Author Topic: What comes after the ACA?  (Read 779480 times)

sol

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Re: What comes after the ACA?
« Reply #4150 on: March 01, 2018, 08:40:57 AM »
All of this reading on balance billing suggests to me that it is an evolving situation, and that providers and insurers are probably sensitive to giving the appearance of sticking it to the patient.  If I were to get a big balance bill, I sure as hell wouldn't just suck it up and pay.  I suspect a savvy consumer stands a decent chance of getting the provider and the insurer to work out a discounted solution so they can avoid entanglements with the state insurance commission.

My experience with that situation is that hospital will take the tax write-off by discharging the remainder of the unpaid debt to a collection agency.  That gives them a partial financial benefit without having to hound people for money, but it certainly does not free the patient from the burden of the debt.

Mr. Green

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Re: What comes after the ACA?
« Reply #4151 on: March 01, 2018, 09:32:13 AM »
Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!
I have trouble accepting this because balance billing is a practice specific to out of network. Balance billing for in network doesn't exist by the very definition of in network so how can they claim it's treated as in network but still balance bill?

Paul der Krake

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Re: What comes after the ACA?
« Reply #4152 on: March 01, 2018, 10:13:28 AM »
Me Green: search for the term “drive-by billing” for horror stories. The idea is that you diligently go to an in-network provider, then a specialist (maybe the anesthesiologist you never selected yourself for the surgery) who performs on you is out of network

Exflyboy

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Re: What comes after the ACA?
« Reply #4153 on: March 01, 2018, 10:39:40 AM »
Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!
That depends on the state.  In California, at least last I checked, balance billing was not legal.

Yes a few states are getting on this. In Oregon a new bill comes into effect today in fact that makes balance billing illegal for in network facilities.

Unfortunately emergency care from OON providers can still balance bill.

Maybe eventually all the blue states will have full protection for emergency care, then we can plan our in country vacations accordingly..:)

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4154 on: March 01, 2018, 10:42:07 AM »
Yes so you're basically wide open to any cost the ER/ICU decides to charge you... Your insurer will cover some of that cost but the rest is up to you.

It no worse than it always has been though.. Just prices are now way higher than they used to be.

So maybe only be prepared to drop $100k if you have a heart attack away from home.. At least its not $200k.

I feel so much better!
That depends on the state.  In California, at least last I checked, balance billing was not legal.

Yes a few states are getting on this. In Oregon a new bill comes into effect today in fact that makes balance billing illegal for in network facilities.

Unfortunately emergency care from OON providers can still balance bill.

Maybe eventually all the blue states will have full protection for emergency care, then we can plan our in country vacations accordingly..:)

I mean, the Commerce Clause is just screaming out on this one. We're talking about millions of people traveling across state lines, spending money.

Mr. Green

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Re: What comes after the ACA?
« Reply #4155 on: March 01, 2018, 10:55:52 AM »
Me Green: search for the term “drive-by billing” for horror stories. The idea is that you diligently go to an in-network provider, then a specialist (maybe the anesthesiologist you never selected yourself for the surgery) who performs on you is out of network
In emergency situations? I'm aware of this issue under non-emergency circumstances.

Bateaux

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Re: What comes after the ACA?
« Reply #4156 on: March 01, 2018, 01:38:25 PM »
Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

i still scoff b/c the current system isnt sustainable so do what you want you are not only way over saving to a 3% SWR your post acutally said you were saving another 1.5MM for those 2 specific things.  thats fine you'll likely die with multiple millions of dollars. and you're a year or so away from FIRE so you've already worked much longer than is likely necessary.  in your situation i'd have FIREd probably 5 or so years ago b/c thats got to be close to the minimum extra time you've worked to amass all that.  and i'd be on a healthshare plan.

B42 when I get into nervous Nelly mode yours is generally the voice of reason.

Bateaux

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Re: What comes after the ACA?
« Reply #4157 on: March 01, 2018, 01:40:29 PM »
Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

If you are able to save those kinds of sums for healthcare, that is great.  I'd love to have that kind of cushion and would likely plan for it if I was a high earner.   However, those types of sums are out of my reach unless I want to give up on FIRE before 65 or 70, so I'll have to take some risk of a medical catastrophe if I want to enjoy some years of freedom.

I wish you luck and health.  Death is guaranteed.   So yes, enjoy life when you're really living.

boarder42

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Re: What comes after the ACA?
« Reply #4158 on: March 01, 2018, 01:47:12 PM »
Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

If you are able to save those kinds of sums for healthcare, that is great.  I'd love to have that kind of cushion and would likely plan for it if I was a high earner.   However, those types of sums are out of my reach unless I want to give up on FIRE before 65 or 70, so I'll have to take some risk of a medical catastrophe if I want to enjoy some years of freedom.

I wish you luck and health.  Death is guaranteedcurrently.   So yes, enjoy life when you're really living.

fixed that for you. - google's futurist thinks the millenials will have to choose when they die or IF they die for that matter.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4159 on: March 01, 2018, 02:18:29 PM »
Like in that show "Altered Carbon", where you get a new sleeve when you don't really die.

