'cookieChoices = {};'

Governments are instituted among Men,
deriving their just powers from the consent of the governed,
That whenever any Form of Government becomes destructive of these ends,
it is the Right of the People to alter or to abolish it,
and to institute new Government

Tuesday, March 28, 2017

What’s POSSIBLE now in Health Care?

Fact: Obamacare will die in catastrophic fashion as insurance companies stop offering it in state after state beginning in January
Non negotiable items to Republicans:
  1. Mandate must end
  2. Insurance company bailouts each year or EVER as a policy to guarantee  profit cannot occur
  3. Health Care availability ITSELF must be the target as well as lower premiums
  4. Recognize that a $6,500 deductible is WORSE than no insurance (you are compelled to pay premiums) except to insurance companies, since this is bankruptcy to a LARGE % of families and therefore they won’t or can’t use health care
  5. Do away with current subsidy structure
Non negotiable items to Dems:
  1. Obamacare itself should be fixed
  2. Obamacare cannot be repealed
  3. Any change must accomplish lower premiums
  4. Health care to be recognized as a right
Goals of both parties:
  1. Lower premiums
  2. Lower MAXOOP
  3. Maintain pre-existing condition situation
  4. Maintain keeping kids on family plans thru 26 yrs
  5. No limit on lifetime payouts
Ironically IMO, Obama has won his bet with society in making health care a right. The last poll I saw (within the week)  on this specific subject showed about 2/3 of the US people now accept this argument. This means the sales job the Republican party has to do is monumental.
In fact, impossible IMO.
Therefore, it is time for the Republican political class and this freedom caucus to start considering an end around this conundrum and create a Medicare for All system. Currently Medicare A&B for ~$105/month for people my age covers 80% of physician and hospital costs and virtually nothing else. Becuase of this a robust private insurance business to cover the balance has grown up and both together cost about 1/8 of an Anthem plan, and about 1/13th of Obamacare and almost every medical costs is covered, AND there are a blizzard of plans available, AND most of them are available nationally.
I am SURE this cannot be done for $105/month/person insured, but it can be done. And if it can’t be then an effort to DO THIS and show the people why not is needed.
ONE THING…private care will have to be BANNED, for all, including congress. Whatever final plan is arrived at the political class is also mandated to follow.
There is no doubt the impact on research will be profound, certainly at the start. Govt financing will be the central core of resourcing this now, but the reality is that with the contraction of the number of Rx companies over the years since it began in the 90’s, the amount of research has slowed as large entities have become more risk averse, and govt regulation has blossomed.
I think the equilibrium has slipped past the return to a private system that will have lower premium and better heath care.
But if this is done I have some advice.
GREATLY INCREASE THE NUMBER OF MEDICAL SCHOOLS, because people WILL go to the doctor, and people will NOT accept what the veterans are going through.
I don’t like this situation, but I accept this is the reality.
Unless the republicans are far more intelligent, adept, and streetwise in reality than they appear to be this day.
Bookmark and Share
posted by Epaminondas at permanent link#


Anonymous Anonymous said...

The Dems will win in the court of public opinion with "Health Care is a Right." Of course it's not a right, and never can be. This dichotomy, making the impossible mandatory by legislative fiat, is why every single government run health care system will eventually fail. Every one.

Tuesday, March 28, 2017 10:52:00 pm  
Blogger Always On Watch said...

Obama has won his bet with society in making health care a right. The last poll I saw (within the week) on this specific subject showed about 2/3 of the US people now accept this argument. This means the sales job the Republican party has to do is monumental.
In fact, impossible IMO.

Yep. To deny these points is to deny reality.

I think the equilibrium has slipped past the return to a private system that will have lower premium and better heath care.

Probably. I'd say a 95% probability.

BTW, my Medicare is $134/month. I pay $132/month for very high end Medigap insurance and another $30 month for Medicare Part D (pharmacy coverage which is so-so). I turned 65 in February.

But I found out something when I recently had a CT scan on March 3. Charge = $1700. Allowed Medicare amount = $80, and facility takes Medicare assignment. I owe nothing, and my Medigap plan didn't have to pay a dime. Do I really need that Medigap plan? I dunno. What do you think, Epa?

Tuesday, March 28, 2017 10:53:00 pm  
Blogger Epaminondas said...

The difference in what you are paying and what I am paying illustrates just how EFFED the ENTIRE structure is.

I pay $105 for Medicare A&B. I have Aetna as Medicare advantage, and that's all I need. The AEtna Plan is $39/month. The choices which are national were dizzying and it took me a month of study to be sure I had the best one for me. I based the choice on my medical needs at that moment.

The sum total of Rx copay/month is about $20.


