Author Topic: What comes after the ACA?  (Read 308984 times)

former player

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Re: What comes after the ACA?
« Reply #2400 on: May 22, 2017, 01:05:14 AM »
http://www.buckeyesurgeon.com/2017/05/mandate.html


From an emergency surgeon's perspective, post surgery.

Quote
And the guy was not some street urchin or derelict.  He owned his own landscaping business.  He worked 60 or so hours a week.  He was married and had children.  By all metrics, he was an upstanding, contributory member of his community.  But he didn't have any health insurance.  And the reason is because he was able to choose not to have health insurance.

I'll never understand why some people think they're immune to the possibility of expensive medical care.
Or (I've seen it more than once around here) they'll just get on a plane and go somewhere cheaper for it.
Be frugal and industrious, and you will be free (Ben Franklin)

Lagom

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Re: What comes after the ACA?
« Reply #2401 on: May 22, 2017, 02:28:24 AM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.
« Last Edit: May 22, 2017, 02:32:55 AM by Lagom »

golden1

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Re: What comes after the ACA?
« Reply #2402 on: May 22, 2017, 05:10:32 AM »
My brother in law is like that landscaper.  He is a painter.  He works usually 80+ hours a week.  He does a lot of physical labor and is over 40.  He has no health insurance (in Massachusetts of all places) and stubbornly pays the fine every year.  I will have to thank him for sticking us with the bill when he or his wife finally has some sort of health emergency, but they live in denial that anything will ever happen.  It's maddening. 

FIRE Artist

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Re: What comes after the ACA?
« Reply #2403 on: May 22, 2017, 05:16:58 AM »
http://www.buckeyesurgeon.com/2017/05/mandate.html


From an emergency surgeon's perspective, post surgery.

Quote
And the guy was not some street urchin or derelict.  He owned his own landscaping business.  He worked 60 or so hours a week.  He was married and had children.  By all metrics, he was an upstanding, contributory member of his community.  But he didn't have any health insurance.  And the reason is because he was able to choose not to have health insurance.

I'll never understand why some people think they're immune to the possibility of expensive medical care.

The same psychology is at play that is studied in behavioural safety psychology.  Soon, certain, positive reinforcers trump later, uncertain, negative consequences.  The temptation to spend on immediate gratification today can easily trump spending on insurance for some unknown future health concern.

protostache

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Re: What comes after the ACA?
« Reply #2404 on: May 22, 2017, 09:33:52 AM »
The White House has reportedly asked for a 90 day delay on the cost sharing reduction (CSR) payments lawsuit. Insurers are required to post their final rates for review to the states by June 15th, which means they have to assume they won't be getting CSR payments in 2018. They're legally obligated to price polices for people eligible for CSRs assuming they get the payments, which means insurance policies on the individual market will be 19-20% more expensive for everyone to make up for the payments they won't be getting from the government.

https://twitter.com/ASlavitt/status/866671313481596928

This is a viable strategy for skewing public opinion back away from ACA and will give the Senate GOP more political cover to get rid of it. This is the GOP directly causing the ACA to fail in a way that they can point at it later and say "See? It failed!"

wenchsenior

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Re: What comes after the ACA?
« Reply #2405 on: May 22, 2017, 09:34:36 AM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.

+1000

Shit happens, and it is likely to happen to you or someone you love at some point.

I have mentioned this before, but one of our close friends got a random minor bacterial infection, could have come from a cut or whatever (he has no idea where or how it started).  Lodged in his spine, ate the bone through over a couple weeks, compressed his spinal cord. Presto, instant lower body paralysis.  One emergency neurosurgery, intensive care and regular hospital stay (3 weeks), several months of live-in physical therapy, and 2 + years of twice weekly out-patient physical therapy later, and he has a permanent catheter and is just now managing short walks with a walker. Mostly, he uses a wheelchair. He has had to renovate his house for wheel chair access (or he would have had to change houses).

Now, how much do you think that 'minor' infection has and will cost over his lifetime?  Thankfully, he has excellent insurance and family money to help offset his bills, which have run to a couple hundred thousand over two years, and will costs tens of thousands more in lifetime ongoing care.  Without insurance? That is millions of dollars.

Only a tiny fraction of people on the planet can ever realistically plan for this kind of scenario. But it happens a hell of a lot more often than young 'invincible-just-live-a-healthy-lifestyle' types want to believe.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2406 on: May 23, 2017, 06:59:45 AM »

https://www.nytimes.com/2017/05/23/opinion/health-care-bill-senate.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

Senate is taking up a very quiet and closed to the public effort to draft its own legislation of the AHCA. A select few people have been invited to send feedback to an email address healthreform@finance.senate.gov no later than today

The CBO should release the score for the house version tomorrow.

nereo

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Re: What comes after the ACA?
« Reply #2407 on: May 23, 2017, 07:31:32 AM »

https://www.nytimes.com/2017/05/23/opinion/health-care-bill-senate.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

Senate is taking up a very quiet and closed to the public effort to draft its own legislation of the AHCA. A select few people have been invited to send feedback to an email address healthreform@finance.senate.gov no later than today

The CBO should release the score for the house version tomorrow.

I'm certain this is going to be a giant poo-storm.

What's become clear over the last 48 hours (if it wasn't before) is that the WH is pushing forward their goal of reducing federal entitlement programs. Gone are the lofty promises of not cutting medicare, medicaid or SS ('Harmless truthful hyperbole!"), and in its place come work requirements, state waivers and reduced budgets.

I could almost respect that position if they also hadn't openly promised not to do these very things (Coverage for everyone; we won't cut these programs; lower deductibles with better coverage, etc).
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NESailor

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Re: What comes after the ACA?
« Reply #2408 on: May 23, 2017, 08:42:17 AM »

https://www.nytimes.com/2017/05/23/opinion/health-care-bill-senate.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

Senate is taking up a very quiet and closed to the public effort to draft its own legislation of the AHCA. A select few people have been invited to send feedback to an email address healthreform@finance.senate.gov no later than today

The CBO should release the score for the house version tomorrow.

I'm certain this is going to be a giant poo-storm.

What's become clear over the last 48 hours (if it wasn't before) is that the WH is pushing forward their goal of reducing federal entitlement programs. Gone are the lofty promises of not cutting medicare, medicaid or SS ('Harmless truthful hyperbole!"), and in its place come work requirements, state waivers and reduced budgets.

I could almost respect that position if they also hadn't openly promised not to do these very things (Coverage for everyone; we won't cut these programs; lower deductibles with better coverage, etc).

And you know there will be a-holes using lines like "You can keep your doctor" as some sort of a retort.  As if that was in any way comparable.  Yes, those promises were also broken and they cause some hardship to some people.  But the budget and AHCA, as proposed, will cause a SHITTON of hardship to a SHITTON of people.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2409 on: May 23, 2017, 02:47:40 PM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.


What's become clear over the last 48 hours (if it wasn't before) is that the WH is pushing forward their goal of reducing federal entitlement programs. Gone are the lofty promises of not cutting medicare, medicaid or SS ('Harmless truthful hyperbole!"), and in its place come work requirements, state waivers and reduced budgets.


Hold on, if the plan is to just cut some of these social services then that is garbage, but to incentives people who can work to actually work and thereby decrease the need for social service spending is an idea I can definitely get behind.

I heard one comment state that we we will judge the quality of our safety net not by how many people are in it, but by how many people we can help get off it.  If true I think that is a great idea.
« Last Edit: May 23, 2017, 02:55:23 PM by EnjoyIt »

nereo

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Re: What comes after the ACA?
« Reply #2410 on: May 23, 2017, 03:18:49 PM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

It's simply untrue to say there would be no recourse if you choose not to pay. Yes in a life-threatening emergency care will be given to save and stabilize the patient. Once the patient is stabilized they are discharged regardless of what follow up care they *should* get.
But what I really object to is this idea that one could simply 'choose' not to pay and not be penalized for it.  If you run up a $100k bill they will come after you. The hospital (or collection agency) will sue, and you can have your home and assets seized.  This is the very reason why there's ~800,000 bankruptcies each year that list medical expenses as the primary cause.
"Do not confuse complexity with superiority"

nereo

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Re: What comes after the ACA?
« Reply #2411 on: May 23, 2017, 03:23:56 PM »
What's become clear over the last 48 hours (if it wasn't before) is that the WH is pushing forward their goal of reducing federal entitlement programs. Gone are the lofty promises of not cutting medicare, medicaid or SS ('Harmless truthful hyperbole!"), and in its place come work requirements, state waivers and reduced budgets.

