U.S. Politics: Hairpiece In the Middle East Part 2

[OldGimletEye]

Just now, Cas Stark said:

What makes you think that those same people can afford to use services when their deductable is six or seven thousand dollars?  They are in the same place they were w/out insurance only now they are paying monthly premiums for insurance but still can't afford to access actual care beyond a yearly doctor visit.

Well off the top of my head, those under 250% FPL get help for for deductibles. But supposing there is no help. A Silver Plan has deductible of about 6,600, I believe. That's a lot of money. But, it sure in the hell beats owing several tens of thousands of dollars or more for medical services that you need.

Those under 400% FPL get help for premiums. Now, I agree there is a group people that are well off enough to not get the subsidies, but not so rich they can easily afford an ACA plan. And that is a problem. And something that needs to be fixed.

Nobody, I think, would say the ACA is perfect. It has it's problems. But, the system we had before, was really bullshit. And the ACA,, while not, perfect, was somewhat of step in the right direction. And given how hard it's been to get healthcare reform in this country, some of us are not willing to give up on it easily. It's like you fight like hell to get two yards and then fight like hell to hold on to the two yards you got.

I'm certainly not of a mind to give in to the Republicans on this thing. You think healthcare stinks now? You ain't see nuthin yet.

[Cas Stark]

1 minute ago, OldGimletEye said:

Well off the top of my head, those under 250% FPL get help for for deductibles. But supposing there is no help. A Silver Plan has deductible of about 6,600. That's a lot of money. But, it sure in the hell beats owing several tens of thousands of dollars or more for medical services that you need.

Those under 400% FPL get help for premiums. Now, I agree there is a group people that are well off enough to not get the subsidies, but not so rich they can easily afford an ACA plan. And that is a problem. And something that needs to be fixed.

Nobody, I think, would say the ACA is perfect. It has it's problems. But, the system we had before, was really bullshit. And the ACA,, while not, perfect, was somewhat of step in the right direction. And given how hard it's been to get healthcare reform in this country, some of us are not willing to give up on it easily. It's like you fight like hell to get two yards and then fight like hell to hold on to the two yards you got.

  But if you only needed say $3 or4K of medical services throughout a given year, then you are ahead if you have no insurance at all because you aren't paying the premiums, which would range anywhere from another $1K up to $4K a year. Although this is a risk.

[Gareth]

3 minutes ago, Cas Stark said:

Why is it a mess?  It seems like a pretty smart thing to do if your patient base is such that you can support a concierge practice, why would you not do it as it's more lucrative and less restrictive, no paperwork or adminstrative BS, just practicing medicine.  It's an adjunct to the regular practice which takes regular insurance--I started going to him when I had employer corporate insurance, which I no longer have.  To my knowledge they don't take Medicaid and they don't take the ACA exchange insurances.  He can't bill my insurance for anything because his office doesn't accept it, that is why I am self pay there.

Concierge is a new way to treat patients and if you can get enough subscribers, its a potentially lucrative one.  And thats the jist is getting enough subscribers but not too much that patients can't see you immediately when they need too.  With him having a hybrid system, its a mess because he has to be very careful on what he bill the insurance.  If he accepts medicare, he will be audited, I guarantee you that.  CMS is cracking down on insurance fraud and concierge medicine is on their radar because it is considered double-billing if he bill a lab or service to medicare that is included in the concierge provider-patient relationship agreement.  

And since you are not in the concierge medicine of his practice, the kickback rules apply to you.  So if he is discounting your visit way less than what he is discounting health insurances that he accept, he may be breaking the law, depending on your state law.  Like I said, what a mess.

[DMC]

1 minute ago, Cas Stark said:

  But if you only needed say $3 or4K of medical services throughout a given year, then you are ahead if you have no insurance at all because you aren't paying the premiums, which would range anywhere from another $1K up to $4K a year. Although this is a risk.

This makes it appear you're more interested in gaming the system than acquiring affordable health care.

[Cas Stark]

1 minute ago, Gareth said:

Concierge is a new way to treat patients and if you can get enough subscribers, its a potentially lucrative one.  And thats the jist is getting enough subscribers but not too much that patients can't see you immediately when they need too.  With him having a hybrid system, its a mess because he has to be very careful on what he bill the insurance.  If he accepts medicare, he will be audited, I guarantee you that.  CMS is cracking down on insurance fraud and concierge medicine is on their radar because it is considered double-billing if he bill a lab or service to medicare that is included in the concierge provider-patient relationship agreement.  

And since you are not in the concierge medicine of his practice, the kickback rules apply to you.  So if he is discounting your visit way less than what he is discounting health insurances that he accept, he may be breaking the law, depending on your state law.  Like I said, what a mess.

No good deed goes unpunished I guess.  Perhaps in the Obamacare America, a doctor would be penalized for giving a discount to a long time patient who was paying out of pocket in order to maintain the relationship.  Yeah, that sounds about right.

[Cas Stark]

1 minute ago, dmc515 said:

This makes it appear you're more interested in gaming the system than acquiring affordable health care.

