case that the hospital is reconsidering in a public statement...)
On accepting Medicaid, that's a local program - not seen a Federal politician weigh in, nor does it make sense for them to - and on Medicare, it's an all or nothing thing with how it is under the law more or less. If you want the maximum payout from Medicare, you need to keep yourself open to Medicare patients until you hit the Medicare client cap (varies by field) - if say you take ten Medicare patients and cut it off there (which is perfectly permissible) you'll have a ****ty payout because you'll get an automatic F rating and get payouts about a third of what you'd get with an A rating (And it's not hard to attain basically it's keep accepting Medicare patients until you hit the cap and don't screw up more or less...) - there's no sensible reason a doctor would want to half-ass how many Medicare patients they take, but outside of a HOSPITAL setting there's no requirement to take it. Hospitals however are required to unless they want to exempt themselves from Federal repayment on defaulted bills. (Which of course is a big deal, since no matter what some patients die even if living ones have a 100% pay rate)
. . . (Any network shrinking here is entirely on the insurance side of the equation in MD - and have thusfar heard of literally ONE case that the hospital is reconsidering in a public statement...)
. . .
On accepting Medicaid, that's a local program - not seen a Federal politician weigh in, nor does it make sense for them to . . .
Maryland has had it's own problems with Obamacare
*96% of enrollees to the program are just signing up for your local issue - Medicaid - http://www.nationalreview.com/corner/362389/over-96-percent-obamacare-enrollees-maryland-signed-medicaid-sterling-beard
(this is a problem b/c insufficient young people are signing up for O-care means that premiums will have to rise; also, the number of Medicaid enrollees will increase the state's budget problems down the road when they start to foot a percentage of the medicaid bill for these enrollees)
These problems are not unique to Maryland, but are illustrative of the problems faced all around the country - cut hours for part-time employees, loss of current insurance, etc.
So I just tried to find a plan for me, my wife, and our one child - non smokers - I'm 33, she's 37, kid is 5. We both work, and make 40k/yr household.
Lowest price available is $615 a month. (an increase of about $140, from what we have been paying)
I'd have to take a second part-time job aside from my full time job just to pay for the health insurance. Then, if I did, because of our increase in income from that second job - I bet the rate would change.
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are we bound to prosperity and ruin.”
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So I just tried to find a plan for me, my wife, and our one child - non smokers - I'm 33, she's 37, kid is 5. We both work, and make 40k/yr household.
Lowest price available is $615 a month. (an increase of about $140, from what we have been paying)
I'd have to take a second part-time job aside from my full time job just to pay for the health insurance. Then, if I did, because of our increase in income from that second job - I bet the rate would change.
Wow, that's over 18% of your gross income! I (fortunately) don't have to take part, so I'm not sure how it works, but is that pre- or post-subsidies and discounts?
Although previously your rate was still over 14% - if that's the healthcare component of my income tax over here, then the remaining income tax is phenomenally low!
We don't have joint filing of taxes, so I put your total income as your personal income into the New Zealand tax calculator (using a rough exchange rate of 0.8:1) to see what the highest possible tax bill would be. It turns out it would be about US$7.2k for the year, but because of the child, you'd get about $4k in tax credits, if I'm reading it correctly.
So something on the order of $267/month would cover income tax and healthcare (almost, GP visits have a small out-of-pocket cost, but are free for under-6s).
Curse this socialist dystopia. Pray (or hope, depending on your stance on deital existence) that the Fresh Prince gets his way and you never have to endure it.
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If Frozen Solid is not reprinted, you are aware that I'm quoting you in my sig for eternity?
So I just tried to find a plan for me, my wife, and our one child - non smokers - I'm 33, she's 37, kid is 5. We both work, and make 40k/yr household.
