I am an expert on the PPACA debate me....

Discussion in 'Health Care' started by hudson1955, Jun 14, 2015.

  1. hudson1955

    hudson1955 Well-Known Member Past Donor

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    I am an expert on the PPACA, Obama care and health insurance. I have been replying to posts in the health care forum for quite sometime, No one that has disagreed with my posts have provided factual information to dispute what I have posted.

    So lets get real. The PPACA according to the CBO has not done what it was promised. Remember, they promised premiums would be lowered as would the cost of medical care. Well the cost of "providing medical care" has risen and so have premiums for "good" insurance because of the HHS "minimum essential benefits mandate" which was never specific to the PPACA. The PPACA gave HHS the right to decide what the minimum essential benefits would be. But they knew what they would be all along. They knew they would include maternity and newborn care whether the insured(s) would need this high cost coverage or not. They knew it would include low cost tests such as mammograms, that were 99% covered to begin with.

    They promised health insurance companies providing insurance plans on the State and Federal Exchanges a bailout if the policies they offered loss money. They never told us this prior to passage of PPACA. They knew illegals and those not effected by the individual mandate that remain uninsured would continue to seek ER care and still impact the premiums the rest of us pay. They knew there were no regulations that mandated what care or surgery these policies must cover. They knew these policies would limit who could give care and where it could be given. They failed to require full transparency of coverage provided by insurance purchased on the exchanges. The entire PPACA should have been deemed unconstitutional as the President and the Democratic Congress said the "fee" charged for not having insurance was not a tax. But the SCOTUS decided to change the law and call it a tax in order to deem it constitutional. The pending SCOTUS hearings will likely continue to support Obama.

    The liberal media continue to lie. But this isn't a party issue, it is a financial issue. We are being forced to pay higher premiums to pay for benefits many of us will never need, such as maternity and newborn care benefits, the highest contributors to higher premium cost. We have been lied to prior to the passage of this law and we continue to be lied to.

    Unfortunately more and more patients/insureds are finding that their coverage is basically worthless due to the high deductible and co-pay and the few in network providers. I know our patients are not happy. I know our fellow physicians and surgeons are hardly able to stay in practice. Luckily, my husband(surgeon) is near retirement. Thank God. As our reimbursements do not pay the bills, only investments in pharmacies and surgical centers pay the bills so we can continue to treat our patients. This is sad.

    To you that want single payer/universal health care. Just what do you think the federal government should pay physicians, surgeons, hospitals, nursing homes and the like under that system. As they will all be employees of the Federal Government and I assume they will purchase all hospitals, clinics and nursing homes. If they don't, then what?
     
  2. CourtJester

    CourtJester Well-Known Member

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    Still waiting for you to clarify whether you are a doctor as intimated in some postings or a clerk in billing as claimed in some other postings. In other words what are your qualification that allow you to claim expert knowledge.

    As for knowledge you have repeatedly claimed that the ACA allows insurers to charge more for pre-existing conditions. When asked or proof you have never been able to provide any because of course the claim is untrue.

    Oh, and by the way your posts rarely have any actual facts or data. Opinions are not facts although you are certainly welcome to have your own opinions, you are not welcome to pretend they are facts.
     
  3. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Insurers are guaranteed a profit by the ACA so if healthcare costs more, so will insurance. Adding pre-existing conditions to the mix raises cost; thus, raises the cost of health insurance. The reason that insurance companies did not cover it before is that the private product would be too expensive for anyone to afford. This is simple math and business that some seem unable to understand.
     
  4. tkolter

    tkolter Well-Known Member

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    Well I'm for giving our top students a ,well not free, but low cost university education up through the graduate and professional advanced degrees, say covering books and supplies at one Federally funded university in each State. So doctors could be educated at a low cost in good but "basic schools" as in no major frills. A nice basic dorm, labs would be fine being good and so forth. So they could channel medical doctors and other professionals from those to a national medical service. So paying them say, $60k for basic general practice and covering malpractice costs would be fine (well say Middle Class) and with specialties more and also based on length of service adding a COLA and expertise bump in pay every ,say, five years.

    But I would also have in every county (or group of counties if lightly populated) a Federal medical facility a hospital with attached clinics and specialty centers for the poor to go to.
     
