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eridani

(51,907 posts)
Sun Jun 2, 2013, 01:37 AM Jun 2013

Insurers limit doctors, hospitals in state-run exchange plans

http://www.latimes.com/business/la-fi-health-rates-deals-20130525,0,4396720.story

California's health insurance rates for a new state-run marketplace came inlower than expected this week, but one downside for many consumers will be far fewer doctors and hospitals to choose from.

People who want UCLA Medical Center and its doctors in their health plan network next year, for instance, may have only one choice in California's exchange: Anthem Blue Cross. Another major insurer in the state-run market, Blue Shield of California, said its exchange customers will be restricted to 36% of its regular physician network statewide.

Paul Markovich, chief executive of Blue Shield, said renegotiating with hospitals and physician groups for lower reimbursements was a key factor for insurers in holding down rates. Medical providers are sometimes willing to accept lower payments in return for higher patient volume from these narrow networks.

And Cedars-Sinai Medical Center, one of Southern California's most prestigious and expensive hospitals, said it's not included in any exchange plans at the moment.


Comment by Don McCanne of PNHP: There was quite a celebration amongst Affordable Care Act (ACA) enthusiasts when California, a leader in health care financing innovation, announced that premiums for plans to be offered through the state exchange would not increase sharply over current health plan rates. What is now evident is that the anticipated increases were at least partially offset by further limiting the number of in-network hospitals and physicians, made possible by insurers negotiating lower provider payments in exchange for a promise of greater volume.

This exposes the big lie of the ACA promise of "Choice." As has been stated so many times, the choice we really want - the choice of health care professionals and institutions - was taken away by the insurers by means of their restricted networks of providers.

Now choice is being restricted even further by narrowing down these networks of providers. These further restrictions in choice are also being in the employer-sponsored market. It can be anticipated that narrow networks will become the new standard in health plans.

At least the traditional Medicare program does not restrict patients to networks, though the private Medicare Advantage plans do. It is true that physicians can totally opt out of Medicare, but very few do. If an improved version of the traditional Medicare program covered all of us, this injustice of taking away patient choice would not exist.

My comment: I don't really mind restriction of initial choice of provider. What really pisses me off is the power of insurance companies to disrupt an established relationship with a provider.


