"What an order like this is doing is making care nearly impossible -- to the point where a patient will avoid using the care they've paid for and pay double, by paying out of pocket."

This is why for a lot of people, it makes economic sense to skip the insurance part and just pay out of pocket.

At any rate, it may be moot by this June when the Supreme Court ruling comes down.

"After all, she'd supported President Obama and the act as a matter of principle."

Too bad she didn't look at it as a matter of cost and availability. Like so many of these "principled" morons she thought it would only cost everybody else money and inconvenience. After all she'd supported President Obama!

Maybe I'm missing the point but why couldn't she take a cab to/from? That's the price you pay when you don't need a car for everyday living.

And there are still Obama supporters who will say that woman didn't try hard enough to find affordable insurance.

> her insurer said that Stamford was 14 miles from
> her home

Manhattan to Stamford is at least 30 miles - something doesn't add up here.

everyone is acting like all this is a bug and not a feature.

Ever been on hold with customer service for 2 hours?

Yeah, they're HOPING you give up. You've already spent money on whatever it is, and because everyone's customer service is pretty bad they figure you won't punish them by going elsewhere.

The govt. generally does an identical thing, and certainly obamacare does.

It may well be that we simply had it too well for too long, in terms of our expectation of healthcare... and that it simply was not sustainable in the longrun. It wasn't that long ago that insurance was 80/20 and deductibles were high, so when you went to the doctor most, you simply paid cash... How it was when I was a kid.

The catch is, because of the intervening HMO years and a lot of other expectation, prices went insane... so now it's hard to pay cash for anything.

I tried to get a cash price from my Dr. for something, and they just said it would be the same regardless if it was through insurance or not.
:shrug: so I had it go against my deductible, and since it was in network, the ins. company did the old $325 to $80 cramdown, that then I had to pay cash on.
If they woulda worked with me, I mighta paid them direct at the time, cash in pocket..
apparently they have forgotten how to do that too.

Ultimately pay attention to what they DO, not what they say.

The law was written by insurance companies, and provides them benefit.

When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. "It was ridiculous -- didn't they notice it was in another state?"

Well, you don't have to cross a check point and present papers, so...I'm not sure what the problem is? besides, you "supported President Obama and the act as a matter of principle".

I am reminded of observation that a person says they approve of something in principle, it means they haven't the slightest intention of carrying it out in practice.

With apologies to Bismark

SwissArmyD has summed it up well.

If you're going to run a purely capitalist system, you just have to keep the government out. And that means if doctors get sick of people coming in for treatment and not paying their bills, the doctor can stop treating them. Do you expect doctors to work for free? Maybe there are charities who will help that person out.

Or you can say that while doctors can't be expected to work for free, you can't just let someone die either, so everyone else has to be forced to kick in for that person's medical bills, and it comes out of everyone's taxes. You just socialize the entire thing.

What we have now doesn't seem to benefit anyone but the insurance companies, which makes sense because they are the ones who lobbied for Obamacare.

By the way, I'm self-employed and in the same boat as Amy.

I pay around $200 a month for a catastrophic-only plan with a $6,000 deductible. So if I ever go to the doctor I'm pretty much going to be paying for everything myself. Maybe I'd be better off just sticking that $200 per month into a health savings account, if I'm never actually going to get insurance benefits anyway.

Of course, if I got some kind of dread disease requiring hospitalization I couldn't afford, I'd just die from it.

And then again, if insurance becomes too expensive, it becomes a quality of life issue, and maybe it makes sense to say you'd rather enjoy your life now than scrape by in poverty for years and years just in case you ever get cancer. If I got cancer I wouldn't get treated for it anyway - I'd just die. Other diseases I would get treatment for. It just depends.

The problem is the ObamaCare architects (and namesake) didn't understand the difference between healthcare and health insurance and, so conflated the two.

Now, instead of a semi-competitive healthcare industry financed by health insurance, we have a oligopoly health insurance industry with nominal actual healthcare coverage.

...because of the intervening HMO years and a lot of other expectation, prices went insane... so now it's hard to pay cash for anything. ~ Posted by: SwissArmyD at February 11, 2015 10:14 AM

Exactly.

The HMO was implemented with the idea that if you got people to go to the doctor for little things, those little things wouldn't become big things and cost more in the long run. A co-pay system was implemented with a low cost to the consumer of a regular doctor visit.

Unfortunately, that didn't work out. People visited the doctor for any little thing, things they used to treat with over-the-counter medications (colds, warts, etc.). The cost of these frequent visits far outweighed the savings from catching diseases early.

Even caught early, treating a disease is still expensive. Cancer was still cancer and its treatment cost a fortune even if it was detected early (and, in fact, if detected early the patient had to be treated whereas if detected "too late" that patient couldn't be treated and actually saved the system money).

Insurance companies purchased the now-floundering HMOs and wrapped them into their coverage plans - figuring to save money by owning the provider of the healthcare they were paying for anyway.

