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The Ultimate (Frisbee) Argument For Visiting Healthcare.gov
October 9, 2013 10:47 AM   Subscribe

John Hodgman posted about the ACA, which led his followers to tweet him about the various health problems they had encountered and the effect insurance or a lack thereof had to their lives. Hodgman retweeted many of the stories from people in their 20's and then posted 17 reasons for young people to get insured to his blog.
posted by reenum (189 comments total) 35 users marked this as a favorite

 
John Hodgman is rapidly becoming an Indispensable Pundit, in the realm of Ta-Nehisi Coates and post-voice Roger Ebert. If you're not listening to the Judge John Hodgman podcast, you are missing out.
posted by Etrigan at 10:52 AM on October 9, 2013 [6 favorites]


Great! Still waiting for account access on Healthcare.gov to work, but once it does, I'm making all my younger siblings sign up.
posted by ThePinkSuperhero at 10:55 AM on October 9, 2013


"FINALLY, REMEMBER, YOUNG PEOPLE: just because you don’t want to pay for health insurance now doesn’t mean you’ll be able to bit-torrent it for free when you need it later."

The JJH podcast is indeed great. (<— Buzzmarketing!)
posted by Atom Eyes at 10:58 AM on October 9, 2013 [4 favorites]


>17: FINALLY, REMEMBER, YOUNG PEOPLE: just because you don’t want to pay for health insurance now doesn’t mean you’ll be able to bit-torrent it for free when you need it later.


"when you need it LATER"

That is just it. From a mathematical point of view. Most young people don't need health insurance. A very large percentage of young people that don't have insurance don't have it because they don't choose to have it. Young people simply speaking are less likely to require health insurance so are better off using that money to do other things with. It is cheaper to self-insure.

The problem is the system requires a large number of people paying into the system that won't make use of the system. The people who statistically speaking won't be using a lot of health care has to pay for those who who will likely need it. And for those with pre-existing conditions who will definitely need it.
posted by 2manyusernames at 11:00 AM on October 9, 2013 [1 favorite]


The Verge peice on Healthcare.gov launch.

I'm hearing it's more stable this week so you may want to give it a try.
posted by Artw at 11:02 AM on October 9, 2013


A recent report about the ACA and Californians specifically, done by our public opinion & survey team, found:
Though some may presume the reason most of the state’s uninsured lack coverage is because they don’t feel they need it, the survey suggests this isn’t true. According to the survey, the large majority of California’s eligible uninsured – eight in ten – do feel they need health insurance coverage. Even seven in ten (72 percent) of the youngest uninsured Californians – those ages 19 to 25 – say they need health insurance. Overall, just under two in ten instead say they feel healthy enough that they don’t need coverage.

The desire for insurance is even more widespread among those with more health problems. Among those in ‘poor’ or ‘fair’ health, nine in ten feel they need coverage. But even among those who say they are in good health, a majority—three in four—feel they need health coverage.
posted by rtha at 11:03 AM on October 9, 2013 [8 favorites]


Tried again this morning, same problems as last week. I'll keep checking in!
posted by ThePinkSuperhero at 11:03 AM on October 9, 2013


2manyusernames: "A very large percentage of young people that don't have insurance don't have it because they don't choose to have it."

This is actually nothing but a myth and I wish people would stop spreading it as if it was true:

"But the Commonwealth survey suggests that it’s money that stops 20-somethings from signing up for health insurance, not some idea that they don’t need it.
“There is a stereotype that young adults believe they are ‘invincible’ and don’t want or need health insurance,” said Collins. “This survey shows that is a myth—a typical uninsured young adult is from a low- or middle-income family and works a low-wage job. In general, young adults value health insurance but cannot afford it.”
“Enrollment rates of working young adults in their own employer-sponsored plans average nearly 70 percent, with cost being a principal factor cited among those who do not enroll,” the report reads."

posted by Hairy Lobster at 11:05 AM on October 9, 2013 [24 favorites]


People Are Calling This Obamacare Insurance Exchange in Tears

For Xerox’s Kevin Walsh, “10/1,” as he calls this past Tuesday, was years in the making. Walsh is the managing director of a division of Xerox that’s working with states on the insurance exchanges created by the Affordable Care Act, and Oct. 1 was the day all of them went live. I checked in with him to see how the first few days of the exchange went in Nevada, where the company both runs the technology that underpins the website and operates the call centers that field queries from the public.

When the exchange opened—17 minutes later than the 8 a.m. scheduled start time—the website and call centers were flooded with inquiries. Walsh said that in the first few hours“it was just raw emotion calling in.” People eager for insurance, at times in tears, wanted to get coverage that they didn’t have before. “They were calling up saying, ‘Can I get my coverage today so I can see my doctor this afternoon?’” he says. “That is in one sense moving but also frustrating because, sure, you can sign up—but the coverage can’t be effective until Jan. 1.”

posted by Artw at 11:07 AM on October 9, 2013 [15 favorites]


Most young people don't need health insurance.

And no one can tell which ones do; even a perfect medical detection scheme cannot predict someone rupturing a spleen during an ultimate frisbee game. That's why it's insurance, and that's why expanding the pool by requiring everyone to have it is better than the system that existed two weeks ago.
posted by Etrigan at 11:09 AM on October 9, 2013 [10 favorites]


OK, I will out my cousin here. He aged off his father's insurance just before he was to graduate from college. (This is a few years back.) His parents made him sign up for insurance, because you never know, right? Less than eight weeks later (he had not even gotten his insurance card), he accidentally drove off a bridge in Connecticut, spent at least 20 minutes underwater, was rescued, given a 30% chance of survival, and spent a month in Yale New Haven Hospital. When he called his insurer upon returning home, they thought he was upset because he hadn't gotten his card yet. They were extremely surprised to find out he was just calling to find out the correct address to send the hundreds of thousands of dollar bill.
posted by roomthreeseventeen at 11:10 AM on October 9, 2013 [14 favorites]


I finally found the catch in my new California coverage! The prices are good, the benefits are good... the list of providers is shit. Ah, well, I knew there had to be a catch somewhere.
posted by Justinian at 11:11 AM on October 9, 2013


The prices are good, the benefits are good... the list of providers is shit. Ah, well, I knew there had to be a catch somewhere.

I'm sensing this could be an issue for a lot of individuals purchasing healthcare on the exchange. Insurers are maintaining small provider networks for those products on purpose (by offering lower reimbursements, it's not hard for providers to say no). Why? If I had to guess, I'd say it was to scare the sickest into buying coverage from somebody else.
posted by ThePinkSuperhero at 11:14 AM on October 9, 2013


I don't have a lot of choice, the plan I had is going away. I'm a supporter of health care reform but "if you like your plan, you can keep your plan" is clearly bullshit.
posted by Justinian at 11:17 AM on October 9, 2013 [3 favorites]


That stinks!
posted by ThePinkSuperhero at 11:18 AM on October 9, 2013


I don't have a lot of choice, the plan I had is going away.

Our insurer (Anthem) sent us a letter last week telling us that they could no longer offer the plan we were on (The one they just created a year ago). Since we're self-insured, we'll probably take a close look at the exchange. The bad part of that is we're in Indiana, about the most ACA-unfriendly states. And the government here hasn't quite made up its mind what they're going to do.
posted by Thorzdad at 11:20 AM on October 9, 2013 [2 favorites]


Most young people don't need health insurance.

Shouldn't that read (assuming it's statistically true) "most young people don't ever have substantial medical bills"? Most houses don't burn down either but that doesn't mean you don't need home insurance.
posted by George_Spiggott at 11:23 AM on October 9, 2013 [12 favorites]


I'm hearing it's more stable this week so you may want to give it a try.

Not remotely. I spent four hours on it yesterday trying to sign up my elderly aunt. The database kept bogging down, dropping information we'd previously entered, and sending us all the way back to the start. It finally went down so completely that all we got was an Apache error.

I told my aunt we would try again on November 1st, and if we can't get the website to work then, she would have to call and sign up that way.
posted by headspace at 11:24 AM on October 9, 2013


I don't know about any of the state exchanges, but the federally-run exchange website doesn't really seem to be working yet, unfortunately. Has anyone had any luck creating a federal marketplace account?
posted by muddgirl at 11:25 AM on October 9, 2013


Has anyone had any luck creating a federal marketplace account?

None here. I can get as far as getting the e-mail verification, and then when I click it immediately upon receipt, the site says, oh no, you waited too long to verify your e-mail!
posted by ThePinkSuperhero at 11:26 AM on October 9, 2013


Yeah I get stuck at the same step.
posted by muddgirl at 11:27 AM on October 9, 2013


"Young people simply speaking are less likely to require health insurance so are better off using that money to do other things with. It is cheaper to self-insure.

Bull-fucking-shit.

There is not one human being alive who is not susceptible to food poisoning, accident, or injury. The whole myth of "young invincibles" is something that has been eating at the heart of our society for decades, and it really needs to stop. Just because your heart is beating at this moment does not mean that it won't stop in the next few minutes. It also doesn't mean that you won't twist your ankle walking down the stairs, like you've done a hundred times before, and need medical attention.

I've had this arguement with so many people, and I can actually use my own experience to show just how bad this mentality is. I ended up in a coma for 3 days on a ventilator because I thought I was invincible. No amount of youth or vigor, or special pleading will get you out of a coma. No one alive today is not going to need medical attention tomorrow, or the day after that. You are not paying for other peoples treatment, either. You are paying into what you will end up using later. NO ONE GETS OUT OF HERE ALIVE. So keep on dreaming of living forever and being young and beautiful. Tomorrow you will wake up with new aches that you don't know where they came from, and then you'll wonder what happened. What happened is you believed the lie, and now you get to pay for it.
posted by daq at 11:27 AM on October 9, 2013 [18 favorites]


Reports are that Covered California now lets you check which providers are included in the networks of the offered plans but damn if I can figure out how to do it. Has anyone successfully used the website? I know the shitty list which the plan Blue Shield is switching me to will include but I'd like to check the other providers.
posted by Justinian at 11:29 AM on October 9, 2013


Two words: Pre-existing condition. Best to get insurance before yours is diagnosed.

If you wait until you need insurance to get insurance, you'll pay too much and the thing you need it for won't be covered.
posted by Sys Rq at 11:29 AM on October 9, 2013


Incorrect.
posted by ThePinkSuperhero at 11:30 AM on October 9, 2013 [3 favorites]


Sys Rq, actually, that doesn't matter anymore. One of the flagship parts of the ACA is you cannot be denied coverage for a pre-existing condition.
posted by roomthreeseventeen at 11:31 AM on October 9, 2013 [10 favorites]


Has anyone had any luck creating a federal marketplace account?

None here. I can get as far as getting the e-mail verification, and then when I click it immediately upon receipt, the site says, oh no, you waited too long to verify your e-mail!
posted by ThePinkSuperhero at 2:26 PM on October 9 [+] [!]


I got stuck at this step a few nights ago and I cried so hard and for so long that I haven't had the guts to go back and try again. I opened that email instantly, after refreshing and refreshing until it came through. To be told that I had failed again was just...I felt like I must be standing in Dickens' Circumlocution Office. It just...it felt like I was being told I'm poor and uninsured because I don't move quickly enough.