Mr. Green

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Re: What comes after the ACA?
« Reply #4160 on: March 01, 2018, 03:24:45 PM »
Like in that show "Altered Carbon", where you get a new sleeve when you don't really die.
The future could be closer to that than we think. We know that it's nothing but electrical signals that interface with the brain. We are just scratching the surface of what we know about death. I read stuff about cryogenics and what scientists are currently able to do to preserve life by reducing damage to the brain in trauma situations and they're only going to get better and better at it. If we can somehow map the whole brain into some machine format then I think it could totally be possible.

Bateaux

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Re: What comes after the ACA?
« Reply #4161 on: March 01, 2018, 08:16:00 PM »
I'm going to download to the Resurrection Ship like the Cylons on Battlestar Galactica.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4162 on: March 01, 2018, 09:07:03 PM »
Me Green: search for the term “drive-by billing” for horror stories. The idea is that you diligently go to an in-network provider, then a specialist (maybe the anesthesiologist you never selected yourself for the surgery) who performs on you is out of network
In emergency situations? I'm aware of this issue under non-emergency circumstances.
Looks like you're right, I'm not finding any such stories in true emergency situations.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4163 on: March 01, 2018, 09:09:40 PM »
Some of you scoffed when I said that I was saving an extra 500k for medical and 500k for elder care outside my FIRE amount.  It's not going to get better unless we adopt a better system.  Now back to saving 600K more so I can think of leaving my employer plan and FIRE.

If you are able to save those kinds of sums for healthcare, that is great.  I'd love to have that kind of cushion and would likely plan for it if I was a high earner.   However, those types of sums are out of my reach unless I want to give up on FIRE before 65 or 70, so I'll have to take some risk of a medical catastrophe if I want to enjoy some years of freedom.

I wish you luck and health.  Death is guaranteedcurrently.   So yes, enjoy life when you're really living.

fixed that for you. - google's futurist thinks the millenials will have to choose when they die or IF they die for that matter.

I'm not sure I would want to be around for what the future holds.  For many things, I'm sure I don't.

protostache

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Re: What comes after the ACA?
« Reply #4164 on: March 06, 2018, 07:45:46 AM »
House Democrats formally introduce ACA 2.0

Quote
This is, in effect, a short-term service pack. It's meant to stabilize, improve and strengthen the ACA for the next few years, presumably until we have a Democratic President in the White House.

"But there's no chance of this passing before 2019 either!" you say. Probably not. However, it does give the Dems a solid, reasonable package of improvements to campaign on with the understanding that this is for the short term only. This is to get the healthcare system through 2021...more realistically, 2022 or even 2023, since any major Medicare For All-style overhaul signed into law in 2021 likely wouldn't start ramping up until 2022 at the earliest. That means we're very likely "stuck" (for good or for bad) with the current general healthcare framework (Medicare, Medicaid, the ACA, etc) for the next 3-5 years no matter how lofty anyone's "pure Single Payer" dreams may be.

"But Donald Trump would veto this bill as well!" Well, probably...but given how erratic and clueless he is, there's at least a small chance he'd sign a bill like this. Keep in mind that he did sign the 10-year CHIP extension bill in the end. Again, I'm not saying he wouldn't veto it...but he'd likely have bigger problems on his mind starting in January 2019 anyway.

Of course, if the Dems don't retake at least one house of Congress this November, this is all moot anyway.

Again, look at the end date on several of these provisions: 2021. I think it's pretty clear that the House Dems are introducing this primarily as a package designed to guide the ACA through the rough waters of the next 4 years. After that, the reins would presumably be handed off to whatever major Universal Healthcare System they have in mind as being the Next Big Thing, whether it's Bernie Sanders' "Medicare for All", CAP's "Medicare Extra" or whatever.

On the one hand, "only" 7 of my 20 proposals are included in this package. On the other hand, it also includes another half-dozen or so provisions which I didn't have on my list at all...each of which is a positive thing. Overall, I love this package of improvements (again, as a stop-gap to tide things over for the next few years, at least).

Chances of it passing this year? Zilch. Chances of it becoming law if it passes next year? Close to zilch. But this is far more than "crumbs". These are solid improvements with real teeth to them.

This is what Democrats need to keep momentum for this year and 2020. A package of legislative text that they can all point at and campaign on, with concrete actionable ideas that improve people's lives.

This package is a boon for FIers. In particular, it improves subsidies and removes the 400% cap: no one will spend more than 8.5% of their income on premiums. No cliffs, no cutoffs. It also vastly improves cost sharing reductions. Now there's two bands: 100% of FPL to 250% of FPL will be able to get a 97% AV Silver plan (very low copays and deductibles) and 250% to 400% of FPL will have an 87% AV Silver plan. It also formally, permanently appropriates the CSRs.

freya

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Re: What comes after the ACA?
« Reply #4165 on: March 06, 2018, 08:07:12 AM »
This is what I'm watching for fixing health care:

https://www.cnbc.com/2018/02/09/bezos-buffett-dimon-health-care-plan-will-be-a-very-difficult-effort.html

The current system is ripe for some seriously intelligent overhauling.  Private insurance companies are wasteful beyond belief.  Between their internal overhead and the added burden their requirements have imposed on physicians and hospitals, something like 30-40% of private health care costs are pure overhead - maybe more.  In contrast, Medicare's overhead is in the single digit percent - and they're not beyond criticism either.