Hold on, if the plan is to just cut some of these social services then that is garbage, but to incentives people who can work to actually work and thereby decrease the need for social service spending is an idea I can definitely get behind.

I heard one comment state that we we will judge the quality of our safety net not by how many people are in it, but by how many people we can help get off it.  If true I think that is a great idea.

You can decide that cutting these programs is a good idea or not. While I don't agree with them, I at least give the freedom caucus credit for being consistent with their rhetoric and ideology.

My point was that this is a direct reversal by DJT of not cutting SSI or Medicaid/Medicare, and of offering coverage for everyone which would cost less.
"Do not confuse complexity with superiority"

EnjoyIt

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Re: What comes after the ACA?
« Reply #2412 on: May 23, 2017, 03:32:17 PM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

It's simply untrue to say there would be no recourse if you choose not to pay. Yes in a life-threatening emergency care will be given to save and stabilize the patient. Once the patient is stabilized they are discharged regardless of what follow up care they *should* get.
But what I really object to is this idea that one could simply 'choose' not to pay and not be penalized for it.  If you run up a $100k bill they will come after you. The hospital (or collection agency) will sue, and you can have your home and assets seized.  This is the very reason why there's ~800,000 bankruptcies each year that list medical expenses as the primary cause.

I don't believe you are correct.  Although the hospital can send for collections, they are unable to force you to pay or put a lien on your home.  Your credit score will go into the dumpster, but they still can't force you to pay.  Eventually that bill is dismissed.  I think it takes 7 years, and then you have another few years to start rebuilding your credit score.  It isn't a great scenario, but it sure is better than losing your home.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2413 on: May 23, 2017, 03:35:05 PM »
What's become clear over the last 48 hours (if it wasn't before) is that the WH is pushing forward their goal of reducing federal entitlement programs. Gone are the lofty promises of not cutting medicare, medicaid or SS ('Harmless truthful hyperbole!"), and in its place come work requirements, state waivers and reduced budgets.

Hold on, if the plan is to just cut some of these social services then that is garbage, but to incentives people who can work to actually work and thereby decrease the need for social service spending is an idea I can definitely get behind.

I heard one comment state that we we will judge the quality of our safety net not by how many people are in it, but by how many people we can help get off it.  If true I think that is a great idea.

You can decide that cutting these programs is a good idea or not. While I don't agree with them, I at least give the freedom caucus credit for being consistent with their rhetoric and ideology.

My point was that this is a direct reversal by DJT of not cutting SSI or Medicaid/Medicare, and of offering coverage for everyone which would cost less.

He is kinda getting around his statement.  He is not cutting those services from the people getting them.  He is talking about helping people not require those services and naturally it would decrease government spending on those services.  It all depends on how you choose to interpret the information and more importantly how DJT chooses to make that happen.

Lagom

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Re: What comes after the ACA?
« Reply #2414 on: May 23, 2017, 03:39:06 PM »

In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

Everyone in this thread knows this information and I don't appreciate the pedantry given my current circumstances. You know very well where I was coming from and it wasn't a fear that I would have to pay a bill I couldn't afford. But I will grant I was scared and distraught and a little tipsy when I posted so apologies if I offended anyone (in general, not saying you seem offended).
« Last Edit: May 23, 2017, 03:43:46 PM by Lagom »

Miss Piggy

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Re: What comes after the ACA?
« Reply #2415 on: May 23, 2017, 03:42:17 PM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.

Agreed, and it's very real for my family as well. So in my mind, the question becomes "How can this potential reality become more real for people who haven't YET experienced it, without them having to actually experience it?"  (I hope that makes sense.)

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Re: What comes after the ACA?
« Reply #2416 on: May 23, 2017, 03:48:03 PM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

It's simply untrue to say there would be no recourse if you choose not to pay. Yes in a life-threatening emergency care will be given to save and stabilize the patient. Once the patient is stabilized they are discharged regardless of what follow up care they *should* get.
But what I really object to is this idea that one could simply 'choose' not to pay and not be penalized for it.  If you run up a $100k bill they will come after you. The hospital (or collection agency) will sue, and you can have your home and assets seized.  This is the very reason why there's ~800,000 bankruptcies each year that list medical expenses as the primary cause.

I don't believe you are correct.  Although the hospital can send for collections, they are unable to force you to pay or put a lien on your home.  Your credit score will go into the dumpster, but they still can't force you to pay.  Eventually that bill is dismissed.  I think it takes 7 years, and then you have another few years to start rebuilding your credit score.  It isn't a great scenario, but it sure is better than losing your home.
Even if you can wiggle out of paying the hospital/doctor/anesthesiologist/respiratory therapist/physical therapist/pharmacy bills for the emergency care, if you have no ability to pay, how do you expect to get follow up care? 

Most medical care doesn't consist of the doc waving a magic wand and back to work you go. 

I don't see why people don't get this.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2417 on: May 23, 2017, 09:23:45 PM »
And we are all only temporarily able bodied. Why should some of us not have access to healthcare, while others are ?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2418 on: May 24, 2017, 02:56:25 AM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

It's simply untrue to say there would be no recourse if you choose not to pay. Yes in a life-threatening emergency care will be given to save and stabilize the patient. Once the patient is stabilized they are discharged regardless of what follow up care they *should* get.
But what I really object to is this idea that one could simply 'choose' not to pay and not be penalized for it.  If you run up a $100k bill they will come after you. The hospital (or collection agency) will sue, and you can have your home and assets seized.  This is the very reason why there's ~800,000 bankruptcies each year that list medical expenses as the primary cause.

I don't believe you are correct.  Although the hospital can send for collections, they are unable to force you to pay or put a lien on your home.  Your credit score will go into the dumpster, but they still can't force you to pay.  Eventually that bill is dismissed.  I think it takes 7 years, and then you have another few years to start rebuilding your credit score.  It isn't a great scenario, but it sure is better than losing your home.
Even if you can wiggle out of paying the hospital/doctor/anesthesiologist/respiratory therapist/physical therapist/pharmacy bills for the emergency care, if you have no ability to pay, how do you expect to get follow up care? 

Most medical care doesn't consist of the doc waving a magic wand and back to work you go. 

I don't see why people don't get this.

You can go to a different doctor than the one who treated your emergency condition and pay cash. Definitely not ideal, but the reality is that if someone has an emergency they can get medical care for that emergency and not have to pay a dime for it. I'm not saying what we have is good.  Everyone should have the ability to have reasonable healthcare at a reasonable price.

Lagom, I hope I did not offend you. Not my intention or goal.  Just trying to share information.

nereo

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Re: What comes after the ACA?
« Reply #2419 on: May 24, 2017, 05:39:57 AM »

You can go to a different doctor than the one who treated your emergency condition and pay cash. Definitely not ideal, but the reality is that if someone has an emergency they can get medical care for that emergency and not have to pay a dime for it. I'm not saying what we have is good.  Everyone should have the ability to have reasonable healthcare at a reasonable price.

I find this suggestion to be both overly rosy and incredibly misleading. First off - in most states you can have a lein put on your home for unpaid medical bills, including in California. And I believe in every state can file a lawsuit against you for unpaid medical bills... its why there are so many bankruptcies. 
This is more than just being mildly inconvenienced by seeing your credit score drop into the toilet. If you can't pay to avoid the lawsuit you by definition don't have the money to pay cash for the follow up care, which often runs into the $tens-of-thousands. If you do, I'd imagine you'd be arrested for fraud. If you simply don't pay the bill doesn't just "go-away" in 7 years - for that to happen you must go through bankruptcy, where you disclose your assets to the court.

Most of the time what happens is you are simply put on a long-term repayment plan. A friend of mine had a 30 year repayment plan for an accident he suffered in college.

tl/dr: if you cant pay for an emergency
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Re: What comes after the ACA?
« Reply #2420 on: May 24, 2017, 10:16:55 AM »

You can go to a different doctor than the one who treated your emergency condition and pay cash. Definitely not ideal, but the reality is that if someone has an emergency they can get medical care for that emergency and not have to pay a dime for it. I'm not saying what we have is good.  Everyone should have the ability to have reasonable healthcare at a reasonable price.

