Originally Posted By SuperDry <<< The other option would have been COBRA, which is about as useless an unemployment "benefit" as you can imagine. Not only do you pay the full cost yourself (while unemployed), they actually add on 1% for administrative fees. Worthless. >>> I think you are drastically underestimating the value of COBRA. Granted, it is less important these days now that ACA is in effect, but it's still valuable. You claim that it's "worthless" because you have to pay the premium yourself. Prior to the ACA, do you have any idea how many people would have paid practically any price to get health care coverage? I'm specifically talking about those where someone in the family has a pre-existing condition. <<< [My wife] was let go after an ownership change at her employer >>> That kind of thing - more generally, losing their job for any number of reasons, most of which aren't their fault - happens to a great many people. Prior to ACA, and without COBRA, the entire family that relied on that job for healthcare coverage was instantly without it. Coverage ends when employment does. That is, you get called in on a Friday afternoon and are told that you're being let go due to downsizing - your entire family's healthcare coverage lapses at midnight that night as you're no longer an employee. What if one of the family members had ongoing treatment for a serious disease, like cancer? Saturday morning's chemo treatment is suddenly and without prior notice a 100% patient pay treatment. Or, less drastic, someone in the family has a chronic but manageable health condition such as diabetes. There's no immediate life-threatening treatment that's put in jeopardy, but in either case, there's no way that such an individual could get an individual health policy with those pre-existing conditions. At that point, the clock starts ticking. If you manage to find another job that offers an immediate group healthcare benefit within 62 days, then all is well - you once again have coverage, and since it's considered continuous because there was a gap of less than 63 days, there's no pre-existing condition waiting period or exclusion. But what if you don't find a job and actually start within 62 days? Or what if that job doesn't come with health care coverage? Or what if you have to be employed for X amount of time before become eligible for coverage? Those sorts of situations cover a great many people. But given the choice, I would imagine that the vast majority of people would choose COBRA if they are happy with their (former) employer's policy, for it keeps you in the exact same policy that you had before you lost your job: same benefits, same copays, same doctor/hospital networks, etc. There's no chance of any disruption whatever because you actually remain in the same policy for up to 18 months. Then you always have the option of going with an ACA individual policy if you don't find another job with a good health plan in 18 months. And I might add, if you find the cost of the COBRA policy ridiculously high, you probably didn't fully appreciate that that was the amount your prior employer was paying for you each month as a benefit that never showed up on your paycheck. That's where COBRA comes in. It allows you to keep your prior employer's group coverage for up to 18 months. Sure, you pay the premium, but to say because of that it's "worthless" is really missing the point surrounding all of the situations I mentioned above. 18 months is a much more reasonable time period to give someone to find another job with health care coverage so that it can kick in and still maintain the chain of continuous coverage that's required to not create a waiting period for pre-existing conditions. The reason that the ex-employee must pay was that was what was necessary to get the law passed. Would you expect employers to be required to continue to pay benefits for a fired or laid off employee? Now with ACA, COBRA is much less important, as anyone that finds themselves suddenly out of a job and thus cancelled from their prior employer's plan has a choice: they can opt for COBRA coverage (but only if the employer is required to offer it - it doesn't apply to employers with fewer than 25 or 50 employees), OR they can get an individual policy. The ACA mandates that insurers must accept applicants for individual policies without regard to pre-existing conditions, and the normal annual "open enrollment" period is waived for someone that just lost their job. And, you don't have to go through your state's exchange, or qualify for or accept the federal subsidy, to get this important benefit.
Originally Posted By ecdc >>And I might add, if you find the cost of the COBRA policy ridiculously high, you probably didn't fully appreciate that that was the amount your prior employer was paying for you each month as a benefit that never showed up on your paycheck.<< Kar2oonMan can speak for himself, but I understood his comments differently. I don't think he's disputing that having insurance is valuable, but that COBRA is for most people a worthless option *due to its cost.* Saying "Hey, insurance is expensive ya know" isn't much of a defense of COBRA. The larger issue is that healthcare is prohibitively expensive—in other words, what kind of option is something that very few people can afford? I had about half a dozen friends lose their jobs at some point during the Great Recession. All but one of them could not afford COBRA, no matter how badly they wanted it. The one who could was older and had more in savings and retirement.