Lowest price available is $615 a month. (an increase of about $140, from what we have been paying)
I'd have to take a second part-time job aside from my full time job just to pay for the health insurance. Then, if I did, because of our increase in income from that second job - I bet the rate would change.
welcome to obamacare. you are young and healthy therefore you are going to get smacked.
i found the kaiser family calculator and ran mine. i got slammed too.
although not as bad. it was only a 50 dollar increase from what i was paying. but the coverage was worse.
millions of middle class people are getting slammed by this thing.
So something on the order of $267/month would cover income tax and healthcare (almost, GP visits have a small out-of-pocket cost, but are free for under-6s).
Curse this socialist dystopia. Pray (or hope, depending on your stance on deital existence) that the Fresh Prince gets his way and you never have to endure it.
new zealand is not the US. in the US if they were to impliment single payer system pay roll taxes would jump to about 45%.
now please explain to me if half of my check is going to the government for taxes how am i suppose to support my familiy?
no one can ever answer this question.
my company isn't going to pay me more money. they will probably cut back due to the increase in taxes.
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So something on the order of $267/month would cover income tax and healthcare (almost, GP visits have a small out-of-pocket cost, but are free for under-6s).
Curse this socialist dystopia. Pray (or hope, depending on your stance on deital existence) that the Fresh Prince gets his way and you never have to endure it.
now please explain to me if half of my check is going to the government for taxes how am i suppose to support my familiy?
no one can ever answer this question.
That's because it's a silly question. If you pay more money in taxes, but get more from the government in support, it's a tradeoff, not an extra payment. Almost 20% of IcecreamMan80's family income is going on health insurance alone. If his income tax rate is in the ballpark of 25% he's already in the situation you describe. (Assuming that payroll tax is income tax, or is that something different?)
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I am willing to bet my collection that Frozen and Solid are not on the same card. For example, Frozen Tomb and Solid Wall.
If Frozen Solid is not reprinted, you are aware that I'm quoting you in my sig for eternity?
so the averag person making 50k pays about 13% federal tax
another 7.5% for FICA
if you add another 20% for healthcare that is 40% tax.
that doesn't include state and local taxes for those that have them.
That's because it's a silly question. If you pay more money in taxes, but get more from the government in support, it's a tradeoff, not an extra payment. Almost 20% of IcecreamMan80's family income is going on health insurance alone. If his income tax rate is in the ballpark of 25% he's already in the situation you describe. (Assuming that payroll tax is income tax, or is that something different
because currently all benefits are paid PRE-Tax. IE they are not taxed.
what is taxed is after they take out healthcare/401k.
who says i am getting more back from the government. I hardly ever go to the doctor.
cutting my check in half and sending it to the government hurts me more than helps me.
i have food and bills to pay i can't do that if half of my income is going to the government.
what is worse for ICM is that both him and his wife get hit. so that is there income combined but they will be paying double the tax.
again my plan is cheaper more affordable and everyone is covered and it isn't run by the government.
I don't get what's worse: That they'd go to this extent, or they think downloading the Low-Orbit Ion Cannon and clicking IMMA CHARGIN MAH LAZAH!!!! is something no one else has ever done. Seriously, the LOIC has been used over nine thousand times by a variety of bored basement dwellers. But rest assured, we will neither forgive nor forget the right-wing extremists l33t h4x0r sk1llz. And...that's all the 4chan memes I can think of.
And about the "your plan was canceled due to the ACA" canard:
Seriously, mystery, if you believe the ACA is why your plan was canceled, I've got some "spider medicine" that you might be interested in. (To explain, look up the Lakota word for spider.)
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Card advantage is not the same thing as card draw. Something for 2B cannot be strictly worse than something for BBB or 3BB. If you're taking out Swords to Plowshares for Plummet, you're a fool. Stop doing these things!
That's because it's a silly question. If you pay more money in taxes, but get more from the government in support, it's a tradeoff, not an extra payment. Almost 20% of IcecreamMan80's family income is going on health insurance alone. If his income tax rate is in the ballpark of 25% he's already in the situation you describe. (Assuming that payroll tax is income tax, or is that something different
because currently all benefits are paid PRE-Tax. IE they are not taxed.
what is taxed is after they take out healthcare/401k.
who says i am getting more back from the government. I hardly ever go to the doctor.