I find this suggestion to be both overly rosy and incredibly misleading. First off - in most states you can have a lein put on your home for unpaid medical bills, including in California. And I believe in every state can file a lawsuit against you for unpaid medical bills... its why there are so many bankruptcies. 
This is more than just being mildly inconvenienced by seeing your credit score drop into the toilet. If you can't pay to avoid the lawsuit you by definition don't have the money to pay cash for the follow up care, which often runs into the $tens-of-thousands. If you do, I'd imagine you'd be arrested for fraud. If you simply don't pay the bill doesn't just "go-away" in 7 years - for that to happen you must go through bankruptcy, where you disclose your assets to the court.

Most of the time what happens is you are simply put on a long-term repayment plan. A friend of mine had a 30 year repayment plan for an accident he suffered in college.

tl/dr: if you cant pay for an emergency

OK, you got me to do research on the subject and understand it a bit more.  You are correct that a hospital can put a lien on your home.  But, it very very rarely happens. Just imagine the bad press a hospital would get if it forced someone to give them their home. Working in my hospital closely with our chief financial officer, the hospital sells the debt to a collections agency and the agency tries to collect some money.  You can often negotiate a much much smaller payment if you are willing to pay. We do not go after your property though. Doing more digging it appears that this is a very rare practice in the medical community.  Private practice physicians also do not go after personal property.

Looking at our hospital financials we have about 25% of patients that are seen and treated and also uninsured.  About 90% of the uninsured don't every pay their bills. I went and inquired with other colleagues at other hospital systems who said the exact same thing but with different percentages of uninsured patients. This was a very small sample size.

Bottom line. You are correct, but the actual practice by hospitals is different.

Regarding post hospital care and follow up. If the patient really has no money and minimal to no income, that patient will be visited by a case manager who will set them up with Medicaid.  This will allow for follow up care. Also, there are many clinics located throughout the country that see patients for cash payment.  These clinics don't require the same data keeping and insurance collections and therefor able to charge much less as compared to other out patient practices.  Although the service is not free, it often costs <$100 for a visit allowing for a reasonably priced out patient evaluation.  Our clinic charges $72/visit. Most medication can be bought for $4-$10 if purchased outside of CVS/Walgreens type facilities. Yes some specific meds can be ridiculously priced with no reasonable lower cost alternative and those patients can really be put into bankruptcy for treating a chronic medical condition. So if you make some form of income you should be able to divert funds to pay for follow up care medications.  If you barely make any income, well then you are on Medicaid and it will be covered by the Government.

I must keep qualifying these comments with my disclaimer that I think all people should have access to reasonable medical care at a reasonable price.
« Last Edit: May 24, 2017, 10:32:24 AM by EnjoyIt »

marion10

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Re: What comes after the ACA?
« Reply #2421 on: May 24, 2017, 10:27:35 AM »
My daughter's current boyfriend ended up at age 23,almost dying from a heart  valve defect that was undiagnosed. He had no health insurance having recently graduated and aged off his parents policies. His parents unfortunately, dealt with the bills by shoving them a drawer. He did not find out about them until a year or so later. He is 30 now, and still paying off what might be 100,000 or more in bills. (I am not sure of the amount)- he has negotiated with hospitals and doctors and has cut the amount significantly- but it hangs over him.

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Re: What comes after the ACA?
« Reply #2422 on: May 24, 2017, 10:31:53 AM »
Regarding post hospital care and follow up. If the patient really has no money and minimal to no income, that patient will be visited by a case manager who will set them up with Medicaid.  This will allow for follow up care. Also, there are many clinics located throughout the country that see patients for cash payment.  These clinics don't require the same data keeping and insurance collections and therefor able to charge much less as compared to other out patient practices.  Although the service is not free, it often costs <$100 for a visit allowing for a reasonably priced out patient evaluation.  Our clinic charges $72/visit. Most medication can be bought for $4-$10 if purchased outside of CVS/Walgreens type facilities. Yes some specific meds can be ridiculously priced with no reasonable lower cost alternative and those patients can really be put into bankruptcy for treating a chronic medical condition. So if you make some form of income you should be able to divert funds to pay for follow up care medications.  If you barely make any income, well then you are on Medicaid and it will be covered by the Government.
If your state did not expand Medicaid and you are under 65 and not blind then you must be classified as "disabled" before Medicaid can kick in, and that would be after you spend down all your assets.  If you are able bodied you will never be eligible for it.  If you get a condition that requires an expensive biologic or drug then you are SOL, you can just go off and die.  The only thing you can do is keep going to the emergency room where they are legally required to look at you. 

BeanCounter

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Re: What comes after the ACA?
« Reply #2423 on: May 24, 2017, 10:33:27 AM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

It's simply untrue to say there would be no recourse if you choose not to pay. Yes in a life-threatening emergency care will be given to save and stabilize the patient. Once the patient is stabilized they are discharged regardless of what follow up care they *should* get.
But what I really object to is this idea that one could simply 'choose' not to pay and not be penalized for it.  If you run up a $100k bill they will come after you. The hospital (or collection agency) will sue, and you can have your home and assets seized.  This is the very reason why there's ~800,000 bankruptcies each year that list medical expenses as the primary cause.

I don't believe you are correct.  Although the hospital can send for collections, they are unable to force you to pay or put a lien on your home.  Your credit score will go into the dumpster, but they still can't force you to pay.  Eventually that bill is dismissed.  I think it takes 7 years, and then you have another few years to start rebuilding your credit score.  It isn't a great scenario, but it sure is better than losing your home.
Even if you can wiggle out of paying the hospital/doctor/anesthesiologist/respiratory therapist/physical therapist/pharmacy bills for the emergency care, if you have no ability to pay, how do you expect to get follow up care? 

Most medical care doesn't consist of the doc waving a magic wand and back to work you go. 

I don't see why people don't get this.
They don't get follow up care. They wait until the issue or related issue crop up again and then they hit another emergency room.

BFGirl

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Re: What comes after the ACA?
« Reply #2424 on: May 24, 2017, 10:34:33 AM »

You can go to a different doctor than the one who treated your emergency condition and pay cash. Definitely not ideal, but the reality is that if someone has an emergency they can get medical care for that emergency and not have to pay a dime for it. I'm not saying what we have is good.  Everyone should have the ability to have reasonable healthcare at a reasonable price.

I find this suggestion to be both overly rosy and incredibly misleading. First off - in most states you can have a lein put on your home for unpaid medical bills, including in California. And I believe in every state can file a lawsuit against you for unpaid medical bills... its why there are so many bankruptcies. 
This is more than just being mildly inconvenienced by seeing your credit score drop into the toilet. If you can't pay to avoid the lawsuit you by definition don't have the money to pay cash for the follow up care, which often runs into the $tens-of-thousands. If you do, I'd imagine you'd be arrested for fraud. If you simply don't pay the bill doesn't just "go-away" in 7 years - for that to happen you must go through bankruptcy, where you disclose your assets to the court.

Most of the time what happens is you are simply put on a long-term repayment plan. A friend of mine had a 30 year repayment plan for an accident he suffered in college.

tl/dr: if you cant pay for an emergency

OK, you got me to do research on the subject and understand it a bit more.  You are correct that a hospital can put a lien on your home.  But, it very very rarely happens. Just imagine the bad press a hospital would get if it forced someone to give them their home. Working in my hospital closely with our chief financial officer, the hospital sells the debt to a collections agency and the agency tries to collect some money.  You can often negotiate a much much smaller payment if you are willing to pay. We do not go after your property though. Doing more digging it appears that this is a very rare practice in the medical community.  Private practice physicians also do not go after personal property.

Looking at our hospital financials we have about 25% of patients that are seen and treated and also uninsured.  About 90% of the uninsured don't every pay their bills. I went and inquired with other colleagues at other hospital systems who said the exact same thing but with different percentages of uninsured patients. This was a very small sample size.

Bottom line. You are correct, but the actual practice by hospitals is different.