48 replies = new reply since forum marked as read
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Insurers limit doctors, hospitals in state-run exchange plans (Original Post) eridani Jun 2013 OP
really nice they kept insurance companies in healthcare Skittles Jun 2013 #1
Yes, once again there was no reason discussion of HC systems ... slipslidingaway Jun 2013 #22
whores, all of them Skittles Jun 2013 #23
Yes, pretty obvious if you pay attention with an open mind ... slipslidingaway Jun 2013 #25
How will out of network providers get patients? House of Roberts Jun 2013 #2
The ACA has its limitations, to be sure. Laelth Jun 2013 #3
The economics of health care is that in every age bracket, 15% of the people account for eridani Jun 2013 #10
Trust me. I am not defending the ACA. Laelth Jun 2013 #15
The reality of healthcare is that any one of us is just pnwmom Jun 2013 #20
I looked up the cost of a Silver plan and it's $305/month CreekDog Jun 2013 #33
I suspect zipplewrath Jun 2013 #19
So does every other insurance plan unless you take the PPO option SoCalDem Jun 2013 #4
That was the main reason our company dropped Kaiser Ms. Toad Jun 2013 #7
We HATE HATE HATE their pharmacy. SoCalDem Jun 2013 #8
Have you tried Kaiser's mail order pharmacy? Ms. Toad Jun 2013 #16
The "choices" are being limited by the doctors and facilities not accepting the agreement RB TexLa Jun 2013 #5
This is accurate mythology Jun 2013 #13
Even Medicare and Medicaid have In and Out of network providers.... cbdo2007 Jun 2013 #6
Traditional Medicare does NOT have in and out of network providers eridani Jun 2013 #11
yeah I wouldn't exactly call Medicare single payer. My dad gets about $1000/month in SS. liberal_at_heart Jun 2013 #18
A single payer system would make it impossible for medical providers to have a choice... Humanist_Activist Jun 2013 #34
I think it's wonderful that doctors & hospitals in Canada aren't allowed to turn away sick people n/ eridani Jun 2013 #40
Well they still can, if they already have too many patients... Humanist_Activist Jun 2013 #44
True--a very reasonable policy eridani Jun 2013 #45
This is true for me every year when we look at our new group policy @ work. It's true for everyone. Honeycombe8 Jun 2013 #9
It isn't unrealistic in Canada, and they spend half per capita what we do on health care eridani Jun 2013 #12
We are not in Canada or Mexico or Portugal or Norway. So I don't see the relevance. Honeycombe8 Jun 2013 #17
Sometimes you cannot wait months for treatment, imagine having to receive treatment ... slipslidingaway Jun 2013 #24
Quit whining about not getting your pony. Someone else got it, though. Be happy for them. Honeycombe8 Jun 2013 #42
"I don't want a fucking pony..." and was not even speaking of myself... slipslidingaway Jun 2013 #47
No, not "some" people will be help. MILLIONS are being helped. Honeycombe8 Jun 2013 #48
There is not a single developed country in the world without universal health care eridani Jun 2013 #41
And even if they are "in network" when you choose, they may become "out of network" during SharonAnn Jun 2013 #14
I hope all the people who are criticizing Obamacare pnwmom Jun 2013 #21
I hope you know some registered Repubs also want a national HC system... slipslidingaway Jun 2013 #26
Medicare for all had zero chance of passing this time around, pnwmom Jun 2013 #29
A not for profit national HC system will never pass if the Dems ... slipslidingaway Jun 2013 #46
eridani ... slipslidingaway Jun 2013 #27
Saw this coming a long time ago. 1KansasDem Jun 2013 #28
If we want low premiums, that is one way to do it. Hoyt Jun 2013 #30
So tell us, just what serious illnesses have you had while in Kaiser's model system? n/t Egalitarian Thug Jun 2013 #31
You get a really serious illness, last thing you need is a bunch of uncoordinated docs treating you. Hoyt Jun 2013 #35
I would rather have access to Kaiser than no access at all CreekDog Jun 2013 #37
That's certainly true. But, why is it that this cycle of ever-lowering expectations and standards Egalitarian Thug Jun 2013 #38
I didn't readily accept it. Don't you understand *when* this decision was made? CreekDog Jun 2013 #39
Jeez, for the first time a disabled person could buy insurance for the same cost CreekDog Jun 2013 #32
Exactly. Hoyt Jun 2013 #36
I concur, CreekDog. I helped a friend get coverage who couldn't have had it before. NYC_SKP Jun 2013 #43

slipslidingaway

(21,210 posts)
22. Yes, once again there was no reason discussion of HC systems ...
Mon Jun 3, 2013, 11:36 PM
Jun 2013

the HC CEO's were invited to the WH while SP advocates were locked out of discussions.

We cannot blame that on the other Party

slipslidingaway

(21,210 posts)
25. Yes, pretty obvious if you pay attention with an open mind ...
Tue Jun 4, 2013, 12:14 AM
Jun 2013

and take off those rose colored glasses. I'm so tired of the "my side is right your side is wrong attitude."

People are dying and being forced out of their homes and politicians are playing the blame game.

House of Roberts

(5,120 posts)
2. How will out of network providers get patients?
Sun Jun 2, 2013, 07:35 AM
Jun 2013

Can you see an orthopedic surgeon making a living if all of his/her patients have to pay the full bill out of pocket?

No. They find a way to become in-network providers by falling in line with the insurers.

Laelth

(32,017 posts)
3. The ACA has its limitations, to be sure.
Sun Jun 2, 2013, 09:23 AM
Jun 2013

Still, some medical care is better than none, and some choice of medical provider is better than none. I also resent the power of the health insurance companies to control the market, but my hope is that the ACA will drive for-profit health insurers out of the market by forcing them to cover pre-existing conditions, preventing them from dropping people with expensive medical conditions, and eliminating caps on coverage.

It will be interesting to see how the law plays out.

-Laelth

eridani

(51,907 posts)
10. The economics of health care is that in every age bracket, 15% of the people account for
Sun Jun 2, 2013, 02:11 PM
Jun 2013

--85% of the costs. ACA is forcing the healthy 85% to line the pockets of insurers, which will make them more profitable, even though they have to cover sick people. ACA doees NOT require that any insurance company actually pay claims. Count on them to deny expensive claims in cases where the appeal process will guarantee that the patient will probably die before the matter is adjudicated, or if paying the fine is cheaper than paying the claim.

Also, just about everyone is going to pick a bronze plan, leaving them on the hook for 40% of expenses after a high deductible.

