The Widdershins

SOMETIMES I JUST LOSE IT (and it ain’t pretty)

Posted on: November 25, 2013

medical staff picture

generic picture of medical folk

The other night I was in a semi-public location (it’s the lobby of the small hotel where I have two rooms) and an older gentleman was checking in.  While he was in the process (and I have no idea how the conversation started) he got onto the topic of Obamacare.  He was berating it, describing it as “socialism” (I sure wish it was!) and talking about how it would be the ruination of the American health care system which is “the greatest the world has”and how it was going to “destroy the country”.  I listened to the point where something clicked in my brain and I found myself getting up and asking the gentleman if I could ask him a few questions. I asked him how he thought that Obamacare was going to ruin the healthcare system of the United States.  He replied that one way was because of the people being thrown off the plans that they had and that they were happy with.  I asked him if he was aware that folks were sent those notices because the plans they had did not meet the criteria for health policies under Obamacare and were, in essence, “junk” policies.  I asked him if he had seen  the story about the lady in Florida who was happy with the plan she had, but when a health care specialist from consumer reports analyzed her policy it paid for practically nothing.  I explained to him that many of these types of policies were cash cows for the insurance companies because they raked in hundreds of dollars a month in premiums to cover almost nothing in return.

The gentleman then countered by explaining how Obama was funding Obamacare by “robbing” medicare to pay for it.  I explained to him that, no, medicare wasn’t in the least robbed, that what was done was to curtail the excess amounts the government paid to “medicare advantage” plans as opposed to what the government paid for a claim under regular medicare.  Now, I didn’t have this information at hand from the Kaiser Foundation, but it would have bolstered my argument:

Over the past decades, Medicare payment policy for plans has shifted from one that produced savings to one that focused more on expanding access to private plans and providing extra benefits to Medicare private plan enrollees.  These policy changes resulted in Medicare paying private plans more per enrollee than the cost of care for beneficiaries in traditional Medicare, on average (MedPAC 2010).

The Affordable Care Act (ACA) of 2010 produced another shift in payment policy by reducing federal payments to Medicare Advantage plans over time, bringing them closer to the average costs of care under the traditional Medicare program. It also provided for new bonus payments to plans based on quality ratings, beginning in 2012, and required plans beginning in 2014 to maintain a medical loss ratio of at least 85%, restricting the share of premiums that Medicare Advantage plans can use for administrative expenses and profits.  (my comment:  hence the “we was robbed” position taken by some)

You can go over to the Kaiser website if you want to read more about the Advantage plans.

But here’s the thing in my conversation with this gentleman:  I could not tell him that I personally knew one person  who was going to benefit by Obamacare and who was going to be healthier because of it.  I couldn’t do that because the person was the man working behind the front desk.

James appeared to be the picture of health.  He’s very fit, no belly or gut hanging over his belt, runs a couple of miles several times a week and lifts weights.  He’s what you might call “fit and trim”.  However, a couple of weeks ago he did something that guys sometimes like to do:  he had a place on his hand that was bothering him so he picked at with a needle.  Well…at a point after that he started feeling bad and within a matter of hours had a fever of 105.  James has no health insurance (and no car) so he took a cab to the local doc-in-a-box outfit.  After being seen and paying $165 he found out his hand was infected.  So, he was given a prescription for an antibiotic and a test was done for  his blood sugar.  Fredster here got a call from the doc ina box to see if I could give him a ride back from the office.  He got his antibiotic script filled at the doc’s office but they didn’t have the test back for his glucose and other things.  A day or so later James wasn’t feeling that much better so he decided to go to the emergency room.  There they made the diagnosis that he has type 2 diabetes.  They “washed him out” with probably two bags of saline and got his blood sugar down. He got a script for metformin and we got him a glucose meter.  He hasn’t gotten a statement yet from the hospital but he’s talked to one of the financial counselors and he may luck out and be able to get a reduction in his charges since he has no insurance and his income isn’t that high.  So now James has a disease which will be with him for the rest of his life.  I had put James in touch with our nurse chat and she said he’s probably had the disease for awhile but because of his overall good health conditions it never manifested itself before the big ole infection on his hand.  But there is a good part to this story.

James did decide to sign up for a healthcare plan under Obamacare.  Now, as I said, he works the front desk at this small hotel and jobs in the hospitality industry do not pay a great deal.  James looked at the plans offered here in the Birmingham area and decided he could afford a bronze plan.  Now the plan isn’t great:  it has a deductible of $6350 and almost everything is under the deductible.  He gets three “illness related” visits with a doctor for a co-pay of $40.00 and he gets a yearly physical.  After that, as the brochure says “doctor’s visits thereafter,[are]covered at 100%; Subject to calendar year deductible”.  In his plan the phrase “covered at 100%; Subject to calendar year deductible” appears a lot!  But as James explained it he’s relatively healthy other than the diabetes issue and as he further explained “if something were to happen to me, the most I can have in medical bills is $6350 and then everything is picked up at 100% of the allowed amount for in network services.”.  Further he has preventive services and immunizations which are covered before the deductible and he also has prescription coverage with a $20 co-pay for generics.  He also found out that if he gets a doctor’s prescription for them he can get his test strips and lancets covered by the insurance and with only one co-pay if he gets them filled at the same time.  So here’s a guy who, after the first of the year, will not have to run to the local doc-in-a-box if he gets sick, nor will he have to go to an emergency room and get “free” treatment due to his income.  And as we all know, the “free” treatment is usually made up by other patients who can pay, either by cash or insurance.  So he’s an individual who, had there not been any Obamacare, would probably be laughed at by Blue Cross had he decided to try to get a health policy; those big ole pre-existing conditions!  He now will be able to manage his disease and at a reasonable cost instead of, say, $165 a pop at the doc-in-a-box.  And let’s not forget that Fredster here will be signing up with one of the metals from Obamacare.  I however, am looking towards the silver or maybe the gold plans.  I know that I’m a ticking time bomb and will need lots of prescription coverage plus maybe lots of doctor visits too.  No bronze plans for me!