Given that health care is a 3-4 TRILLION/year industry, the potential savings (and thus current waste) is mind-boggling.   The ACA is a bandaid on the finger in the dike in comparison.   Since government is frozen solid by the lobby & FDA/revolving door systems, I'm really hoping these guys can in effect create our national health care system.

An example:  my mother recently had a minor procedure to remove a varicose vein (medical need not cosmetic).  It was all covered by insurance, but she was shocked when she saw the bill:  $24,000 not including the physician fees.    For a 20 minute day procedure.  I went on Medigo to see what the price would be for this elsewhere, and the most expensive option was a clinic in Germany that advertised a cost of $4,200.  Even assuming the actual cost is closer to $6-8K, that's still a pretty huge gap that simply shouldn't exist.

protostache

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Re: What comes after the ACA?
« Reply #4166 on: March 06, 2018, 08:47:35 AM »
This is what I'm watching for fixing health care:

https://www.cnbc.com/2018/02/09/bezos-buffett-dimon-health-care-plan-will-be-a-very-difficult-effort.html

The current system is ripe for some seriously intelligent overhauling.  Private insurance companies are wasteful beyond belief.  Between their internal overhead and the added burden their requirements have imposed on physicians and hospitals, something like 30-40% of private health care costs are pure overhead - maybe more.  In contrast, Medicare's overhead is in the single digit percent - and they're not beyond criticism either.

It's an interesting effort but I don't see where it'll succeed where so many other prior efforts have failed. Large companies have done this repeatedly over the years and have never gotten anywhere, and beyond that it doesn't really help anyone not employed by those companies. Billionaires aren't going to solve the nation's problems, they're going to solve their own problems.

The ultimate fix here is a universal healthcare system, ideally with an expanded federal Medicare system taking a much larger role. Medicare Extra as detailed in another thread is the most recent credible effort. The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.

swampwiz

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Re: What comes after the ACA?
« Reply #4167 on: March 06, 2018, 09:49:11 AM »
I signed up for Cobra last year, which I’m entitled to, by law. After FOUR WEEKS of them taking my $1200 for two months of coverage, it still had not been activated. I eventually cancelled and went with the garbage ACA plan.

I struck out on my own (late '90s), getting COBRA insurance while I figured out a good individual plan to get.  To paraphrase that Mercury Morris (retired NFL Dolphins player), "and then I got cancer".  I discovered then what a nasty & brutish world the individual market was.  I can remember getting a big 4-month checkup on the 2nd the last day of my COBRA eligibility - and then going to the state hospital to ask how much ti would be for me to get my panel of tests, talking to higher and higher ups until I got to someone that I think was the boss of the facility.  She asked if I was employed, and I said that I was "self-employed", to which she responded, "oh, then you're unemployed, so you can get free care".  I was doing contracting at the time, and I made sure to be at least temporarily unemployed whenever I had to show up for another round of tests.  (My state, Louisiana, had some special situation where DHAP funding paid for this.)
« Last Edit: March 06, 2018, 10:42:21 AM by swampwiz »

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4168 on: March 06, 2018, 07:39:17 PM »
House Democrats formally introduce ACA 2.0

Quote
This is, in effect, a short-term service pack. It's meant to stabilize, improve and strengthen the ACA for the next few years, presumably until we have a Democratic President in the White House.

"But there's no chance of this passing before 2019 either!" you say. Probably not. However, it does give the Dems a solid, reasonable package of improvements to campaign on with the understanding that this is for the short term only. This is to get the healthcare system through 2021...more realistically, 2022 or even 2023, since any major Medicare For All-style overhaul signed into law in 2021 likely wouldn't start ramping up until 2022 at the earliest. That means we're very likely "stuck" (for good or for bad) with the current general healthcare framework (Medicare, Medicaid, the ACA, etc) for the next 3-5 years no matter how lofty anyone's "pure Single Payer" dreams may be.

"But Donald Trump would veto this bill as well!" Well, probably...but given how erratic and clueless he is, there's at least a small chance he'd sign a bill like this. Keep in mind that he did sign the 10-year CHIP extension bill in the end. Again, I'm not saying he wouldn't veto it...but he'd likely have bigger problems on his mind starting in January 2019 anyway.

Of course, if the Dems don't retake at least one house of Congress this November, this is all moot anyway.

Again, look at the end date on several of these provisions: 2021. I think it's pretty clear that the House Dems are introducing this primarily as a package designed to guide the ACA through the rough waters of the next 4 years. After that, the reins would presumably be handed off to whatever major Universal Healthcare System they have in mind as being the Next Big Thing, whether it's Bernie Sanders' "Medicare for All", CAP's "Medicare Extra" or whatever.