I say you're getting more back from the government. If you pay more tax but get health insurance (and thus don't have to pay for private health insurance), you're getting more back from the government than you were, and at least breaking even (or probably doing better).
cutting my check in half and sending it to the government hurts me more than helps me.
i have food and bills to pay i can't do that if half of my income is going to the government.
what is worse for ICM is that both him and his wife get hit. so that is there income combined but they will be paying double the tax.
The top tax bracket here for someone earning under about US$38,400 (the exchange rate fluctuates but that's a ballpark figure) is 19.2%, including the health care coverage and comprehensive coverage of accident-related issues. I don't know what your flat 20% tax across all incomes would cover, but it must be pretty impressive.
again my plan is cheaper more affordable and everyone is covered and it isn't run by the government.
Although I note it's funded by the government - "in order to help lower income people the government could easily issue a credit to the account". And it does nothing to attempt to cover catastrophically expensive care, particularly for the aforementioned poor.
Edit: I also note that your plan requires the participant to pay 5% of their income, and also the employer to pay 5% - which basically means a cut to the employee's pay, so that's a 10% tax. How is it that your system, which is a 10% tax, is sufficient where a government system would require double that? Is this going to be waved away as 'government is inefficient and there's no way that cash-based healthcare providers would collude on prices so invisible hand'?
Um... that's "why it's hard to get on the ACA site" in the same sense that thorn pricks are "why Jesus died". There are many, many, much larger issues with the site, acknowledged by Sebelius and HHS themselves.
I am always puzzled, though, what the endgame is for people like this. Even if they accomplish their goals and destroy the website entirely, what do they actually think will happen? The law will still be there.
I say you're getting more back from the government. If you pay more tax but get health insurance (and thus don't have to pay for private health insurance), you're getting more back from the government than you were, and at least breaking even (or probably doing better).
Right, because the Government is the model of efficiency :rolleyes:.
The additional costs incurred from Governmental involvement will almost assuredly be higher then the profits of private insurance companies.
Did you see they christened the USS Gerald Ford? 70% completed and already two billion over budget.
Private companies have to answer to shareholders, the Government has no reason to be efficient.
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Would learn my licks with a bottle neck slide
I say you're getting more back from the government. If you pay more tax but get health insurance (and thus don't have to pay for private health insurance), you're getting more back from the government than you were, and at least breaking even (or probably doing better).
Right, because the Government is the model of efficiency :rolleyes:.
The additional costs incurred from Governmental involvement will almost assuredly be higher then the profits of private insurance companies.
Did you see they christened the USS Gerald Ford? 70% completed and already two billion over budget.
Private companies have to answer to shareholders, the Government has no reason to be efficient.
And yet for IcecreamMan80's income in New Zealand, the tax he would pay, and have healthcare (among other things) included, is about the same as what he pays in insurance premiums alone in the US. The government may not be optimal in terms of efficiency, but that just makes your insurance companies look worse.
Private companies have a goal of making money for their shareholders; this means that they want to a) take in as much in premiums as possible, and b) pay out as little as possible for care. That's how they make their profit.
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I am willing to bet my collection that Frozen and Solid are not on the same card. For example, Frozen Tomb and Solid Wall.
If Frozen Solid is not reprinted, you are aware that I'm quoting you in my sig for eternity?
Bollocks they would. That's what ICM80's family is going to be paying now, with the insurance companies soaking up profit in the middle.
Well based on all our options right now, we may actually drop coverage completely, pay the tax penalties for a couple years, and actually save a few thousand dollars.