Originally Posted By TomSawyer Skinner, apply Occam's Razor to the situation. The most likely scenario by far is that the physician discharged the patient without fully comprehending how important his travel history was. The only way that a "hospital manager" would order a patient to be discharged against medical advice would be if there is a significant safety risk to staff and other patients - anything else would pretty much result in an immediate loss of CMS certification, which means no more Medicare or Medicaid payments. I don't think you understand how far removed most hospital administrators are from patient care.
Originally Posted By Kar2oonMan >And I might add, if you find the cost of the COBRA policy ridiculously high, you probably didn't fully appreciate that that was the amount your prior employer was paying for you each month as a benefit that never showed up on your paycheck.<< You couldn't be more wrong about that. We paid 100% out of pocket ourselves for several years. 4 adults, 2 kids, so believe me that I fully appreciated and understood the "true" cost of healthcare insurance because we paid for it each and every month. When my wife went back to work to a job with medical benefits, it was a tremendous financial burden removed. So yes, I get it. I never assumed it was "free" or anything of the sort. But what I am saying is that essentially I could get the same (or better, with the "administrative cost" removed) deal without COBRA. Pre ACA, when you could be blocked due to preexisting conditions and such, yes, COBRA had its place. But isn't it a little crazy to expect someone who is unemployed to pay the full open book rate for healthcare insurance at a time when the money has stopped coming in? >>It allows you to keep your prior employer's group coverage for up to 18 months.<< Yes, at a time when your income is a fraction of what it used to be (unemployment vs. a paycheck.) Classic catch 22 situation. Many (most?) people don't have those sorts of cash reserves in place to maintain that level of coverage. Here, you can now cover all the costs to keep your plan even though you have no income and have to now choose between food and shelter vs. healthcare insurance, isn't that awesome? In other words, worthless. My larger point is that having healthcare insurance involved in any way with ones employment is just a dumb concept. It sets up the crazy quilt system we have now: haves and have-nots, people working but unable to afford healthcare insurance, tremendous inefficiencies, waste, basic unfairness, soaring costs.
Originally Posted By ecdc >>Classic catch 22 situation. Many (most?) people don't have those sorts of cash reserves in place to maintain that level of coverage.<< Exactly. I find this to be the true state of things, whereas this >>I would imagine that the vast majority of people would choose COBRA if they are happy with their (former) employer's policy<< might be ideally true, the "majority of people" are in no financial condition to opt for COBRA.
Originally Posted By Kar2oonMan >>I'm as vociferous a defender of Obamacare as anyone, but I can't believe they botched the website.<< As am I. Our broker, when last we spoke with him, said that they were sending out yet another update that was intended to fix the site, but he had heard that same thing several times before. He sounded a little battle weary. The website troubles are the stuff that will grab headlines, and lead to "See? SEE!? The government can't even get the website to work. That's who you want sitting in on grandma's death panel!??? That's who you trust to guard your private medical information!???"
Originally Posted By ecdc I should add, I find TomSawyer's perspective to be really insightful and valuable. It strikes me as yet another sign of the problem with our healthcare system. When something is for-profit, it inevitably spawns more and more ways to make more and more money, and that sometimes results in "middle management" type bureaucracies. Free Marketism 101 wants us to believe the opposite is true: that when there's a drive for profits, it forces businesses to stay lean. But the reality usually turns out to be much different, and then those businesses end up cutting costs in ways that almost always hurt the consumer, because it's much easier than a complete restructuring of their company.
Originally Posted By Kar2oonMan >>18 months is a much more reasonable time period to give someone to find another job with health care coverage<< You do realize that unemployment runs out in 6 months time? Even if one were to devote their whole unemployment check towards health insurance (not an uncommon scenario for a family) what happens at the end of 6 months? The family is screwed is what happens. >>Would you expect employers to be required to continue to pay benefits for a fired or laid off employee?<< Nope. I'd expect us to come up with a better system than linking healthcare with employment in the first place. It's long overdue.