On the one hand, "only" 7 of my 20 proposals are included in this package. On the other hand, it also includes another half-dozen or so provisions which I didn't have on my list at all...each of which is a positive thing. Overall, I love this package of improvements (again, as a stop-gap to tide things over for the next few years, at least).

Chances of it passing this year? Zilch. Chances of it becoming law if it passes next year? Close to zilch. But this is far more than "crumbs". These are solid improvements with real teeth to them.

This is what Democrats need to keep momentum for this year and 2020. A package of legislative text that they can all point at and campaign on, with concrete actionable ideas that improve people's lives.

This package is a boon for FIers. In particular, it improves subsidies and removes the 400% cap: no one will spend more than 8.5% of their income on premiums. No cliffs, no cutoffs. It also vastly improves cost sharing reductions. Now there's two bands: 100% of FPL to 250% of FPL will be able to get a 97% AV Silver plan (very low copays and deductibles) and 250% to 400% of FPL will have an 87% AV Silver plan. It also formally, permanently appropriates the CSRs.

This would be a great step forward.

orangepalm

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Re: What comes after the ACA?
« Reply #4169 on: March 07, 2018, 11:23:18 AM »
This is what I'm watching for fixing health care:

https://www.cnbc.com/2018/02/09/bezos-buffett-dimon-health-care-plan-will-be-a-very-difficult-effort.html
...
Given that health care is a 3-4 TRILLION/year industry, the potential savings (and thus current waste) is mind-boggling.   The ACA is a bandaid on the finger in the dike in comparison.   Since government is frozen solid by the lobby & FDA/revolving door systems, I'm really hoping these guys can in effect create our national health care system.

An example:  my mother recently had a minor procedure to remove a varicose vein (medical need not cosmetic).  It was all covered by insurance, but she was shocked when she saw the bill:  $24,000 not including the physician fees.    For a 20 minute day procedure.  I went on Medigo to see what the price would be for this elsewhere, and the most expensive option was a clinic in Germany that advertised a cost of $4,200.  Even assuming the actual cost is closer to $6-8K, that's still a pretty huge gap that simply shouldn't exist.

One can hope, but I'm not holding my breath. I wouldn't be surprised nothing ever comes of it, and it was all for show (even though they may have good intentions).

I'd never heard of Medigo before, that's a great tip! Being able to compare prices across clinics makes medical tourism much more tangible. I looked around the site a bit and I really like the concept, although it's a bit barebones as of yet (I know from experience they're not listing most medical tourism oriented clinics, at least in IVF).

PiobStache

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Re: What comes after the ACA?
« Reply #4170 on: March 07, 2018, 12:06:47 PM »
Here's an interesting article that goes beyond the usual talk in the US where it all revolves around the current status quo vs. single payer.  The article indicates the best three countries are not single payer systems and superior to both Canada's and the UK's.

https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html

scottish

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Re: What comes after the ACA?
« Reply #4171 on: March 07, 2018, 03:24:40 PM »
Interesting.   Being relatively wealthy I like the idea of being able to purchase better health care.   Of course I can always go to the US.

It would be nice to have more of the background data.   Goggle is my friend...

Many of the systems are not-for-profit as opposed to single payer.   Maybe the US should consider not-for-profit insurance instead of what you've got now?  Maybe Canada should too... 

The downside of single payer seems to be the government regulation.   For example, Ontario has been restricting the number of students entering medical school for quite a while now as a means of keeping health care costs down.     Governments that do central planning are often pretty inefficient.

wenchsenior

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Re: What comes after the ACA?
« Reply #4172 on: March 07, 2018, 04:28:41 PM »
Interesting.   Being relatively wealthy I like the idea of being able to purchase better health care.   Of course I can always go to the US.

It would be nice to have more of the background data.   Goggle is my friend...

Many of the systems are not-for-profit as opposed to single payer.   Maybe the US should consider not-for-profit insurance instead of what you've got now?  Maybe Canada should too... 

The downside of single payer seems to be the government regulation.   For example, Ontario has been restricting the number of students entering medical school for quite a while now as a means of keeping health care costs down.     Governments that do central planning are often pretty inefficient.

How would that keep costs down? Seems like it would do the opposite...

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4173 on: March 07, 2018, 04:43:32 PM »
I think a medical education is very expensive. In the United States, the federal government subsidizes the cost of medical schools and training and the teaching hospitals associated with them.

Jrr85

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Re: What comes after the ACA?
« Reply #4174 on: March 07, 2018, 04:56:04 PM »
Interesting.   Being relatively wealthy I like the idea of being able to purchase better health care.   Of course I can always go to the US.

It would be nice to have more of the background data.   Goggle is my friend...

Many of the systems are not-for-profit as opposed to single payer.   Maybe the US should consider not-for-profit insurance instead of what you've got now?  Maybe Canada should too... 

The downside of single payer seems to be the government regulation.   For example, Ontario has been restricting the number of students entering medical school for quite a while now as a means of keeping health care costs down.     Governments that do central planning are often pretty inefficient.