In MA, years after Romneycare, 50% of all bankruptcies are still health care related.

Laelth

(32,017 posts)
15. Trust me. I am not defending the ACA.
Sun Jun 2, 2013, 03:05 PM
Jun 2013

I have argued against it all along, but I do hope that it causes health insurance companies to become unprofitable.

The problem, as I see it, is that health care does not work on the insurance model. Insurance is for spreading risk, and it works well when it protects against a risk that is low. In health care, however, the risk is very high that 90% of us will, sooner or later, need very expensive medical care. Thus, there's no real risk-spreading. For this reason, health insurance should not be profitable. It is, at the moment, only because it is highly subsidized by the Federal government (through Medicare and Medicaid, both of which cover some medical costs from people who got dumped on the system by the profit-driven insurance companies). Health insurers also stay profitable by denying coverage to people with pre-existing conditions, setting lifetime and yearly caps on benefits, and by regularly denying coverage. This can not last, and the ACA, at least, addresses the first two of these strategies. The third, as you rightly note, health insurers will continue to employ, and they will probably intensify their coverage-denial efforts in order to continue to be profitable. I hope this strategy fails.

-Laelth

pnwmom

(108,925 posts)
20. The reality of healthcare is that any one of us is just
Mon Jun 3, 2013, 10:59 PM
Jun 2013

one car accident or cancer diagnosis away from moving into the 15%.

The 15% and the 85% are not fixed groups.

CreekDog

(46,192 posts)
33. I looked up the cost of a Silver plan and it's $305/month
Tue Jun 4, 2013, 01:43 AM
Jun 2013

that is so much less, for so much more insurance than I could get under the current system.

zipplewrath

(16,646 posts)
19. I suspect
Mon Jun 3, 2013, 08:17 PM
Jun 2013

I am a little suspicious that the ultimate effect of ACA will be that hospitals and provider networks will buy insurance companies. It will allow them to steer patients to them, and they won't particularly care about the profit restrictions since there isn't any restriction on the provider profit levels.

SoCalDem

(103,856 posts)
4. So does every other insurance plan unless you take the PPO option
Sun Jun 2, 2013, 09:25 AM
Jun 2013

When my husband's company chose Kaiser, we had to quit going to the facility we had been using for 30+ years..

The only way we could have stayed was to take the 80-20% ppo they offered with Aetna.. so we have been in Kaiser-hell for 2+ years now..

Ms. Toad

(33,915 posts)
7. That was the main reason our company dropped Kaiser
Sun Jun 2, 2013, 09:38 AM
Jun 2013

We had gone with Kaiser when they had a plan which treated certain non-Kaiser doctors as in Network. They revised their plan entirely, cut out all non-Kaiser doctors primary care doctors and many specialists, all non-Kaiser pharmacies (which meant the closest one was about 15 miles away).

We'd put up with one shrinkage - but this major revision (which disrupted every primary care doctor relationship in the firm) was more than the bosses were willing to tolerate.

Since I had been forced to spend countless hours training their customer service staff on their own policies when they repeatedly failed to follow them, I was thrilled.

But yes - virtually all insurance companies limit which doctors you can see.

SoCalDem

(103,856 posts)
8. We HATE HATE HATE their pharmacy.
Sun Jun 2, 2013, 09:47 AM
Jun 2013

It usually takes my husband at least FOUR trips to the pharmacy to get his meds..

Sometimes they have some of them ready but not the others.. sometimes they have the quantity wrong or refuse to refill one that clearly says 2 refills..sometimes they substitute..sometimes he has to actually go back to the doctor for a re-written prescription because apparently they cannot call the doctor to clear things up..

he hates to waste all that time, but has no choice

With our old plan, he just faxed the sheet in & 2 days later they appeared on our doorstep..

Ms. Toad

(33,915 posts)
16. Have you tried Kaiser's mail order pharmacy?
Sun Jun 2, 2013, 08:26 PM
Jun 2013

We did most of our medicine that way, and had no complaints. We did have lots of trouble with the walk in pharmacy, and avoided it when possible (the 24 hour - at least - delay via their fax system really stinks, at least in Ohio).

 

RB TexLa

(17,003 posts)
5. The "choices" are being limited by the doctors and facilities not accepting the agreement
Sun Jun 2, 2013, 09:28 AM
Jun 2013

Meaning, they aren't accepting what is going to be paid.