HMOs and insurance providers could exclude people with pre-existing conditions that they knew were going to cost money and keep the costs manageable for the rest of the population.

That was "unfair" according to activists who wanted a single-payer system like they have in Europe and Canada with everyone covered no matter what (again, the conflation of healthcare and health insurance).

They imagined a futuristic "Gattaca" society in which the imperfect were doomed to live in poverty and squalor.

Unable to conceive that an open healthcare market unshackled from health insurance might provide lower-cost treatments, they insisted on government-mandated coverage for all.

As a result, we get ObamaCare with high deductibles, high premiums, and low levels of actual healthcare provided.

==============================

Also, keep in mind that "modern medicine" didn't gain traction in the treatment of disease until the early 20th century.

Before that, your local doctor most likely got his training from an apprenticeship to another ill-trained "doctor" - if he had any training at all. The lucky ones got someone who had actually studied at a college.

Quackery abounded - snake oil, narcotics, and "miracle" elixirs were peddled buy con men and avidly consumed by people who had little hope of being cured by their local sawbones.

Bleeding with leeches was still a common treatment in the 1918 influenza pandemic - weakening patients already stricken with a debilitating flu and contributing to the high death toll.

With the advent of scientific medicine and the greater understanding of disease, medicine was able to cure more people and death by curable disease was something more affluent people worried about less than the poor did - cures cost money.

When the Constitution was written, rich people were almost as likely as poor people to die of tuberculosis, small pox, polio, etc. With the advent of modern medicine these diseases were eradicated for those who could afford (or be given) medicine to prevent or cure them.

The root of our current conflict over medical care and coverage for all is due to the game-changing advances that have been made in medicine over the last 100 years.

Medical care was not considered a "right" in Constitutional days since it was hit-or-miss for everyone. Activists began seeing it as a "right" when it actually became effective.

Jo,

In the long run you will certainly do better saving and paying cash for medicine instead of paying for insurance. But be careful when looking at tax advantaged savings plans. Many have odd strings attached. At one time the government confiscated any savings Jan 1st. I don't know if they do that now but it wouldn't surprise me.

One thing about insurance, some of the highest cost procedures are the ones that are the least effective at actually *curing* you.

If you read enough cancer studies notice how effective treatments are expressed in five year survival rates, and not *cures*

I am not totally against chemotherapy, a friend just went through a course of it for a fast moving ovarian cancer that was detected early.
However, in diseases such as late stage stomach cancer, lung cancer, or pancreatic cancer, it is almost always a very expensive *Hail Mary*.

Also Conan if you are going to dis on 19th and early 20th century medicine, the 1950's were almost worse. Frontal lobotomies to treat mental illness, and radical surgery and poisonous radiation to treat most cancers, with little effect, and *bed rest* for heart attacks.

The Romans and the Greeks actually did some things better than 20th century western doctors, right up until the late 1960's.

Not a decade to remember fondly.

Ben,

In the long run you will certainly do better saving and paying cash for medicine instead of paying for insurance.

But now there's that tax penalty.

As for tax advantaged savings plans, I believe you are thinking of flexible spending accounts. Those are where you set tax-free money aside and have to use it by the end of the year. You can use it with any kind of health insurance.

A health savings account is different. You can only have one if you have a high-deductible plan, but there's no "use it by the end of the year or else." Your donations are free of income tax, but if you are under age 60, you can still use the money as long as it's for medical or dental expenses. After age 60, you can continue to use the money tax-free for medical expenses, and you also have the option to use it just like an IRA, for non-medical expenses, but you will have to pay income tax at that point on non-medical withdrawals.

If you funnel all medical and dental expenses through this type of account, basically you never pay income tax on the money you had to earn to pay those expenses.

Also Conan if you are going to dis on 19th and early 20th century medicine, the 1950's were almost worse. Frontal lobotomies to treat mental illness, and radical surgery and poisonous radiation to treat most cancers, with little effect, and *bed rest* for heart attacks.

Not a decade to remember fondly.

~ Posted by: Isab at February 11, 2015 3:15 PM

The '50s were actually a decade of progress for medicine. In that decade we saw:

• the first aorta transplant
  
• the synthesis of penicillin
  
• the discovery of Hepatitis A
  
• the development of a vaccine for yellow fever
  
• the first use of a heart-lung machine to keep someone alive
  
• the first use of electric shock to restart a stopped heart
  
• the first first open-heart surgery
  
• the invention of the pacemaker
  
• the discovery of Streptomycin (successful in combating Tuberculosis)
  
• the development of vaccines for polio, whooping cough, and dyptheria
  
• the first kidney transplant
  
• the first use of a kidney machine for dialysis
  
• Watson and Crick discover the structure of DNA
  
• the invention of the birth control pill
  
• the first war in which combat wounds killed more soldiers than disease

The procedures you cited were horrific and were abandoned when they proved ineffective or better methods were found.

Just because medicine had finally modernized and adopted the scientific method didn't mean it had all the answers at once.