How would that keep costs down? Seems like it would do the opposite...

The government uses its monopsony power to keep prices low, so prices don't rise in response to the restriction on demand.  Instead, people just go without care. 


boarder42

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Re: What comes after the ACA?
« Reply #4175 on: March 07, 2018, 07:43:31 PM »
Interesting.   Being relatively wealthy I like the idea of being able to purchase better health care.   Of course I can always go to the US.

It would be nice to have more of the background data.   Goggle is my friend...

Many of the systems are not-for-profit as opposed to single payer.   Maybe the US should consider not-for-profit insurance instead of what you've got now?  Maybe Canada should too... 

The downside of single payer seems to be the government regulation.   For example, Ontario has been restricting the number of students entering medical school for quite a while now as a means of keeping health care costs down.     Governments that do central planning are often pretty inefficient.

How would that keep costs down? Seems like it would do the opposite...

The government uses its monopsony power to keep prices low, so prices don't rise in response to the restriction on demand.  Instead, people just go without care.

I made the non for profit comment in a much less politically acceptable way a few pages ago. But really it's the best solution. My statement was centered around healthshares which drives all these pre existing conditions people nuts. Bc most don't support them though more coming out are.  The private sector a vanguard version of helath insurance would be better than what any given could provide.

bacchi

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Re: What comes after the ACA?
« Reply #4176 on: March 07, 2018, 10:19:09 PM »
Here's an interesting article that goes beyond the usual talk in the US where it all revolves around the current status quo vs. single payer.  The article indicates the best three countries are not single payer systems and superior to both Canada's and the UK's.

https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html

Japan wasn't compared and it's also not single-payer. Better results, way less money, and a strictly regulated price sheet.

JLee

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Re: What comes after the ACA?
« Reply #4177 on: March 07, 2018, 10:25:05 PM »
I don't see how making health insurance non-profit would make much of a difference when the underlying health care system as a whole is a profitable industry.

boarder42

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Re: What comes after the ACA?
« Reply #4178 on: March 08, 2018, 04:54:12 AM »
I don't see how making health insurance non-profit would make much of a difference when the underlying health care system as a whole is a profitable industry.

You don't see how cutting out profits of 10-20% would help lower the cost of insurance. Please explain your reasoning

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4179 on: March 08, 2018, 08:04:17 AM »
The health insurance industry won't lay down and die and allow Congress to pass laws that make their existence disappear.
The Republicans are always going to have enough Senators in the Congress to prevent such a law from passing.
The best way to change health care in this country has been written about time and again by health care economists and it won't be single payer, but instead will be some of the models discussed in that article above.
Getting healthcare costs to not rise is going to be a combination of government funded research efforts of best medical practices, promoting prevention and lifestyle changes, and to some extent parsing out care.

beltim

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Re: What comes after the ACA?
« Reply #4180 on: March 08, 2018, 08:48:30 AM »
I made the non for profit comment in a much less politically acceptable way a few pages ago. But really it's the best solution. My statement was centered around healthshares which drives all these pre existing conditions people nuts. Bc most don't support them though more coming out are.  The private sector a vanguard version of helath insurance would be better than what any given could provide.

You never addressed the point that about half of Americans are already covered by nonprofit health insurance providers.  If it were the magic bullet you think it is, they would have already outcompeted all the for-profit insurers.

There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

The salient difference is that the health share has no contractual obligation to reimburse anyone for anything.

and they run as non profits which i think we can all agree is bsst for this industry.

the reason they are under no contractual obligation is b/c it keeps them out of the insurance red tape if they started down that path they would have increased costs added due to the regulations around the insurance industry.

The eliminate all the red tape paperwork a provider must fill out to process insurance claims - hospitals in america have insanely high volumes of nurses just to process paperwork - this eliminates the need for that and trends toward a what you see is what you pay pricing model.  - which many GPs in my area are moving towards and they arent accepting insurance - so i can use this guy who says its 100 bucks for this procedure and i dont take insurance and my healthshare just pays it - or i can use this guy who says its 350 dollars for this procedure but on insurance its 120 with company x and 180 with company y and 200 with company z and i say i dont have insurance so they send me a bill for 350 and it gets negotiated down to probably 100 bucks b/c he didnt have to fill out all the damn paperwork.

1) about half of Americans are covered by nonprofit health insurers: http://www.nonprofithealthcare.org/resources/BasicFacts-NonprofitHealthPlans.pdf

2) insurers can operate this way too. The fact that most don’t suggests it isn’t as efficient or low-cost as you think.

Jrr85

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Re: What comes after the ACA?
« Reply #4181 on: March 08, 2018, 09:15:54 AM »
I don't see how making health insurance non-profit would make much of a difference when the underlying health care system as a whole is a profitable industry.

You don't see how cutting out profits of 10-20% would help lower the cost of insurance. Please explain your reasoning

10% to 20%???  You're going to have to show your work there.  Even if you exclude the significant portion of the industry that is not for profit, I don't think you can get to 10-20% profits.  Probably more like 3-5% if I were going to guess. 