Your comment: It's not the insurance company doing, it is the provider.
 

mythology

(9,527 posts)
13. This is accurate
Sun Jun 2, 2013, 02:28 PM
Jun 2013

It's the same as any other insurance group. I'm having some knee issues and my network with a non-profit insurance company (ranked very highly in terms of customer satisfaction for many years) is three hospital networks. Granted they are pretty good hospitals, but I couldn't go to whatever doctor I wanted.

cbdo2007

(9,213 posts)
6. Even Medicare and Medicaid have In and Out of network providers....
Sun Jun 2, 2013, 09:30 AM
Jun 2013

so a single payer system wouldn't help that. Just choose someone in network and get your services done.

eridani

(51,907 posts)
11. Traditional Medicare does NOT have in and out of network providers
Sun Jun 2, 2013, 02:13 PM
Jun 2013

Only Medicare Advantage does that.

liberal_at_heart

(12,081 posts)
18. yeah I wouldn't exactly call Medicare single payer. My dad gets about $1000/month in SS.
Mon Jun 3, 2013, 08:13 PM
Jun 2013

He can't afford the premium or the copays for Medicare. True single payer is paying taxes so that you have 0 premiums and 0 bills walking out of the doctor's office. That is true single payer. Medicare is a public/private insurance.

 

Humanist_Activist

(7,670 posts)
34. A single payer system would make it impossible for medical providers to have a choice...
Tue Jun 4, 2013, 02:04 AM
Jun 2013

you think doctors and hospitals in Canada can refuse to accept Canadian Medicare patients? Of course not, by law, only Canadian Medicare can provide coverage for primary care, private insurance for supplemental, so doctor's and hospitals can try to be selective, and starve, or accept the system as is.

 

Humanist_Activist

(7,670 posts)
44. Well they still can, if they already have too many patients...
Wed Jun 5, 2013, 02:42 AM
Jun 2013

just like in the United States, a reasonable restriction, doctor's have to eat and sleep, after all, so you can't have them become overwhelmed. What I don't understand is why doctor's and hospitals can refuse to see American Medicare or Medicaid patients. My fiancee is on Medicaid, and finding a GP wasn't that difficult, but finding a specialist that accepts Medicaid? In this case Orthopedics, that's impossible, we haven't found one yet, and have been looking for a year.

eridani

(51,907 posts)
45. True--a very reasonable policy
Wed Jun 5, 2013, 07:18 PM
Jun 2013

Here, medicine is about profit, and if you have to kill a few sick people without much money, that's perfectly acceptable. And the ACA does not change that.

Honeycombe8

(37,648 posts)
9. This is true for me every year when we look at our new group policy @ work. It's true for everyone.
Sun Jun 2, 2013, 11:22 AM
Jun 2013

It's true for national care systems, as well, since some care providers leave the system, opting instead to make more money doing something else.

No big surprise. This is only for those using those exchanges, which is not a requirement. So there IS choice. You did not have coverage before, and now you do, and you have a list of providers to choose from, whereas before, you had none.

Under my current group policy, I have a list of providers who are "in network." My current doctors are in that list, but every year, they may or may not be. For the dental part, my dentist is NOT on the list.

Were you expecting lists of every provider in the state? Talk about unrealistic. That has NEVER been the case in this country, since HMOs and PPOs came into being.

People can still buy policies that cover every provider, if they can afford it (I can't). Those policies are now taxed as cadillac policies, I think.

The ACA is a very good deal, indeed, bringing the possibility of affordable care to millions who had no health care before.

eridani

(51,907 posts)
12. It isn't unrealistic in Canada, and they spend half per capita what we do on health care
Sun Jun 2, 2013, 02:21 PM
Jun 2013

I don't mind restriction of initial selection of provider. I mind the power of insurance companies and employers to disrupt ongoing relationships any time they feel like it. In 2009 we had a chance to change that, but didn't. ACA does not provide health care; it provides insurance. It will actively prevent people who are low income but not officially poor from the office visits than can catch problems before they become serious. Those people will have to skip such visits because the money they would pay the doctor under their high deductible bronze plan is going to an insurance company instead.

Honeycombe8

(37,648 posts)
17. We are not in Canada or Mexico or Portugal or Norway. So I don't see the relevance.
Mon Jun 3, 2013, 08:09 PM
Jun 2013

They have totally different systems, differently run governments, different taxes, everything.

Ins. cos. have always, to my knowledge, determined who and who would not be on their "lists." They offer the care providers a certain amount of money....if the care providers don't agree to the contract price, they are not put on the list.

