"A health insurance exchange in which you choose the plan that's right for you"

[BattyDem]

In other words, you choose the plan and benefits that you can afford. Isn't this what we have now? :shrug: Those with more money get better coverage and too bad for you if you can't afford the best plan. :-(

Of course, this is better than not having health insurance and no access to healthcare, but why must we continue with a multi-tiered system where the "haves" get all the choices and the "have-nots" get the bare minimum? If you can only afford the cheapest plan, does that mean the reimbursement rates will be less? Wouldn't that cause providers to avoid that plan (like they do now), which would severely limit the choice of providers? :shrug:

If people want to pay more for insurance in order to get coverage for elective or cosmetic procedures, that's fine, but when it comes to medically necessary procedures and preventative care, why shouldn't there be standardized coverage for everyone? Every American should have the same quality of healthcare that Congress has. If you're going to have multiple private insurance plans and multiple public insurance plans (Medicare, Medicaid, VA, etc.) then ALL providers should have to accept ALL plans ... period.

I'm getting worried. The more I hear about all this, the more I fear that all we're really going to get is mandatory insurance and no exclusions for pre-existing conditions (which is certainly needed, but it's not enough). :-(

[Myrina]

1. Yeah, that's what I don't understand ...

... why the automatic solution is 'insurance for everyone' instead of going back to the days when there were no bigass insurance companies sucking all our dollars and we just paid the doctors directly, what we could, when we could.

They've (even Obama) framed the debate so as to eliminate one of the simplest and cheapest options.


:shrug:

[hedgehog]

2. The problem is that you and I may have the exact same benefits,

but your plan costs twice as much as mine because I'm in a group and you're not. I think every plan in the exchange will have to provide certain minimum benefits and then others can be added to lure customers (for example - discounts at a health club). Another kicker is that the plan has to be offered to anyone who wants it. No chery picking healthy young adults and excluding fifty year olds with bad knees.

Once the health plan is passed, it's up to us to make sure the minimum benefits are not the bare minimum. I suspect the British National Health Plan has always been underfinanced.


BTW - my mother has "the same quality of healthcare that Congress has". She's covered by the Postal Workers' Plan, which is one of the choices now offered to Congress.

[BattyDem]

15. That will be the key ...

what do they consider "minimum benefits" - are they a realistic minimum or a "let's-cut-costs" minimum?

Just curious ... is your mother happy with her plan?

[phantom power]

3. There is absolutely no reason we couldn't just shitcan all the complexity and have single payer

One pool of 300 million Americans. One set of coverage rules. One medical care payer.

There is no goddamned reason not to do this.

[SoCalDem]

17. There are MILLIONS of reasons we'll never get this

Millions of dollars spent by lobbyists...money spent to rent congresspeople & senators, which they turn over to media corporations as ads, so they can keep their <$300K a year jobs :eyes:

[Teaser]

4. no, we don't have this.

This is the equivalent of setting up a single "insurance store" where you can compare plans, coverage, etc.

[BattyDem]

7. Yes, but it's the "comparing coverage" part that bothers me

What is going to be the lowest level of coverage offered? Will it be a bare minimum? Will the cheaper plans have higher deductibles and co-pays? We know how it works now ... the better plans have lower deductibles and co-pays. But what if the only plan you can afford is the cheap one? If you're still going to get hit with thousands of dollars in deductibles if you get sick, how is that different than what we have now? I know people with insurance who avoid going to the doctor because they haven't met their deductible and they can't afford the cost of the visit, which on average is about $75. Add the cost of medication to that and it gets even tougher. :-(

I don't know what the answer is (well, that's not true - it's single-payer, but we won't get that). I'm just trying to figure out how all this is going to make things easier for us.

[DrToast]

5. No, it's nothing like we have right now

The health insurance exchange will use community ratings. Right now the insurers will look at you as an individual and rate your risk accordingly. This is why sick people are refused insurance and why even healthy people have to pay extremely high costs. Right now the insurance companies are weighing the benefit of adding one more person to cover. By participating in the exchange, they're adding millions.

[BattyDem]

8. I get that ... and that's great! It should bring down costs.

But I don't understand what the choices will be in the exchange. President Obama said that there will be multiple private plans to choose from, so you can choose the one that's right for you and your family. Well, I think we can all agree that the plan that's "right" for our family is the one that offers the most coverage, a prescription plan, low out-of-pocket expenses, etc. We all want the best for our family, but what if our family can't afford that particular plan? I assume the cheaper plans will have higher out-of-pocket expenses, but will they also have less coverage or will all plans have to meet a certain standard?

I just don't want us to end up with a reformed system that continues to charge people OUTRAGEOUS deductibles and co-pays because they can't afford the "gold" plan. Like you said, they're adding millions, so there's no reason to burden individual families with obscenely high expenses.

[DrToast]

12. There will be some level of subsidies

Hopefully that will be enough for everyone to be able to afford it.

According to the house plan, within five years all plans will have to offer a minimum level of benefits. I don't know if those have been defined as of yet.

[BattyDem]

13. I didn't know there was a minimum level of benefits.

Thanks for the info. :hi:

Let's just hope the level isn't too much of a "minimum".

[alc]

6. I agree

At least I'd like to hear more about the options.

If the options are related to co-pays, deductibles, yearly caps, and things like that, I'm ok with it. As a self-employed person I've had years with HIGH deductibles and yearly caps (catastrophic coverage only pretty much) and other years with those low. It depended on how much risk I was willing to take that year (guaranteed monthly fees vs. potential fees if I'm hurt or sick).

If the options are "covers cancer"/"doesn't cover cancer" or "any doctor"/"some doctors" or "covers what doctors charge"/"covers what doctors charge if they agree to take a big fee cut" then I'm not ok with it. With options like that we'll be right were we are now with the poorest people not covered, or "covered" but unable to find a doctor who accepts the coverage.

[rollingrock]

9. The more providers you have, the higher the premiums

because the pool is split up in too many ways, and that problem will still exist under the exchange system. single payer keeps costs down because the pool is so large, and doctors aren't forced to deal with the different, unique set of rules and policies that every insurance company has, which again results in extremely high administrative costs and paper work. under single-payer, everything is standardized and simplified because everyone follows the same guidelines.

[Thrill]

10. As long as one of the options is a Public Option. Thats the key

We don't have that now

[sandnsea]

11. The base plan will be legislated

Every plan will have the same legislated set of requirements so everybody will know their needs are covered.

After that, a plan might exclude pregnancy, for those of us who have absolutely no need for that coverage. It might offer a cheaper premium for a $2500 deductible. Or someone, like me, might choose to pay a little more and have a $500 deductible. I am 50 years old and am highly unlikely to need extensive mental health or addiction treatment care. I might choose a smaller amount of coverage for mental health that than if I were younger. Maybe I'll want to add dental, maybe I have false teeth and don't need it anymore. Options based on personal circumstances, that's all.

[BattyDem]

14. "Options based on personal circumstances, that's all."

Well, that's not too bad. Just as long as the options are reasonably priced.

[rollingrock]

16. The base plan will be legislated?

really? I don't know about that. I don't think these insurance companies will go for that.
seems to me like they would immediately attack such legislation as being too much regulation, government interference, or heaven forbid, commie-nism! oh, no. anything but that!

while at the same time, these free-market loving insurance companies have no problem accepting government handouts in the form of taxpayer subsidies that they don't even need.