And I couldn't help but wonder how I'm supposed to move faster. And now I'm going to cry again.
posted by bilabial at 11:31 AM on October 9, 2013 [2 favorites]


You can't be denied insurance, but does the insurance you're not denied cover your preexisting condition?
posted by Sys Rq at 11:32 AM on October 9, 2013


Yes.
posted by roomthreeseventeen at 11:33 AM on October 9, 2013 [5 favorites]


It's me I'm the young person who naively ignores the advice of his elders and believes I am invincible. I may learn the value of responsibility with a monthly check, however...
posted by gorbweaver at 11:33 AM on October 9, 2013


Aww, sorry to hear it, bilabial! At least the deadline to sign up for January 1 coverage isn't until December 15th. Surely it'll be fixed by then!

Please don't link back to this comment and mock me if I'm wrong!
posted by ThePinkSuperhero at 11:33 AM on October 9, 2013 [2 favorites]


That's the whole point of Obamacare, Sys Rq. No more pre-existing conditions exclusions because everybody is required to obtain coverage.
posted by Justinian at 11:34 AM on October 9, 2013 [2 favorites]


Two words: Pre-existing condition. Best to get insurance before yours is diagnosed.

From ThePinkSuperhero's link:
Starting in 2014, being sick won't keep you from getting health coverage. An insurance company can't turn you down or charge you more because of your condition.

Once you have insurance, the plan can't refuse to cover treatment for pre-existing conditions. Coverage for your pre-existing conditions begins immediately.

This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.
posted by Atom Eyes at 11:34 AM on October 9, 2013 [3 favorites]


The only exception is for grandfathered individual health insurance plans--the kind you buy yourself, not through an employer. They do not have to cover pre-existing conditions.

Good thing everyone's permanently employed!
posted by Sys Rq at 11:34 AM on October 9, 2013 [1 favorite]


Next line:
"If you have one of these plans you can switch to a Marketplace plan during open enrollment and immediately get coverage for your pre-existing conditions."
posted by Atom Eyes at 11:36 AM on October 9, 2013 [9 favorites]


John Hodgman is rapidly becoming an Indispensable Pundit, in the realm of Ta-Nehisi Coates and post-voice Roger Ebert. If you're not listening to the Judge John Hodgman podcast, you are missing out.

Seconding the JJH podcast recommendation. Really, the best thing about it is finding out that Hodgman is not just a first-class wit, but genuinely warm-hearted and wise when it comes to helping people navigate their problems and interpersonal conflicts. A few of his final judgments on the show have actually gotten me a tiny bit verklemmt while riding the bus, which is a bit embarrassing and I basically hate him for it.
posted by Strange Interlude at 11:38 AM on October 9, 2013 [3 favorites]


If you're getting the "you waited too long!" error message, just go back to the site and login with the login and pass you created. I got that error too. Turns out that you did actually validate by clicking, but the error message goes on and on.

Now if somebody can tell me how I can decline optional dental coverage so I can finish an enrollment, I would love them forever!
posted by headspace at 11:38 AM on October 9, 2013


If you're getting the "you waited too long!" error message, just go back to the site and login with the login and pass you created.

I TRIED THAT!! and it didn't work either.
posted by ThePinkSuperhero at 11:39 AM on October 9, 2013 [1 favorite]


Ugh, I'm sorry, TPS. The site's such a mess right now.
posted by headspace at 11:40 AM on October 9, 2013


Sys Rq: The idea is that if you have a pre-existing condition you would drop your old plan which excludes it and switch to one of the marketplace plans which would NOT exclude it.
posted by Justinian at 11:41 AM on October 9, 2013


Even if there's a statistical likelihood that you won't get meningitis from a mosquito bite while camping, or need heroic surgery after an accident or whatever, that still misses the point of insurance. If those things do happen, you or your family will be wiped out, or the public will have to eat the costs and you won't get anything like the quality of care you'd get if you were covered.

Insurance isn't for the things you expect to happen, it's for the things you pray to god almighty WON'T happen.
posted by George_Spiggott at 11:42 AM on October 9, 2013 [3 favorites]


biliabal - it's broken for everyone! Are you able to call the phone number instead? Hopefully this all gets sorted out soon.

"the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325."

I TRIED THAT!! and it didn't work either.

Yeah. And when I tried to re-register it said my username was taken. And when I tried to reset my password it sent me a reset code, but that also failed to work. It's pretty broken.
posted by muddgirl at 11:43 AM on October 9, 2013


Huh, I finally (I think) figured out how to check whether doctors and hospitals are included in the various California plans. It only requires about 9 clicks and filling out two different forms. Of course it's currently hanging because of the server load so I can't be sure it is actually what I'm looking for.

The website is really amateur hour.
posted by Justinian at 11:43 AM on October 9, 2013


Special snowflake question - does anyone know what happens if you buy your insurance in State A (your legal residence) but you spend most of your time in State B (and sometimes C and D)? Is the provider network national, is what I'm asking, or would I be stuck traveling back to State A when I need to see a doctor?
posted by desjardins at 11:44 AM on October 9, 2013


I seriously wonder if some Tea Party folks are DDOSing the healthcare.gov site. It would not surprise me... in fact, I actually expect that to be the case.
posted by desjardins at 11:45 AM on October 9, 2013 [6 favorites]


The problem is the system requires a large number of people paying into the system that won't make use of the system.

Thank you for providing the definition of "insurance".
posted by benzenedream at 11:46 AM on October 9, 2013 [26 favorites]


I don't know the answer to that, desjardins, but I'm curious, so I'm going to dig around and see what I can find out (I know a guy....)
posted by ThePinkSuperhero at 11:47 AM on October 9, 2013


So what happens when I switch to one of these plans, and then the jackasses steering our ship of state defund and/or repeal the whole thing? How much faith are we supposed to have that this stuff is really going to stay in place?
posted by Sing Or Swim at 11:49 AM on October 9, 2013


If the health insurance exchange web sites are any indicator of the government's ability to run a big data operation, suddenly I'm not that worried about the NSA.
posted by mullingitover at 11:51 AM on October 9, 2013 [7 favorites]


To play devil's advocate, health insurance is a rare kind of insurance, because it's the only one where you're paying for both preventative/101-level care and catastrophic coverage. Imagine if your homeowner's insurance covered the yearly gutter cleaning, or your renter's rider on your engagement ring also covered resizes and bi-annual cleaning. I think when people say, but I'm young and I don't even use insurance!!!, they're thinking more of the preventative care benefit than the catastrophic benefit; they don't want to pay several thousands of dollars a year for one doctor's visit and a flu shot.
posted by ThePinkSuperhero at 11:52 AM on October 9, 2013 [2 favorites]


Special snowflake question - does anyone know what happens if you buy your insurance in State A (your legal residence) but you spend most of your time in State B (and sometimes C and D)? Is the provider network national, is what I'm asking, or would I be stuck traveling back to State A when I need to see a doctor?

Depends on the plan, but most of them are national-affiliated at least, and emergency care is less a factor. Plan on seeing a doctor for regular check-ups when you're in State A and you'll be fine.
posted by Etrigan at 11:53 AM on October 9, 2013


I'm pretty sure that, if not for their failure to accurately cover the shutdown and debt limit, this would be the defining piece of media criticism for 2013.

Billy Eichner and Olivia Wilde play Obamacare or Shut Up!
posted by MCMikeNamara at 11:53 AM on October 9, 2013 [3 favorites]


: "So what happens when I switch to one of these plans, and then the jackasses steering our ship of state defund and/or repeal the whole thing? How much faith are we supposed to have that this stuff is really going to stay in place?"

It's not gonna happen. The reason the republicans are making such a stink about this is because they know they lost, but they're trying to get as much attention as possible to throw red meat to their base. This is about the 2014 elections, not about actually defunding the ACA.

If anything, it'd be amusing to let the republicans have their bill to defund it, and then force them to re-implement it on their own. They'd get absolutely crushed in popular opinion when they strip insurance from millions, then absolutely crushed again when they implement their own inevitably defective system.
posted by mullingitover at 11:54 AM on October 9, 2013 [4 favorites]


So what happens when I switch to one of these plans, and then the jackasses steering our ship of state defund and/or repeal the whole thing?

Well, the subsidies are federal, so there'd have to be a federal-repeal to get rid of those. Can't imagine there'll be a huge group (of either patients or insurers) pushing for that once the money starts flowing.
posted by ThePinkSuperhero at 11:55 AM on October 9, 2013


So what happens when I switch to one of these plans, and then the jackasses steering our ship of state defund and/or repeal the whole thing?

If we're talking about the exchanges, it's a contract with a private company, so they generally can't make plan changes until the next open enrollment period. Then it would go back to the way it is now.
posted by muddgirl at 11:55 AM on October 9, 2013


If you have one of these plans you can switch to a Marketplace plan during open enrollment and immediately get coverage for your pre-existing conditions."
posted by Atom Eyes at 2:36 PM on October 9 [+] [!]


KEY WORDS: OPEN ENROLLMENT. You will not be able to enroll after you break your spleen playing Ultimate Frisbee. You will have to wait until the next open enrollment period. There are a couple of exceptions like getting married, having a baby, losing your job and current insurance.
posted by Gungho at 11:57 AM on October 9, 2013 [1 favorite]


Olivia Wilde told me I could sign up online in 10 minutes. Why do we hurt the ones we love, Olivia Wilde? Why?
posted by Justinian at 11:58 AM on October 9, 2013 [1 favorite]


And open enrollment this year will last beyond the typical sometime-before-the-previous-calendar-year deadline -- March 31, 2014 is the deadline this year.
posted by MCMikeNamara at 12:00 PM on October 9, 2013


Or this time, I guess, not this year. You know what I mean.
posted by MCMikeNamara at 12:01 PM on October 9, 2013


(Funny or Die just scored BIG points with me by using HTML5 video by default instead of f***ing Flash. I cannot wait for Flash video to die forever.)
posted by George_Spiggott at 12:01 PM on October 9, 2013


This stuff is so bonkers. I still find it fucking crazy that it's an uphil battle to sell the idea of nationalized health care in the states.

Most young people don't need health insurance.

And for people trying to argue that young people should just buy equities with their insurance money till they are old and busted, what kind of crazy bubble do you live in? Just because people choose to forgo insurance doesn't make them immune to random illness or accidents. A car ran over my leg when I was 29, which is a pretty random ass thing to have happen. Since I live in Canada, it was mostly painful and inconvenient, rather than a tale of woe and financial tragedy. To compare, klangklangston fell off his bike around the same time and ended up with a 50K hospital bill. I'm actually not sure how much more he had to pay after that. Who wants to have a god damn bake sale to pay for your hospital bills.

Insurance exists for the times when things don't go the way you expect it to.
posted by chunking express at 12:04 PM on October 9, 2013 [15 favorites]


Actually, all the data is being sent to the NSA first, so that's helps explain the delays! I was surprised (but why?) to learn from the Hodgeman tweets that an emergency appendectomy costs around 20K. Roughly 3 years ago, when I was living in Sweden, my 14-year-old's emergency surgery cost us 30 bucks (including 3 days in the hospital).