If there are SOME care providers on the list, poor people do not have to skip visits. They have to travel farther and wait longer. This has always been the case for those of us with employer group policies. The smaller your employer, the smaller the group policy, the few the drs on the list, the longer you have to wait and the farther you have to travel.

A few years ago I needed to go to a specialist. There was only ONE in my group policy's list of "in network." Also, there were NONE within miles of my work or home, so out of network wasn't feasible. I had to wait a long time to get in for the visit.

We have had the FIRST STEP in an improved system. Those people who are poor had NO health care before. Now they do. It wont' be a cadillac policy.

When someone else pays for your benefits, you generally don't get the best that's out there.

The ACA provisions will be tweaked, the exchanges will be tweaked and improved hopefully. This is just starting. True, we'd all like single payer. I'd like to be 18 with an 18 inch waist. But reality intervenes in those wishes.

slipslidingaway

(21,210 posts)
24. Sometimes you cannot wait months for treatment, imagine having to receive treatment ...
Tue Jun 4, 2013, 12:04 AM
Jun 2013

at a facility that you know is inferior? To put it bluntly, it can really suck!

We've met a few people in our journey who knew they were receiving inferior care during a life threatening disease, but they had to receive questionable care, that is all they had.

Have you sat across the breakfast/lunch/dinner table with these people at an ACS Hope Lodge facility, I have and it really sucks ... really sucks.

We need to strive for a system that delivers care by Need instead of who can pay the most, unfortunately Obama and the Dems did nothing to advance this idea. In fact Obama mocked and misrepresented those who wanted a national, not for profit system. Forget about blaming the Repubs on this issue, the Dems let us down, BIGTIME.

"A few years ago I needed to go to a specialist. There was only ONE in my group policy's list of "in network." Also, there were NONE within miles of my work or home, so out of network wasn't feasible. I had to wait a long time to get in for the visit.

I'm not sure you realize that "waiting a long time" can be luxury, for some people they do not have the luxury of time, as time is of the essence ... their life ends.

The Dems and Obama could have done SO much more to advance the idea of a more equitable system, IMO they failed Miserably!!!

Yes, reality intervenes and I know what the Dems did not do during the HC debate.









Honeycombe8

(37,648 posts)
42. Quit whining about not getting your pony. Someone else got it, though. Be happy for them.
Tue Jun 4, 2013, 08:37 PM
Jun 2013

My state won't get exchanges AT ALL. How's them apples, for you?

We ALL have it tough. Sometimes, sometimes, never, never, hardship, hardship. We ALL encounter these things. This is nothing new.

The glass IS half full. Millions of people are being helped with the ACA. It's not what YOU wanted, but you are not King. This is a democracy. This is the law that was passed, and it's a HUGE improvement.

For the first time in our country's history, we have a cap of sorts on premiums, we have SUBSIDIZED policies for the working class, and full payment for health care for more than just the very poor.

This is a good...no, GREAT...thing we have. Quit whining.

slipslidingaway

(21,210 posts)
47. "I don't want a fucking pony..." and was not even speaking of myself...
Wed Jun 5, 2013, 10:37 PM
Jun 2013

not being able to access care. In case you missed it I was speaking of other people, such as a few people on Medicaid, who knew they were receiving inferior care and might likely die because of the care they were receiving, or more accurately not receiving.

No doubt some people will be helped, but as I said SO much more could have been done with all eyes focused on health care, it is a shame the Dems did not seize the opportunity.

Stop trying to point the finger at others who think the Dems compromised too much and who want more for others.

"I don't want a fucking pony..."

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5366113

"...We must always speak out when we believe the people in power are wrong, it doesn't matter if the people in power are Republicans or Democrats all politicians need to be held accountable. Politics is not a game, people's lives can improved by politics and people's lives can be destroyed by politics. The issues that are facing this nation are serious, and the only way we are going to solve them is if the people demand that they are solved. Our target is not Obama, our target is a right-wing agenda that has been in place long before Obama took office, and if we want Obama to bring about real change by stopping that agenda in its tracks then we need to put pressure on him to do so. Dissent is patriotic, and if we want real change then we must continue to fight for a better world no matter who is in power."



