How Obama's health care plan will actually work--just the facts

[thewise1]

Originally Posted by motivez

That's my point, the entire industry is built to profit off the suffering of other people because they know you can't afford it without them, and to maximize profits, they'll deny anyone they can.

It makes much more sense for something like health insurance to be covered by an entity that isn't concerned with denying your care to make a profit first, and your care only if they're unable to weasel their way out of it.

Oh, they should just be fiscally irresponsible and pay out whatever, screw their fiduciary responsibility to the other policy holders, they can deal with not having enough money to handle that when the time comes.

Right?

[thewise1]

Why not have the government offer state run food stores and farms and internet and gas stations? It worked great for the soviets, removing those evil profiteers from the equation and all

[motivez]

Originally Posted by thewise1

Oh, they should just be fiscally irresponsible and pay out whatever, screw their fiduciary responsibility to the other policy holders, they can deal with not having enough money to handle that when the time comes.

Right?

Exactly why stuff like this should be taken care of by an entity not concerned with profit, but with care.

At least you've admitted that if you aren't wealty and healthy, there are 0 good options.

Try finding an insurance company that has an affordable policy for someone making 25k a year who has no insurance through their employer and suddenly has a serious illness, they don't exist.

[thewise1]

Originally Posted by motivez

Exactly why stuff like this should be taken care of by an entity not concerned with profit, but with care.

At least you've admitted that if you aren't wealty and healthy, there are 0 good options.

Try finding an insurance company that has an affordable policy for someone making 25k a year who has no insurance through their employer and suddenly has a serious illness, they don't exist.

I did not concede that point.

[motivez]

Originally Posted by thewise1

Why not have the government offer state run food stores and farms and internet and gas stations? It worked great for the soviets, removing those evil profiteers from the equation and all

There's already food stamps in place for people who can't afford food, there's no good reason to do what you're saying here.. slippery slope argument failure

I actually think the gas one would make an interesting topic for discussion in another thread if you wanted to make it

[thewise1]

Insurance Plan Summary
Plan Name

Heritage Value Plus 30
Apply

Plan Type

PPO
Estimated Cost

$212.00 monthly
Online Physician Directory

Find Doctors
Primary Care Physician Required

No
Specialist Referrals Required

No
HSA Eligible

No
Out-of-Network Coverage

Yes (More Details)
In-Network Coverage
Deductible

Individual:$2,500
Coinsurance

30% after deductible
Out-of-Pocket Limit

Individual:$8,500
Includes deductible
Office Visit


Primary Doctor

30% Coinsurance after deductible
Specialist

30% Coinsurance after deductible
Periodic Health Exam

Not Covered
Periodic OB-GYN Exam

Not Covered
Well Baby Care

Not Covered
Chiropractic

30% Coinsurance after deductible (12 visits maximum per calendar year)
Mental Health

30% Coinsurance after deductible. Outpatient: 6 Visits Per Calendar Year; Inpatient: 6 Days Per Calendar Year
Prescription Drugs


Generic

20% Coinsurance after deductible ($5,000 maximum per calendar year)
Brand

30% Coinsurance after deductible ($5,000 maximum per calendar year)
Non-Formulary

50% Coinsurance after deductible ($5,000 maximum per calendar year)
Separate Rx Deductible

$500 Individual
applies to
Generic, Brand, Non-Formulary
Mail Order

Not Available
Outpatient Lab/X-Ray

30% Coinsurance after deductible
Emergency Room

$100 Copay (waived if admitted) plus 30% Coinsurance after deductible
Outpatient Surgery

30% Coinsurance after deductible
Hospitalization

30% Coinsurance after deductible
Maternity


Pre & Postnatal Office Visit

Not Covered
Labor & Delivery Hospital Stay

Not Covered
Lifetime Maximum

$2 Million per person
Additional Information
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Exclusions and Limitations
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Plan Name

Heritage Value Plus 30
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Hey look, a $2 million dollar maximum policy with 70% coverage for most things and an $8500 max out of pocket per year for $212/mo

[motivez]

Originally Posted by thewise1

I did not concede that point.

Really?

Go ahead and call up these insurance companies you say are so great for people outside of employers insurance, and find one that's affordable for someone making 25-30k, with some kind of history of problems, including an active one

You wont find one that will accept them, and if you do, the price will be so high that they can't afford it.

[motivez]

That's all great as long as you're healthy, like I said. Those cost estimates assume you're in perfect health.

[thewise1]

Originally Posted by motivez

That's all great as long as you're healthy, like I said. Those cost estimates assume you're in perfect health.

Really? I didn't see that in the assumptions

[motivez]

If you say you have anything wrong with you during the sign up process, your costs will be significantly higher or they will straight up turn you down.

[JaJae]

Originally Posted by motivez

If you say you have anything wrong with you during the sign up process, your costs will be significantly higher or they will straight up turn you down.

Right on.

And if you don't admit it they won't pay for treatment and say it's a pre-existing condition.