By the '60s, we were no longer electro-shocking our mentally ill. Instead, we were giving them psychotropic drugs and turning them loose to wander the streets.

Radiation treatments gave way to chemotherapy in treating cancer. By the way, the paper that started scientists on the hunt for a virus as the cause of some cancers was published in the '50s.

And the Greeks and the Romans had their issues as far as quackery and medical misconceptions go.

The Greeks based their medical treatment on humors, although the did recognize geography and living conditions as a factor in disease as well as adopt testing methods to dispense with cures that didn't work. The Romans adopted a public policy view of medicine and developed medical specialties - but they failed to advance internal medicine beyond the Greek humors basis.

In all, I'd rather have been sick in the '50s than in the decades preceding them. Although, I watch old movies and cringe at what passes for medical care in them.

I wonder what they will say about current medical procedures and beliefs in another sixty years.

I notice that Patrick is missing - whose health care "isn't going anywhere".

Please note that the ACA requires your enrollment to be reviewed, the clock reset on your deductible, periodically.

I noted that healthcare.gov does let you se what gross effects the plans will have on your bank account now. I would pay $467 per month - up front, you will notice, for a service I do not get - and then my annual deductible is $6600, with no breaks.

That's theft. I pay $5604 for the privilege of paying everything myself, up to $12204.

This is a solution.

But since it doesn't allow a bureaucracy to TELL you what you may do, I see little hope of anything like this passing.

We might as well start killing doctors.

wonder what they will say about current medical procedures and beliefs in another sixty years.
Posted by: Conan the Grammarian at February 11, 2015 4:41 PM

Very little that is good.

I give the fifties less credit than you do, because even though the theoretical basis was laid down in science for some advancements, you didn't see them in the hospitals til much later.

I had an appendectomy in 1965. It was done almost exactly as it would have been performed in 1940. In other words, just like the one, my mother had....

Conan: "By the '60s, we were no longer electro-shocking our mentally ill."

"Radiation treatments gave way to chemotherapy in treating cancer."

Electroconvulsive therapy is currently a standard psychiatric treatment used as a last line of intervention for major depression, mania and catatonia.

Many different forms of radiation therapy are used to treat cancer, especially in the early stages of some cancers.

Both radiation therapy and ECT are a lot more technologically advanced, sophisticated and effective than they were in the 1960's.

Fortunately my medical insurance premium is only increasing by 20% this year. Unfortunately the deductible has been doubled and the amount of expenses covered by insurance has been decreased from 85% to 70%.

"Stamford was 14 miles from her home and 15 was considered a reasonable travel distance"

That's a problem, not just for insurance. A few years ago I was contacted by a job recruiter, who lived in the Midwest; she was contacting me about a job in New York, not far from where I lived in New Jersey. Not far on a map anyway.

I had to explain to her that I was in New Jersey and a job in Manhattan would be commutable, but, this was a job in Brooklyn which would have added another hour to my commute into the city. She wasn't really aware how much more that would make the commute - after all, to her, Brooklyn was a part of New York.

For folks who don't know a particular urban area what seems reasonable just isn't. It might look good in their database; but, they don't know the traffic patterns, the mass transit involved, etc.

This recruiter I talked to was good about it; she thank me for clearly explaining it to her. She wanted to make sure she wasn't wasting her time or others in trying to match job applicant to open positions.

But, the author in this piece ran into a bureaucrat - never an easy thing to deal with. And, many times just plain fruitless. That's one of the problems with Obamacare (or any other government program) - it places a bureaucrat between the patient and the health care provider.

So, sure maybe driving 15 miles in some suburbs might be okay, but, 15 miles in a congested area can be much more trouble - especially if you're on crutches.

But, I really have no sympathy for this author - she supported Obamacare from the get-go without thinking it through. Others did think it through, sounded the alarm, and were called "uncaring" and other stupid names for it.

I so hope that congress can overturn Obamacare - one of the biggest piece of shit laws ever passed.

"Thanks, Obama voters"

"WE LOVE HILLARY! DERP!!!"

Even the mighthy Douthat feels compelled to genuflect before the palaverous Atlantic article—

The big foreign policy piece that everyone is talking about this week, and deservedly, is Graeme Wood’s deep Atlantic dive into the religious premises…

…Blahblah. But Douthat, unlike (apparently) everyone else on the planet, sobers up to conclude with clarity:

So even as we acknowledge the obvious and describe ISIS as Islamic, we should give the rest of Islam credit for being, well, Islamic as well, and for having available arguments and traditions and interpretations that marginalized this kind of barbarism in the past, and God willing can do so once again. Those arguments and traditions may not suffice to synthesize Islam fully with Western modernity; whether that’s possible (or desirable) is a larger and more complicated debate. But we can reasonably hope that they will suffice intellectually in the face of the Islamic State, whose arguments for its own deep orthodoxy are contradicted by centuries of Muslim theology and tradition, and which is as much at war with the lived historical reality of Islam as it is at war with Christianity, secularism or the West.

Good boy.

moarsoon

Wrongthread. I feel bad.