Honeycombe8

(37,648 posts)
48. No, not "some" people will be help. MILLIONS are being helped.
Thu Jun 6, 2013, 08:29 PM
Jun 2013

There are people who were dropped from policies, who can get ins next year. There are millions who can't get insurance now, who will be able to get it next year. Medicaid has been greatly expanded in many states...it's not just for the very poor in those states; it will include the working class. Then there are lower middle class people who will be able to get part of their policies paid for by the taxpayers.

These total to MILLIONS of people, not "some," as you say.

This is not the end. This is the beginning. Be happy for these people who are being helped and will be helped to get health care.

No, Medicaid is not great care. I have a sister on it. It's a truism that WHEN SOMEONE ELSE PAYS YOUR WAY, YOU WILL NOT BE GOING FIRST CLASS. That's the way life is. BUT...they are getting free care. That's more than I get. I have more drs to choose from. But I have to pay every mo. for that luxury, and I have a co-pay and 20% of teh bill to pay, as well as a high deductible. My sister on Medicaid pays zero. In return, she is limited to a couple of drs. and one hospital. If I can't pay the deductible and 20%, I get NO care or I get sued for it. Neither way is a great way.

eridani

(51,907 posts)
41. There is not a single developed country in the world without universal health care
Tue Jun 4, 2013, 05:44 PM
Jun 2013

There are dozens of different models to choose from that do not allow mass murderers to be the only interface between you and your health care providers.

ACA will definitely help for a couple of years. Then the exchanges must become self-supporting, which means no more federal subsidies to operate them. That is when you will see massively unpopular sticker shock.

SharonAnn

(13,766 posts)
14. And even if they are "in network" when you choose, they may become "out of network" during
Sun Jun 2, 2013, 02:37 PM
Jun 2013

your coverage period.

It's an interesting contract, you sign up for a year based on their list of "in network" providers and are obligated to stay for the entire year.

They can change their list of providers at any time during the year, and some do, but you have no recourse., You're stuck for the entire year.

pnwmom

(108,925 posts)
21. I hope all the people who are criticizing Obamacare
Mon Jun 3, 2013, 11:02 PM
Jun 2013

are pushing for Medicare for all.

But I don't think so. (Except, of course, among DUers.)

slipslidingaway

(21,210 posts)
26. I hope you know some registered Repubs also want a national HC system...
Tue Jun 4, 2013, 12:31 AM
Jun 2013

funded by tax dollars, unfortunately Obama took it off the table.



pnwmom

(108,925 posts)
29. Medicare for all had zero chance of passing this time around,
Tue Jun 4, 2013, 01:09 AM
Jun 2013

and even the public option couldn't make it through after Ted Kennedy died.

We never, not for one day, had a filibuster proof majority in the Senate.

So I wonder what you're trying to accomplish by pretending that Medicare for all could have been passed except that "Obama took it off the table." What a crock.

slipslidingaway

(21,210 posts)
46. A not for profit national HC system will never pass if the Dems ...
Wed Jun 5, 2013, 10:16 PM
Jun 2013

keep taking it off the table, first under Clinton and then under Obama, and never do anything to even advance the issue.

What a crock that some people continue to blame others and not look at what is happening in their own Party.


"Imagine if P. Obama had called upon Dr. Maria Angell to speak at the WH summit instead of Karen Ignagni, members of Congress might be pleading for a public option.

Dr. Marcia Angell not invited to attend and therefore not called upon to speak, Conyers asked that two single-payer advocates be invited to attend....Dr. Quentin Young and Dr. Marcia Angell - his request was denied...."

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=385&topic_id=328837&mesg_id=328837

I continue to hear that the administration is fighting these nasty corporations while they continuously get invitations to join the discussions at the WH and Congressional hearings.

Last week they moved a scheduled meeting from HHS to the WH (Wednesday to Thursday) Obama then popped into the meeting and read the CEOs a letter from a person who was having problems with her HC. The press then states that the President is reading the riot act to the CEOs.

But they received the invitations while their most vocal opponents have been locked out of the discussions.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=439x1389233



1KansasDem

(251 posts)
28. Saw this coming a long time ago.
Tue Jun 4, 2013, 12:56 AM
Jun 2013

The "state run marketplace" was setup to handle those who couldn't get insurance through their workplace. It needed to have relatively low priced plans. Cut out the best hospitals and the best doctors, and you can sell a cheaper plan.
Once ACA was passed, it became clear many employer's would stop offering healthcare and send their employee's to the state run plans. Employer's pay a small penalty for not offering health care. Their company saves a bundle on healthcare costs.
With the ACA we will have different levels of healthcare as we have always had.