Because we were at the children's hospital (14 and under), I spent the first night with her on the cosy daybed next to her hospital bed. The kind nurse's aid person who greeted us at around 3 am, after we'd been sent up from the emergency room, asked if I was hungry. When I said yes, she brought me a cheese sandwich (open-faced, natch, it was Sweden) and a cup of tea and I practically wept in gratitude and exhaustion.

This is what the hospital didn't have: Lots of gadgets. No flat-screen TVs. Old TVs and old VHS family movies. Honestly, I didn't care. They seemed to have everything needed in the chilly operating suite where I got to hold her hand as she went under.

I'm a big fan of single-payer health insurance after my 8 years in Europe. But we don't have that and we're not going to have that. And as an unemployed, uninsured, pre-existing-condition gal I consider the ACA a veritable miracle. The kinks will get worked out and then I will be able to get insurance again. Several friends will be able to leave jobs they hate once this thing is functioning well. Can't wait, can't wait, can't wait!
posted by Bella Donna at 12:04 PM on October 9, 2013 [11 favorites]


People tend to talk about Europe as if they had a single monolithic system. In fact The Netherlands has a system that's at least superficially comparable to ACA/Obamacare.
posted by George_Spiggott at 12:16 PM on October 9, 2013 [4 favorites]


Bella Donna: To be completely accurate the appendectomy cost you 30 bucks. It cost the government considerably more. Which is good because the government can afford it and you can't. But it still costs a lot to do an emergency surgery no matter what the system.

The total cost was very likely less than the total cost here in the USA, though, since the price incentives are all screwed up under a private system.
posted by Justinian at 12:19 PM on October 9, 2013 [2 favorites]


Why do I, as a young person, not currently have health insurance in Massachusetts? Because I have sent in an application twice and the Commonwealth has either lost or ignored it both times. Subsidization is great, but it's not like all the red tape is suddenly gone...
posted by threeants at 12:22 PM on October 9, 2013


(One difference in the Netherlands is that hospitals and insurance underwriters don't profit from healthcare and insurance. For the underwriters it seems to be a breakeven proposition and their profits come from other areas.)
posted by George_Spiggott at 12:23 PM on October 9, 2013


Roughly 3 years ago, when I was living in Sweden, my 14-year-old's emergency surgery cost us 30 bucks (including 3 days in the hospital).

Because we were at the children's hospital (14 and under), I spent the first night with her on the cosy daybed next to her hospital bed.


Nothing against you personally, Bella Donna, but I hate comments like these because it's like sitting in front of a hungry homeless person and eating a delicious cupcake. We already know Europeans et al have better healthcare systems. No need to constantly shove it in our faces.
posted by desjardins at 12:26 PM on October 9, 2013 [7 favorites]


Insurance, as a class, is risk mitigation. It is almost always a technical waste of money, because you buy it and don't need it. This is a good thing, of course, we don't like it when your house burns down or someone drops a piano on your car or you rupture your spleen playing ultimate.

The problem, of course, is you cannot know exactly if and when your house will burn down, the piano will hit your car, or your spleen will rupture. So, you have three choices on how to handle the risk of fire, rupture, or piano.

1) Put a very large amount of money aside in case of fire, rupture or piano. This is called self-insurance. It's a valid way of doing things, but it requires a very large amount of money. It costs nothing if nothing happens, and a lot if it does, but you have the money, so you're okay.

2) Do noting and hope the fire, rupture or piano never hits. It costs nothing if nothing happens, and a lot if it does, but you have no money and so you're utterly fucked.

3) Pay a smaller amount of money to a company who will, if the fire, rupture, or piano shold occur, will pay to cover the damages and such. It costs some amount of money if nothing happens, but costs little to no more if it does happen.

The first is gambling with money you have. The second is gambling with money you don't have. The third is accepting a small loss -- and it is a loss, that premium is gone forever -- to make sure the big loss never happens.

And, unless you can afford to gamble, you shouldn't, and you should have insurance.

Fundamentally, again, it's risk mitigation. There is a risk of bad thing X. Can you survive it? If the answer is clearly yes, do nothing. If the answer is "no, no matter what I do", do nothing -- don't buy planet-buster insurance. If the answer is "well, I'll be in bad shape but maybe", then look at how to mitigate the risk. In the cast of a monetary hit, insurance is how you mitigate that.

Personally, I'm doing pretty well, but I'd rather spend my money on fun things than on piano mitigation, so I have insurance. I suggest you do the same.

BTW: Preventative Health Care is also risk mitigation. There are a ton of conditions that are vastly easier to deal with if caught early. Easier, and cheaper, to deal with.
posted by eriko at 12:28 PM on October 9, 2013 [2 favorites]


desjardins, I think I can account for the impulse to point these things out: so many Americans seem unable or unwilling to even conceive of a viable alternative system; they're convinced there's a catch (and the insurance industry feeds these fears with contemptible ad campaigns). I think there's great value in pointing out that there are other ways which are not hypothetical, they exist now, and real people, some of them Americans, can attest to them.
posted by George_Spiggott at 12:30 PM on October 9, 2013 [3 favorites]


so many Americans seem unable or unwilling to even conceive of a viable alternative system

I don't think you'll find many of those Americans here on Metafilter, though.
posted by Justinian at 12:32 PM on October 9, 2013 [2 favorites]


someone rupturing a spleen during an ultimate frisbee game. That's why it's insurance,

And when did doctors and hospitals stop treating a ruptured spleen and Insurance did?

The prices are good, the benefits are good... the list of providers is shit.

And this is where contract law becomes fun. If one is "forced" to accept a contract with poor terms, when can you sue for relief? And would providing you with relief be cheaper than your $400 filing fee in Fed Court?
posted by rough ashlar at 12:39 PM on October 9, 2013


I would like to imagine that the ongoing problems with the various online exchanges would be taken as a sign that the methods the public sector uses to procure software are totally broken. However, the people that run the companies that contract this work have basically figured out how to convert them into money presses. I have no doubt that the contractors who failed to deliver the software to support these exchanges in time are now billing triple-digit hourly rates to fix the bugs. The bugfixes will introduce new bugs, but that's okay, it's good enough for government work and there's a time and materials contract now! As I said, I'd like to imagine that this would happen, instead, the fact that governments can't get software that actually works will be transmuted into a critique over the concept of healthcare in general. I'm sure it's just a coincidence that these contracting companies are predominantly run by hardline-and-proud Republicans.
posted by feloniousmonk at 12:41 PM on October 9, 2013 [3 favorites]


One of the flagship parts of the ACA is you cannot be denied coverage for a pre-existing condition.

Ahhhh, but isn't it also true if you did not identify all conditions on the contract and one is a pre-existing condition the insurance firm can opt to not cover/drop you?
posted by rough ashlar at 12:42 PM on October 9, 2013


I've been trying for nine days to get into healthcare.gov, and still no luck. I'm both desperate and terrified to see what it says. We're in PA, which has chosen not to expand Medicaid, but the preliminary numbers/estimates for how much insurance is going to cost for one adult and one child is over a hundred bucks a month--which is cheap for insurance, but is a substantial enough chunk of our budget that I burst into tears when I saw the estimate. Hopefully it'll be better than feared, but I'm not optimistic.
posted by MeghanC at 12:42 PM on October 9, 2013


Chunking express: hope you are fully recovered! I am klangklangston's girlfriend and i can say for sure:
1. He fell off his bike,
2. Total bill for his ambulance ride, week in the hospital, and 2 surgeries was about $120,000
3. After weeks of runaround, the hospital forgave 100k in debt
4. Donations from Mefites and friends and family paid the rest (i count Mefites as friends but wanted to clearly state it here!)
5. He is doing well now and has a new job with insurance, that doesnt cover the appliances installed in his body in step 2, because its a pre-existing condition
6. We are counting down the days till this is struck out on Jan 1 and he can finally get his post-surgical appointments, only 3 years later than he was supposed to. The wires in his arm were supposed to be removed in 2011 but i guess well wait till 2014.
posted by holyrood at 12:43 PM on October 9, 2013 [13 favorites]


rough ashlar: "Ahhhh, but isn't it also true if you did not identify all conditions on the contract and one is a pre-existing condition the insurance firm can opt to not cover/drop you?"

No. As of 2014, insurers cannot charge consumers different rates for health insurance because of health status or gender. There is no point within the process at which you are asked about pre-existing conditions. The only question you are asked related to health/lifestyle is if you are a smoker.

(The trick you mention was used in the past. Getting rid of it as a possibility is probably one of the biggest ACA wins in terms of making our broken system slightly less Kafka-esque.)
posted by MCMikeNamara at 12:47 PM on October 9, 2013 [4 favorites]


so many Americans seem unable or unwilling to even conceive of a viable alternative system; they're convinced there's a catch

I think that's slightly uncharitable. I think many Americans are unable to imagine a European-type system here in the US for several reasons. First, the political battle in the US to get it off the ground is a total no-go (look at the mess we're in now). Second, there IS a catch in Europe- it's not free healthcare. Everybody's paying more taxes to provide universal coverage/care. Given the piss-poor state of the US economy, I can't imagine people being thrilled at the idea of substantially higher taxes to pay for something a majority of people already have ( which probably makes THEM uncharitable)
posted by ThePinkSuperhero at 12:53 PM on October 9, 2013 [1 favorite]


Ahhhh, but isn't it also true if you did not identify all conditions on the contract and one is a pre-existing condition the insurance firm can opt to not cover/drop you?

This is not my understanding. I can go ask the expert in our org about this if you like, but the language of the ACA is that insurance companies cannot ask about your health status when you enroll. What you describe is what the pre-ACA system allowed.

And when did doctors and hospitals stop treating a ruptured spleen and Insurance did?

Snark should be at least funny, and not obtuse.
posted by rtha at 12:54 PM on October 9, 2013 [2 favorites]


The only question you are asked related to health/lifestyle is if you are a smoker.

I've gotten far enough along in the process to see that. But I've yet to see the Insurance contracts that are being offered. Given the below - I'm guessing the Doc's don't know the terms of the contracts they are under, just like how most of us who are offering up an opinion on ACA haven’t read the 10,000+ page bill.


(My last "interaction" with the healthcare beast was 3.5 hours of phone/pharmacy with .5 hours on hold with the insurance "help" line. The end result: 2 15 pill prescriptions at $10 co pay per fill ($20 w/insurance) or 1 30 pill fill at $13.99 for no insurance coverage whatsoever. The 1/30 $13.99 option is what the Doc's script was for, the 2/15 $20.00 was the result of the 3.5 hours of my life attempting to get what the Doc claimed I should get.)
posted by rough ashlar at 12:57 PM on October 9, 2013


Oww, just talking about Ultimate makes my ankle hurt all over again. My last game (ever) cost my insurance at least a thousand in doctor's visits and x-rays and I was hobbled for a month. Maybe not a huge amount of money but if I'd been 24 and un(der)employed, it would have been a big deal.
posted by octothorpe at 1:00 PM on October 9, 2013


I seriously wonder if some Tea Party folks are DDOSing the healthcare.gov site. It would not surprise me... in fact, I actually expect that to be the case.

I suspect that would be a blip compared with people wanting healthcare.
posted by Artw at 1:02 PM on October 9, 2013 [3 favorites]


It is cheaper to self-insure.