  5. CourtJester

    CourtJester Well-Known Member

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    That didn't answer either question.

    You have stated repeatedly and incorrectly that the ACA allows insurance companies to charge more for people with pre-existing conditions. This is clearly untrue. Trying to pretend that you said covering people with pre-existing conditions raises the overall cost of healthcare is just untrue and not what you have repeatedly claimed. Expert status is clearly unwarranted and obviously disproved.

    And if your husband is losing money on his practice a single payer system like the one in Canada would obviously be beneficial. This will help your knowledge base.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110239/
     
  6. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Again, simple math that many don't understand or the reason it was not covered in the first place, cost. The reason the actuaries are requesting very high increases now is because they had to get the information they needed after the big change and now the chickens are coming home to roost. For instance, this is also based on the insurance pool and the ACA has missed it's target of enrollees and especially the ones they expected to pay for it, the young.

    What you don't understand is that no matter what system is used, someone has to pay for it either in higher taxes or insurance premiums. There is no free lunch.
     
  7. CourtJester

    CourtJester Well-Known Member

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    What you don't understand is you said insurance companies can charge more to insure people with pre-existing conditions. Period. You can duck and weave all you want and pretend you said what you didn't actually say but your credibility is totally busted.
     
  8. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Of course they can charge more, that is what actuaries are for. You are just misreading what I am saying. In case you missed it, everyone gets the coverage. The rates were hit and miss and set up in the beginning by the HHS to be modified when actuarial data can be obtained after the big change. That is why companies are hiking their rates. They are limited in what they can use the money for by the HHS so the rate hikes are based on cost, not something imaginary.

    Previously they could have included pre-existing conditions in all insurance policies, but then nobody could have afforded them.

    Math, so difficult for some.
     
  9. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Yep, here is how well single payer works.

    http://www.thedailybeast.com/articl...ptoms-doctors-ignored-her-now-she-s-dead.html
     
  10. CourtJester

    CourtJester Well-Known Member

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  11. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Sorry to hear.
     
  12. hudson1955

    hudson1955 Well-Known Member Past Donor

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    Anyone that smokes tobacco or has smoked tobacco in the last 5 years is quoted a higher rate. Why else do you think they ask this question and others when you apply for health insurance through the exchange or otherwise? Check it out. They include this as pre-existing. You will pay a higher rate. And if you answer no, and get lung cancer, they can deny coverage of your treatment if they find you had or still do smoke.

    So you are wrong about this and Hoosier is in part right in what he/she said.
     
  13. hudson1955

    hudson1955 Well-Known Member Past Donor

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    Sorry he died. But you say he went to his doctor, what kind of doctor? Family physician, Gastroenterologist?
    Unfortunately, these days, many insurance plans have what they call "gate keepers", primary care/family physicians that you must see first and they are suppose to direct you to the appropriate specialist if they think you need to see a specialist. So that is why I ask. I doubt very much that the individual you speak of sought treatment from a Gastroenterologist who would have virtually never have brushed it off. This is why the PPACA doesn't work, nor does managed care.

    If you have an eye problem you should be smart enough to know you need to see an eye doctor, a heart problem a cardiologist, and so on. Why should you pay more money only to see a primary care physician that would treat your problem but only refer you to the specialist you already knew you should see? It is stupid.
    But perhaps I am giving people to much credit. Perhaps there are really stupid people that have a problem urinating and don't know a urologist is the one that can help them. Or someone that has a skin rash and doesn't know a dermatologist is the specialist that they should see.

    So the health care system can perhaps cost more because of the stupidity of patients and their lack of willingness to "google the health problem they are having to find the correct doctor or surgeon to help them.

    And, oops, not to forget that the u.s. federal government has the right to mandate that hospitals/doctors and clinics treat anyone that presents for emergency care regardless if they can pay for that care or not. Virtually they only occupation mandated to do so. Attorneys charge by the minute, Plumbers, Electricians charge as they like. But highly educated, private practice physicians and privately owned Hospitals and Clinics; "screwed" by the U.S. Government. So, where does this lead in the future? I will tell you that the only solution under these current restrictive laws is that all Physicians/Surgeons are employed by the Federal Government and all Hospitals, Clinics, Pharmacies, Drug Companies, Home Health Care Companies, Equipment and Supply Companies are owned by the U.S. Government.