That's because it's a silly question. If you pay more money in taxes, but get more from the government in support, it's a tradeoff, not an extra payment. Almost 20% of IcecreamMan80's family income is going on health insurance alone. If his income tax rate is in the ballpark of 25% he's already in the situation you describe. (Assuming that payroll tax is income tax, or is that something different
because currently all benefits are paid PRE-Tax. IE they are not taxed.
what is taxed is after they take out healthcare/401k.
who says i am getting more back from the government. I hardly ever go to the doctor.
I say you're getting more back from the government. If you pay more tax but get health insurance (and thus don't have to pay for private health insurance), you're getting more back from the government than you were, and at least breaking even (or probably doing better).
I disagree.
If I paid a tax, and got something I USED from the government, I'd agree - but this isn't the case.
I haven't been to the doctor in like 7 years. My wife, not since 2010. My kid, not since his 2 year shots (he's now 5) So Being generous - we've been paying for something we DON'T USE for at minimum 3 years now. Me personally, for seven years.
Now, we've made the choice to do this. However, if the government is going force it upon us, AND increase the costs...then I have to disagree with you completely.
If healthcare was a tax (single payer) then the government is taking the money from us regardless of choice, while we do not USE the coverage, then we are NOT getting anything from it.
We are simply having our money stolen from us by the government to pay for other people's treatments.
That is quintessentially theft.
I also like the idea of an HSA plan. Mine would differ from both Mystery's model, and differ greatly from the Singapore model - but it's the plan with the most personal responsibility and freedom of choice, and least amount of government bureaucracy.
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“Thus strangely are our souls constructed, and by slight ligaments
are we bound to prosperity and ruin.”
― Mary Shelley, Frankenstein
I haven't been to the doctor in like 7 years. My wife, not since 2010. My kid, not since his 2 year shots (he's now 5) So Being generous - we've been paying for something we DON'T USE for at minimum 3 years now. Me personally, for seven years.
Now, we've made the choice to do this. However, if the government is going force it upon us, AND increase the costs...then I have to disagree with you completely.
If healthcare was a tax (single payer) then the government is taking the money from us regardless of choice, while we do not USE the coverage, then we are NOT getting anything from it.
We are simply having our money stolen from us by the government to pay for other people's treatments.
That is quintessentially theft.
I understand what you're saying - but most people don't plan to have incredibly expensive accidents. Who will foot the bill if, despite not having been to the doctor for 7 years, in year 8 you have an accident that requires care costing hundreds of thousands of dollars?
Do you think that while you're paying an insurance premium, if you don't make any claims, you're not getting anything from it? Do you think that that money isn't being used for other people's treatments?
Edit: part of my feeling here is that you're OVERpaying for something you don't use.
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If Frozen Solid is not reprinted, you are aware that I'm quoting you in my sig for eternity?
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As a person who works with several medical entities and has a lot of family in medicine, I'll back this up - the vast majority of good doctors and hospitals in my area are backing away from exchange insurance. At best, a few are approaching it cautiously.
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WBR Alesha Hatebear Recursion
WBR Daddy Tariel
UBR [Je]love-a Your Deck
GWU Almost Critterless Enchantress
WUB Sydri+Artifacts=WUB
WURG Glint-Eye Combo
They're lying if they're saying THEY are. They're not allowed to pick an choose policies they participate in and networks within a company that exist in the exchange must have a non exchange policy they overlap with.
If they don't want to take UHC exchange plans, they can't take ANY UHC plans, etc. And every insurance company is required to offer exchange plans (3 minimum I think?).
Now on the reverse though many insurance companies are slimming the range of their networks which means the average doctor will accept fewer. (Although out of network claims are required under the ACA - but out of network is annoying and generally more costly even after reimbursement)
Re: People misusing the term Vanilla to describe a flying, unleash (sometimes trample) critter.
Umm, that doesn't make sense. Helathcare providers (not the insurance companies -- the doctors) don't have to take any patients they don't want to, as long as they aren't discriminating based on a protected class and aren't an ER.