Unfortunately, the rare 20-something who is diagnosed with leukemia is unlikely to have enough savings to cover the cost of treatment. But I guess they can quit their job so they'll qualify for Medicaid.
posted by Mental Wimp at 1:02 PM on October 9, 2013


(sorry, that Euro-attitude really chaps my hide)

If its any consolation while I complain about your countries healthcare I'll be over here experiencing the full stupidity of it.

Last year I changed jobs and experienced an insurer refusing to pay for something because it was "pre-existing" under the old insurer for the first time - that resulted in much euro-scorn, I can tell you.
posted by Artw at 1:05 PM on October 9, 2013


...who are offering up an opinion on ACA haven’t read the 10,000+ page bill.

Um, it's less than a 1000, but I guess you were being hyperbolic?
posted by Mental Wimp at 1:07 PM on October 9, 2013 [1 favorite]


holyrood, that's crazy. And it's not like that sort of story isn't something that's played out again and again, or some dirty secret no one knows about. Like, who wouldn't want nationalized health insurance? Robots is the only class of person I can think of? And I guess people who make money of the current shitty system.

And yeah, I am fine now, though I still have two metal rods buried in my leg. (For the curious, I wrote about the 6 weeks I was in a cast on my blarg. It's mostly a discussion about pain meds, though.)
posted by chunking express at 1:09 PM on October 9, 2013 [1 favorite]


It is cheaper to self-insure.

Yeah, the Republicans have been arguing for years that the best solution is to have a tax-free HSA to cover the routine expenses, and a high-deductible insurance to cover the catastrophes. So you'd have a strong incentive to pick the cheapest doctor while still having no risk of a medical bankruptcy.

And you know what? I actually agree with them ... in a kind of nerdy, economics-studenty kind of way. If the system were set up such that everyone could use part of their premium to fill up the HSA, and the deductible on the insurance were set to automatically match the balance of the HSA, and preexisting conditions were outlawed, and you didn't randomly lose all the money in the HSA every year, it could be an OK system.

But they didn't actually put together a proposal that does that, they're just using the idea as pointless obstructionism.
posted by miyabo at 1:12 PM on October 9, 2013 [4 favorites]


Second, there IS a catch in Europe- it's not free healthcare. Everybody's paying more taxes to provide universal coverage/care.

More taxes, but on the whole spending more, for healthcare specifically? We in America are awfully good at, and even committed to, hiding the real price of things from ourselves. The immense difference in profit-taking alone makes it reasonable to wonder if people are actually spending as much, share of tax included, on healthcare as we are. I'd like to see some real comparisons. Taxes in Europe -- to overgeneralize unreasonably -- pay for a lot of social goods, and their economies are mostly smaller in terms of per capita GDP (though that is changing rapidly).
posted by George_Spiggott at 1:12 PM on October 9, 2013 [2 favorites]


Why do Americans spend far more for the same procedure than their European counterparts? If the free market the US has now is truly the best and most efficient thing ever, you would think that it would be exactly the opposite. More care for less, instead of spending way more than most countries for what's approaching third-world infant mortality rates.

Most of us are one medical incident away from complete bankruptcy. I won't even speculate how much of a person's estate evaporates into nothing when they hit end-of-life care. It's madness.
posted by fifteen schnitzengruben is my limit at 1:28 PM on October 9, 2013 [1 favorite]


But I guess they can quit their job so they'll qualify for Medicaid.

Best not ever plan on getting an estate afterwords because of claw-backs.

Here’s why dropping the asset test got the BINGO – Estate Recovery! You won’t find the following info in the ACA. It’s in the Omnibus Reconciliation Act of 1993 (OBRA 1993) – a federal statute which applies to Medicaid, and, if you are enrolled in Medicaid, it will apply to you depending on your age.

a) OBRA 1993 requires all states that receive Medicaid funding to seek recovery from the estates of deceased individuals who used Medicaid benefits at age 55 or older. It allows recovery for any items or services under the state Medicaid plan going beyond nursing homes and other long-term care institutions. In fact, The Centers for Medicare & Medicaid Services (CMS) site says that states have the option of recovering payments for all Medicaid services provided. The Department of Health and Human Services (HHS) site says at state option, recovery can be pursued for any items covered by the Medicaid state plan.
posted by rough ashlar at 1:30 PM on October 9, 2013 [2 favorites]


Why do Americans spend far more for the same procedure than their European counterparts? If the free market the US has now is truly the best and most efficient thing ever, you would think that it would be exactly the opposite.

For laughs - go to a hospital and ask for a rate sheet. Ask them to give you a quote or even a fixed quote for a procedure.

Americans spend more because they can't actually comparison shop. And the hospitals charge differing amounts for the same procedure in many cases.
posted by rough ashlar at 1:32 PM on October 9, 2013 [5 favorites]


miyabo: "And you know what? I actually agree with them ... in a kind of nerdy, economics-studenty kind of way. If the system were set up such that everyone could use part of their premium to fill up the HSA, and the deductible on the insurance were set to automatically match the balance of the HSA, and preexisting conditions were outlawed, and you didn't randomly lose all the money in the HSA every year, it could be an OK system.

But they didn't actually put together a proposal that does that, they're just using the idea as pointless obstructionism.
"

That's what drives me crazy. Under ACA, HSAs do currently qualify as a high deductible health plan according to the IRS and it probably wouldn't have required that much change to not lose the money annually. If the Republicans or anybody had ever given that as an option (not as the only option but AN option), a serious discussion could have been had and a better option for younger people would be a possibility. But that's not the political climate we live in.

My kingdom for a nerdy, economic-studenty conservative intelligentsia. (And no, I'm not talking about the Paul Ryan kind)
posted by MCMikeNamara at 1:33 PM on October 9, 2013


John Green of "vlogbrothers" and Mental Floss has a great little rant on WHY health care costs more in the U.S.of A., followed up by a demo on Applying for Health Insurance With/Without the ACA Exchanges.

I'd say this guy is looking like the Second Indispensable Pundit after Hodgman right now, especially after his 30 Life Hacks Debunked (or, How to Open a Jar with Duct Tape while getting the contents all over your shirt)
posted by oneswellfoop at 1:41 PM on October 9, 2013 [5 favorites]


Americans spend more because they can't actually comparison shop. And the hospitals charge differing amounts for the same procedure in many cases.

Insurance providers do not pay these rates; they pay a negotiated amount, even for the things they supposedly pay "in full". This is a different thing from your co-pay, deductible, and coverage limit. The uninsured are subsidizing the insured if they pay the full price. Hospitals do often 'forgive' much of this, in the case of major, life-altering incidents in the tens of $K, in which case it's subsidized by everyone else, including the staggering prices of smaller services. All the above is just a part of why a Tylenol is $60 in the ER.
posted by George_Spiggott at 1:43 PM on October 9, 2013


ThePinkSuperhero: Second, there IS a catch in Europe- it's not free healthcare. Everybody's paying more taxes to provide universal coverage/care.

I'm not European, but I am a Canadian with single-payer health care. I thought I'd take a look to see how much more I'm paying in taxes than the lightly-taxed, small-government Americans. I chose California and $50,000 income arbitrarily, Ontario because that's where I live, and self-employment to avoid hiding the company portion of FICA and CPP contributions.

A single, self-employed Ontarian earning $50,000 pays:

$8,887 Income Tax (Federal and Provincial combined)
$4,712 CPP contribution (Canada Pension Plan)
------------------------------
$13,599 total

A single, self-employed Californian earning $50,000 pays:

$6,093 Federal Income Tax
$2,008 State Income Tax
$7,065 FICA contribution
------------------------------
$14,751 Total

We're not being charged an arm and a leg for our health care - assuming I didn't mess up my numbers too badly, we're actually paying less taxes to provide universal coverage/care

I got the Canadian tax numbers here, US tax numbers here, and the FICA here.
posted by Turbo-B at 1:45 PM on October 9, 2013 [22 favorites]


miyabo: "And you know what? I actually agree with them ... in a kind of nerdy, economics-studenty kind of way. If the system were set up such that everyone could use part of their premium to fill up the HSA, and the deductible on the insurance were set to automatically match the balance of the HSA, and preexisting conditions were outlawed, and you didn't randomly lose all the money in the HSA every year, it could be an OK system. "

Just a nitpick, but last I checked the money in my Health Savings Accounts doesn't currently get confiscated, it rolls over year to year until age 59.5 at which point it rolls over and is also like retirement money. For a lot of young people, for whom insurance is expected to cover random, unexpected and fundamentally catastrophic problems, this model works rather well.

What it doesn't do is make insurance any cheaper for geriatrics or those with known medical conditions. Because these people are actually using health care, and as rough ashlar points out, health care is one of the most opaque markets around. For a good chunk of the insured, health care is purchased by a insurance company picked by their employer for an employee who they by law cannot ask the medical situation of. Like, even if you knew a person's exact risk tolerance, it's damn near impossible to look at an insurance plan and think 'I'm certain this is plan is worth more than the cost premium', and adding a billion middlemen doesn't make it any more efficient.
posted by pwnguin at 1:46 PM on October 9, 2013 [2 favorites]


Best not ever plan on getting an estate afterwords because of claw-backs.

The subject was a 20-something who was "self-insured" and was diagnosed with leukemia. Not sure they'd have an estate to claw back.
posted by Mental Wimp at 1:48 PM on October 9, 2013


Yes, your HSA does roll over; it's basically untaxed income for medical bills only, no real strings attached. But you pay (insane) retail medical prices when you use it; not the negotiated prices an insurance company would pay.
posted by George_Spiggott at 1:49 PM on October 9, 2013 [1 favorite]


We're not being charged an arm and a leg for our health care - assuming I didn't mess up my numbers too badly, we're actually paying less taxes to provide universal coverage/care

Medical coverage isn't the only difference between the two governments, for one thing.

For another, taxes would go up to provide universal coverage, because it's money that the U.S. government isn't currently paying (for the most part). Total expenditures on health care would go down, but it's hard to convince people that they're better off losing $10 per paycheck against $100K for medical care that they don't think they'll ever need.
posted by Etrigan at 1:50 PM on October 9, 2013


Americans spend more because they can't actually comparison shop

We hear this all the time, but if I'm really supposed to go comparison shopping when, e.g., I need an appendectomy right now, then this proposed "fix" is still very very broken.
posted by kiltedtaco at 1:53 PM on October 9, 2013 [4 favorites]


We hear this all the time, but if I'm really supposed to go comparison shopping when, e.g., I need an appendectomy right now, then this proposed "fix" is still very very broken.

Comparison shopping for price is essentially impossible, and it's not particularly easy to do it for quality, either. A close relative of mine awaiting heart surgery paid out of pocket for an ambulance ride to a different hospital 120 miles away because of that hospital's significantly better outcomes for that procedure. This relative is married to a medical professional who was able to work this all out and make it happen in a timely way. It's not something most people can or would know how to do.
posted by George_Spiggott at 1:58 PM on October 9, 2013


To flesh that out a little bit more, plenty of other countries pay less without forcing patients to make consumer-like decisions. That is, the reason Britain's NHS pays less isn't because patients know the prices.
posted by kiltedtaco at 2:00 PM on October 9, 2013 [1 favorite]


George_Spiggott: "Yes, your HSA does roll over; it's basically untaxed income for medical bills only, no real strings attached. But you pay (insane) retail medical prices when you use it; not the negotiated prices an insurance company would pay."

