Health care penalty?

[zibazinski]

So what? Can't get blood from a stone. It isn't like we are allowed to let you die because you don't have insurance. 

[fairlycrazy23]

Oct 29, 2013 22:00:06 GMT -5 Sum Dum Gai said:

Even with a subsidy the fine will probably be cheaper than the insurance.  However, that was true prior to the ACA too.  It's always been cheaper to skip insurance than it is to buy it.  Most people didn't go without health insurance by choice though, so all the doom and gloom predictions of people doing so now seems pretty silly.

Prior to the ACA the math looked like this:
Go without insurance:
cost = $0

Get insurance:
cost = a lot

Now the math looks like this:
Go without insurance:
cost = 1% of your pay

Get insurance:
cost = a lot

For some reason even though the go without insurance option just got more expensive everyone is predicting that more people will choose it because it's less than a lot.  I don't see it.

The piece everyone is overlooking, except health insurance consumers, is that the cost of going without insurance isn't really as cheap as it seems.  One hospital trip and suddenly you're formerly $0, now 1% of annual pay, choice just cost you $50-100k.  

Just get insurance after you get sick.

[Deleted]

Dem, zib was obviously responding there to Dark's hypothetical one-off expensive emergency hospital visit, which under EMTALA would see you treated and stabilized, very probably the majority of your charges written off to indigent or charity care, and the balance either parcelled out in manageable payments or, more likely, left unpaid. Depending on how aggressive the hospital's collections operation is, you might have a suit filed against you for that balance, or your wages garnished, and you might decide to declare bankruptcy. All of that can certainly be very bad - I've been on the wrong end of an aggressive law firm, I've had my assets frozen, it's not fun, and I'm not trying to minimize it.

What you're talking about is more a rationing-of-care thing. Certainly lack of insurance is one mechanism for that; so is having insurance that takes an obstructionist approach to authorizing your care (I've worked in healthcare long enough to see insurers gamble that the patient would just go ahead and obligingly die rather than become expensive, not that I'd say that's normative corporate behavior for them); and so is putting some finite fund in charge of disbursements, like the "sickness funds" in Germany, or the NHS in the UK. An agency of the National Health Service there is the National Institute for Clincal Excellence (NICE, you can't make this stuff up), which exists to determine how many Quality-Adjusted Life Years (QALY) a procedure will add to a patient's projected lifespan. An 82-year-old with chronic emphysema won't really get QALYs from a lung transplant, which would be expensive anyway; better to give that lung transplant to a mother in her 30s with early-stage lung cancer relating to chemical exposure. A Regional Health Authority will be funded for so many sigmoidoscopies or angioplasties per quarter; either it performs them first come, first served until it runs out and oops, sorry, wait a bit guys, or it restricts criteria for access to the procedure. This is absolutely necessary to control costs, but it rather leaves the oldest and sickest people - the ones with the least QALY benefit from a procedure - up the proverbial creek. Obviously rich old sick people can get the healthcare they can pay for: but the reason healthcare can't be a free market is that there is no viable mechanism for giving every old sick person the same access. Horrors. I know. But that's how it has to be: it has to suck for a few who aren't rich enough to cheat death longer, or it has to suck for everybody, who can't subsidize that few cheating death for long.

[Deleted]

fairlycrazy23 - and that demonstrably happens, and, under the wording of PPACA (Memo to all future Congresses: if you're drafting major legislation, get it to conference - if you can't get a conference draft together, it really is better to let it die), should be what happens under Obamacare. The incentives work if you're sick; they don't if you're healthy. The law was found constitutional explicitly because healthy people were not compelled by the law's mandates to incur onerous penalties in the event they chose not to get healthcare coverage they didn't need.

[mmhmm]

Oct 29, 2013 20:19:26 GMT -5 zibazinski said:

That's so mean! Plus, it still doesn't answer my question. Where can I get a test for colon cancer without a colonoscopy?

A CAT scan will do the job, to an extent, zib.  However, if there are abnormalities, a colonoscopy will still be required.

[zibazinski]

Is a cat scan less invasive than a colonoscopy? I've had the one but not the other.

[resolution]

Oct 30, 2013 8:35:33 GMT -5 fairlycrazy23 said:

Oct 29, 2013 22:00:06 GMT -5 Sum Dum Gai said:

Even with a subsidy the fine will probably be cheaper than the insurance.  However, that was true prior to the ACA too.  It's always been cheaper to skip insurance than it is to buy it.  Most people didn't go without health insurance by choice though, so all the doom and gloom predictions of people doing so now seems pretty silly.

Prior to the ACA the math looked like this:
Go without insurance:
cost = $0

Get insurance:
cost = a lot

Now the math looks like this:
Go without insurance:
cost = 1% of your pay

Get insurance:
cost = a lot

For some reason even though the go without insurance option just got more expensive everyone is predicting that more people will choose it because it's less than a lot.  I don't see it.

The piece everyone is overlooking, except health insurance consumers, is that the cost of going without insurance isn't really as cheap as it seems.  One hospital trip and suddenly you're formerly $0, now 1% of annual pay, choice just cost you $50-100k.  

Just get insurance after you get sick.

 There is a waiting period for most insurance before it becomes effective and it won't go back and retroactively pay your hospital bill. For the federal exchange you better hope you get sick during the annual open enrollment period and not during the middle of the year.

[Sum Dum Gai]

Just get insurance after you get sick

There are still waiting periods, and good luck shopping for insurance from the back of an ambulance after a car accident or something. By the time the hospital has you stabilized you'll already owe $50k.

[djAdvocate]

Oct 30, 2013 10:18:06 GMT -5 Sum Dum Gai said:

Just get insurance after you get sick

There are still waiting periods, and good luck shopping for insurance from the back of an ambulance after a car accident or something. By the time the hospital has you stabilized you'll already owe $50k.

in other words, the person who suggests this as a solution either has not sufficiently considered the problem, or doesn't care about it.

[mmhmm]

Oct 30, 2013 9:13:48 GMT -5 zibazinski said:

Is a cat scan less invasive than a colonoscopy? I've had the one but not the other.

A CAT scan isn't at all invasive.  It's similar to an X-ray.  Sorta like an X-ray in the round.  The scanning device take pictures in pieces by revolving around the area being examined.  You will, however, still have to put up with the bowel cleansing done prior to the CAT scan (just as it's done prior to a colonoscopy).  Usually you drink what seems like an ocean of special fluid the night before the procedure.  It's not pleasant, but it's not invasive.

[zibazinski]

The actual colonoscopy isn't that big of a deal. I was trying to avoid the drinking the yuck part. Since I can't do that, there's no point to avoiding the colonoscopy. I thought a poster had mentioned there were less expensive and invasive ways of handling it.

[mmhmm]

There are definitely less expensive, and less invasive ways, zib.  The CAT is the least invasive.  However, no matter what route you take you're going to have to cleanse your bowel first. That's the only way the procedure can be effective.  While it's not fun, it's not all that awful, either.  Honest, it's not.