    Does that mean they will hire all current providers and buy all hospitals and clinics and other ancillary companies? I doubt it, knowing the U.S. Government and their fraudulent ways, their will winners and losers when this comes about. I can only be glad that my husband/surgeon is near retirement. But I tell you that know l providers I know personally are advising the young to study medicine. If a good income is their goal they would be better of taking up a trade such as plumber or electrician. And if they just have to be involved in medicine then dentistry or veterinary is a better choice as you can set you own fees and charge cash for your services.
     
  14. Nebraskan

    Nebraskan New Member

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    Insurers aren't guaranteed a profit under the affordable care act. There are reinsurance, risk adjustment and risk corridor programs designed to stabilize premiums, but they do not guarantee a profit. Insurers are required by the law to have a minimum medical loss ratio requirements of 80% or 85 %. Adding pre existing conditions into the mix does raise costs, but those costs are supposed to be off set by the individual mandate, and there should be more and more young adults enrolling in health plans as the penalty increases. Insurers had pre existing conditions set up in the old system when the insurance companies business model was perversely tied to attracting low cost health individuals and avoid payments to the sick.
     
  15. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Of course they are, why do you think insurance companies were for the ACA and helped write it? Pre existing conditions cost more money and the reason they did not cover them before is because they could not sell the product due to the cost of the product. The ACA did not make math magically go away.
     
  16. Nebraskan

    Nebraskan New Member

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    Find any credible article that states that insurers are guaranteed a profit under the ACA. Yes pre existing conditions did cost money, and insurers did not have the proper risk pool to pay for those conditions. The subsidies and mandate have changed that.
     
  17. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Not really seeing how the majority of those signing up are the elderly and sick. They have not hit their targets and the ACA is not popular with the young that are not sick and normally don't get insurance until they are older.

    BTW:

    http://www.forbes.com/sites/scottgo...-subsidy-of-them-why-the-distinction-matters/
     
  18. hudson1955

    hudson1955 Well-Known Member Past Donor

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    They may not be guaranteed a profit but the deal Obama worked out with them would bail them out(just like the banks were), if they lose money on the "Exchange PLans" they offered or due to covering individuals with costly pre-existing conditions.

    "Although insurers can't charge more for health status, they can charge more for smoking status", obamacarefacts.com/obamacare-smokers

    Another implication of the PPACA we were never told was that the PPACA gave insurance companies the right to charge smokers more because under the PPACA, smoking was not identified as a pre-existing condition, purposefully, and the Government did this to discourage people from smoking even though they knew that even if a person had stopped smoking the insurance company could still charge them a higher premium, more lies. "ObamaCare Gives Smokers a New Incentive to Quit

    "We have the facts on ObamaCare and smokers, from the ObamaCare smoker glitch to the amount smoking can increase your premium, ObamaCare affects smokers. Although insurers can’t charge more for health status, they can charge more for smoking status. Those of us looking to save money on our health insurance premiums will want to take another look at the true cost of being a smoker. Let’s take a look at a scenario below to see how ObamaCare affects smokers."
    http://obamacarefacts.com/obamacare-smokers/
     
  19. hudson1955

    hudson1955 Well-Known Member Past Donor

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    "adding pre-existing conditions into the mix doesn't raise the cost", you mean the cost of providing insurance? Duh. You are forced to cover patients who already have a costly condition to treat but can't charge them more because you already know your cost of insuring them will be higher? And you think that doesn't raise the cost of insuring this person. What planet do you come from? It is like saying that forcing a lawyer to take a case on contingency that already know they can't win isn't a losing proposition. Or forcing homeowners insurance to pay for damage that existed prior to the homeowner purchasing the companies insurance. Or buying car insurance where the insurance company must cover damage to the vehicle incurred prior to the insurance being purchased. Or all auto insurance must cover routine maintenance, oil changes and the like. Really? Part of the rising cost of providing health care has been caused by the unreasonable expectations of those purchasing insurance. Health Insurance is suppose to be insurance that helps you pay for non-elective medical/surgical care. You select the benefits and coverage you can afford, just as you select other insurance coverage.