Aren't you required to have said insurance to even contribute to an HSA? I mean, I'm willing to believe that my employer offered HSA was unusual, and possibly incomparable to whatever the exchanges are offering, so I'd enjoy an extended explanation on that one.
posted by pwnguin at 2:01 PM on October 9, 2013


Yes, you need a high deductible insurance plan to qualify. But when you decide to put it on your HSA -- because for example you have reached your coverage limit for that category of care -- the bill the provider hands you is not for the amount that an insurance provider would have paid for that procedure -- it's basically a cash deal and you're treated for billing purposes like a walk-in.
posted by George_Spiggott at 2:03 PM on October 9, 2013


kiltedtaco: "We hear this all the time, but if I'm really supposed to go comparison shopping when, e.g., I need an appendectomy right now, then this proposed "fix" is still very very broken."

Not all procedures are ER procedures though. According to this link which is listing 2010 data there were 24.1 million non-ER discharges vs 19.3 million ER visits resulting in admissions to hospitals/critical care units.
posted by Hairy Lobster at 2:05 PM on October 9, 2013


Most young people don't need health insurance.

Unfortunately most young people also age.
posted by srboisvert at 2:05 PM on October 9, 2013 [3 favorites]


Most peple with any kind of insurance don't need the insurance, you just dint know if you are most people - that's why it's insurance.
posted by Artw at 2:07 PM on October 9, 2013 [2 favorites]


Etrigan: For another, taxes would go up to provide universal coverage, because it's money that the U.S. government isn't currently paying (for the most part).

Are you sure? Because according to this, the U.S. government already spends more per capita on health care then the Canadian government (or almost any other government) does. If they could somehow instantly switch to our system, it should actually reduce government spending.

Of course it's more complicated than that, there are many other factors at work, but the point is:
1. Almost every single-payer system on earth is cheaper per capita for full coverage than the American mishmash of Medicare, Medicaid and who knows what all else.
2. It is completely mindbogglingly insane that an uninsured American who never so much as sets foot in a doctor's office is already paying more for no healthcare than a fully-insured Canadian.
posted by Turbo-B at 2:08 PM on October 9, 2013 [10 favorites]


The subject was a 20-something who was "self-insured" and was diagnosed with leukemia. Not sure they'd have an estate to claw back.

And if this 20-something has a recovery and 5 years later starts making money to have an estate? There will be no claw-back?
posted by rough ashlar at 2:10 PM on October 9, 2013


Oh, pwnguin, to clarify a bit more: while you have to have a high deductible insurance plan to qualify for one, the HSA itself isn't necessarily (nor I expect usually) carried by your insurance provider; it's done (AFAIK) by a financial services company. When you spend your HSA you're basically just spending out of a bank account, precisely as if you were opening your wallet. Your insurance company (and its negotiated price scheme) is not involved in that transaction.
posted by George_Spiggott at 2:11 PM on October 9, 2013 [1 favorite]


We're not being charged an arm and a leg for our health care - assuming I didn't mess up my numbers too badly, we're actually paying less taxes to provide universal coverage/care


You left out the hours and hours of figuring out health care options that American residents have to do every couple of years. Then there is the bill fighting/negotiation and time spent on hold... I conservatively put the costs of health care planning at about $500 a year and I put dealing with post treatment billing at around another 500+ (depending on how much you enjoy music interspersed with 'we value your call. All our operators are busy. please hold'). Now these costs may be imposed on employers since the calls have to be made during business hours so perhaps it is just a GDP and career performance hit rather than an actual loss of personal time but the costs are still be borne somewhere.

There are so many hidden costs to the American health care system that i suspect the actual monetary values thrown about are just the tip of a larger iceberg made up of errors, insecurity, opportunity costs, duplication, perverse incentives and malpractice.

I have a good healthcare plan and I am still terrified of American healthcare (even more than the NHS which is still making use of WWII era hardware in some places - I at least knew they were trying!)
posted by srboisvert at 2:22 PM on October 9, 2013 [2 favorites]


Honestly, this talk about HSA's is bunk. They are a massive tool to fleece people out of their earnings by financial institutions that are not insurance. I see a lot of people talking about them rolling over, but every time one has been presented to me at any of the various places I have worked, there was never any roll over, and there was a hard cap on how much of your earnings you could put in them (they do come out of your paycheck pretax, which is how they get some of their "good karma" from finance and bean-counters). But realistically, they are useless unless you have a known amount you will need to spend on your preventative healthcare over the course of a year (either calendar or date of hire, depending on how your HR has cut the deal with the salesman). We just went through one of these where I work, and man, I made that sales guy work for his time, because I know I have high health costs (pre-extisting conditions, expected hospitalizations), and I know that for the most part, for ALMOST everyone who doesn't spend their evenings rebalancing their finances and trying to eke out every little bit of utility from their earnings, an HSA is just a bad idea. It become one more thing that you have to try and keep track of, and it's ridiculous because the amount of pre-tax money you are supposedly saving is miniscule on anything under a 6 figure salary (and if you are already making 6 figures, the amount the pretax savings probably amounts to diddly as the marginal utility of your earnings get minimized by your income).

Now, please, someone inform me how HSA's are a "good plan" for young people to use. More than anything else, in this age of short-term employment and complete lack of realistic job security, unless you are purchasing an HSA as a self-employed entrepenuer, I see nothing that makes them anything more than shifting the burden of healthcare from the insurance industry and a way for a financial company to get a hold of your money (and then invest it and earn more off the interest than you'd ever see).

I also hate banks, but that's a whole different thread.
posted by daq at 2:26 PM on October 9, 2013 [1 favorite]


(daq, not to disagree with the main substance of what you're saying, but an HSA differs from an FSA (Flexible Spending Account) in part in that it does roll over. FSAs came first and they really are a ghastly boondoggle; I never participated in one for the reasons you give. But carry on-- I agree that HSAs solve nothing except allow you to save a bit on taxes and get around the tax deduction minimums for some small amount of services.)
posted by George_Spiggott at 2:32 PM on October 9, 2013


Wow, didn't mean to trigger Euro-related crankiness. I'm American born and bred, native Californian, currently poor and sorry about triggering unhappiness with a wistful memory about something I can't have either.

In Feb 2012 I fell off my bike, broke my elbow and needed surgery. The out-of-pocket fee was $8,000. I had savings at the time. When I figured out how much private insurance would have cost, it seemed like either a wash or an actual savings. At that time. Cause my health conditions required expensive insurance (even tho I'm actually healthy. Odd).

Now, of course, I'm in debt and don't have any money for any kind of insurance. For the record, I'm also a hungry person watching other people eat well.

The taxes are high in Sweden but you get a lot for your tax dollars. My kid complained at the time that jeans were too expensive. I'd prefer a place where clothes were more expensive and health care much less.

Swedish healthcare is less expensive in large part because the government negotiate the prices for drugs and because there are no for-profit insurance companies vacuuming bills out of the citizens' wallets. So yeah, sorry about my brief vacation experiencing a better but not perfect system. :-)
posted by Bella Donna at 2:34 PM on October 9, 2013 [2 favorites]


Wait, stop, no. I meant hungry in the metaphorical sense. Just traded my salmonella-tainted Foster-Farms chicken for something else so I'm good to go on the food front. Just a too-hasty reference to the cupcake remark earlier. Oops.
posted by Bella Donna at 2:37 PM on October 9, 2013


The HSA's at my work only roll over funds under a certain annual contribution cap. If you contribute more than a set amount in a given year, and don't use it, it does indeed disappear.
posted by saulgoodman at 2:52 PM on October 9, 2013


John Hodgman is a gentleman and a scholar. That is all.
posted by homunculus at 3:02 PM on October 9, 2013 [1 favorite]


Every day I get one page further in the NYS exchange application. The anticipation is killing me.
posted by PhoBWanKenobi at 3:04 PM on October 9, 2013 [2 favorites]


And if this 20-something has a recovery and 5 years later starts making money to have an estate? There will be no claw-back?

According to the internet, the claw-back only applies to Medicaid costs incurred over the age of 55 or to nursing home care (or equivalent) costs incurred below 55. I don't think leukemia involves nursing home care, so our hero should be ok. (A definitive answer would require far more knowledge of what 'equivalent' means and of what care actually is required for leukemia than I have, of course).

It also does not apply so long as the late Medicaid recipient dies with a surviving spouse, minor child or deaf/blind child of any age, so just make sure you die before your spouse.
posted by jacalata at 3:25 PM on October 9, 2013 [2 favorites]


saulgoodman, that has to be an FSA or something like it. Here's the IRS doc. As far as I know under no circumstances will you 'lose' money in an HSA -- excess contributions will simply be taxed as income. FSA yes, which is basically why it completely blows.

(None of which endorses this silly idea that an HSA is good for anything but getting a tax deduction on out-of-pocket expenses which would not meet the minimum for a deduction at filing time.)
posted by George_Spiggott at 3:38 PM on October 9, 2013


To be fair, an HSA is a great tax shelter altogether for people who are already maxing out their IRAs. But yeah, not really that great for the people who most need help.
posted by muddgirl at 3:45 PM on October 9, 2013 [1 favorite]


And if this 20-something has a recovery and 5 years later starts making money to have an estate? There will be no claw-back?

Hence the value of the evil Obamacare. They get treated, survive, and continue they're productive ways. Without an insurance program, they impoverish themselves, hopefully get adequately treated, and then have to fight they way back to solvency, perhaps even facing clawbacks.

I'm not sure you're tracking the argument here.
posted by Mental Wimp at 3:52 PM on October 9, 2013 [3 favorites]


Yeah, in theory an HSA is better than just taking the tax deduction, since you can put money in it to grow tax-free. You contribute pre-tax, growth (since it can be invested while in the HSA) is tax free, and withdrawal is tax free if on a qualifying expense. And they roll over (of course, since it is an investment vehicle).

I don't use one because at my company they are only offered with a high-deductible plan combo (this may always be true, I dont know) and our regular plan is super cheap and awesome and involves a lot less thought / planning.
posted by wildcrdj at 4:03 PM on October 9, 2013 [1 favorite]


Whoa.

For the first time, I've gotten as far as the part of the application where I report our income. And it wants our earnings from 2014, when I don't even know what our 2013 earnings will be, between 2 part-time jobs with variable schedules and the fact that a significant portion of my income is freelance and not guaranteed at all. Hrm.
posted by PhoBWanKenobi at 4:18 PM on October 9, 2013


I don't understand the earnings from 2014 question either! I am unemployed so I have no idea. Can someone explain how anyone is expected to be able to answer this with any confidence?
posted by futz at 4:23 PM on October 9, 2013


Playing ultimate I strained ligaments in my left ankle and left knee and fucked up my back. I've had friends knocked out and taken away by ambulance, have their teeth knocked out, their nose broken by a disc and them go into shock and taken away by ambulance, snap their ACL and dislocate their kneecap. A team mate have his foot opened up to find the ligament had basically disappeared through wear. Know someone who put his hand through security glass and then pull back cutting very deeply into his bicep. Had a friend break both hands running into a wall and someone repeatedly dislocate his shoulder joint.