Regarding post hospital care and follow up. If the patient really has no money and minimal to no income, that patient will be visited by a case manager who will set them up with Medicaid.  This will allow for follow up care. Also, there are many clinics located throughout the country that see patients for cash payment.  These clinics don't require the same data keeping and insurance collections and therefor able to charge much less as compared to other out patient practices.  Although the service is not free, it often costs <$100 for a visit allowing for a reasonably priced out patient evaluation.  Our clinic charges $72/visit. Most medication can be bought for $4-$10 if purchased outside of CVS/Walgreens type facilities. Yes some specific meds can be ridiculously priced with no reasonable lower cost alternative and those patients can really be put into bankruptcy for treating a chronic medical condition. So if you make some form of income you should be able to divert funds to pay for follow up care medications.  If you barely make any income, well then you are on Medicaid and it will be covered by the Government.

Even if it is not the typical practice for hospitals/collection agencies to sue for collection for medical bills, they can sue and get a judgment.  Once they have a judgment, they can seek to collect on their judgment by seeking to attach non-exempt assets.  Exempt assets are different by each state, but they would almost always be able to collect against any non-retirement savings/brokerage accounts.  If they can put a lien against a home, then they probably won't force the sale of the home, but would wait and try to collect when you try to sell the home because it would show up as an issue in regards to a title policy.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2425 on: May 24, 2017, 10:35:39 AM »
Regarding post hospital care and follow up. If the patient really has no money and minimal to no income, that patient will be visited by a case manager who will set them up with Medicaid.  This will allow for follow up care. Also, there are many clinics located throughout the country that see patients for cash payment.  These clinics don't require the same data keeping and insurance collections and therefor able to charge much less as compared to other out patient practices.  Although the service is not free, it often costs <$100 for a visit allowing for a reasonably priced out patient evaluation.  Our clinic charges $72/visit. Most medication can be bought for $4-$10 if purchased outside of CVS/Walgreens type facilities. Yes some specific meds can be ridiculously priced with no reasonable lower cost alternative and those patients can really be put into bankruptcy for treating a chronic medical condition. So if you make some form of income you should be able to divert funds to pay for follow up care medications.  If you barely make any income, well then you are on Medicaid and it will be covered by the Government.
If your state did not expand Medicaid and you are under 65 and not blind then you must be classified as "disabled" before Medicaid can kick in, and that would be after you spend down all your assets.  If you are able bodied you will never be eligible for it.  If you get a condition that requires an expensive biologic or drug then you are SOL, you can just go off and die.  The only thing you can do is keep going to the emergency room where they are legally required to look at you.

The above is completely true. :(

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Re: What comes after the ACA?
« Reply #2426 on: May 24, 2017, 10:42:55 AM »

I must keep qualifying these comments with my disclaimer that I think all people should have access to reasonable medical care at a reasonable price.
I absolutely agree with you on the above point.
We (as a society) get into the weeds about what constitutes "access", "reasonable care," and "affordable".
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Re: What comes after the ACA?
« Reply #2427 on: May 24, 2017, 10:56:37 AM »
Regarding post hospital care and follow up. If the patient really has no money and minimal to no income, that patient will be visited by a case manager who will set them up with Medicaid.  This will allow for follow up care. Also, there are many clinics located throughout the country that see patients for cash payment.  These clinics don't require the same data keeping and insurance collections and therefor able to charge much less as compared to other out patient practices.  Although the service is not free, it often costs <$100 for a visit allowing for a reasonably priced out patient evaluation.  Our clinic charges $72/visit. Most medication can be bought for $4-$10 if purchased outside of CVS/Walgreens type facilities. Yes some specific meds can be ridiculously priced with no reasonable lower cost alternative and those patients can really be put into bankruptcy for treating a chronic medical condition. So if you make some form of income you should be able to divert funds to pay for follow up care medications.  If you barely make any income, well then you are on Medicaid and it will be covered by the Government.
If your state did not expand Medicaid and you are under 65 and not blind then you must be classified as "disabled" before Medicaid can kick in, and that would be after you spend down all your assets.  If you are able bodied you will never be eligible for it.  If you get a condition that requires an expensive biologic or drug then you are SOL, you can just go off and die.  The only thing you can do is keep going to the emergency room where they are legally required to look at you.

The above is completely true. :(

But doesn't that put a big dent in your previous argument about how accessible care is to the uninsured? Plus, insofar as there are states that expanded Medicaid, your argument that Medicaid will play caped crusader for able-bodied people in those states is only true as long as the ACA remains law.

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Re: What comes after the ACA?
« Reply #2428 on: May 24, 2017, 12:13:47 PM »
Regarding post hospital care and follow up. If the patient really has no money and minimal to no income, that patient will be visited by a case manager who will set them up with Medicaid.  This will allow for follow up care. Also, there are many clinics located throughout the country that see patients for cash payment.  These clinics don't require the same data keeping and insurance collections and therefor able to charge much less as compared to other out patient practices.  Although the service is not free, it often costs <$100 for a visit allowing for a reasonably priced out patient evaluation.  Our clinic charges $72/visit. Most medication can be bought for $4-$10 if purchased outside of CVS/Walgreens type facilities. Yes some specific meds can be ridiculously priced with no reasonable lower cost alternative and those patients can really be put into bankruptcy for treating a chronic medical condition. So if you make some form of income you should be able to divert funds to pay for follow up care medications.  If you barely make any income, well then you are on Medicaid and it will be covered by the Government.
If your state did not expand Medicaid and you are under 65 and not blind then you must be classified as "disabled" before Medicaid can kick in, and that would be after you spend down all your assets.  If you are able bodied you will never be eligible for it.  If you get a condition that requires an expensive biologic or drug then you are SOL, you can just go off and die.  The only thing you can do is keep going to the emergency room where they are legally required to look at you.

The above is completely true. :(

But doesn't that put a big dent in your previous argument about how accessible care is to the uninsured? Plus, insofar as there are states that expanded Medicaid, your argument that Medicaid will play caped crusader for able-bodied people in those states is only true as long as the ACA remains law.

The other chink in that original position is the suggestion that there are those who are insured and can deal with this vs. the Medicaid (eligible) crowd. 

What we have today is system with a "safety net" with holes the size of a school bus.  You can be part of group 1 - employed with an awesome insurance plan, fall ill for unpredictable reasons, eventually lose your job, income, and your insurance coverage.  The system as it's set up now will force you to literally spend down everything you have (one could call that - "lose everything") before the Medicaid caped crusader will save you.  In other words, even if you're doing everything right - working, saving, carrying necessary insurance - you can still end up nearly destitute over a health issue.  I cannot accept that this is the most efficient way of structuring our health care delivery and payment system.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2429 on: May 24, 2017, 02:23:06 PM »

But doesn't that put a big dent in your previous argument about how accessible care is to the uninsured? Plus, insofar as there are states that expanded Medicaid, your argument that Medicaid will play caped crusader for able-bodied people in those states is only true as long as the ACA remains law.

Somewhat.  If you are able bodied, shouldn't you be working and be able to afford some basic follow up and meds?  If you are not able bodied then you are disabled and on medicaid.  Either way if you have a medical emergency you will be treated for it regardless of ability to pay. Some states who have not expanded medicaid have other community options that help pay for medical care for the poor.  Texas I know has options like that. The system isn't great, it is a bunch of half assed piece meal safety nets where it is easy to fall right through.


What we have today is system with a "safety net" with holes the size of a school bus.  You can be part of group 1 - employed with an awesome insurance plan, fall ill for unpredictable reasons, eventually lose your job, income, and your insurance coverage.  The system as it's set up now will force you to literally spend down everything you have (one could call that - "lose everything") before the Medicaid caped crusader will save you.  In other words, even if you're doing everything right - working, saving, carrying necessary insurance - you can still end up nearly destitute over a health issue.  I cannot accept that this is the most efficient way of structuring our health care delivery and payment system.

No kidding.  It really is scary how difficult it may be.  It is almost better to buy your own health plan to bypass employer provided healthcare.  The only really positive thing that the ACA did is allow anyone to purchase healthcare despite pre-existing conditions.  I really hope whatever the republicans put together still has that provision in place.

The reality is that the cost of what Americans believe/expect as reasonable healthcare is way to expensive for so many reasons I have listed before.  I believe it is the attributing factor why we have so much trouble getting to a reasonable solution.  Imagine the cost was cut by 40% and we would likely not be having these discussions today.  So far I have yet to see a single conversation from our government leaders on real cost reductions. Until that happens we will continue screwing around and arguing past each other. It is really sad.