    There are only two choices that make sense. Universal Health Insurance, where all physicians/surgeons are employees of either the State or Fed Government and all hospitals, clinics and pharmacies owned by the State or Federal Government; or Free Market System where all providers, hospitals, clinics, pharmacies and other medical providers vie for business in a competitive market place. The current PPACA will not work.

    An example of the free market system would be Dentist. Most dental plans have a yearly $1500.00 coverage regardless of the premium you pay. Many Dentists don't even accept insurance plans and require payment up front. Giving you information for applying for credit through an outside credit provider.

    Thus, an intelligent patient shops the fees dentists charge for the treatment they need. Dental Care is some of the most costly medical care provided. And, Dental insurance my cover extraction of an infected tooth that can lead to death if not treated or extracted; but won't pay to replace the tooth once pulled. Lack of teeth leads to many other digestive conditions that can eventually cause other health problems or death. Yet the ACA fails to address this issue.

    And, looking to surgical vets; ones love for their pet often costs them thousands of dollars. Even have pet health insurance fails to pay for the most expensive surgical and medical the pet requires. Yet, their owners are willing to make payments, charge the fees and even pay cash. But when it comes to their own health care, they seem reluctant to do so.

    I often say to my husband, why didn't you go to dental school or veterinary school instead.

    He and his colleges are tired of being paid peanuts for performing surgeries where insurance companies also expect their payments to cover all follow-up care for 6 months post op while a veterinarian is paid, in cash 2 to 3 X's as much for the same type of surgery they performed on an animal. And dentists, paid $5000.00 up for a replacing a tooth.

    Example, my husband is paid $300.00 to amputate a diabetic, gangrene foot and give 6 weeks of post up care, where as before the onset of managed care, HMO's, PPO's he was reimbursed by insurance 1000.00 up.

    The stagnant Medicare reimbursements lead to this as did the fact providers were willing to sign up for these lower reimbursement plans in order to be able to continue to treat their patients on these plans. I warned him not to sign up and suggested their Organization boycott these plans across the board. But unfortunately due to Federal Law, doing so would have been illegal as doctors are banned from even discussing their fees amongst themselves. What a crock of you know what.

    So to you that believe Doctors are greedy. You couldn't be more wrong. Doctors accepting medicare have not seen a reimbursement increase since the early 1990's. All past and current hype over "reducing their reimbursements" has lead anywhere because they have been receiving the same or less reimbursements since the early 1990's regardless that their costs of providing care to medicare patients as increased 25% plus since that time. At a point in the near future I predict more and more providers will be forced to pull out of the Medicare Program..Reimbursements simply will not cover the cost of providing the care let alone make them any profit.
     
  20. CourtJester

    CourtJester Well-Known Member

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    No, smoking is a behavior not a pre-existing medical condition.

    - - - Updated - - -

    You actually need to do some actual research about how single payer systems work in other countries.
     
  21. CourtJester

    CourtJester Well-Known Member

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    This was prior to the ACA with a company supplied plan that required going to a gatekeeper before seeing a specialist. And perhaps if he had bypassed the system and gone to a specialist he might have come out OK. But his real act of stupidity was trusting the doctor.
     
  22. Nebraskan

    Nebraskan New Member

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    Well, that was a long rambling rant. First of all, I never said adding pre existing conditions doesn't raise costs. I said the exact opposite in fact. Go back and read my post. Second, a free market system won't work because when it comes to people's health they no longer act as rational consumers of health care. Third, the Medicare system of reimbursement is fundamentally broken because of its fee for service model. The affordable care act is working to address this by shifting to a value based care model.
     
  23. Nebraskan

    Nebraskan New Member

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  24. Hoosier8

    Hoosier8 Well-Known Member Past Donor

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    Basically they are subsidized by the government for losses due to the ACA. Same thing.
     
  25. Nebraskan

    Nebraskan New Member

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    No, it's not the same thing lol. The incentive is still for health plans to price premiums 3 % higher than expected medical claim spend. And the plan is always paying a portion of the losses. It's not like if the health plans are losing a lot of money that the federal government comes in and picks up the whole tab. These types of risk adjustment programs are pretty much the same thing that was included with Medicare Part D.
    [​IMG]
     

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