Observations on life

Is health care affordable⁉️

No‼️

You can look at the cost of health care from several perspectives.

There is the basic cost of care driven by prices and utilization. There is the premium you pay and there are your out-of-pocket costs.

Premiums directly reflect the other two factors. You OOP costs directly reflect your utilization of health care.

While there has been some moderation in the trend for prices and utilization, health care inflation is still several times general inflation just as it has been for years.

Premiums are still rising at hefty rates (driven in large part by prescription drugs)  in Obamacare exchanges, among employers who are asking workers to pay an ever-increasing higher percentage of the premium, and for Medicare.

In addition, deductibles and co-pays are going up as well, frequently in conjunction with higher premiums. This will accelerate as we get closer to 2018 and the 40% tax on some health plans.

Contrary to policy expert opinion, employers are not making up cuts in health care by giving raises. In fact, I have seen employers give a raise to workers and then take it back by increasing premiums and OOP costs for their health benefits.

So no, unless you avoid care altogether, health care is not affordable. Even among those Americans heavily subsidized by Obamacare it is not affordable. The costs are merely shifted to others.

Where do we go from here?

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7 replies »

  1. No. No and No. I’ve written in comments in Jan. when my husband started looking for a provider under our plan for cataract surgery. It took many many many hours and phone calls to the insurance co. and to drs. to find one. The insurance co. list is inaccurate. We were actually told by the insurance co. to call doctors in our area to see if they know anyone who will take our insurance. Shouldn’t the insurance co. know better than the doctors but we tried. In the end there were 2 doctors in a 50 mile radius( and they were about 50 miles away) who did cataract surgery and took our insurance. Finally in April I get an appointment asking both the insurance co. and the dr if a referral is needed. Insurance said to ask the dr. who said no not needed. Again insurance co isn’t much help and we learned that you call the insurance co more than once to ask the same question because you will most likely get two different answers to the same question. After the first visit think ready to go. I go to schedule the appointment for surgery the dr tells me her partners will not accept my insurance. I get a bill from the dr. insurance won’t pay no referral, She reduced the price but that appointment cost me $120 for nothing. In June insurance co. finds another dr who will take our insurance. The insurance co. actually calls the dr. for us in 3 way phone call to verify they take our insurance. First appointment goes fine, second appointment does all kinds of measurements to prepare for surgery. Surprise now we are told the surgery center and anesthesiologist will not take our insurance. We leave to think it overnight and talk to our insurance co. Insurance co. won’t do anything. Call the doctor to schedule decide we have no choice. Cost of surgery for two eyes $10,000. Cost to insurance co. $0 cost to us $10000. No other option, there isn’t an option of eye dr, surgery center and anesthesiologist all being in network. And that $10,000 max. out of pocket only counts to in network. Use out of network it doesn’t count toward the $10,000. All this at a cost of $18,000 a year for my husband and myself under the affordable care act. I can’t imagine being seriously sick and having to go through this. It isn’t just the cost, it is the torture you have to go through to find a dr. and then know and be sure everyone else involved is in network before having any procedure. I remember President Obama telling the story of his poor mother with cancer sitting at the table go over insurance papers late at night. I think it is just as bad or worse with the limited number of providers.

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    • You must either live in a relatively rural area or you have crummy insurance. Many states require some accommodation in this situation so you can obtain in-network services or have services paid as if they were. You should have filed formal appeal and or complained to insurance commission.

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      • Just wanted to update you. We are an hour outside of NYC, in rural area for NJ as rural as you can get for the area. Things are more expensive, it is $1500 more because it is laser surgery (insurance doesn’t pay that part). I did contact the insurance commissioner in NJ. After reading your comment I also filed an appeal with the insurance co. Last week a representative from the insurance co. replied to our complaint to review the situation. Today they called they will cover the procedure working it out with the doctors office and will pay us back (minus the deduction of course) for the first doctor my husband visited that wouldn’t do the surgery.
        When I sent an e-mail to the insurance commissioner I was just complaining. I really didn’t expect anything. Just kept thinking people need to complain about in-networking lack of co-ordination with surgical centers and anesthesiologist so something would change. I was getting nowhere with the insurance company. Although the appeals made to the insurance co. may have contributed to the final results. Couldn’t ask for better results but it is a shame this is what you have to go through in today’s world.