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Re: What comes after the ACA?
« Reply #2430 on: May 24, 2017, 04:25:42 PM »
Lagom, I hope I did not offend you. Not my intention or goal.  Just trying to share information.

It's OK, I shouldn't have been posting. Just looking for escapism in the wrong place during a difficult time. The good news is that my wife is doing well and will probably be released tomorrow. The bad news is that the odds of a recursion are high and the odds of multiple recursions are not small. Definitely the kind of preexisting condition that could thoroughly screw us depending on the outcome of this health debate.

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Re: What comes after the ACA?
« Reply #2431 on: May 24, 2017, 05:51:44 PM »
My otherwise super healthy and fit wife very (very) recently had multiple unforeseeable and extremely serious surgeries due to a previously undetectable congenital defect (detached bowel) that didn't manifest until now (in her mid 30's). I have legitimately feared her death twice now in the past couple months. Our insurance mistakenly sent us the full bill (as in we were said to literally owe 100% of the cost--thank god only because of a mistake in their process), which would have ruined us and our children. Fuck anyone who claims that it's your own fault if you can't pay your hospital bills. I mean, I intellectually would have agreed with myself before it became real for my family, but now I know to the depths of my soul that you are a bonafide piece of shit excuse for a human being if you think people should lose their lives and livelihoods because of things 100% out of their control, when we as a society could easily prevent that with little (if any) sacrifice to overall quality of life.


In the US no one is turned away from emergently needed care regardless of insurance or ability to pay.  If you and your family chose to not have health insurance, your wife would still be taken care of with likely no difference in the care she received. You would have received the bill, likely higher than what your insurance negotiated, and if you chose not to pay, there is no recourse. The bill will be shared by all the people/insurance companies buy paying more for their own care.  Not that I agree with this process, just providing information.

It's simply untrue to say there would be no recourse if you choose not to pay. Yes in a life-threatening emergency care will be given to save and stabilize the patient. Once the patient is stabilized they are discharged regardless of what follow up care they *should* get.
But what I really object to is this idea that one could simply 'choose' not to pay and not be penalized for it.  If you run up a $100k bill they will come after you. The hospital (or collection agency) will sue, and you can have your home and assets seized.  This is the very reason why there's ~800,000 bankruptcies each year that list medical expenses as the primary cause.

I don't believe you are correct.  Although the hospital can send for collections, they are unable to force you to pay or put a lien on your home.  Your credit score will go into the dumpster, but they still can't force you to pay.  Eventually that bill is dismissed.  I think it takes 7 years, and then you have another few years to start rebuilding your credit score.  It isn't a great scenario, but it sure is better than losing your home.
Even if you can wiggle out of paying the hospital/doctor/anesthesiologist/respiratory therapist/physical therapist/pharmacy bills for the emergency care, if you have no ability to pay, how do you expect to get follow up care? 

Most medical care doesn't consist of the doc waving a magic wand and back to work you go. 

I don't see why people don't get this.
They don't get follow up care. They wait until the issue or related issue crop up again and then they hit another emergency room.

That's the beauty of the US system . . . it already is socialized in that people are generally not refused service at an ER if they're about to die - everyone else ends up picking up the tab for these cases.  It's just socialized medicine in the most cost inefficient way imaginable.  It's shitty for the people who need care and it's more expensive for the people who have to foot the bill.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2432 on: May 24, 2017, 07:50:59 PM »
Lagom, I hope I did not offend you. Not my intention or goal.  Just trying to share information.

It's OK, I shouldn't have been posting. Just looking for escapism in the wrong place during a difficult time. The good news is that my wife is doing well and will probably be released tomorrow. The bad news is that the odds of a recursion are high and the odds of multiple recursions are not small. Definitely the kind of preexisting condition that could thoroughly screw us depending on the outcome of this health debate.

Right on. I am sincerely glad she is doing well. I'm sure she and you are looking forward to spending the night together in your own home. That has to be a great feeling.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2433 on: May 24, 2017, 07:54:28 PM »

That's the beauty of the US system . . . it already is socialized in that people are generally not refused service at an ER if they're about to die - everyone else ends up picking up the tab for these cases.  It's just socialized medicine in the most cost inefficient way imaginable.  It's shitty for the people who need care and it's more expensive for the people who have to foot the bill.

That is so true. It really is a broken system. I'm curious how long it will last in its current state before real change is forced to occur.

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Re: What comes after the ACA?
« Reply #2434 on: May 24, 2017, 08:52:50 PM »

OK, you got me to do research on the subject and understand it a bit more. 

So let me get this straight. For pages and pages, you post as if you are an authority on a subject, using your education level and the fact that you are in the field as evidence your word is to be taken as gospel. When someone proves to you what you are saying is garbage, you THEN look for evidence to see if what you have been saying it actually correct. In that research you still failed to find the articles that say prior to ACA, somewhere between 40% and 60% of foreclosures had a medical bill component.  Kind of makes it hard for me to tell if I should ever believe something EnjoyIt says. I wonder if I am alone.

It is too bad... you are a very good writer. I just didn't realize it was fiction.

Maybe you will have to forgive me, I had minor surgery this morning (you know the definition of minor surgery; surgery performed on someone else :). The medications I had today (14 hours prior to this writing) do not allow me to operate heavy machinery, and it is recommended that I do not enter into a binding contract for 24 hours after waking up. I even talked to someone 1 hour ago, and I have NO idea who it was. I might be posting an apology tomorrow, if I remember I posted this, that it.




EnjoyIt

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Re: What comes after the ACA?
« Reply #2435 on: May 24, 2017, 10:04:38 PM »

So let me get this straight. For pages and pages, you post as if you are an authority on a subject, using your education level and the fact that you are in the field as evidence your word is to be taken as gospel. When someone proves to you what you are saying is garbage, you THEN look for evidence to see if what you have been saying it actually correct. In that research you still failed to find the articles that say prior to ACA, somewhere between 40% and 60% of foreclosures had a medical bill component.  Kind of makes it hard for me to tell if I should ever believe something EnjoyIt says. I wonder if I am alone.

It is too bad... you are a very good writer. I just didn't realize it was fiction.

Maybe you will have to forgive me, I had minor surgery this morning (you know the definition of minor surgery; surgery performed on someone else :). The medications I had today (14 hours prior to this writing) do not allow me to operate heavy machinery, and it is recommended that I do not enter into a binding contract for 24 hours after waking up. I even talked to someone 1 hour ago, and I have NO idea who it was. I might be posting an apology tomorrow, if I remember I posted this, that it.

Thanks for the "good writer" comment. I found that comical. As for the rest. . . . I probably do come off a bit preachy and can't help it because by practicing in this world I get to see all the good and bad our medical system has turned into. I am not without flaws and most definitely not an expert on healthcare policy. When my knowledge and understanding is sparse I research to fill those gaps to help me understand the subject better. In all honesty since this thread has been started by Sol, I have spent a significant amount of time learning more. My comment about people not losing their homes to healthcare bills was accurate.  Hospitals and physicians do not go after their patient's belongings.  I again admit that I did not realize that there is no law that prevents that from happening. I can equally envision a significant health care related event exacerbating a poor financial situation into bankruptcy.  People lost their homes in 2008-2012 not because of healthcare.  They lost their homes because they overextended themselves on credit, lost their jobs and could not afford to keep up with their bills. Even a $1k healthcare bill is catastrophic to such a family.  All I can tell you is that the health system I work in and the physician group I work for expect 25% of the patients to never pay their bill and believe me we do not own a bunch of foreclosed homes.

I would prefer you did not take everything I say as gospel and do some research on your own.  Come back and have a meaningful discussion. Unfortunately there are too many people who throw out these blanket statements such as "we need universal health care." Without digging into it, who can argue with that statement? But how would we transition into such a system? How much will it cost? Who will pay for it? What will happen to all those people who are currently employed to keep our current system afloat?  What will keep the costs from skyrocketing? What health services are part of this universal healthcare?  The other common comment I see is to look at other countries that have "successful" models and just bring it to the US. Once again they are not really delving into the details of such an endeavor. I would urge before making such a blanket statement to actually look at those details and think about the nuance. These transitions are not that simple to make and I enjoy having an educated discussion with those who have a different opinion.

Radram, I hope your procedure went well and you are underway to a speedy recovery.

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Re: What comes after the ACA?
« Reply #2436 on: May 25, 2017, 06:29:54 AM »

OK, you got me to do research on the subject and understand it a bit more. 

