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ObamaCare Clusterfuck: If you've got leukemia and good coverage, wait, and your policy will hit the lowest common denominator

An interesting paper from Millman, Inc (a provider of actuarial services):

2014 Individual Exchange Policies in Four States: An Early Look for Patients with Blood Cancer
The ACA rules do permit variation among exchange plans, and these variations can be significant for services important to people with blood cancer.

This variation among plans is high in the initial 2014 exchange launch, but the authors believe it may diminish in future years as competing insurers converge toward lower-cost and more restrictive features.

So if you like your plan, you won't be able to keep it.

Based on our review of four states— California, New York, Florida and Texas,we have the following high-level observations:

  1. Many QHPs include only a limited number of National Cancer Institute designated cancer centers or transplant centers in their networks. This could discourage enrollment in these QHPs or result in non-coverage of treatments that would otherwise be recommended for some patients with blood cancer. We note that expert care and clinical trials can be provided outside NCI-designated cancer centers.
  2. As expected, we found high cost-sharing levels for the silver and bronze plans, which most observers expect to be the most popular choices because they will have the lowest premium rates. Deductibles for silver and bronze plans were often at least $2,000 and at least $4,000, respectively.
  3. Within particular cities, there is significant variation in premium rates.
  4. Among the drugs that are important for people with blood cancer, there is variation from plan to plan in which drugs are covered. The annual out-of-pocket limits set for 2014–$6,350 for an individual policy and $12,700 for a family policy–are particularly important to people with blood cancer because their treatments can be very expensive. Some insurers offer plans in some states with lower out-of-pocket limits. However,the out-of-pocket limit does not apply to non-covered drugs or treatment centers.

Now, I have to admit that coverage of pre-existing conditions is a good (assuming you accept the private health insurance model). However, coverage is not the same as care, as the above points make abundantly clear. Under ObamaCare, care -- that is, whether you live or die -- is very much a matter of "luck of the draw," as Millman carefully explains: Care depends on which state you're in, as well as whether the narrow networks and narrow formularies include you and your treatment. And if your networks and formularies aren't narrow now, they will be.

NOTE Hat tip for the source to Mellon IIRC!!

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mellon's picture
Submitted by mellon on

I'm trying to think of a good way to explain a basic fact about healthcare which a lot of people don't get. Our system has evolved in a way that a growing amount or resources has been funneled to players who don't deserve the large shares they have been getting, (insurance companies and drug companies) at the expense of the participants who do deserve much more, doctors and patients.

What we especially need to do is drastically reduce the burdens on patients and employers and increase the amounts given to doctors - in order so we can painlessly have a transparent, accountable, professional system where all doctors are "in network", no gag clauses exist, where doctors are trusted, (as they ARE trained to make intelligent use of medical resources) The system attempts to give each patients the best possible care available, within the reasons of common sense. This is what Canada tries and largely succeeds in doing, (compared to us, its like night and day)

There is so much waste that comes from the multi-tiered system that with SINGLE payer we can do that, however the proposals we are hearing now which claim to be single payer are not in fact single payer, they remain multi-payer systems which will by necessity fail because of a failure to be able to contain costs.

**The way the single payer system works is by eliminating that huge layer of waste, and by gaining the clout, as the single buyer of services, to set prices.**

Without the ability to do that, there isn't any point UNLESS the government would be willing to fund the HUGE deficits that system will run, and it can't, unless we took that money out of the military budget! Which I think they would be unlikely to do. (But, that's what would need to happen.)

Without REAL single payer, -

The FAKE "single payer" proposals will all look similar to high risk pools. which typically run huge losses. (which they funded out of special taxes on insurance coverage in those states, generally)

Thats why the state high risk pools membership has historically been limited to people with serious conditions who both could afford individual coverage (only around 15% of the general population) but who could not buy it because of medical underwriting. In short, the high risk pools WERE CLOSED TO MOST SICK PEOPLE BECAUSE THEY COULD NOT HAVE AFFORDED TO BUY INDIVIDUAL INSURANCE EVEN WERE THEY HEALTHY.

(Look at the weird logic there!)

Its likely that the population served by Obamacare will look a bit like the sick who were not in high risk pools. Contrast them with the fact that the high risk pools were good isurance, meaning they paid 90% of all costs and had good networks. after all they were meant for sick RICH people. So a policy in a state high risk pool might cost several thousdand dollars a month, but that would be a predictable cost and the out of pocket costs would largely be included with manageable extra bills, low co pays and deductibles, etc. BUT, that premium was only a portion of the plans actual cost. The rest, at least half, was paid by this tax. Which means that if this insurance which allows people to be sick without dumping them wasn't heavily subsidized it might cost $4000 a month. (As much as an average family PPO policy in New York City.)

One can see the problem. This system is obscenely expensive because it wastes 40% of a huge amount of money. That 40% just can't go on being wasted.

Also, what happens ten or twenty years from now where jobs are few and far between for most people who are of working age today? How are they supposed to pay these huge costs? Its not going to be possible.

The for pay system already doesn't make sense now, and it will make even less sense in the near future. The government knows this. So why are they lying and pretending that this system makes sense?

Probably because the unjust and unaffordable system as it exists today "serves other needs" which they would prefer not be public.

But, the fact exists that it's not working, and it was a mistake to hijack the 2008 victory to rescue the parasitic, failing business models of these two industries (insurance and drugs) which should in a sane world, at the very least, face huge downward pressure on prices. If their models required adjusting THEY should be the ones that adjust, or get out of the business. Instead, the government has done something which is destroying the trust of the American people in government.

Maybe that is their goal? Maybe Obamacare is an attempt at a "burning of the Reichstag" in America?

Its also likely that we get these bad plans forced on us because of trade policy. The meme that the US peddles around the world is that public services represent a past - say the late 20th century, when governments spent a lot of money on public services but those expensitures are unaffordable now. The US promotes the falsehood that privatized services are "more efficient" but the underlying message is that they shift responsibility off of (often increasingly corrupt) governments onto private companies who are largely unaccountable to anybody. That message resonates with corrupt officials around the globe.

It makes sense here to call attention here to the fact that the US is actually one of the least taxed developed nations.

Here is a link to research that shows that current medical spending would be enough to fund REAL single payer ... (none of the current proposals are real single payer as far as I can tell) completely without any need for additional taxes.

(real) Single payer also means a single buyer!

(Woolhandler, et al. “Paying for National Health Insurance — And Not Getting It,” Health Affairs 21(4); July / Aug. 2002)