I work for a small company and I was involved in the start-up of our health care policy. It's a basic HMO with prescription, no dental or vision care with Horizon Blue Cross Blue Shield. I'm paying $85 a pay for this basic shitty coverage where I have to call them up and fight with them to pay for things that they're supposed to pay for. I had to go to an ear specialist. I went to my doctor and got a referral and went to the specialist. When it came time for them to pay they refused... for eight months. I had the ear specialist calling me for the money, I was calling Horizon, it was a nightmare over a $250 bill of which I paid $30 up front as a specialist co-pay.

We have an employee who wanted to sign up for our healthcare making $34k a year and she had asthma. Basically if she didn't tell them up front that she had asthma they wouldn't cover any of her asthma related (or what they deemed to be asthma related) illnesses. However, since it was a pre-existing condition they wouldn't cover anything for her asthma for the first sixth months she was on the policy. I remember thinking it was the most ridiculous thing. During that 6 month period she needed new inhalers, had to go to the doctors twice and the hospital once. And even though she was paying for health insurance, they wouldn't cover any of it. I remember my boss on the phone with them screaming and threatening to cancel the policy if they didn't help her out. They refused. They'd rather lose our small business as subscribers to a competitor than "help" her with the bills. It's absurd.

We pay so much in this country for health care and what do we get out of it? I don't believe a complete government takeover is the answer, but something needs to change to make it affordable for lower class employees.

[thewise1]

I wish those of you who are so eager to volunteer others wealth and livelihoods to help those in need would be more eager to give everything you've got first.

[WickedLou9]

Originally Posted by thewise1

I wish those of you who are so eager to volunteer others wealth and livelihoods to help those in need would be more eager to give everything you've got first.

That's actually the way it works now. Those who can't afford care still get it if they really need it. Emergency care. EXPENSIVE care. The rest of us who CAN afford it foot the bill in the way of higher insurance premiums and higher costs in general. So those who can't afford insurance get it for free. Usually they end up in bankruptcy but that doesn't help the system at all. It makes it worse.

The solution being proposed is to spread the cost and mandate that everyone has coverage so that risk and cost is spread over a larger number of people. For those that can't afford standard coverage on thier own, the government would subsidize a plan for them. Yes that would mean you pay higher taxes. However it would also mean that your insurance premiums go down. The total amount of money that you would ultimately pay would be less. Those who were previously unable to get insurance either because of a preexisting condition, or because they simply coudln't afford it would be contributing something back into the system.
This is what insurance is. Everyone pays into the pool betting that they will need the coverage. Insurance companies set rates so that, by playing odds, they take in more than they pay out. More people paying in means a larger pool and the risk averages out.

[Ardentfrost]

Originally Posted by WickedLou9

That's actually the way it works now. Those who can't afford care still get it if they really need it. Emergency care. EXPENSIVE care. The rest of us who CAN afford it foot the bill in the way of higher insurance premiums and higher costs in general. So those who can't afford insurance get it for free. Usually they end up in bankruptcy but that doesn't help the system at all. It makes it worse.

The solution being proposed is to spread the cost and mandate that everyone has coverage so that risk and cost is spread over a larger number of people. For those that can't afford standard coverage on thier own, the government would subsidize a plan for them. Yes that would mean you pay higher taxes. However it would also mean that your insurance premiums go down. The total amount of money that you would ultimately pay would be less. Those who were previously unable to get insurance either because of a preexisting condition, or because they simply coudln't afford it would be contributing something back into the system.
This is what insurance is. Everyone pays into the pool betting that they will need the coverage. Insurance companies set rates so that, by playing odds, they take in more than they pay out. More people paying in means a larger pool and the risk averages out.

As I said, the added cost of health care due to the uninsured needing health care is absorbed by anyone with insurance whether or not they need health care. The only people not helping pay for uninsured people are uninsured people who never need health care.

[thewise1]

Originally Posted by WickedLou9

That's actually the way it works now. Those who can't afford care still get it if they really need it. Emergency care. EXPENSIVE care. The rest of us who CAN afford it foot the bill in the way of higher insurance premiums and higher costs in general. So those who can't afford insurance get it for free. Usually they end up in bankruptcy but that doesn't help the system at all. It makes it worse.

The solution being proposed is to spread the cost and mandate that everyone has coverage so that risk and cost is spread over a larger number of people. For those that can't afford standard coverage on thier own, the government would subsidize a plan for them. Yes that would mean you pay higher taxes. However it would also mean that your insurance premiums go down. The total amount of money that you would ultimately pay would be less. Those who were previously unable to get insurance either because of a preexisting condition, or because they simply coudln't afford it would be contributing something back into the system.
This is what insurance is. Everyone pays into the pool betting that they will need the coverage. Insurance companies set rates so that, by playing odds, they take in more than they pay out. More people paying in means a larger pool and the risk averages out.

I'll believe my insurance premiums will go down when I see it, honestly.