PiobStache

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Re: What comes after the ACA?
« Reply #4182 on: March 08, 2018, 09:28:07 AM »
Folks in the US need to consider the cost of med-mal too, in all its many facets.  They also need to remember the impact of America's hyper-litigious situation will not wear off for at least a generation after it's fixed.  The reason is physicians that have been practicing "defense medicine" their entire careers are not going to suddenly stop just because there's been tort reform.  It always makes me scratch my head to hear some folks in the US want healthcare like the rest of the world yet the US won't do things like the rest of the world does such as severely limit non-economic damages.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4183 on: March 08, 2018, 05:49:22 PM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

dividendman

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Re: What comes after the ACA?
« Reply #4184 on: March 08, 2018, 06:00:24 PM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

The dems might lose seats in the Senate just because of how many they are defending, but the House is up for grabs.

JLee

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Re: What comes after the ACA?
« Reply #4185 on: March 08, 2018, 07:20:45 PM »
I don't see how making health insurance non-profit would make much of a difference when the underlying health care system as a whole is a profitable industry.

You don't see how cutting out profits of 10-20% would help lower the cost of insurance. Please explain your reasoning

10% to 20%???  You're going to have to show your work there.  Even if you exclude the significant portion of the industry that is not for profit, I don't think you can get to 10-20% profits.  Probably more like 3-5% if I were going to guess.

Yeah, I'd like to see some numbers too.

$3.3 trillion was spent on health care in the US in 2016.   Using the higher 2017 numbers, health care profits were $6 billion in the second quarter of 2016. Let's extrapolate out to a full year and we have $24 billion in profits (again, this is comparing larger 2017 profit numbers to lower 2016 overall health care spending numbers, so this should be biased showing higher than actual profits for insurance companies).

$24,000,000,000 profit
vs
$3,300,000,000,000 spending

The combined profits of the largest six health care companies are 0.73% of what our overall health care spending is.

On top of that:

Few people understand that most profits from health insurers stem from their return on investing their pool of premium dollars while awaiting those dollars being paid out in claims months or even years after being collected. Wharton School insurance expert Scott Harrington calculates that in 2013, insurers in the individual (nongroup) insurance market overall earned negative pre-tax profits of 3.1% on the premiums they collected. That is, they actually lost 3.1 cents for every premium dollar collected, but they presumably made these losses up from their underwriting gains for group coverage as well as returns on investments.

Now, if health insurance company profits were 50% of our health care spending, then eliminating them would put us in line with average spending levels.

@boarder42 Now that I have explained my reasoning, please do the same for yours.

freya

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Re: What comes after the ACA?
« Reply #4186 on: March 08, 2018, 08:42:51 PM »
The profits of the private insurers aren't the problem.  It's their overhead, and the overhead that they impose on physicians & hospitals.  Those two things together suck up the majority of private health care dollars.

Consider the hours physicians/nurses must spend on the phone getting preauthorizations and filling out paperwork when requested to justify a bill which happens very frequently.  There's also the typical 30% overhead for outsourced billing.  That means that when you pay a physician $100, $30 of that goes to the organization the physician pays for billing services.  The patchwork of different insurance companies & plans and the incredibly complex requirements they each have are so overwhelming that outsourcing is virtually a requirement.

In contrast, Medicare's overhead is in the single digits, and their billing procedure is much less complicated.  I know this is politically impossible, but if we changed nothing about our healthcare system except to move all privately insured people to Medicare and set their premiums to cover expenses, health care spending would instantly drop by around $600 billion.  Getting rid of many of the onerous and pointless requirements imposed by Obamacare (EHRs, "meaningful use", PQRI etc) would easily chop another $100 billion.

Oh, and add another $100 billion in savings if Medicare were allowed to negotiate drug prices, and got them to the equivalent of what Canada pays.

That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4187 on: March 09, 2018, 07:41:06 AM »
The profits of the private insurers aren't the problem.  It's their overhead, and the overhead that they impose on physicians & hospitals.  Those two things together suck up the majority of private health care dollars.

Consider the hours physicians/nurses must spend on the phone getting preauthorizations and filling out paperwork when requested to justify a bill which happens very frequently.  There's also the typical 30% overhead for outsourced billing.  That means that when you pay a physician $100, $30 of that goes to the organization the physician pays for billing services.  The patchwork of different insurance companies & plans and the incredibly complex requirements they each have are so overwhelming that outsourcing is virtually a requirement.

In contrast, Medicare's overhead is in the single digits, and their billing procedure is much less complicated.  I know this is politically impossible, but if we changed nothing about our healthcare system except to move all privately insured people to Medicare and set their premiums to cover expenses, health care spending would instantly drop by around $600 billion.  Getting rid of many of the onerous and pointless requirements imposed by Obamacare (EHRs, "meaningful use", PQRI etc) would easily chop another $100 billion.

Oh, and add another $100 billion in savings if Medicare were allowed to negotiate drug prices, and got them to the equivalent of what Canada pays.