All were treated on the NHS, free at the point of care. No death panels, no bankruptcies, just people fixed to get on with their lives and carry on with being productive and healthy citizens.
posted by biffa at 4:31 PM on October 9, 2013 [1 favorite]


yes biffa, we get it. we are hoping for something similar.
posted by futz at 4:45 PM on October 9, 2013 [1 favorite]


No death panels

What, do you think they'd let you see them? You didn't think that was a mirror in the examining room, did you?
posted by George_Spiggott at 4:48 PM on October 9, 2013


So maybe there is a point in the discussion when people living outside of the US pointing out our terrible system compared to yours becomes less a 'absurdity by comparison' and more rubbing it in our faces.
posted by Think_Long at 4:52 PM on October 9, 2013 [1 favorite]


My understanding is that the 2014 earnings is just your best guess at your income for next year. If you eventually make less money in 2014, you will get a tax credit above and beyond the subsidy. If you make more than you'll have to make up the difference, I guess? But it should be pretty small unless you vastly underestimate.
posted by muddgirl at 4:54 PM on October 9, 2013


I thought the mirror was so I could check my twerking had not been adversely affected by my injury?
posted by biffa at 4:56 PM on October 9, 2013 [1 favorite]


This NYT column has a pretty thorough explanation of how the subsidy/tax credit works.
posted by muddgirl at 4:58 PM on October 9, 2013


My understanding is that the 2014 earnings is just your best guess at your income for next year. If you eventually make less money in 2014, you will get a tax credit above and beyond the subsidy. If you make more than you'll have to make up the difference, I guess? But it should be pretty small unless you vastly underestimate.

For self-employment, it actually asks you to guess for three separate months so it can figure out an annual average, which would be fine, and I guess I'm in a weird position in trying to sell books and all. But for me, that freelance income could be anything from nothing to big six-figure book bucks (ha, a girl can dream). Telling them what I'm going to make in January--and then telling them what I expect my business expenses for 2014 will be (???) is pretty ridiculously difficult.

Anyway, I finally got through the application. My husband and I are at 142% of the federal poverty line using 2013's income as an estimate, and according to this they want me to sign up for medicaid (because pregnant) but he's not eligible for any financial assistance at all (though according to all the calculators we used before this, he was, so I don't quite get it), and we can't shop for a plan yet either, for some reason. I'm a big big ACA fan but I have to admit this is all fairly baffling.

Time to find out if Medicaid covers home births, I guess.
posted by PhoBWanKenobi at 5:09 PM on October 9, 2013


Oh, also the best part of the application was the section where we enter our current health coverage. It's a huge drop down list that is inexplicably not in alphabetical order. I think I entered the right plan name, but who knows if I missed something?
posted by PhoBWanKenobi at 5:10 PM on October 9, 2013


desjardins, I asked my guy (who works for a nationwide insurance carrier in NY) about your snowflake question, and he said....he's not sure. He's heard different things about different products. It sounds like nobody is sure, and that there might be some issues at least on the employer exchange side, because some of the products there only cover the state where the employer is, which stinks for people who live in one state and work in another (very common in NY/NJ/CT, of course). I'll keep my ear to the ground!
posted by ThePinkSuperhero at 5:33 PM on October 9, 2013 [1 favorite]


thanks. this will become very relevant to our RV adventure if we lose our current employer-provided coverage.
posted by desjardins at 5:36 PM on October 9, 2013


This whole thing about "young people don't/need want insurance" is baffling to me as a young woman. I've never ever met another young woman who didn't care about health insurance. Birth control is really friggin expensive if your system doesn't tolerate the $4 brands or you need an IUD. Many, many women need health insurance just for routine maintenance and to make it through the month, not even taking into account the "you might get hit by a car/get leukemia/etc."
That's why this whole thing about "most people never need it so they don't want to pay into the system" is completely outside my experience. Everyone I've ever met has considered health insurance the pinnacle of human achievement.

It is not the American people who are against health are reform. REPEAT: EUROPEANS AND CANADIANS: It is not the American people who are against health care reform. So you can stop rubbing our faces in how great you have it now. We've been hearing your stories in these threads for years, ever since ACA was proposed. Health insurance companies are a lucrative business and they weren't willing to see their business legislated out from under them. That's the entire story.
posted by bleep at 7:01 PM on October 9, 2013 [7 favorites]


People in the states where the federal government is operating the exchange can learn a lot about their new options at https://www.healthcare.gov/health-plan-information/. The Menu icons in the column headings let you filter the data by state, county, etc. This list shows each plan's premiums for individuals age 27 or 50, and family rates. Note: these are the "federally facilitated marketplaces" only, not the state-operated exchanges.

The individual plans' websites should have information on the provider network(s) available in their marketplace products.

Using these data sources, separately from the enrollment process, you can scout out the plan that best meets your needs while the feds are fixing the enrollment system. Once it's working better, you should be able to get the enrollment done faster if you already know what plan you want to buy.
posted by Snerd at 7:09 PM on October 9, 2013


HSA is not the same as FSA. HSA's do roll over because they're just regular bank accounts owned by you.
posted by odinsdream at 8:01 PM on October 9, 2013


It is not the American people who are against health are reform.

Certainly not all Americans, but there seem to be plenty of Americans against health care reform. I regularly see people going ape shit online about Obamacare. I mean, the fact it's regularly referred to as Obamacare all over the place is kind of weird in and of itself.
posted by chunking express at 8:53 PM on October 9, 2013


Let's assume, just for a moment, that an entirely ridiculous premise is completely true -- namely, that "young people", being made entirely of Brawndo and Steel, neither want nor need health insurance.

Yes, I know it's not true, but I let's just pretend for a moment that it is. "I am invincible!" they might shout. "I have no need of this so-called 'insurance', for if hit by a bus it will simply bounce off my mighty frame!"

But a strange thing happens - years pass, and like magic, these "young people" turn into "not young people".

"I am fifty now," they would suddenly realize. "And statistics show that I am now at a 97% risk for epididymitis of the spleen. Now, like the sensible, rational actor I am, I shall buy health insurance. Insurance man! Sell me some insurance!"

"Certainly," says the insurance man. "They will cost you seventeen millions of dollars."

"What!" cries the no-longer-young person, aghast. "But that is exactly what it costs to treat epididymitis of the spleen without insurance at all! It will bankrupt me!"

"Well, yes," replies the insurance man. "Since in this hypothetical scenario, only sick people who need treatment ever buy insurance anyway, there is no means of spreading out the cost. So it costs what it costs. Like, duh!"

"Curses!" shouts the no-longer-young person. "If only society has chosen to create a safety net by collecting some small amount of money from everyone over time, not only out of feeling for their fellow man but as a means of enlightened self-interest to protect themselves from the circumstances of the nigh-on-inevitable future!"

"That would be nice," replies the insurance man. "But it could have been even worse, you know."

"But ... HOW?"

"Well, as it is, you have five good decades of bouncing buses before your decline. But imagine what the world might be like if ANY person could need serious medical attention at ANY time, in ways that are sometimes even completely random and unpredictable. Without the safety net you propose, you might have died miserably at the age of twenty or thirty or even ten, completely unable to afford the costs of your own care unless you happened to be lucky enough to be wealthy enough."

"My! It certainly is a good thing that we don't live in that dystopic society, where anyone not wealthy enough can die an easily preventable, miserable death at any time, but instead in this dystopic society, where only older people who aren't wealthy enough can die an easily preventable, miserable death at any time."

"Indeed, for in this dystopic society, you can at least spend a few decades pretending you will never get old, like an idiot. In that other dystopic society, you'd have to be a complete lunatic to assume that you would never fall ill."

The no-longer-young person and the insurance man shared a hearty laugh. And then they both died of epididymitis of the spleen. The end.
posted by kyrademon at 4:29 AM on October 10, 2013 [10 favorites]


I'm not sure you're tracking the argument here.

The same can be said of you.

Hence the value of the evil Obamacare. They get treated, survive, and continue they're productive ways. Without an insurance program, they impoverish themselves, hopefully get adequately treated, and then have to fight they way back to solvency, perhaps even facing clawbacks.

Under the present system:

Uninsured 20ish hero racks up bill (and lived!), goes bankrupt, moves on.

And yes the INSURED above 20ish hero does what you claim. And in fact if Insurance can't cover it the hero of this tale can go bankrupt and move on.

But under evil Obamacare, the 20ish Cancer hero ends up below the poverty rate and is forced onto Medicaid. Now the bill the hero racks up and lives to see is now subject to Medicaid recovery rules. And under Clinton, that is subject to clawback. North Carolina MA-2900 wants to take lottery winnings over $600 to repay Medicaid payments. And while the present law talks about being between 55-65 and dead, the law's idea is to get medicaid repaid. Does anyone think that one can go bankrupt on past medicaid payment payments?

But go ahead folks, believe that our 20ish year old hero won't be held responsible to repay that medicaid debt because the regulators are kind and won't demand payment.
posted by rough ashlar at 4:58 AM on October 10, 2013


Everyone I've ever met has considered health insurance the pinnacle of human achievement.

Really? Insurance is the pinnacle of human achievement?
posted by rough ashlar at 5:01 AM on October 10, 2013


The no-longer-young person and the insurance man shared a hearty laugh. And then they both died of epididymitis of the spleen. The end.

I feel so bad that people in that dystopic society know nothing of the curative power of mouse bites.
posted by ROU_Xenophobe at 6:28 AM on October 10, 2013 [3 favorites]


Everyone I've ever met has considered health insurance the pinnacle of human achievement.

Have you only ever met people whose sole education about the history of human achievement comes from watching the opening to the 2012 Olympics?
posted by Etrigan at 6:35 AM on October 10, 2013 [1 favorite]


My husband and I are at 142% of the federal poverty line using 2013's income as an estimate, and according to this they want me to sign up for medicaid (because pregnant) but he's not eligible for any financial assistance at all (though according to all the calculators we used before this, he was, so I don't quite get it), and we can't shop for a plan yet either, for some reason. I'm a big big ACA fan but I have to admit this is all fairly baffling.

I did hear on NPR last week that there may be a bug where the proper subsidies weren't showing up yet?

Has anyone called the Marketplace Call Center? 1-800-318-2596. It's supposed to be more than just a technical service line and actually help people find their subsidy and sign up for plans, but I worry that they're just using the same buggy system as the rest of us.
posted by muddgirl at 6:58 AM on October 10, 2013


I distinctly remember being fresh out of college, working a retail job that paid me slightly under 7/hour (minimum wage was 5-something an hour) and they even offered me a healthcare plan. If I could give up even more of my tiny wage to pay for it. Which, needing food and shelter, I couldn't.

I didn't have many healthcare needs at that age, but instead of a blithe feeling of invincibility I instead felt uneasiness and dread; it wasn't too hard to think of horrible things that could happen to me. I still had my appendix, I was sometimes accident-prone, and like most Texans I had to drive everywhere and saw accidents happen frequently. It wasn't like I'd never been sick as a kid; I'd had a broken arm, stitches from a dog bite, dental issues, I'd been in a car wreck with a friend in college, I'd needed a tetanus shot after stepping on a nail.

I don't really recall any of my fellow co-workers being dismissive about it either. Some of them were married to people with better jobs and had insurance. Lots of them were in the same boat as me, and hated it and we griped frequently about our crappy lack of affordable benefits.