Your standard family physician has absolutely no legal requirement that they take people on exchange insurance.
[Citation]?
There may be contracts between the insurance companies and the providers, but there's no law that I'm aware of that requires a healthcare provider that takes one plan to take every plan from that insurance company.
just to repost what i posted a couple pages ago.
http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare
http://nypost.com/2013/10/17/hospitals-reject-six-obamacare-plans/
http://nypost.com/2013/10/29/docs-resisting-obamacare/
it is only going to continue to get worse and there are just some people that can't see it coming.
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In fact, Obamacare seems to have incited quite a few doctors and medical centers to go "concierge," taking cash payments up front for services rendered and backing off their standard practice proportionally. (BMJ, sadly paywalled)
As more and more doctors offer concierge-type services, it'll be the new free market of healthcare, and cash customers will want this service. Meanwhile, non-cash customers will be competing for ever-smaller shares of medical practitioners' time, creating queues. The prediction is that Obamacare is basically going to result in a health system that is as bad as Canada's if you're poor (multiple-month waits for non-emergency care) but like the plot of Elysium if you're rich.
Which if thou dost not use for clearing away the clouds from thy mind
It will go and thou wilt go, never to return.
this is why my system of a massive HSA system works and works well.
i wish i could talk my company into just giving me the amount of money it spends on insurance into an HSA every year.
plus my own contribution. i have 0 premium to pay and can put in whatever i want.
the account would just grow and grow + interest.
a simple 10% tax 5% by you and 5% by the company + whatever else the company wanted to contribute tax deducted.
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While our system may get glorified by plenty of idiots our system is far from "bad"
Yes and no - they can refuse people on X insurance but if they're refusing people on X insurance they have to refuse them for that insurance company on their standard non-exchange policies as well as their exchange policies.
They can't parse out just some from within a providers packages. The only way they could do that is if some of the providers start going EXCLUSIVELY exchange - which I'm not aware of.
There might be some weird corner cases where it can happen - but overall it can't ON THE PROVIDERS SIDE - the insurers side is definitely narrowing network sizes though, which does have a similar net effect.
But it's chicken and the egg - where we know the insurer is the one starting things.
[/quote]
Citation on which part? Every insurance company that wants to provide something requiring an exchange offering (or multiples) is part of the ACA and pretty well publicized.
On the other half that's stuff I've known since '90 or so when I was working in the medical records for the doctor's office way back when - they can try to find another excuse to refuse a patient - but if you say "I'm refusing you because you have Y insurance package managed by BC/BS" that's illegal unless that office is refusing ALL BC/BS packages.
It's similar to EOE that way - you can find secondary reasons to get around it - but the overt version is not permitted unless EVERY package managed by the company is also refused.
[But I don't know the law to cite, it's possible it's a MD only thing as that's the only state I did records for, although we did have some PA patients pretty sure PA laws don't apply for such cases]
Re: People misusing the term Vanilla to describe a flying, unleash (sometimes trample) critter.
Technically speaking if you're trying to echo Singapore you're missing a few key points that effect a handful of people although that is how it works for the majority of people. [Also I believe the government collects the interest for themselves, that it goes towards the "overflow" costs when someone ends up costing the system money when they need care over what they've paid in and the government eats the bill]
Re: People misusing the term Vanilla to describe a flying, unleash (sometimes trample) critter.
I thought accusing people of lying wasn't something you did. Tsk tsk.
As has been noted, it's an all or nothing approach and the reality as documented here is that an overwhelming majority of doctors are either refusing to take anyone in the exchanges or are tiptoeing around a final decision on it.
All the way back to 09 and the healthcare debates doctors were saying these very things, as well as talking about retiring instead of attempting to ride this out of control and toxic bull. Sure Obama had his press conferences with doctors as props backing him up saying that everything was great and it was supported across the board but those were schills and direct employees for those who lobbied for this.
http://www.bostonglobe.com/magazine/2013/10/12/why-hard-find-doctor/AZmAhh8DJowD63cIVF0vPO/story.html
There's the Romneycare example that shows exactly where this is going to go. The reforms and policy changes spoke of in the article are not going to stop the flow of doctors and providers out of the system, at some point it comes down to a simple "who wants to deal with that kind of headache for so little gain?" game.