I had a heart attack the night of of the first debate (Sept #3), but both enzyme tests were negative so they sent me home ($3851), my cost $75, I had another the last day of October and they did extensive testing this time keeping me overnight, and found evidence this time there was cellular damage(THREE troponin tests ..takes at least 9 hours). This was on a Thurs night. They kept me for a cath the next day - Friday ...whoops too busy in the cath lab (they have 4 cath rooms), sorry WAIT TILL MONDAY (room was like a Marriott Resort, btw, go figure, welcome to Bangor) On Monday they tell me it looks like it will be Tuesday, I tell them I don't believe them and I am getting dressed and leaving (symptom free and happy from the ambulance ride on, and read 2.5 books), they do the cath within 4 hours, and find NOTHING, and have NO IDEA what is going on, in fact tell me the heart looks as good as it did in 2006 (1st infarct), then send me back to the room for an echo which shows LV ejection fraction ,,,, the actual function of the heart's ability to pump into the body is 30%..DANGER ZONE and to go home I have to wear a defibrillator vest 24x7 because that much non functioning tissue means electrical conductance to the remaining muscle in the heart is compromised and you can slip into fibrillation and die (15% survive that). To get the vest you have to wait for the manufacturer's rep to come and teach you how to use it(It's a big deal now). The rep never shows and they tell me I have to stay in the hospital another day.
I tell them this is a fortune for SOMEONE over a delay in a test which takes about 2 hour from prep to done and I am leaving, NOW. They tell me ok, since I am an asshole (they didn't say that but that's the reality), they will send the rep to my home to teach me that night ... she shows at 8 and tells me it's a PART TIME JOB.

$54,000.My part $1500. Bill for the tests, ER, Cath (which could have been done in ONE NIGHT)? About $8k. So, one person, waiting for one test was $46,000. The care level was incredible, the people fantastic, but $46,000 to wait in a room? Keep half and I take everyone to visit Obama in Tahiti and STILL might not spend the other half.

You are all helping to paying for that. Thanks. Now, at every weekend at every hospital that does emergency caths ONLY on weekends ..well, you figure it out.

Do you need the medigap, AoW? I don't think so. But the variance among plans is ASTONISHING. And you have to figure this based on individual medical needs. I based mine on trips to the doctor under normal circumstances, and therefore predictable diagnostic testing, drugs I take and coverage in the case of a heart attack emergency.

BTW the PERSONAL denouement here is this ...when you have a heart attack, the heart muscle can be 'stunned' and it may not be dead, it just acts that way. Based on my career I was very hopeful, since otherwise I was symptom free, this was the case. In fact I just had my followup echo and the Ejection Fraction has returned to almost normal for my age. Give me another 6 months and maybe I get all the way there

Wednesday, March 29, 2017 10:47:00 am  
Blogger Epaminondas said...

AoW, that Aetna plan covers pats C&D and the donut hole.

Wednesday, March 29, 2017 10:53:00 am  
Blogger Always On Watch said...

Are you referring to Aetna Medicare HMO? I know quite a bit about that because Mr. AOW has that plan, the only plan he could get because he entered Medicare after his disabling stroke. His Aetna Medicare HMO plan costs $59/month. The first year (2012? 2013?) the premium was $39/month, but has risen every year since.

We've run into a few problems with the plan: (1) several of his doctors didn't participate in Aetna Medicare HMO, and (2) every PT session cost $40 (for a cost of $320/month).

I opted for BCBS Medigap for myself because I want to keep my retinal surgeon, an outright miracle worker when it comes to that particular medical field, and my neurologist.

The Medigap plans available vary by state. Even worse, they have a way of suddenly disappearing. Aetna has a presence here, but BCBS, the federal employee program, "owns" the presence.

Do you need the medigap, AoW? I don't think so.

I may actually be better off not to have any Medigap plan here in Northern Virginia because almost all providers take Medicare assignment. I'm going to keep an eye on every EOB to see the lay of the land. What is maddening is that I couldn't see how the costs and payments were split until I actually had Medicare. Lack of transparency!

Wednesday, March 29, 2017 11:47:00 am  
Blogger Always On Watch said...

room was like a Marriott Resort

I had the same experience here when I was hospitalized in October and November.

How much hospitals have changed since 2009, when Mr. AOW was hospitalized for a month in two different facilities!

Wednesday, March 29, 2017 11:48:00 am  
Blogger Epaminondas said...

Yes, but it's called AEtna Medicare Advantage up here.

I started with Anthem plan, then that plan was replaced by one at about 175 a month so I started looking and Aetna fit much better. I am only nearsighted so That part of the situation is pretty clean for me. For Mrs Epa she is still 100% covered by WHAT USED TO BE a cadillac plan as a teacher, UNTIL OCARE, and then the teacher's union (compulsory join) went to a worse plan to avoid cadillac tax, and now our maxoop which we hit very year because of diagnostics is $3500. In May we will start assessing if going to Medicare_+ Advantage will actually be cheaper because of lowered dedectible and MAXOOP
She needs prisms and transitions and all sort of crap, an even with insurance her last pair of glasses was $400. So that will become a critical consideration.

Thursday, March 30, 2017 10:23:00 am  
Blogger Epaminondas said...

BTW, up here, there is NO DOCTOR not in that plan, and it's been at $39/month for 2+ years. Go figure.

Thursday, March 30, 2017 10:27:00 am  
Blogger Always On Watch said...

These plans vary widely by state.


My only significant pre-existing condition is chronic kidney disease. It may be best to remove that offending kidney. We'll see. In any case, I picked the best BCBS plan offered here because of this kidney problem.

Terrible what happened to your wife's plan, Epa!

Thursday, March 30, 2017 1:06:00 pm  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home

Older Posts Newer Posts