In fact, even though in many ways I loved the job itself, the crappy wages and also lack of benefits was what drove me to get out of retail entirely instead of trying to stay on and move up.

The day I got my first insurance card, I breathed a sigh of relief.
posted by emjaybee at 7:02 AM on October 10, 2013


I did hear on NPR last week that there may be a bug where the proper subsidies weren't showing up yet?

Has anyone called the Marketplace Call Center? 1-800-318-2596. It's supposed to be more than just a technical service line and actually help people find their subsidy and sign up for plans, but I worry that they're just using the same buggy system as the rest of us.


I figured out the problem last night. There's a page on the NY state exchange site that asks if you have health insurance "now." If you say that you do--and I do now, in 2013, as I'm filling out the application, but I won't as of January 1st 2014 because Healthy NY, the current low income option in New York State is being discontinued--they don't offer you a subsidy. It's essentially asking you to fill out the entire application as if we're already in 2014; everything is worded that way (it asks for income sources and it's implied that those sources will be accurate for 2014 but it never says so). It's really, really poor design, but anyway, I filled it out without that information and now my husband is showing up as (correctly) eligible for a subsidy.
posted by PhoBWanKenobi at 7:46 AM on October 10, 2013 [4 favorites]


Heathcare.gov cost a whole buncha money and how much of it went to American coders VS outsourced outside American borders?
posted by rough ashlar at 8:42 AM on October 10, 2013


Well why don't you do the research and find out? Federal contracts should be open information.
posted by muddgirl at 8:46 AM on October 10, 2013


The weird thing is that the New York State exchange page looks beautiful--and I guess I made the mistake in thinking it would be therefore easy to use, too. But the application is really unclear, and filling it out was approximately as stressful as filing taxes can be. In fact, the wording of several questions, the bizarre drop down menus--all of that reminded me vaguely in dealing with confusing IRS verbiage. Not the best model.
posted by PhoBWanKenobi at 8:50 AM on October 10, 2013


I think that's pretty typical of a government application. There are a million hands in there trying to get all of the questions they need, while trying to make it apply to multiple situations - including your unique one - and they probably put more money into marketing communications than in user experience testing. Just a guess anyway.
posted by Think_Long at 8:59 AM on October 10, 2013


Well why don't you do the research and find out?

Its almost like I knew an answer before I asked the question.

CGI Federal is a Canadian Company. So 1 answer can be 100% of the money was 'outsourced'.
posted by rough ashlar at 9:13 AM on October 10, 2013


I think that's pretty typical of a government application. There are a million hands in there trying to get all of the questions they need, while trying to make it apply to multiple situations - including your unique one - and they probably put more money into marketing communications than in user experience testing. Just a guess anyway.

Yeah, but opening the exchange in 2013 and then asking if you have health insurance "now"--and then incorrectly telling someone they're ineligible for assistance if they say yes--is pretty horrendous from a communications standpoint. Sure, it's typical, but IRS-level usability is pretty horrifically poor, and I say this as a person who is a pretty big ACA proponent.
posted by PhoBWanKenobi at 9:14 AM on October 10, 2013 [1 favorite]


CGI is a multinational with worldwide job postings, including many postings in the US. They have onshore IT centers in Alabama, Ohio, Texas, and Virginia. So no, it does not seem a given that 100% of the money was outsourced.
posted by muddgirl at 9:19 AM on October 10, 2013


Uninsured 20ish hero racks up bill (and lived!), goes bankrupt, moves on.

I see where your problem lies. No, 20ish hero racks up bill, can't pay it, goes bankrupt, can't start his utopian American dream business to make the country great again and lives out his life in abject moochery on the gummint. Or, fearing the wrath of his Tea Party fellows, declines diagnosis until it's too late for the treatment he can't pay for and dies an agonizing death.

...under evil Obamacare, the 20ish Cancer hero ends up below the poverty rate and is forced onto Medicaid.

No, the whole point is that the 20ish hero has health insurance under Obamacare. You really don't understand this, do you?
posted by Mental Wimp at 1:29 PM on October 10, 2013


I just concluded a soul-sucking conversation with a young 24-year-old co-worker who absolutely hates Obamacare and thinks the problems with the websites mean the government can't be trusted to do a good job at anything. It was just so fucking Hobbesian and filled with cynical libertarian bullshit, I feel like I've been bathed in acid.

I did my best, but the worst thing about ACA (for me personally) is having to defend a law I don't even particularly like all that much, because, even with all its faults, it's just so much better than what we had before.
posted by longdaysjourney at 1:38 PM on October 10, 2013


...under evil Obamacare, the 20ish Cancer hero ends up below the poverty rate and is forced onto Medicaid.

are you trolling, or are you honestly trying to say that Obamacare created medicaid and is forcing people onto it? I think you may have misunderstood it.
posted by jacalata at 1:45 PM on October 10, 2013


or are you honestly trying to say that Obamacare created medicaid and is forcing people onto it? I think you may have misunderstood it.

Considering Medicaid existed before the ACA (Obamacare) your above text shows a lack of understanding.

The less charitable position is I'm being accused of being a lair.

But do show where my understanding is wrong:

For a single person - under $11,000 gross income one does not get any deductions for an insurance program from your taxes. (forced on Medicaid)
For $12000+ to 400% of the poverty line - you can buy insurance from an exchange and get part of the payments refunded from the IRS. (no recovery of what was spent unlike Medicaid)

Go ahead - show where my understanding with those exact terms is wrong.

Further - show that payments made under Medicaid are not subject to recovery from the year 2000 forward. Now the law mentions age 55 to 65, but Law as Congress wrote is not the same as Law as expressed via regulatory action or Law as Courts have decided. I've made reference to the North Carolina position of getting money from lottery winnings and I did not mention that some States seem to spend no effort on Medicaid recovery. I lack access to Lexis-Nexis ATM to look up what individual case law shows WRT recovery efforts but ACA Medicaid recovery sure does seem to be an option for the States.

To be fair to the proACA side - that which is similar is not the same and there has been no adjudication on Medicaid recovery WRT the ACA. But rather than accuse me of arguing in bad faith can you show across the 50 states there has been no recovery efforts VS the under 55 ers who's situation changed and could pay some amount on previous Medicaid reimbursements?

Hell, pointing to Page X of the ACA which sayith something like: 'and thou shalt gnot collecting thine payments already maide under medicaid if thine recipient hast the face of providence smile opone thine' to support the idea that Medicaid support under the ACA is not subject to 1993 clawback would be a change of pace in this discussion.
posted by rough ashlar at 3:00 PM on October 10, 2013


under $11,000 gross income one does not get any deductions for an insurance program from your taxes.

This is wrong, as I understand it. It sounds like you think the credit is only available as a refund of tax you would otherwise owe? but it will actually be paid directly from the irs (or wherever) to the insurance company. The Kaiser calculator says a 25yo in Washington making $11,000 in 2014 would pay 3% of their income (~$330 for the year) as health insurance premiums, the rest would be paid by the government.

Being under the federal poverty line, if they choose not to get it, they will pay no penalty. I don't know if hospitas somehow force people to use Medicaid if they are eligible for it, but I'd be surprised.
posted by jacalata at 4:04 PM on October 10, 2013


Your poverty-stricken student above who did not have insurance would likely have been put on their state's Medicaid when they got sick anyway, prior to the ACA, and therefore subject to whatever clawbacks their state's Medicaid program had, if any. You sound like you're blaming the ACA for forcing people onto Medicaid, when even prior to the ACA, the hospital or clinic where they went for care would have gotten them to enroll for it if they qualified, because then at least the hospital or clinic would get *some* payment for their treatment.

Any googling I do for Medicaid clawback brings me stories about clawbacks as relates to state funding (not individuals), and retirement planning and the rules around what counts as assets if you're going into a nursing home. I can't seem to find anything about a state's Medicaid program anywhere going after lots of individuals for paybacks after they no longer need Medicaid.

Also, I googled up "North Carolina MA-2900" from your earlier comment and the title of that page is "Adult Medicaid Manual MA-2900 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES" and seems to be about...abuse and fraud. Not getting money back from someone who was actually eligible for Medicaid. It is long and I did not read the entire thing. I ctrl-f'd for "lottery" and it didn't turn up.
posted by rtha at 4:15 PM on October 10, 2013


Justinian: "I finally found the catch in my new California coverage! The prices are good, the benefits are good... the list of providers is shit. Ah, well, I knew there had to be a catch somewhere."

Earlier today I heard in passing a conference call in which one health insurer was complaining about another health insurer's choice of deductible for their Silver level policies and how it was making everyone else look expensive. Seemed like a valid complaint for me. It would almost not qualify as a high deductible plan for HSA purposes because the out of pocket limits are so high. Not sure how they got it in there, but they did.

Are there any penalties for not meeting the requisite cost sharing targets? Are they fined at some point for offering Silver plans that cover on average less than the 70% of total cost they are supposed to if the claims experience turns out that way?

As far as provider networks go, the ones I have examined closely enough to have some confidence in describing have been the same, excluding the one shady insurer above, who offers multiple plans whose only difference is the provider network. The plan on the exchange with the network that comes with group coverage is, of course, $10-$20 a month more than the special exchange-only offering.

MCMikeNamara: "a better option for younger people would be a possibility. But that's not the political climate we live in."

Catastrophic-only plans are available for people under a certain age cutoff which I don't recall at the moment. In my state they are about a third of the cost of a silver plan.
posted by wierdo at 4:27 PM on October 10, 2013


rough ashlar: "But go ahead folks, believe that our 20ish year old hero won't be held responsible to repay that medicaid debt because the regulators are kind and won't demand payment."

They'll be dead before Medicaid sees recovery. And most of the states that are going to pass punitive recovery laws are ones where there will be no expansion and only the most destitute qualify for Medicaid anyway. Hell, I could be homeless and living on the street and make zero dollars and still not qualify for Medicaid where I live, because I am neither a woman with child, a minor, or a senior citizen. And that's how it will remain. I feel for anyone in my state making less than 133% of the poverty line. They will get nothing from ACA thanks to the troglodytes in power.

I have a sneaking suspicion that those who would qualify under an expansion would be quite happy to have it even if it means that the government might take some of their assets after they die.
posted by wierdo at 4:40 PM on October 10, 2013


Pretty sure the clawbacks are there to prevent people with clever accountants and lawyers from qualifying for Medicaid. At least in the state where my elderly grand parents live, they also consider the past 5 years of gifts to family as part of the estate, and can try to claw that back too.
posted by pwnguin at 5:51 PM on October 10, 2013


Oh hey, look at that.

Papa John's Schnatter Says He Will Honor Obamacare And Give Health Insurance To All Employees


There was Walmart, now Papa John's. I really hope they're keeping tabs on the numbers of formerly uninsured and underinsured people who are now getting coverage.
posted by longdaysjourney at 9:30 PM on October 10, 2013


Your poverty-stricken student above who did not have insurance would likely have been put on their state's Medicaid when they got sick anyway, prior to the ACA, and therefore subject to whatever clawbacks their state's Medicaid program had, if any.