It's amusing the acidic attacks from Democrats and their media on this entire thing. The patchwork demands to force every doctor to take every patient no matter what they have, Medicaid/Care or whatnot shows the attempted strongarm tactic to make up for the fact that the entire law and everything it is about just doesn't work, but as I've mentioned several times we can get past the point of saying it was designed to work.
Pay attention, there's calls for single payer hitting the media everyday, only to escalate as this thing blows up.
STRANGER: Indeed?
CASSILDA: Indeed it's time. We all have laid aside disguise but you.
STRANGER: I wear no mask.
CAMILLA: (Terrified, aside to Cassilda.) No mask? No mask!
It's perfectly acceptable to say "Oh, we're not accepting any new patients" to prevent ALL new patients, exchange or otherwise. With the only exceptions made being obvious logical extensions (i.e. family members of existing patients).
And it's not an "overwhelming majority" overall - it does seem that way in a handful of states however since some people are quoting its par for the course some places, while others its unheard of. (Any network shrinking here is entirely on the insurance side of the equation in MD - and have thusfar heard of literally ONE case that the hospital is reconsidering in a public statement...)
On accepting Medicaid, that's a local program - not seen a Federal politician weigh in, nor does it make sense for them to - and on Medicare, it's an all or nothing thing with how it is under the law more or less. If you want the maximum payout from Medicare, you need to keep yourself open to Medicare patients until you hit the Medicare client cap (varies by field) - if say you take ten Medicare patients and cut it off there (which is perfectly permissible) you'll have a ****ty payout because you'll get an automatic F rating and get payouts about a third of what you'd get with an A rating (And it's not hard to attain basically it's keep accepting Medicare patients until you hit the cap and don't screw up more or less...) - there's no sensible reason a doctor would want to half-ass how many Medicare patients they take, but outside of a HOSPITAL setting there's no requirement to take it. Hospitals however are required to unless they want to exempt themselves from Federal repayment on defaulted bills. (Which of course is a big deal, since no matter what some patients die even if living ones have a 100% pay rate)
Re: People misusing the term Vanilla to describe a flying, unleash (sometimes trample) critter.
Maryland has had it's own problems with Obamacare
*96% of enrollees to the program are just signing up for your local issue - Medicaid - http://www.nationalreview.com/corner/362389/over-96-percent-obamacare-enrollees-maryland-signed-medicaid-sterling-beard
(this is a problem b/c insufficient young people are signing up for O-care means that premiums will have to rise; also, the number of Medicaid enrollees will increase the state's budget problems down the road when they start to foot a percentage of the medicaid bill for these enrollees)
*Community colleges cutting adjunct professors' hours to avoid the mandate - http://articles.baltimoresun.com/2013-10-27/news/bs-md-adjuncts-20131026_1_community-colleges-affordable-care-act-obamacare-supporters
*73,000 Marylanders just lost their old health insurance - another example of the lie that you could keep your insurance if you like it.
http://pjmedia.com/tatler/2013/11/05/obamacare-just-cost-73000-in-maryland-their-health-insurance/
*All Maryland Carefirst customers will lose their plans
http://www.breitbart.com/Big-Government/2013/10/24/40-of-CareFirst-BlueCrossBlue-Shield-Customers-in-VA-MD-D-C-Lose-Insurance-Due-to-Obamacare
*People with cancelled plans will face higher costs (in this story, someone who use to pay $230/month for themselves and 2 children will now be paying $450/month)
http://www.heraldmailmedia.com/news/local/some-western-md-residents-frustrated-with-obamacare/article_e2a6f81e-48cd-11e3-ae68-001a4bcf6878.html
These problems are not unique to Maryland, but are illustrative of the problems faced all around the country - cut hours for part-time employees, loss of current insurance, etc.