Now I haven’t even begun to mention the other “enlightened” attitudes this gentleman had.  Opinions about the “unconstitutionality” of the Democrats doing away with the filibuster in the Senate and other talking points he probably picked up from Faux News and Rush.  It was all just about enough for your poor Fredster to  do this:

angry guy steam

It was either that above or having poor Fred develop a case of the vapors and you just really don’t see overweight, older guys get the vapors…unless they are having a stroke.  😆

Now we were mostly polite during our discussions but I came to the conclusion he wasn’t changing his mind and I knew I wasn’t changing mine.  However, I did have the supreme satisfaction of knowing I was right.  🙂

This is an open thread.

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9 Responses to "SOMETIMES I JUST LOSE IT (and it ain’t pretty)"

Absolutely. What kept your friend out of trouble was general good health plus daily running, which likely burned off a lot of the excess sugar. Add an infection and away he goes.

A perfect example of the people who will be dragged kicking and screaming to a better life through the despise Obamacare. A great example Fredster.

I saw a statistic the other day about the “invincibles,” those 20-30 somethings, who believe they are superheroes without the capes. If you are an invincible, 1 in 7 can expect an “unexpected” hospital visit during any given year — average cost $13K — whether it be a basketball broken limb, a “Fast and Furious” car accident, or someone, like your friend, who sticks a dirty needle into his hand.

There’s a distinct minority opinion floating around amongst the intelligentsia that the tech savvy invincibles might surprise everyone and sign up in goodly numbers for the ACA. That would be a most good thing.

Prolix@2: Actually James wasn’t being dragged into Obamacare. He had been looking at the plans and mainly because he didn’t want to have to pay the penalty for not having insurance. It’s just the fact that unfortunately, he had this condition manifest itself before his coverage kicked in. 😦 Now also on the bright side, he was given a doctor’s name here in this area and he had his first appointment with hm. I knew the doc’s name but had no experience with him. However, James said he liked the doctor and felt comfortable with him. He said the doc was one who seemed to want to listen to the patient and also had no problems with answering any questions. He gave the doc a copy of a brief outline of his coverage and the doc said they could work within the boundaries of the policy coverage. If they can get it right, when he goes back it will be for the annual physical and he’ll also be able to get labs done for his cholesterol, get some immunizations and other things and not have to pay a cent!

Let’s hope the “millennials” do sign up in droves because from my understanding, that’s what’s going to make the entire thing work from the financial end.

Excellent post, Fredster. There are a lot of people already being helped by the ACA. Their stories need to be told, but some people are so full of Obama-hate, they just don’t want to hear the truth.

Beata said:

but some people are so full of Obama-hate, they just don’t want to hear the truth.

Exactly! And you cannot imagine how, in one way, I felt so uncomfortable having to defend him, but hell, had it not been for the ACA I wouldn’t have been able to get medical ins. under that PCIP program. That ends on Jan. 1st so I have to get an obamcare plan. The plans here in Bama and in La aren’t the greatest but I’ve seen worse. I will need to concentrate on which one will give me the best deal on doctor’s visits and prescription coverage for maintenance meds.

@5: You already know more about the ACA than most people which will be a big help in finding a new plan. If you have patience, I believe you will be able to get a good one. ((( HUGS ))) to you, Fredster. Keep us posted on how it works out for you.

One thing you mentioned in your post really resonated with me. Over the past ten years or so, I have been amazed at how many people I know who thought they had excellent health insurance UNTIL they got sick and found out their policies were crap. It was like an epidemic of hidden crap policies. The ACA should prevent those “surprises” from happening in the future. That alone is a very good aspect of the new law.

Beata: the key to it, as they have said, is competition and how many companies are in the markets where you are living. Here in metro B’ham there are two companies, Humana and BCBS that are offering plans. In metro Nola there were 3 companies offering plans with 40 variations of them. There are still only the 4 levels, but the companies offer variations on the policies at those “metal” levels. What truly amazed me was the Atlanta metro market. I think they had a total of 67 different plans available to look at!

I really believe that if someone needs health insurance they should be able to find a plan that will meet their requirements.

Good story Fredster. I love it that Southerners are so polite!

annie@8: Well, not always. It was all I could do to not scream at the guy HOW CAN ANYONE BE THAT STOOPID!!! But really I just wanted to show him where he didn’t have the correct information. I’ve heard the thing about “stealing from medicare” until I do want to scream! LOL!

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