Paying out of pocket for your own medical expenses is not gaming the system.

[OldGimletEye]

Just now, Cas Stark said:

  But if you only needed say $3 or4K of medical services throughout a given year, then you are ahead if you have no insurance at all because you aren't paying the premiums, which would range anywhere from another $1K up to $4K a year. Although this is a risk.

If I read you correctly, this is how insurance works. Some people will pay into the system and get less out of it than others.

Also, I understand you're estimating that your expected need for medical services is about 3 or 4k a year. But, what happens if suddenly your medical cost spike, because of an unforeseen illness and becomes like 60K, 70K, or 100K?

[Gareth]

Just now, Cas Stark said:

No good deed goes unpunished I guess.  Perhaps in the Obamacare America, a doctor would be penalized for giving a discount to a long time patient who was paying out of pocket in order to maintain the relationship.  Yeah, that sounds about right.

This has nothing to do with Obamacare.  Anti-Kickback statute have been around since the 1930-1940s and the subsection for medicare/medicaid in the 1990s.  In reality, the insurance companies and the GOP tried to use the anti-kickback laws to get rid of Obamacare.  At the time (circa 2013), there were a chance that it might violate the anti-kickback law since the law is very general and has a broad scope.

[DMC]

8 minutes ago, Cas Stark said:

Paying out of pocket for your own medical expenses is not gaming the system.

Actually, yes, it could.  Regardless, I'm just employing simple logic to refute your points.  This has been your MO throughout the board for as long as I can remember, which I've always appreciated.

[Cas Stark]

32 minutes ago, OldGimletEye said:

If I read you correctly, this is how insurance works. Some people will pay into the system and get less out of it than others.

Also, I understand you're estimating that your expected need for medical services is about 3 or 4k a year. But, what happens if suddenly your medical cost spike, because of an unforeseen illness and becomes like 60K, 70K, or 100K?

Like I said, its a risk.  It's a risk that I undertook for several years, before ACA, when my premiums for an individual w/no children were apprx. $600 a month, and I determined this was much more than what I would be spending  if I paid for everything myself.  I saved tens of thousands of dollars by being uninsured.  And, I never had that unforseen illness, but believe me, I needed those thousands much more than the insurance company did.  I don't know what else to say really, other than, it feels like people simply don't like my story and my perspective because it doesn't fit with the idea that ACA has been a godsend to people who were previously uninsured.  It's an unfortunate sign of the times that anything that doesn't fit with most people's belief systems is met with the same level of unpleasantness I have experienced since sharing my story.  I will have to make another note myself to not ever tell another personal story unless it involves cats.

[Cas Stark]

20 minutes ago, Gareth said:

This has nothing to do with Obamacare.  Anti-Kickback statute have been around since the 1930-1940s and the subsection for medicare/medicaid in the 1990s.  In reality, the insurance companies and the GOP tried to use the anti-kickback laws to get rid of Obamacare.  At the time (circa 2013), there were a chance that it might violate the anti-kickback law since the law is very general and has a broad scope.

So, every doctor who gave me a discount for not having insurance, the PCP, the podiatrist, the dermatologist, the optometrist, they all were breaking the law? This seems unlikely.  Really, really unlikely.

[DMC]

6 minutes ago, Cas Stark said:

I don't know what else to say really, other than, it feels like people simply don't like my story and my perspective because it doesn't fit with the idea that ACA has been a godsend to people who were previously uninsured.  It's an unfortunate sign of the times that anything that doesn't fit with most people's belief systems is met with the same level of unpleasantness I have experienced since sharing my story.  I will have to make another note myself to not ever tell another personal story unless it involves cats.

It's not that people don't sympathize with your story.  It's that how your situation would be in any way different - or better - without the ACA escapes all logic.

[Manhole Eunuchsbane]

7 minutes ago, dmc515 said:

It's not that people don't sympathize with your story.  It's that how your situation would be in any way different - or better - without the ACA escapes all logic.

Well that goes back to his point regarding the mandate. It may not be true now, but he would've been penalized prior to our entry into Trumpcare. 

[OldGimletEye]

Just now, Cas Stark said:

Like I said, its a risk.  It's a risk that I undertook for several years, before ACA, when my premiums for an individual w/no children were apprx. $600 a month, and I determined this was much less than what I would be spending  if I paid for everything myself.  I saved tens of thousands of dollars by being uninsured.  And, I never had that unforseen illness, but believe me, I needed those thousands much more than the insurance company did.  I don't know what else to say really, other than, it feels like people simply don't like my story and my perspective because it doesn't fit with the idea that ACA has been a godsend to people who were previously uninsured.  It's an unfortunate sign of the times that anything that doesn't fit with most people's belief systems is met with the same level of unpleasantness I have experienced since sharing my story.  I will have to make another note myself to not ever tell another personal story unless it involves cats.

If you don't like the system, I'm not going to probably change your mind. And that's that.