Lowest price available is $615 a month. (an increase of about $140, from what we have been paying)
I'd have to take a second part-time job aside from my full time job just to pay for the health insurance. Then, if I did, because of our increase in income from that second job - I bet the rate would change.
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“Thus strangely are our souls constructed, and by slight ligaments
are we bound to prosperity and ruin.”
― Mary Shelley, Frankenstein
Wow, that's over 18% of your gross income! I (fortunately) don't have to take part, so I'm not sure how it works, but is that pre- or post-subsidies and discounts?
Although previously your rate was still over 14% - if that's the healthcare component of my income tax over here, then the remaining income tax is phenomenally low!
We don't have joint filing of taxes, so I put your total income as your personal income into the New Zealand tax calculator (using a rough exchange rate of 0.8:1) to see what the highest possible tax bill would be. It turns out it would be about US$7.2k for the year, but because of the child, you'd get about $4k in tax credits, if I'm reading it correctly.
So something on the order of $267/month would cover income tax and healthcare (almost, GP visits have a small out-of-pocket cost, but are free for under-6s).
Curse this socialist dystopia. Pray (or hope, depending on your stance on deital existence) that the Fresh Prince gets his way and you never have to endure it.
welcome to obamacare. you are young and healthy therefore you are going to get smacked.
i found the kaiser family calculator and ran mine. i got slammed too.
although not as bad. it was only a 50 dollar increase from what i was paying. but the coverage was worse.
millions of middle class people are getting slammed by this thing.
new zealand is not the US. in the US if they were to impliment single payer system pay roll taxes would jump to about 45%.
now please explain to me if half of my check is going to the government for taxes how am i suppose to support my familiy?
no one can ever answer this question.
my company isn't going to pay me more money. they will probably cut back due to the increase in taxes.
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That's because it's a silly question. If you pay more money in taxes, but get more from the government in support, it's a tradeoff, not an extra payment. Almost 20% of IcecreamMan80's family income is going on health insurance alone. If his income tax rate is in the ballpark of 25% he's already in the situation you describe. (Assuming that payroll tax is income tax, or is that something different?)
how do you think they are going to pay for it?
they would need at least a 20%+ healthcare tax.
so the averag person making 50k pays about 13% federal tax
another 7.5% for FICA
if you add another 20% for healthcare that is 40% tax.
that doesn't include state and local taxes for those that have them.
because currently all benefits are paid PRE-Tax. IE they are not taxed.
what is taxed is after they take out healthcare/401k.
who says i am getting more back from the government. I hardly ever go to the doctor.
cutting my check in half and sending it to the government hurts me more than helps me.
i have food and bills to pay i can't do that if half of my income is going to the government.
what is worse for ICM is that both him and his wife get hit. so that is there income combined but they will be paying double the tax.
again my plan is cheaper more affordable and everyone is covered and it isn't run by the government.
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http://www.informationweek.com/security/vulnerabilities/hackers-threaten-destruction-of-obamacar/240163729
I don't get what's worse: That they'd go to this extent, or they think downloading the Low-Orbit Ion Cannon and clicking IMMA CHARGIN MAH LAZAH!!!! is something no one else has ever done. Seriously, the LOIC has been used over nine thousand times by a variety of bored basement dwellers. But rest assured, we will neither forgive nor forget the right-wing extremists l33t h4x0r sk1llz. And...that's all the 4chan memes I can think of.
And about the "your plan was canceled due to the ACA" canard:
http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013309240089&nclick_check=1
Seriously, mystery, if you believe the ACA is why your plan was canceled, I've got some "spider medicine" that you might be interested in. (To explain, look up the Lakota word for spider.)
On phasing:
Bollocks they would. That's what ICM80's family is going to be paying now, with the insurance companies soaking up profit in the middle.