So let me get this straight. For pages and pages, you post as if you are an authority on a subject, using your education level and the fact that you are in the field as evidence your word is to be taken as gospel. When someone proves to you what you are saying is garbage, you THEN look for evidence to see if what you have been saying it actually correct. In that research you still failed to find the articles that say prior to ACA, somewhere between 40% and 60% of foreclosures had a medical bill component.  Kind of makes it hard for me to tell if I should ever believe something EnjoyIt says. I wonder if I am alone.

In my office we call this "doctor syndrome." It's so much fun when the doctors know more about what we do every day than we do.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

jim555

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Re: What comes after the ACA?
« Reply #2437 on: May 25, 2017, 07:23:43 AM »
Unpaid medical debt can result in a lien being placed on your home.  Although it is not common practice, a creditor can force the sale of the home.  They will try garnishment and bank levy as well.  So they do come after your belongings.

NESailor

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Re: What comes after the ACA?
« Reply #2438 on: May 25, 2017, 07:27:06 AM »


Thanks for the "good writer" comment. I found that comical. As for the rest. . . . I probably do come off a bit preachy and can't help it because by practicing in this world I get to see all the good and bad our medical system has turned into. I am not without flaws and most definitely not an expert on healthcare policy. When my knowledge and understanding is sparse I research to fill those gaps to help me understand the subject better. In all honesty since this thread has been started by Sol, I have spent a significant amount of time learning more. My comment about people not losing their homes to healthcare bills was accurate.  Hospitals and physicians do not go after their patient's belongings.  I again admit that I did not realize that there is no law that prevents that from happening. I can equally envision a significant health care related event exacerbating a poor financial situation into bankruptcy.  People lost their homes in 2008-2012 not because of healthcare.  They lost their homes because they overextended themselves on credit, lost their jobs and could not afford to keep up with their bills. Even a $1k healthcare bill is catastrophic to such a family.  All I can tell you is that the health system I work in and the physician group I work for expect 25% of the patients to never pay their bill and believe me we do not own a bunch of foreclosed homes.

I would prefer you did not take everything I say as gospel and do some research on your own.  Come back and have a meaningful discussion. Unfortunately there are too many people who throw out these blanket statements such as "we need universal health care." Without digging into it, who can argue with that statement? But how would we transition into such a system? How much will it cost? Who will pay for it? What will happen to all those people who are currently employed to keep our current system afloat?  What will keep the costs from skyrocketing? What health services are part of this universal healthcare?  The other common comment I see is to look at other countries that have "successful" models and just bring it to the US. Once again they are not really delving into the details of such an endeavor. I would urge before making such a blanket statement to actually look at those details and think about the nuance. These transitions are not that simple to make and I enjoy having an educated discussion with those who have a different opinion.

Radram, I hope your procedure went well and you are underway to a speedy recovery.

I'll second the comments about your posts being well written.  I'll even go as far as saying they're insightful - it's useful to have the physician's input since you guys really should be at the center of this issue (you are not, as you probably realize). 

I still take issue with your continued descriptions of the status quo as if there only existed 2 groups of people:  those working and covered and the poor.  You can be in many places between those two groups.  Wealthy, working, with a relatively high net worth does not guarantee that a heath issue couldn't wreck it all.  That's what I don't like.  I'm still young (32), working, above average income, well above average net worth for my age.  I'm covered by a decent employer policy as is my family.  I can still imagine a scenario where we lose everything because protections to prevent that are weak - and AHCA proposes to make them weaker.  This is ridiculous for the wealthiest country on the planet.

Second - I understand that hospitals don't put liens on people's homes but your defense is quite weak there as well.  There is no formal protection against that and that's a fact.  Also, when hospitals sell their slow paying/uncollectible receivables - you lose visibility as to what happens next.  Sure, you can still say "our hospital doesn't sue poor people"...but you can bet your bottom that a collections company will do everything allowed under the law (and then some) to get their money. 

radram

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Re: What comes after the ACA?
« Reply #2439 on: May 25, 2017, 08:54:20 AM »

So let me get this straight. For pages and pages, you post as if you are an authority on a subject, using your education level and the fact that you are in the field as evidence your word is to be taken as gospel. When someone proves to you what you are saying is garbage, you THEN look for evidence to see if what you have been saying it actually correct. In that research you still failed to find the articles that say prior to ACA, somewhere between 40% and 60% of foreclosures had a medical bill component.  Kind of makes it hard for me to tell if I should ever believe something EnjoyIt says. I wonder if I am alone.

It is too bad... you are a very good writer. I just didn't realize it was fiction.

Maybe you will have to forgive me, I had minor surgery this morning (you know the definition of minor surgery; surgery performed on someone else :). The medications I had today (14 hours prior to this writing) do not allow me to operate heavy machinery, and it is recommended that I do not enter into a binding contract for 24 hours after waking up. I even talked to someone 1 hour ago, and I have NO idea who it was. I might be posting an apology tomorrow, if I remember I posted this, that it.

Thanks for the "good writer" comment. I found that comical. As for the rest. . . . I probably do come off a bit preachy and can't help it because by practicing in this world I get to see all the good and bad our medical system has turned into. I am not without flaws and most definitely not an expert on healthcare policy. When my knowledge and understanding is sparse I research to fill those gaps to help me understand the subject better. In all honesty since this thread has been started by Sol, I have spent a significant amount of time learning more. My comment about people not losing their homes to healthcare bills was accurate.  Hospitals and physicians do not go after their patient's belongings.  I again admit that I did not realize that there is no law that prevents that from happening. I can equally envision a significant health care related event exacerbating a poor financial situation into bankruptcy.  People lost their homes in 2008-2012 not because of healthcare.  They lost their homes because they overextended themselves on credit, lost their jobs and could not afford to keep up with their bills. Even a $1k healthcare bill is catastrophic to such a family.  All I can tell you is that the health system I work in and the physician group I work for expect 25% of the patients to never pay their bill and believe me we do not own a bunch of foreclosed homes.

I would prefer you did not take everything I say as gospel and do some research on your own.  Come back and have a meaningful discussion. Unfortunately there are too many people who throw out these blanket statements such as "we need universal health care." Without digging into it, who can argue with that statement? But how would we transition into such a system? How much will it cost? Who will pay for it? What will happen to all those people who are currently employed to keep our current system afloat?  What will keep the costs from skyrocketing? What health services are part of this universal healthcare?  The other common comment I see is to look at other countries that have "successful" models and just bring it to the US. Once again they are not really delving into the details of such an endeavor. I would urge before making such a blanket statement to actually look at those details and think about the nuance. These transitions are not that simple to make and I enjoy having an educated discussion with those who have a different opinion.

Radram, I hope your procedure went well and you are underway to a speedy recovery.

I was glad to see you took my humor as it was intended. That was the part I was unsure if I would be apologizing for. It looks like we share the same sense of humor.

Of course your physician group does not own foreclosed homes. You just said they sell the noncollectable debt for pennies on the dollar to let another entity do that work. How can you then infer that medical bills do not impact foreclosures? You need to look at the listed debts of foreclosures to conclude that. I think the best way to do that is to look at the data in 3 pieces: pre 2008, 2009-2012, and 2012 to present.

2008-2012 was such a strange time with the housing crash. If that is the time frame for your conclusion that medical bills were not a significant root cause of foreclosures, I would be interested in seeing data on that. It would not surprise me to see that the housing crash caused more foreclosures and therefore lowered the medical related percentage. I guess you could argue that the crash was GOOD for medical foreclosures percentage wise. It would also not surprise me if the NUMBER of medical foreclosures also INCREASED in this same time frame(while still being a lower percentage as before), because some who might have been willing to take out a second mortgage in order to pay their medical bill would no longer have the equity to do so. I simply have not found data for this time frame. I have also found very little data for the time frame of 2012-today, though admittedly I have not really looked. My thoughts are that more insured people should have led to less medical foreclosures, absent other factors. I would like to read anything you have found.


Since repeal of ACA is so desirable in congress, I think it is very worthwhile to look at data prior to ACA and prior to the housing crash. There are volumes of data available for this.

Here is an example report that shows that prior to the housing crash, and prior to ACA, medical bills were very much a factor in home foreclosures:
http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

"They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point."