        Thanks for the advice.

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  2. Hey, it is like they say, if you think education is expensive, try ignorance.

    I have been blessed with relative good health, and only modest spend for medical treatment – maybe $ 30,000 over my 63 plus years.

    So, I’ll use my mom as an example – where prior to dying in 2001, she spent over $200,000 of taxpayer/other people’s money after a massive heart attack in 1989. She also spent $40,000 of her own money during that period.

    The question became – would she have survived/enjoyed those 12 years without that spend? Probably not. However, why is it that you never evaluate what people receive for their/our taxpayer money when you evaluate just how “affordable” treatment is?

    You say health treatment is unaffordable, but I say, compared to what … Compared to the alternative – a premature Death, a dramatically lowered standard of living, pain and suffering?

    Or, think of it in terms of spending priorities, altering one’s spending habits – measure it in terms of giving up a car, food, entertainment, home equity …?

    Sure, I would like to pay less for medical services, a new car, college tuition, etc. – but where is the money going to come from, the French? Or, perhaps you believe physicians should simply be paid less – again, compared to who?

    Or, perhaps you believe all of this 1percent drivel the progressives trot out – that we should tax “other people” more so politicians can buy your votes. Bottom line, an American living below the poverty line has average living space that exceeds the average Eyropean, a car, three tv’s, cable, smart phones, food stamps, and if their are minor children in the home – a game console. That’s Americans living in poverty – below the government defined poverty income threshold. In fact, all but the poorest Americans can count themselves among the world’s top 1 percent.

    Affordable… Give me a break.

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    • Benefit Jack you bring up some good points such as affordable compared to what. I would like to add who should pay? Should every life be saved no matter the cost? If it is a child they could be the next Einstein so I see the case to spend whatever it costs. In the case of a 90 year old, should they be on a list for a heart transplant? I am not willing to play God but if they survive how many more years will they get and what will the quality of life be? Your mother is a good case of another 12 good years which lends proof that you should spend the money.

      I have been struggling as were to draw the line for me and only me. I am not willing (as of now) to spend whatever it cost to save my life for an illness and in the process leave my wife destitute. As I approach retirement age, I am not willing (at this time) to spend my life savings to live a few more years. I already know that I am not the next Einstein so that part is easy. Having to stay alive for the kids or grandkids is just selfish on their part. I am almost sure that one day I will die because I do not believe that I am immortal.

      So if we define what is “affordable” as a sliding scale of one’s retirement income, what should that percentage be? 5%, 10%, 25%, 50%, 75%?

      For me only, instead of spending $500,000 on cancer treatments and $250,000 of my savings to send a doctor’s child to college, I rather go on a life celebration cruise with all my loved ones for $50,000 and leave $200k for the wife. When I run out of money throw me over the side for a burial at sea. I call this Terminal Cruise Lines. My doctor told me that I would have people signing for such a cruise. I even had a shirt and a pamphlet made up as a joke. But even though I do not want to spend too much to gain a few months or a year, will I really know when I have spent too much trying to cheat death? Although I cannot not figure out what is affordable to me now, I do not want the government to tell me that I reached that max amount either but I fear one day they will have no choice unless the taxpayers are willing to keep paying more taxes.

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      • Dwayne, only you can choose how much of the taxpayer’s money ( once eligible for Medicare, or if covered thru taxpayer supported health coverage in a public exchange, or via Medicaid) and your own wealth you are willing to spend. It is your choice, decision, as you qualify based on rules set down for each of us under federal programs.

        The main benefit to me of my mother’s added 12 years was that my children enjoyed a little of the grandmother who made it all possible – as my father died at age 53, in 1969 when I was 17. He never had a choice – he incurred all of maybe $5,000 in medical expense in his life, and most of his medical spend was service connected.

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