Originally Posted By skinnerbox <<Skinner, apply Occam's Razor to the situation.>> Actually, I did. Had this happened in a more progressive blue area like where I live in San Francisco, I would have been quite reluctant to blame the hospital's need to protect its profits at all costs. Since this happened in Rick Perry's backyard, with the highest per capita uninsured state rate in the nation (no Medicaid expansion, remember?), I don't feel it's a far-fetched possibility at all. <<The most likely scenario by far is that the physician discharged the patient without fully comprehending how important his travel history was.>> So why doesn't the hospital throw the physician under the bus like they attempted to do with the intake nurse last week? Seems to me that the willingness to blame the nurse which they later retracted would easily apply to the physician if he/she was the one who actually kicked the patient out. Occam's Razor, TS. The private for-profit hospital would never allow its reputation to tarnish because of one bad apple. Throwing the ER physician under the bus if he/she were actually to blame is SOP for these guys. But they've yet to do this. And that's highly suspect. <<The only way that a "hospital manager" would order a patient to be discharged against medical advice would be if there is a significant safety risk to staff and other patients - anything else would pretty much result in an immediate loss of CMS certification, which means no more Medicare or Medicaid payments. I don't think you understand how far removed most hospital administrators are from patient care.>> They actually aren't, at least in the ER. There are case managers present 24/7 working solely at the behest of the hospital administration telling the physicians what they can and cannot do in an effort to control costs. This was highlighted in a 60 Minutes program where Medicare recipients were found to be admitted as inpatients from the ER for relatively mild conditions far more often than other patients with less-stellar insurance. This very thing happened to me last year when a nasty GI infection irritated my hemorrhoids causing mildly bloody diarrhea. I was in the ER for fluids from dehydration, but the attending physician wanted me to stay overnight in the hospital for observation. I had a similar GI infection two years prior with the same symptoms, but no offer to stay overnight to be watched back then. The difference? Between that earlier infection and the latest infection, I went on Medicare. When my Kaiser insurance was an individual policy -- meaning Kaiser was on the hook to pay for any treatment -- I was basically sent out the door to watch my symptoms on my own at home. But once I went on Medicare -- meaning CMS paid for the treatment -- all of a sudden, the mildly bloody diarrhea was a big deal. Obviously Kaiser was wanting to scam Medicare for the extra $$$ by putting me in the hospital for a night. I didn't want to expose myself to unnecessary viruses and bacteria, so I bargained for a couple of extra hours in my ER bed for observation. The diarrhea calmed down, the dehydration was resolved, and the bleeding stopped. I went home three hours later, even though the physician kept urging me to be "cautious" and stay overnight as an inpatient. Seriously. NEVER underestimate the power of the profit margin with these private for-profit hospitals. They'll do anything to make or save a buck.
Originally Posted By skinnerbox And now that the patient has died... ... will the hospital double down on their silence about what went wrong during his first ER visit? There needs to be a Federal investigation into this matter. The whole thing stinks.
Originally Posted By RoadTrip It is not always the hospital calling the shots. Sometimes the insurance requires it. I have very good insurance through the Univ of Minn. I went to the ER once for sudden numbness in my right hand. They did a CT and nothing appeared. They also wanted me to have an MRI and wanted to admit me. I asked why they couldn't just do the MRI without admitting me. I didn't see any sense in paying a $200 hospital admit copay just to have a scan done. They said my insurance would not accept an MRI order from the ER. I would have to be admitted to have my insurance pay. I refused to be admitted, signed the papers saying I was being discharged against their advice and went home.
Originally Posted By RoadTrip It is not always the hospital calling the shots. Sometimes the insurance requires it. I have very good insurance through the Univ of Minn. I went to the ER once for sudden numbness in my right hand. They did a CT and nothing appeared. They also wanted me to have an MRI and wanted to admit me. I asked why they couldn't just do the MRI without admitting me. I didn't see any sense in paying a $200 hospital admit copay just to have a scan done. They said my insurance would not accept an MRI order from the ER. I would have to be admitted to have my insurance pay. I refused to be admitted, signed the papers saying I was being discharged against their advice and went home.