I can certainly understand how someone could conclude that $5000 in medical bills should not alone trigger a foreclosure, so I would claim that the 62% number is inflated. Still, average within that group was close to $18,000, which shows me that prior to 2009 medical bills were absolutely more than a trivial factor.


I guess when discussing  a post ACA world, we must try to figure out where we are most likely to be based on what the replacement is. Based on the CBO report of the house bill, I would conclude we would return more toward a pre-2009 situation, and medical foreclosures will  continue to be a factor. It is also possible that leaving ACA unchanged also returns us to the same period. The CBO does not agree with that at this time, but other proposals (Medicaid cuts for example), might change that.

 
My procedure went great. Umbilical hernia. Strangely enough I had ZERO pain with no meds except for 2 doses in recovery for the entire first day. Feels like the day after a kitchen knife cut today.


The hernia was very small, but I decided to have it done now. This procedure gave me several talking points related to this thread. I knew about it last year, after having another issue that caused me to meet my maximum out of pocket for the year. I have had it for years without even knowing it. Primary Care Physician said I had it and should consider getting a consult for repair. It would have cost $0 last year but I decided to wait because there was no pain and it did not effect my life. I thought I was making the best MEDICAL decision, if not the best FINANCIAL one. 2 months ago, my dog jumped on my lap while playing, and just happened to place a paw on the exact spot. That did not feel good, so uncomfortable, in fact, I decided to have it fixed now, even though so far this year I have spent $0 on healthcare. Due to other things in my life, I was unable to take the time to use this experience as a fact finding mission. It would have been a good one. 1 surgeon with admitting privileges in 2 locations in the same small town. I did not even bother calling each facility to ask how much, as I have zero confidence anyone would actually be able to tell me.


As a physician I would be very interested in your opinion regarding using a calendar to make medical decisions. Is that really the best way to get the best patient outcomes? Does that kind of dialog drive you nuts? I know it does me.

Jrr85

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Re: What comes after the ACA?
« Reply #2440 on: May 25, 2017, 09:26:13 AM »

Of course your physician group does not own foreclosed homes. You just said they sell the noncollectable debt for pennies on the dollar to let another entity do that work. How can you then infer that medical bills do not impact foreclosures? You need to look at the listed debts of foreclosures to conclude that. I think the best way to do that is to look at the data in 3 pieces: pre 2008, 2009-2012, and 2012 to present.

2008-2012 was such a strange time with the housing crash. If that is the time frame for your conclusion that medical bills were not a significant root cause of foreclosures, I would be interested in seeing data on that. It would not surprise me to see that the housing crash caused more foreclosures and therefore lowered the medical related percentage. I guess you could argue that the crash was GOOD for medical foreclosures percentage wise. It would also not surprise me if the NUMBER of medical foreclosures also INCREASED in this same time frame(while still being a lower percentage as before), because some who might have been willing to take out a second mortgage in order to pay their medical bill would no longer have the equity to do so. I simply have not found data for this time frame. I have also found very little data for the time frame of 2012-today, though admittedly I have not really looked. My thoughts are that more insured people should have led to less medical foreclosures, absent other factors. I would like to read anything you have found.


Since repeal of ACA is so desirable in congress, I think it is very worthwhile to look at data prior to ACA and prior to the housing crash. There are volumes of data available for this.

Here is an example report that shows that prior to the housing crash, and prior to ACA, medical bills were very much a factor in home foreclosures:
http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

"They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point."

I can certainly understand how someone could conclude that $5000 in medical bills should not alone trigger a foreclosure, so I would claim that the 62% number is inflated. Still, average within that group was close to $18,000, which shows me that prior to 2009 medical bills were absolutely more than a trivial factor.


I guess when discussing  a post ACA world, we must try to figure out where we are most likely to be based on what the replacement is. Based on the CBO report of the house bill, I would conclude we would return more toward a pre-2009 situation, and medical foreclosures will  continue to be a factor. It is also possible that leaving ACA unchanged also returns us to the same period. The CBO does not agree with that at this time, but other proposals (Medicaid cuts for example), might change that.

 
My procedure went great. Umbilical hernia. Strangely enough I had ZERO pain with no meds except for 2 doses in recovery for the entire first day. Feels like the day after a kitchen knife cut today.


The hernia was very small, but I decided to have it done now. This procedure gave me several talking points related to this thread. I knew about it last year, after having another issue that caused me to meet my maximum out of pocket for the year. I have had it for years without even knowing it. Primary Care Physician said I had it and should consider getting a consult for repair. It would have cost $0 last year but I decided to wait because there was no pain and it did not effect my life. I thought I was making the best MEDICAL decision, if not the best FINANCIAL one. 2 months ago, my dog jumped on my lap while playing, and just happened to place a paw on the exact spot. That did not feel good, so uncomfortable, in fact, I decided to have it fixed now, even though so far this year I have spent $0 on healthcare. Due to other things in my life, I was unable to take the time to use this experience as a fact finding mission. It would have been a good one. 1 surgeon with admitting privileges in 2 locations in the same small town. I did not even bother calling each facility to ask how much, as I have zero confidence anyone would actually be able to tell me.


As a physician I would be very interested in your opinion regarding using a calendar to make medical decisions. Is that really the best way to get the best patient outcomes? Does that kind of dialog drive you nuts? I know it does me.

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   


Gin1984

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Re: What comes after the ACA?
« Reply #2441 on: May 25, 2017, 09:43:56 AM »

Of course your physician group does not own foreclosed homes. You just said they sell the noncollectable debt for pennies on the dollar to let another entity do that work. How can you then infer that medical bills do not impact foreclosures? You need to look at the listed debts of foreclosures to conclude that. I think the best way to do that is to look at the data in 3 pieces: pre 2008, 2009-2012, and 2012 to present.

2008-2012 was such a strange time with the housing crash. If that is the time frame for your conclusion that medical bills were not a significant root cause of foreclosures, I would be interested in seeing data on that. It would not surprise me to see that the housing crash caused more foreclosures and therefore lowered the medical related percentage. I guess you could argue that the crash was GOOD for medical foreclosures percentage wise. It would also not surprise me if the NUMBER of medical foreclosures also INCREASED in this same time frame(while still being a lower percentage as before), because some who might have been willing to take out a second mortgage in order to pay their medical bill would no longer have the equity to do so. I simply have not found data for this time frame. I have also found very little data for the time frame of 2012-today, though admittedly I have not really looked. My thoughts are that more insured people should have led to less medical foreclosures, absent other factors. I would like to read anything you have found.


Since repeal of ACA is so desirable in congress, I think it is very worthwhile to look at data prior to ACA and prior to the housing crash. There are volumes of data available for this.

Here is an example report that shows that prior to the housing crash, and prior to ACA, medical bills were very much a factor in home foreclosures:
http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/

"They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point."

I can certainly understand how someone could conclude that $5000 in medical bills should not alone trigger a foreclosure, so I would claim that the 62% number is inflated. Still, average within that group was close to $18,000, which shows me that prior to 2009 medical bills were absolutely more than a trivial factor.


I guess when discussing  a post ACA world, we must try to figure out where we are most likely to be based on what the replacement is. Based on the CBO report of the house bill, I would conclude we would return more toward a pre-2009 situation, and medical foreclosures will  continue to be a factor. It is also possible that leaving ACA unchanged also returns us to the same period. The CBO does not agree with that at this time, but other proposals (Medicaid cuts for example), might change that.

 
My procedure went great. Umbilical hernia. Strangely enough I had ZERO pain with no meds except for 2 doses in recovery for the entire first day. Feels like the day after a kitchen knife cut today.


The hernia was very small, but I decided to have it done now. This procedure gave me several talking points related to this thread. I knew about it last year, after having another issue that caused me to meet my maximum out of pocket for the year. I have had it for years without even knowing it. Primary Care Physician said I had it and should consider getting a consult for repair. It would have cost $0 last year but I decided to wait because there was no pain and it did not effect my life. I thought I was making the best MEDICAL decision, if not the best FINANCIAL one. 2 months ago, my dog jumped on my lap while playing, and just happened to place a paw on the exact spot. That did not feel good, so uncomfortable, in fact, I decided to have it fixed now, even though so far this year I have spent $0 on healthcare. Due to other things in my life, I was unable to take the time to use this experience as a fact finding mission. It would have been a good one. 1 surgeon with admitting privileges in 2 locations in the same small town. I did not even bother calling each facility to ask how much, as I have zero confidence anyone would actually be able to tell me.