And what should exist is tales of clawbacks. The only medical bill clawback one I know of personally is a dead-beat dad who's baby mama racked up a bill at the hospital for the birth of the child. The State would send him a bill every month and he felt no desire to go and work at a job where his wages could be garnished to pay that bill.
posted by rough ashlar at 11:26 PM on October 10, 2013


The truth about Obamacare's rocky rollout
posted by Artw at 1:08 PM on October 11, 2013


Buried in the Healthcare.gov source: "No Expectation of Privacy"

"Healthcare.gov has a hidden terms of service that is not shown to people when they sign up. The hidden terms, only viewable if you 'view source' on the site, says that the user has 'no reasonable expectation of privacy regarding any communication or data transiting or stored on this information system.'"
posted by jeffburdges at 10:32 AM on October 15, 2013


the user has 'no reasonable expectation of privacy regarding any communication or data transiting or stored on this information system.'"

Um Isn't that against HIPAA?
posted by Gungho at 11:51 AM on October 15, 2013 [1 favorite]


It's only visible when you hit 'view source', not anything the user signs, so it's likely an artifact from earlier development. Just signifies yet more incompetence and laziness on the contractors' parts.
posted by jeffburdges at 1:05 PM on October 15, 2013


I assumed that the problems were being overblown by the opposition to the ACA, but after reading some of this NY Times report, I'm not so sure.

But Mr. Chao’s superiors at the Department of Health and Human Services told him, in effect, that failure was not an option, according to people who have spoken with him. Nor was rolling out the system in stages or on a smaller scale, as companies like Google typically do so that problems can more easily and quietly be fixed. Former government officials say the White House, which was calling the shots, feared that any backtracking would further embolden Republican critics who were trying to repeal the health care law.

Yikes. It really sounds cobbled together and is currently amassing technical debt in a death march.

I really think that the ACA is desperately needed, but I'm starting to worry that they won't be able to get the site in a usable state before the absolutely-has-to-work deadline of mid-December.
posted by zixyer at 2:50 PM on October 16, 2013


Yikes. It really sounds cobbled together and is currently amassing technical debt in a death march.

Plus ça change...
posted by Mental Wimp at 8:55 AM on October 17, 2013 [1 favorite]


The Koch brothers' beer offensive against Obamacare loses its fizz
posted by Artw at 1:07 PM on October 17, 2013 [1 favorite]



Your poverty-stricken student above who did not have insurance would likely have been put on their state's Medicaid when they got sick anyway, prior to the ACA


If Medicaid was available. It's not, in my state, not for adults, just children. As of January, it will be -- my friend who's a single mom will be able get insurance with no copays and a $400 deductible for $40 a month, for her and her two children. (I think those were the numbers anyway)
posted by KathrynT at 3:23 PM on October 17, 2013 [2 favorites]


Four things I learned about Obamacare from shopping on HealthCare.gov
posted by Golden Eternity at 11:34 PM on October 17, 2013 [1 favorite]


The Truth About the Obamacare Rollout: The feds botched the website. But the states are doing much better.

BTW, Sarah Kliff (from Golden Eternity's link) and Jonathan Cohn have been pretty much the premier reporters on Obamacare. Anyone interested in it or really the past, current state, and future of health care in the US should have both of them in their RSS feed and/or following them on Twitter.
posted by zombieflanders at 6:10 AM on October 18, 2013 [1 favorite]


The Truth About the Obamacare Rollout: The feds botched the website. But the states are doing much better.

The New York state site is still pretty awful. Their facebook account is a pretty good reflection of this.
posted by PhoBWanKenobi at 7:15 AM on October 18, 2013


I test-drove the Minnesota site (MNSure) on the first day and it was pretty glitchy: slow, obscure errors, vague instructions in places. Overall, the site is well organized, but it was not ready for primetime. So glad for now I've got employer-provided coverage. So much simpler.
posted by Mental Wimp at 11:13 AM on October 18, 2013


Inside the Fox News lie machine: I fact-checked Sean Hannity on Obamacare
I tracked down Hannity’s guests, one by one, and did my own telephone interviews with them.

First I spoke with Paul Cox of Leicester, N.C. He and his wife Michelle had lamented to Hannity that because of Obamacare, they can’t grow their construction business and they have kept their employees below a certain number of hours, so that they are part-timers.

Obamacare has no effect on businesses with 49 employees or less. But in our brief conversation on the phone, Paul revealed that he has only four employees. Why the cutback on his workforce? “Well,” he said, “I haven’t been forced to do so, it’s just that I’ve chosen to do so. I have to deal with increased costs.” What costs? And how, I asked him, is any of it due to Obamacare? There was a long pause, after which he said he’d call me back. He never did.

There is only one Obamacare requirement that applies to a company of this size: workers must be notified of the existence of the “healthcare.gov” website, the insurance exchange. That’s all.
Once again, you can't reason people out of something they didn't reason themselves into.
posted by tonycpsu at 3:19 PM on October 18, 2013 [5 favorites]


Coming to this late, but I recommend Steven Brill's excellent breakdown of where US healthcare money goes, "Bitter Pill: Why Medical Costs are Killing Us."
posted by GrammarMoses at 7:58 AM on October 19, 2013 [1 favorite]


On a side note, this morning I upgraded to Windows 8.1 on my Surface Pro over the Internet with nary a hiccup. For all the bad-mouthing Microsoft gets, they have a pretty rock-solid updating scheme unmatched by anyone. I hope at some point the Health.gov website becomes as reliable.
posted by Mental Wimp at 11:30 AM on October 21, 2013


Why Liberals Admit Obamacare’s Failures While Conservatives Refuse to Concede Its Successes
Liberal journalists have covered the positive and negative aspects of the law in a way that, if not impartial — they share the goal of helping the poor and sick get access to medical care — is certainly rigorous and fair. Jonathan Cohn noted back in May that the website might not work as the administration had hoped; Ezra Klein calls the launch a “failure.”

Only the negative liberal coverage has pierced the conservative information bubble, as evidence that even die-hard Obamacare lovers recognize the law is failing. It would be nice if these kinds of admissions against interest persuaded conservatives that liberal journalists are not the mirror image of their own hack pundits but informed policy reporters whose analysis is worth listening to in its totality. Instead it has roughly the opposite effect. Klein’s blunt assessment ricocheted around the conservative new world, undergoing wild exaggeration, and embedding itself in the Republican mind as a Buffettesque pseudo-fact:
Rep John Fleming (R-LA) [said] “the biggest threat to America today is not shutdowns, it’s Obamacare.” He said that it was clear that it would be a disaster and cited liberal pundit Ezra Klein of the Washington Post, who he claimed shared his views.
The imbalance in honesty has magnified the impact of bad Obamacare news and blunted the impact of good Obamacare news. And to date, the good Obamacare news seems to be much more significant. Rapidly falling medical inflation suggests that the law’s pay-for-quality reforms may work, perhaps much better than expected. The cost of insurance plans on the exchanges has also come in well under forecast, likewise implying positive things about the success of the markets. Those developments ultimately matter much, much more than the initial success of the website.
posted by zombieflanders at 12:51 PM on October 21, 2013 [3 favorites]


Ohio panel OK's Medicaid expansion in win for Obamacare, conservatives/Republican lawmakers expected to sue
posted by zakur at 11:10 AM on October 22, 2013 [1 favorite]


The New York Times has a paywalled piece up about the disparity in health insurance competition between rural and urban counties and the effects of that difference on premiums: Health Law Fails To Keep Prices Low In Rural Areas*
While competition is intense in many populous regions, rural areas and small towns have far fewer carriers offering plans in the law’s online exchanges. Those places, many of them poor, are being asked to choose from some of the highest-priced plans in the 34 states where the federal government is running the health insurance marketplaces, a review by The New York Times has found.

Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.
...
The Obama administration has said 95 percent of Americans live in areas where there are at least two insurers in the exchanges. But many experts say two might not be enough to create competition that would help lower prices.

For example, in Wyoming, two insurers are offering plans at prices that are higher than in neighboring Montana, where a third carrier is seen as a factor in keeping prices lower.
* Google News is no help in getting full text, but Kaiser Health News comes to the rescue.
posted by wierdo at 9:00 AM on October 24, 2013 [1 favorite]


More than Two Million People Booted From Existing Insurance Plans:
That means consumers have to sign on to new plans even if they don't want or need the more generous coverage. Industry experts say about half the people getting the letters will pay more -- and half will pay less, thanks to taxpayer subsidies. Levitt said, "The winners outnumber the losers here, but because of all the website problems, it's hard to find out who the winners are because they don't even know it themselves."
I think part of the problem is that some people have known from the beginning that there would be winners and losers with the plan, but it's been sold as a no-loser plan. People can't a la carte their health insurance anymore, which is great for those who were ordering a lot off the menu, but not so great for those who were picking and choosing.
posted by corb at 12:21 PM on October 30, 2013 [1 favorite]


Much like the "too big to fail" banks, the people a-la-carte-ing their insurance are taking a risk that they, ultimately, aren't responsible for bailing themselves out of. Unless we're willing to let people who choose to underinsure themselves die in the streets, the question is do taxpayers pay less now, or more later. We're choosing to pay less now, and if we happen to take away someone's "freedom" to pass their catastrophic care costs onto society, well, that's too bad.

(FWIW, the freshest healthcare thread is here).
posted by tonycpsu at 12:41 PM on October 30, 2013


Well, for some people it may be actually irrelevant, though. For example, gay men are now required to have health insurance that includes maternity benefits.

Thanks for the pointer though! There are a lot of these.
posted by corb at 12:45 PM on October 30, 2013


This has already been discussed at length in the other thread, but the TL;DR is that CBS article is pretty misleading on several accounts:

1) The issue isn't so much how it was sold but how utterly shitty the insurance companies are being. They've had three and a half years, and now they're deliberately screwing people over and/or scaring them.

2) The "more generous" coverage here includes "maternity care, emergency visits, mental health treatment and even pediatric dental care." In other words, the bedrocks of basic preventative medicine.

3) The a la carte thing is basically a myth. You were never able to build your own plans, the insurance companies change them quite often because they can get away with it. Obamacare is meant to stop them from doing that.

4) Yes, some people will pay more, but they're getting better coverage. Most will pay less.

5) It's not unusual for issues and low enrollment. Medicare Part D had a rough time of it at the beginning, the difference was nobody was screaming for repealing and replacing it, but rather fixing it. When Romneycare was launched, most people waited until essentially the last minute to enroll.

Well, for some people it may be actually irrelevant, though. For example, gay men are now required to have health insurance that includes maternity benefits.

And as I pointed out above, they also get (among other benefits) emergency visits, mental health treatment, and pediatric dental care for those with children. All of which are ruinously expensive if not covered. As do the many women who will in fact have children.
posted by zombieflanders at 12:51 PM on October 30, 2013


For example, gay men are now required to have health insurance that includes maternity benefits.

Everyone who has health insurance has benefits they'll never use. That's the point of insurance.
posted by Etrigan at 12:54 PM on October 30, 2013 [4 favorites]


Etrigan: " Everyone who has health insurance has benefits they'll never use. That's the point of insurance."

No, you've only provided a succinct definition of economic waste. The point of insurance is to convert a small, unpredictable chance of an expensive thing happening into easily affordable certainty.

The better argument is that the day insurers start offering discounts to gay men is the day gay men suddenly have children at rates approximating straight men.
posted by pwnguin at 8:28 PM on October 30, 2013 [2 favorites]


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