Originally Posted By skinnerbox <<It is not always the hospital calling the shots. Sometimes the insurance requires it.>> I get that. But not with Medicare. In fact, Medicare would demand a detailed explanation as to why the MRI wasn't done FIRST before admitting the patient. Which is how it should be. CMS pretty much pays for just about any hospitalization (which is unfortunate since for-profit hospitals abuse that fact to their financial advantage) but you had better submit acceptable symptoms to justify the admittance in order to be compensated. BTW... did they ever figure out what was wrong? I've had numbness in both hands come and go, mostly my right hand because I'm right handed, that is related to something called thoracic outlet syndrome (TOS). I have fibromyalgia and my myofascial tissue in my upper torso gets super hard and tight like concrete. The nerves in the thoracic outlet that lead down the arm get pinched off under the tight muscles and my hand and lower forearm go numb. Myofascial release of those muscles by my therapist solves the problem, although the release massage is unbelievably painful, like I'd-throw-up-if-food-was-in-my-stomach level of painful. But it works. Numbness goes away once the fascia is relaxed. Desk work/computing/mousing are the leading causes for TOS. Most of her clients are techies from Google and Twitter. She's going through grad school without student loans thanks to their poor posture habits while working. 8^)
Originally Posted By RoadTrip I'm not sure. Five years ago I had numbness and tingling in my left arm and hand. It was diagnosed as a cervical spinal stenosis pressing on a nerve. I tend to think that was the problem with my hand. It was a different situation though... I completely lost all use of it. but recovered it over the following 6 weeks. The same thing recurred about six months later with the same result. I have not had a problem since then and it has been almost 2 years. I saw a neurologist and he thought they were likely mini-strokes. Who knows?
Originally Posted By skinnerbox <<I saw a neurologist and he thought they were likely mini-strokes.>> YIKES!! My mom suffered from TIAs; had them all the time, then a major one in her thalamus which started her dementia problems. Take care, RT. Strokes were the silent killers in my mom's family, taking out some siblings in their fifties before developing hypertension or heart disease.
Originally Posted By fkurucz >>The larger issue is that healthcare is prohibitively expensive—in other words, what kind of option is something that very few people can afford?<< It certainly is. My employer provided plan costs $18,000 a year (that number is in the W2 tax form). When I tell this to my European relatives they are simply flabbergasted. They cannot conceive on how or why it costs so much in the USA. The answer of course is that we have what is perhaps the most inefficient healthcare system in the world, a system that is so expensive that the majority of plans won't cover anything until huge multi-thousand dollar deductibles are met (which also flabbergasts my European relatives). Our system is so expensive that it's a nightmare for most people. I count myself lucky to have a "Cadillac" plan that is mostly paid for by my employer, but most Americans are not so lucky.
Originally Posted By KongKongFuey Is super expensive here because of lawsuits(malpractice insurance), very high pay for MD and RN salaries, drug price gouging, medical equipment astronomical costs(there are $200,000 surgery tables that hospitals buy.) And FDA strict clearance for drugs and equipment creates high prices. Nationalize the medicine, defang the lawyers and FDA, lower doctor and staff salaries by paying them well but not huge and viola lower priced health.
Originally Posted By EdisYoda Kong, don't forget the cost of education in there. Not to mention the price gouging of pharmaceutical companies.
Originally Posted By KongKongFuey But I did say drug price gouging. We need to nationalize medical advice and treatment and surguries , drugs and all equipment from catheters to x ray machines. Let the government seize manufacturing of anything from hospital bed linen to wheelchairs to drip tubes for iv's because like ww2 we are in a crisis. Non visiters should be allowed free medical I believe in 100% lezzy fare economy except when it comes to keeping us healthy.
Originally Posted By KongKongFuey No! My bad NO VISITER SHOULD BE ALLOWED FREE GOVT MEDICAL. I won't pay for some border jumper or tourist coming here to gain the system. This will keep our taxes clean and fair. You want our medicine then pay taxes buddy!!!!