As a physician I would be very interested in your opinion regarding using a calendar to make medical decisions. Is that really the best way to get the best patient outcomes? Does that kind of dialog drive you nuts? I know it does me.

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   
So the American Journal of Medicine is a hack journal in the business of publishing substandard research?  Really?  What is the impact factor of the American Journal of Medicine?  Are your credentials such that they match/exceed those who peer review said journal?  Please, do elaborate.

Sent from my SPH-L710 using Tapatalk


radram

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Re: What comes after the ACA?
« Reply #2442 on: May 25, 2017, 09:59:10 AM »

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   

I would be interested in your sources that show medical bankruptcies were not a factor during this same period using other methods.  I find my link to hold more credibility than Jrr85 without comparable evidence that can be reviewed. Have a great day.

Jrr85

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Re: What comes after the ACA?
« Reply #2443 on: May 25, 2017, 10:48:52 AM »

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   

I would be interested in your sources that show medical bankruptcies were not a factor during this same period using other methods.  I find my link to hold more credibility than Jrr85 without comparable evidence that can be reviewed. Have a great day.

You could try reading the study actually cited:  http://www.amjmed.com/article/S0002-9343(09)00404-5/fulltext#sec2.1

The fact that they clearly wanted to define "medical bankruptcy" to be overbroad suggests that they didn't get the numbers they wanted when they used a more reasonable definition (or at least they were scared they weren't going to get the numbers they wanted). 
 

radram

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Re: What comes after the ACA?
« Reply #2444 on: May 25, 2017, 11:04:09 AM »

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   

I would be interested in your sources that show medical bankruptcies were not a factor during this same period using other methods.  I find my link to hold more credibility than Jrr85 without comparable evidence that can be reviewed. Have a great day.

You could try reading the study actually cited:  http://www.amjmed.com/article/S0002-9343(09)00404-5/fulltext#sec2.1

The fact that they clearly wanted to define "medical bankruptcy" to be overbroad suggests that they didn't get the numbers they wanted when they used a more reasonable definition (or at least they were scared they weren't going to get the numbers they wanted).
Overbroad according to Jrr85, or was there another study you want me to read. What does the data show when this magic reasonable definition is used? What is the definition you used?

Jrr85

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Re: What comes after the ACA?
« Reply #2445 on: May 25, 2017, 11:22:10 AM »

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   

I would be interested in your sources that show medical bankruptcies were not a factor during this same period using other methods.  I find my link to hold more credibility than Jrr85 without comparable evidence that can be reviewed. Have a great day.

You could try reading the study actually cited:  http://www.amjmed.com/article/S0002-9343(09)00404-5/fulltext#sec2.1

The fact that they clearly wanted to define "medical bankruptcy" to be overbroad suggests that they didn't get the numbers they wanted when they used a more reasonable definition (or at least they were scared they weren't going to get the numbers they wanted).
Overbroad according to Jrr85, or was there another study you want me to read. What does the data show when this magic reasonable definition is used? What is the definition you used?

Do you honestly think the factors they used were reasonable?  You could defend combining them with a straight face?  And defend their justification on why their sample (post bankruptcy reform) doesn't make comparing percentages to pre-bankruptcy reforms useless?


Gin1984

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Re: What comes after the ACA?
« Reply #2446 on: May 25, 2017, 11:24:33 AM »

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   

I would be interested in your sources that show medical bankruptcies were not a factor during this same period using other methods.  I find my link to hold more credibility than Jrr85 without comparable evidence that can be reviewed. Have a great day.

You could try reading the study actually cited:  http://www.amjmed.com/article/S0002-9343(09)00404-5/fulltext#sec2.1

The fact that they clearly wanted to define "medical bankruptcy" to be overbroad suggests that they didn't get the numbers they wanted when they used a more reasonable definition (or at least they were scared they weren't going to get the numbers they wanted).
Overbroad according to Jrr85, or was there another study you want me to read. What does the data show when this magic reasonable definition is used? What is the definition you used?

Do you honestly think the factors they used were reasonable?  You could defend combining them with a straight face?  And defend their justification on why their sample (post bankruptcy reform) doesn't make comparing percentages to pre-bankruptcy reforms useless?
I find it interesting that you keep trying to fight about this yet won't respond to my post "So the American Journal of Medicine is a hack journal in the business of publishing substandard research?  Really?  What is the impact factor of the American Journal of Medicine?  Are your credentials such that they match/exceed those who peer review said journal?  Please, do elaborate."


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Jrr85

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Re: What comes after the ACA?
« Reply #2447 on: May 25, 2017, 11:46:04 AM »

Two points:  The study you linked to article about is BS.  Lots of problems with it.  Mainly with how they define which bankruptcies or foreclosures were due to medical issues.  But they also went out of their way to be deliberately misleading, by comparing the percentage of bankruptcies before a major overhaul of the bankruptcy code that was unfavorable to debts to the years shortly after the overhaul.  The number of bankruptcies went way down, including the number of "medical bankruptcies" using their BS definition, but the percentage of "medical bankruptcies" went up, because tons of people who were under financial stress went ahead and filed bankruptcy to get it done before the new law went into effect. 

Aside from having questionable methodology (to put it charitably), if you actually looked, the medical related hardship was primarily driven by loss of income resulting from medical issues preventing people from working.  But they weren't using this to talk about the importance of short term disability insurance; they were using it to push for health insurance, which would not address the vast majority of the hardship they identified in their studies. 

Also, with respect to the foreclosure issue, most states have homestead laws that will prevent a healthcare provider (or debt collector) from foreclosing on their home.  Basically, if you don't take out a mortgage, your home is protected from any debt collection (subject to limitations on value or size that differ from state to state), so there largely aren't going to be medical foreclosures except for people that mortgage their home to pay for healthcare (which does happen but you wouldn't be able to identify that by looking at foreclosure data; you'd have to do surveys to find out which mortgages went to pay for healthcare related costs). 


Bottom line is that our healthcare cost related issues don't show up as some huge unbearable burden across the population.  For the vast majority of our population, it's a manageable (if unduly expensive) cost, and then we have a small portion (but still relatively large number) of our population that have devastating burdens. 

I don't think the charlatans (like Elizabeth Warren) who try to misleadingly characterize people with normal financial issues as victims of our medical system are helpful in addressing issues.  All it does it erode trust when people that are paying attention realize that "the other side" is blatantly lying.   

I would be interested in your sources that show medical bankruptcies were not a factor during this same period using other methods.  I find my link to hold more credibility than Jrr85 without comparable evidence that can be reviewed. Have a great day.

You could try reading the study actually cited:  http://www.amjmed.com/article/S0002-9343(09)00404-5/fulltext#sec2.1

The fact that they clearly wanted to define "medical bankruptcy" to be overbroad suggests that they didn't get the numbers they wanted when they used a more reasonable definition (or at least they were scared they weren't going to get the numbers they wanted).
Overbroad according to Jrr85, or was there another study you want me to read. What does the data show when this magic reasonable definition is used? What is the definition you used?

Do you honestly think the factors they used were reasonable?  You could defend combining them with a straight face?  And defend their justification on why their sample (post bankruptcy reform) doesn't make comparing percentages to pre-bankruptcy reforms useless?
I find it interesting that you keep trying to fight about this yet won't respond to my post "So the American Journal of Medicine is a hack journal in the business of publishing substandard research?  Really?  What is the impact factor of the American Journal of Medicine?  Are your credentials such that they match/exceed those who peer review said journal?  Please, do elaborate."


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I understand the usefulness of appeals to authority when you are dealing with complex issues, but why would you make an appeal to authority when the actual paper is available and it only requires some fairly low level reasoning to understand the issue?  You can read the paper (which is not very long) and come to your own conclusions with less than 10 minutes of thought on it. 

I'm not clear on whether you're unwilling to read it, or whether you've read it and because you can't defend it, are making an appeal to authority?

Dabnasty

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Re: What comes after the ACA?
« Reply #2448 on: May 25, 2017, 12:23:53 PM »
For the love of God can we stop quoting the entire conversation for every comment?

Dabnasty

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Re: What comes after the ACA?
« Reply #2449 on: May 25, 2017, 12:24:40 PM »
Dangit. That loses some effect rolling over to page 50