That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

Why in the ever living fuck would you cut EHR? Just because we had to drag doctors and hospitals kicking and screaming into the 90s doesn't mean it doesn't improve patient care. Maybe there are some with bad implementation, but our EHR helps providers give better care and avoid mistakes in large and small ways. Personally, I wouldn't go to a provider who didn't use an EHR at this point. I've been through trying to make sure provider A has records from provider B and C. It never worked.

sol

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Re: What comes after the ACA?
« Reply #4188 on: March 09, 2018, 08:38:30 AM »
That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

The point is that our economic system is designed to encourage spending, because that's what keeps the engine turning.  Congress doesn't care about universal or affordable health care NEARLY as much as they care about economic growth, and inefficient healthcare is perversely good for economic growth.

In the long run, of course, getting all of that waste out of healthcare would free up those dollars for more productive things like infrastructure or scholarships or actually funding government agencies like the IRS or the State Department so they can do their jobs, unlike the current arrangement.  Of course, it could also be used to give more tax cuts to the very wealthy, if you're a pro-inequality kind of person, but the point is the same; healthcare is inefficient and inefficiency should be bad for the economy.  In the short term, though, all of that healthcare waste pays salaries for millions of mid level workers, people who borrow money for cars and pay their mortgages and shop at target.  Cutting it out overnight would undoubtedly cause a recession, as the entire system had to re-equilibrate and all of those insurance processors and medical billing specialists were suddenly unemployed.

wenchsenior

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Re: What comes after the ACA?
« Reply #4189 on: March 09, 2018, 10:10:42 AM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

This is not meaningful in terms of voter interest by either party.  The Dems never had more than a sliver's chance in hell of getting the Senate back this term, and most projections for the last few years have them losing seats.  Originally, projections were for them to pick up MORE seats in 2016 than they actually did, which they were planning to use as a buffer against their inevitable losses in 2018.  Oops.

Everything hinges on the Dems winning the House in 2018 because it has always been likely the GOP will have a bigger Senate majority after that. 
« Last Edit: March 09, 2018, 10:13:57 AM by wenchsenior »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4190 on: March 09, 2018, 10:31:38 AM »
That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

The point is that our economic system is designed to encourage spending, because that's what keeps the engine turning.  Congress doesn't care about universal or affordable health care NEARLY as much as they care about economic growth, and inefficient healthcare is perversely good for economic growth.

In the long run, of course, getting all of that waste out of healthcare would free up those dollars for more productive things like infrastructure or scholarships or actually funding government agencies like the IRS or the State Department so they can do their jobs, unlike the current arrangement.  Of course, it could also be used to give more tax cuts to the very wealthy, if you're a pro-inequality kind of person, but the point is the same; healthcare is inefficient and inefficiency should be bad for the economy.  In the short term, though, all of that healthcare waste pays salaries for millions of mid level workers, people who borrow money for cars and pay their mortgages and shop at target.  Cutting it out overnight would undoubtedly cause a recession, as the entire system had to re-equilibrate and all of those insurance processors and medical billing specialists were suddenly unemployed.

Yep, U.S. health care is one great big giant poster child for the broken window fallacy.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4191 on: March 09, 2018, 10:37:08 AM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

This is not meaningful in terms of voter interest by either party.  The Dems never had more than a sliver's chance in hell of getting the Senate back this term, and most projections for the last few years have them losing seats.  Originally, projections were for them to pick up MORE seats in 2016 than they actually did, which they were planning to use as a buffer against their inevitable losses in 2018.  Oops.

Everything hinges on the Dems winning the House in 2018 because it has always been likely the GOP will have a bigger Senate majority after that.

Even within the context of a "blue wave" election, I could envision a nightmare scenario in which the Dems lose a few seats in the Senate and fail to capture a majority in the House.  Picking up seats in the House means nothing unless they actually take the majority, or at least get within a handful of seats of the majority such that Repubs in the few swing districts that are left feel some pressure not to totally plunge us into the oligarchic abyss.  Losing any seats at all in the Senate would hurt big time, because there aren't enough Susan Collinses and John McCains to keep the rest of them from going off the deep end.

wenchsenior

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Re: What comes after the ACA?
« Reply #4192 on: March 09, 2018, 10:39:59 AM »
The ACA has to last for another few years until we can get a government in place that's actually interested in helping people.
I sure hope so.  I can't wait for a full scale replacement.  I want to FIRE in a year or so.

Things aren't looking good for midterms at this point, so there's still a chance ACA won't be sticking around.

"Democrats are heading toward some big losses in this fall's midterm Senate races, polls say"

https://www.cnbc.com/2018/03/08/democrats-heading-toward-big-losses-in-midterm-senate-elections-polls.html

This is not meaningful in terms of voter interest by either party.  The Dems never had more than a sliver's chance in hell of getting the Senate back this term, and most projections for the last few years have them losing seats.  Originally, projections were for them to pick up MORE seats in 2016 than they actually did, which they were planning to use as a buffer against their inevitable losses in 2018.  Oops.

Everything hinges on the Dems winning the House in 2018 because it has always been likely the GOP will have a bigger Senate majority after that.