But, when it comes to making public policy decisions, I simply don't find your personal preferences here persuasive. The fact of the matter is that most people will probably need to see a doctor at some point in their lives. And I find it outrageous that some people can't get a decent level of healthcare. Not in a country as wealthy as ours. I simply find that unconscionable. And it's not something I'm willing to leave simply to the "free market".

Now those of us that are relatively lucky will have less medical cost. Problem is none of us know how lucky we're going to be until our lives end. So having insurance is peace of mind for those of us that are lucky. But, some people. are not going to be lucky and are going to have something bad happen to them. And they only get treatment, in most cases, if us lucky ones pay for it through premiums. The only way those premiums stay reasonable for most people is enough people pay into the system, otherwise your likely to get a coordination failure.

As I've said earlier the ACA has it's problems. But, the previous healthcare system sucked. It was probably good to go if you had a great job and a nice big fat subsidy from the government for your healthcare, through the employer tax exclusion, but not so much if you didn't have a great job that didn't give you a big fat subsidy for the government. And that made the prior system regressive and unfair in my view.  And needed to be changed. Plus there is the fact that the ACA makes people little less dependent on their employers, which I think is a good thing.

 

[Fez]

There were some state legislative special elections tonight; Democrats continued their trend of overperforming in these elections since the general election, including finally flipping two seats.

One was a New Hampshire house seat, which is impossible to read into. NH is way too swingy and the state house districts are tiny. But Republicans out-register Democrats 2:1 in the district (though Trump had only won 51-44). The vote for the Democrat here was 52-48.

The other was a New York assembly seat out on Long Island, Peter King's area. Full numbers aren't available yet, but Trump had won the seat by 20 points, so its a big swing away from him.

 

All eyes on Montana-AL on Thursday, despite the idiocy of the DCCC trying to bury the race.

[Cas Stark]

13 minutes ago, dmc515 said:

It's not that people don't sympathize with your story.  It's that how your situation would be in any way different - or better - without the ACA escapes all logic.

The logic is that I was uninsured and that being uninsured was a better financial deal than what I have under ACA.  And that while it's true being uninsured I did limit health care costs, e.g. didn't get a year physical, I did not go without health care, nor did I sponge off the taxpayer through the ER, I simply self paid and was given discounts by almost every doctor I saw during those years.

[DMC]

1 minute ago, Manhole Eunuchsbane said:

Well that goes back to his point regarding the mandate. It may not be true now, but he would've been penalized prior to our entry into Trumpcare. 

Please correct me if I'm wrong, but I'm almost positive the IRS has never penalized anyone for not abiding the mandate.  I say this as someone who got a threatening letter from them this year, even though I've been on my university's plan for almost three years now.  I ignored it.

Anyway, I was skeptical they'd ever enforce the mandate under Obama.  They certainly aren't under Trump.  He's literally ordered it so.

[DMC]

Just now, Cas Stark said:

The logic is that I was uninsured and that being uninsured was a better financial deal than what I have under ACA.  And that while it's true being uninsured I did limit health care costs, e.g. didn't get a year physical, I did not go without health care, nor did I sponge off the taxpayer through the ER, I simply self paid and was given discounts by almost every doctor I saw during those years.

Ok.  That's logical, sure, but how exactly did the ACA screw you in any way that you wouldn't have been screwed regardless?

[MerenthaClone]

26 minutes ago, Cas Stark said:

Like I said, its a risk.  It's a risk that I undertook for several years, before ACA, when my premiums for an individual w/no children were apprx. $600 a month, and I determined this was much more than what I would be spending  if I paid for everything myself.  I saved tens of thousands of dollars by being uninsured.  And, I never had that unforseen illness, but believe me, I needed those thousands much more than the insurance company did.  I don't know what else to say really, other than, it feels like people simply don't like my story and my perspective because it doesn't fit with the idea that ACA has been a godsend to people who were previously uninsured.  It's an unfortunate sign of the times that anything that doesn't fit with most people's belief systems is met with the same level of unpleasantness I have experienced since sharing my story.  I will have to make another note myself to not ever tell another personal story unless it involves cats.

No, people are just irritated that you think that your one anecdote about you being lucky and avoiding all of the myriad medical pitfalls that are possible is somehow worth anything approaching equal weight with the vast numbers of people who simply weren't able to make your choice.  

Great, you got lucky.  That makes as much damn sense as saying that welfare shouldn't exist because one homeless guy won the lottery.  Good social planning, that.  Lets all just buy lottery tickets.  

[Manhole Eunuchsbane]

5 minutes ago, dmc515 said:

Please correct me if I'm wrong, but I'm almost positive the IRS has never penalized anyone for not abiding the mandate.  I say this as someone who got a threatening letter from them this year, even though I've been on my university's plan for almost three years now.  I ignored it.

Anyway, I was skeptical they'd ever enforce the mandate under Obama.  They certainly aren't under Trump.  He's literally ordered it so.

I'm not sure really. Everything I've read suggests that they have enforced the penalty only through deducting it from refunds.