No healthcare
State exchanges (little choice)
Employer provided (bad - great)

The more things change, the more they stay the same.

 

Hoyt

(54,770 posts)
30. If we want low premiums, that is one way to do it.
Tue Jun 4, 2013, 01:20 AM
Jun 2013

Personally, I like Kaiser and think is is way to go.

You can pay extra to choose every provider, or just don't like docs in plan.

To improve system, we all gotta change. But, insurers better change too, and there needs to be some sort of public option.

 

Hoyt

(54,770 posts)
35. You get a really serious illness, last thing you need is a bunch of uncoordinated docs treating you.
Tue Jun 4, 2013, 09:21 AM
Jun 2013

Like I said, you wanta go wherever, you can pay more for an open network plan.

I'm sure there will be plans with high premiums with free choice of providers, brand name drugs for the asking when generics are available, etc. -- just like right now. You'll pay for it though.

CreekDog

(46,192 posts)
37. I would rather have access to Kaiser than no access at all
Tue Jun 4, 2013, 11:34 AM
Jun 2013

Even though I don't carry Kaiser now, I have used it in the past and yes, it's better than no coverage, in fact a lot of people in this area have used Kaiser for decades.

Again, what you are neglecting is having no coverage versus having Kaiser or having access to UCLA and/or Stanford.

You seem to miss the point with respect to what the primary health care problem is in this country.

Is the problem that everybody can't go to UCLA? Or is the problem that a large segment of our people can't even see a doctor when they have an infection because they carry no insurance?

 

Egalitarian Thug

(12,448 posts)
38. That's certainly true. But, why is it that this cycle of ever-lowering expectations and standards
Tue Jun 4, 2013, 02:52 PM
Jun 2013

throughout every aspect of life are so readily accepted? Are we so afraid of confrontation that we are prepared to see a repeat of the worst of history rather than risk fighting for our due?

CreekDog

(46,192 posts)
39. I didn't readily accept it. Don't you understand *when* this decision was made?
Tue Jun 4, 2013, 03:22 PM
Jun 2013

I complained bitterly in 2009 and 2010 --THAT is when this decision was made. You can't change it now without passing a new law or changing this current one.

And it's Joe Lieberman's fault. The 60th vote in the Senate (combination of Ben Nelson, Joe Lieberman and Blanche Lincoln) screwed us, time and time again. The biggest weaknesses in the law can be laid at their feet --Joe for stopping expansion of Medicare, Blanche for killing the public option for good and Nelson for mucking around that ultimately led to more sacrifices in the law.

Of course Baucus and less than stellar leadership from the President at the time.

But all this stuff was in 2010.

You are arguing with decisions made then. More power to you, but it's for naught.

If you want to change the law then WORK TO CHANGE THE LAW. What you are doing, which is of little consequence, is acting like what you are saying will somehow make decisions in 2010 unhappen. They won't.

What we got out of Health Care Reform was:

1) a mostly intact insurance system that now by law is required to charge everyone the same price (with a few exceptions)
2) an expanded Medicaid system
3) financial assistance to lower income people (though not enough assistance --less than most House members voted for, for example) to pay for private insurance

That's what we got. Would I trade these things for nothing? NO.

Does almost everybody here at DU want more? YES.

But this is what we've got. Get cracking to pass a new law, good luck with that. I would support it. But I absolutely will NOT undercut the protections and subsidies since they are positives in the law.

CreekDog

(46,192 posts)
32. Jeez, for the first time a disabled person could buy insurance for the same cost
Tue Jun 4, 2013, 01:42 AM
Jun 2013

as someone without preexisting conditions.

this system has its flaws, but that is a big step.

can't go to any facility you want? you can't now!

and if you don't have insurance, you often can't go hardly anywhere.

progress does not mean the work is done.

how can a liberal keep thinking we shouldn't have done anything as opposed to this?

 

NYC_SKP

(68,644 posts)
43. I concur, CreekDog. I helped a friend get coverage who couldn't have had it before.
Tue Jun 4, 2013, 09:47 PM
Jun 2013

Pre-existing condition made it impossible, or unlikely, got a HIPPA policy for less than $500/month.

Now I'm paying $1,375 for a COBRA policy that was under $500 in 2008, but it ought to drop to half that next year.

Still high but better than no change at all.

Now if only California would get the statewide single payer deal in place.

We came close.

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