Even within the context of a "blue wave" election, I could envision a nightmare scenario in which the Dems lose a few seats in the Senate and fail to capture a majority in the House.  Picking up seats in the House means nothing unless they actually take the majority, or at least get within a handful of seats of the majority such that Repubs in the few swing districts that are left feel some pressure not to totally plunge us into the oligarchic abyss.  Losing any seats at all in the Senate would hurt big time, because there aren't enough Susan Collinses and John McCains to keep the rest of them from going off the deep end.

I agree.  Totally within the realm of possibility.

Jrr85

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Re: What comes after the ACA?
« Reply #4193 on: March 09, 2018, 11:36:58 AM »
The profits of the private insurers aren't the problem.  It's their overhead, and the overhead that they impose on physicians & hospitals.  Those two things together suck up the majority of private health care dollars.

Consider the hours physicians/nurses must spend on the phone getting preauthorizations and filling out paperwork when requested to justify a bill which happens very frequently.  There's also the typical 30% overhead for outsourced billing.  That means that when you pay a physician $100, $30 of that goes to the organization the physician pays for billing services.  The patchwork of different insurance companies & plans and the incredibly complex requirements they each have are so overwhelming that outsourcing is virtually a requirement.

In contrast, Medicare's overhead is in the single digits, and their billing procedure is much less complicated.  I know this is politically impossible, but if we changed nothing about our healthcare system except to move all privately insured people to Medicare and set their premiums to cover expenses, health care spending would instantly drop by around $600 billion.  Getting rid of many of the onerous and pointless requirements imposed by Obamacare (EHRs, "meaningful use", PQRI etc) would easily chop another $100 billion.
  Medicare's overhead is lower for a number of reasons not related to them being more efficient. 

And the excessive paperwork associated with private insurance is largely a result of us making the medical profession a private cartel and then expecting insurance companies to somehow stop medical professionals from collecting rents. 


Oh, and add another $100 billion in savings if Medicare were allowed to negotiate drug prices, and got them to the equivalent of what Canada pays.
  Maybe.  We already have a drug development problem.  I'd just like to see take a most favored nation approach with sales to any developed country.  Or maybe the average of the cost to OECD countries or even 125% of the weighted average price offered to OECD countries.
 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4194 on: March 09, 2018, 03:24:02 PM »
Democrat losses in the Senate can also spell disaster for Democrats' views for health care policy vis a vis Supreme Court nominations and future court decisions on the ACA/Obamacare.

tyort1

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Re: What comes after the ACA?
« Reply #4195 on: March 09, 2018, 03:33:21 PM »
That's what, $800 billion now?  Pretty easy money if we could only do something about the insurance & pharmaceutical lobbies' stranglehold on Congress.  The point is that our medical system is designed to flush money down the toilet, and it does so with sumptuous efficiency.

The point is that our economic system is designed to encourage spending, because that's what keeps the engine turning.  Congress doesn't care about universal or affordable health care NEARLY as much as they care about economic growth, and inefficient healthcare is perversely good for economic growth.

In the long run, of course, getting all of that waste out of healthcare would free up those dollars for more productive things like infrastructure or scholarships or actually funding government agencies like the IRS or the State Department so they can do their jobs, unlike the current arrangement.  Of course, it could also be used to give more tax cuts to the very wealthy, if you're a pro-inequality kind of person, but the point is the same; healthcare is inefficient and inefficiency should be bad for the economy.  In the short term, though, all of that healthcare waste pays salaries for millions of mid level workers, people who borrow money for cars and pay their mortgages and shop at target.  Cutting it out overnight would undoubtedly cause a recession, as the entire system had to re-equilibrate and all of those insurance processors and medical billing specialists were suddenly unemployed.

At least they would have health insurance!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4196 on: April 04, 2018, 04:33:18 PM »
The Final Obamacare Tally Is In. About 400,000 Fewer People Signed Up This Year.

https://nyti.ms/2q2uV1G

"11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. The drop was relatively small, given that Mr. Trump had sharply cut federal outreach efforts and the open enrollment period was half as long as in past years.
Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the Affordable Care Act — popularly known as Obamacare — through their own marketplaces, enrollment remained the same as last year. "

iris lily

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Re: What comes after the ACA?
« Reply #4197 on: April 04, 2018, 04:52:56 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

Threshkin

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Re: What comes after the ACA?
« Reply #4198 on: April 04, 2018, 06:03:50 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.

iris lily

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Re: What comes after the ACA?
« Reply #4199 on: April 04, 2018, 06:42:30 PM »
These people are missng out! In this year of The Donald’s Reign, our Obamacare premiums are $0 and that is down from about $260/month last enrollment period. Score!

I am a new participant this year (COBRA ran out).  Our Bronze plan is a whopping $3.61/month after subsidies.
I love The Donald! And
Obama! Lets vote them all in again!

Last year when our COBrA ran out,  we took a blowout trip to
Romania, Switzerland, and Prague because we could afford it, not having to pay high health insurance premiums.