Bollocks it is. There's no reason not to make the healthcare portion of the tax progressive like the rest of the tax system.
I say you're getting more back from the government. If you pay more tax but get health insurance (and thus don't have to pay for private health insurance), you're getting more back from the government than you were, and at least breaking even (or probably doing better).
The top tax bracket here for someone earning under about US$38,400 (the exchange rate fluctuates but that's a ballpark figure) is 19.2%, including the health care coverage and comprehensive coverage of accident-related issues. I don't know what your flat 20% tax across all incomes would cover, but it must be pretty impressive.
Although I note it's funded by the government - "in order to help lower income people the government could easily issue a credit to the account". And it does nothing to attempt to cover catastrophically expensive care, particularly for the aforementioned poor.
Edit: I also note that your plan requires the participant to pay 5% of their income, and also the employer to pay 5% - which basically means a cut to the employee's pay, so that's a 10% tax. How is it that your system, which is a 10% tax, is sufficient where a government system would require double that? Is this going to be waved away as 'government is inefficient and there's no way that cash-based healthcare providers would collude on prices so invisible hand'?
I am always puzzled, though, what the endgame is for people like this. Even if they accomplish their goals and destroy the website entirely, what do they actually think will happen? The law will still be there.
Read the article again, dude. The plans were canceled by the new ACA requirements; Humana just spun it in an allegedly misleading way.
candidus inperti; si nil, his utere mecum.
Right, because the Government is the model of efficiency :rolleyes:.
The additional costs incurred from Governmental involvement will almost assuredly be higher then the profits of private insurance companies.
Did you see they christened the USS Gerald Ford? 70% completed and already two billion over budget.
Private companies have to answer to shareholders, the Government has no reason to be efficient.
Would learn my licks with a bottle neck slide
And yet for IcecreamMan80's income in New Zealand, the tax he would pay, and have healthcare (among other things) included, is about the same as what he pays in insurance premiums alone in the US. The government may not be optimal in terms of efficiency, but that just makes your insurance companies look worse.
Private companies have a goal of making money for their shareholders; this means that they want to a) take in as much in premiums as possible, and b) pay out as little as possible for care. That's how they make their profit.
Well based on all our options right now, we may actually drop coverage completely, pay the tax penalties for a couple years, and actually save a few thousand dollars.
We're thinking about it anyways.
I disagree.
If I paid a tax, and got something I USED from the government, I'd agree - but this isn't the case.
I haven't been to the doctor in like 7 years. My wife, not since 2010. My kid, not since his 2 year shots (he's now 5) So Being generous - we've been paying for something we DON'T USE for at minimum 3 years now. Me personally, for seven years.
Now, we've made the choice to do this. However, if the government is going force it upon us, AND increase the costs...then I have to disagree with you completely.
If healthcare was a tax (single payer) then the government is taking the money from us regardless of choice, while we do not USE the coverage, then we are NOT getting anything from it.
We are simply having our money stolen from us by the government to pay for other people's treatments.
That is quintessentially theft.
I also like the idea of an HSA plan. Mine would differ from both Mystery's model, and differ greatly from the Singapore model - but it's the plan with the most personal responsibility and freedom of choice, and least amount of government bureaucracy.
Thanks to Xenphire @ Inkfox for the amazing new sig
“Thus strangely are our souls constructed, and by slight ligaments
are we bound to prosperity and ruin.”
― Mary Shelley, Frankenstein
I understand what you're saying - but most people don't plan to have incredibly expensive accidents. Who will foot the bill if, despite not having been to the doctor for 7 years, in year 8 you have an accident that requires care costing hundreds of thousands of dollars?
Do you think that while you're paying an insurance premium, if you don't make any claims, you're not getting anything from it? Do you think that that money isn't being used for other people's treatments?
Edit: part of my feeling here is that you're OVERpaying for something you don't use.