Health Insurance

[mariaf]

I am starting a new thread because I didn't want to hijack Cody's thread "Need Some Opinions". (Cody - I truly hope you can find some relief and answers soon)!

I was following the discussion about the situation that Cody and others find themselves in, basically caught between a rock and a hard place, with a medical condition that requires care but with no insurance. There does not seem to be an easy answer here. If a patient is lucky enough that a parent can carry them on their insurance, that buys them until they turn 26. While some employers still offer offer family coverage at a somewhat reasonable cost, many do not - and sadly, that seems to be the trend with fewer and fewer jobs offering family coverage, or any coverage at all. For young people, in particular, any entry-level job they can get likely doesn't provide insurance outside of maybe civil service jobs and a few others. As someone mentioned, the situation in other countries (like Canada) is even worse in many ways.

What are everyone's thoughts on this - and do you think the Affordable Care Act, which I believe (someone correct me if I'm wrong) requires folks to be insured by 2014 or, in most cases, be penalized will make things better? worse?

It just seems wrong that Cody and others like him are victims of a situation that is not of their making. Seems like something that the powers that be should be able to come up with a solution for.....but can't.

Just interested in hearing any thoughts.....

p.s. (Too bad there's not a system structured like Shriners Hospitals for Children, but for adults!)

[rohrer01]

I'm not much interested in politics. However forcing people to buy insurance or be penalized will put the same burden on the common citizen as it does on businesses. Depending on the cost, some people will be forced to pay the penalty if it's cheaper than the insurance. After the insurance mandate our premiums went up over $100/mo while our coverage went way down making our out-of-pocket expenses even higher than they were. My drug coverage also went down and the copays went up.

But forcing people to buy insurance or pay a penalty doesn't help people like Cody, who don't work. How are you going to pay a penalty if you don't work? My boys don't make enough money. Unfortunately it will force many couples, who would otherwise wait, to have children so that they can qualify for state insurance. Single young men will have it the worst. Single young women who refuse to get pregnant out of wedlock will also have it bad. It "might" force some people to consider going back to university type schooling, since that package usually comes with insurance. However, college education does not equal gainful employment. Some of the most gainfully employed people I know don't have a college degree. So that will solve nothing.

You are right Maria, there is no good solution to this problem. That's why I stay out of politics.

[jrnyc]

what is the answer then....?
people bemoan that folks like Pontiac don't have insurance
and cannot get medical help....
kids can stay on their parents' insurance til age 26, i believe...
but it costs money...
so if a penalty is not the answer....what is...???

i do not have any easy solutions....
it seems that this country will still not be covering everyone
with medical care....

who is to pay for those who do not work????...
if they can prove disability, there is Medicare...
if they can prove need, there is Medicaid...
obviously, it is not sufficient...

what is the answer as to WHO pays to cover people who cannot
afford insurance...???
who is volunteering to pay for them...???

jess...and Sparky
(vet insurance is also quite expensive...but i do advise
it...i regret not getting it for Spark the day i brought him home, as
now some companies won't cover him due to pre existing conditions!)

[mariaf]

Again, I don't know everything about this issue, which is one reason I brought it up (to learn more).

Is there going to be a sliding scale where the less money you earn, the less you will be charged for the insurance you must purchase? Will those who are not employed qualify for insurance without charge? I honestly don't know.

As for young men having it the worst - that's probably true and I get what you are saying, Rohrer - but having a 22 year old daughter, I can tell you that (thankfully), she would not choose to have a baby early just to qualify for state insurance....which will then, unfortunately, put her in the same position as young men.

[LindaRacine]

There is truly no good answer. I think the key is to get to these folks when they're still young, before they start having significant back pain and become disabled. Unfortunately, one someone is on disability, it's relatively rare that they get off, even if they eventually have surgery. I think these folks need to do everything in their power to get a decent education and hopefully a job that can provide benefits.

Unfortunately, doing scoliosis surgery on people who don't have insurance is not sustainable under the current model. And, I suspect as long as their is a conservative party, we will never have socialized medicine in the U.S. By the way, as it turns out, socialized medicine seems to be faltering a bit. I was told earlier this week that most physicians in the U.K. are filling their schedules with patients willing to pay cash, as there's little incentive to treat patients who are only covered by the government. And, we've seen a lot of examples in the last few years in Canada, of kids who waited on the waiting list while their curves exceeded 100 degrees.

The only solution I've ever come up with is for patients who need surgery to go to Barbados and have their surgeries performed by the volunteers who go there as part of the F.O.C.U.S. charity. I believe Americans can go there and have the surgery performed for a relatively small amount of $. I'm guessing that one could also go to someplace like India to have the surgery performed, but I'm not sure how safe that will be.

--Linda

[mariaf]

I'm not surprised to hear that there's little incentive for doctors to treat patients covered only by government insurance.

While I was actually speaking more in general about the state of healthcare in this country, of course, patients with scoliosis are a prime example to use to see if the system works or not.

I think the key (and it's very sad) is that years ago, even in the late 70's when I was entering the work force, it was relatively easy to get a job that provided health insurance. Today, it is very difficult for most people it seems.

[rohrer01]

I was talking to my grandson's dentist about this situation last year. He said that the state barely pays him enough to cover the supplies to give a child a dental exam. He said that he, himself, could not turn any child away, but that if it wasn't done he would go broke and not be able to help anyone. So he hires tough staff to enforce his policies about absenteeism. Which is another problem with many people with state funded insurance. They don't realize that the doctors are actually treating them for free plus cost of supplies and when they don't show up for appointments it puts the doctors in a real bind, since they could have filled the slot with a paying customer.

I'm not picking on people with Medicaid. I, myself, have had periods of time in my life where I've had to be on state assistance and times when I've had really good insurance and times where I fell into the category of no insurance. So I've felt the impact of it all. I hate to say this, but people with Medicaid do, sometimes get substandard care. They get ostracized and labeled. I personally know someone, who as a child, had surgery for scoliosis. Looking at the results and the instrumentation used, it was obvious that this person didn't get the most current hardware. So it happens with scolis, too, unless the parents know where to take their child.

Everyone is right. It's not humanly possible to completely solve this problem. As long as people get sick, the problem will exist. It's not about political parties, conservatives vs. liberals. No one can have a perfect solution. For the current situation, the best that parents can do for their children, especially if they have a sick child. is to remember that their kid/s will be 18 someday and try to save and prepare to put them on parental insurance or if it's bad enough, start the disability process before the kid ages out. I know a family who has two severely disabled boys (autistic) who thought ahead. Their kids are already on SSI and won't age out of the system. Yes, it's a pain in the bahootie to do the paperwork and the fighting and getting involved with all of the agencies. But it's worth it in the end. I guess that's all I have to say on the matter. I just don't want to see this turn into a political debate about conservatism vs. liberalism. That's not the issue and neither have a good solution. This is a forum about scoliosis and we should be supportive of each other no matter our political views.

[mariaf]

I don't see it as a political issue either. Like so many problems in the world today, it's bigger than any one group and took years to get to this point.

I wonder (not sure if anyone knows the answer) if the insurance that folks will soon be able to buy under the Affordable Care Act will be much better than Medicaid. I am talking about the insurance for low-to-middle class folks that would (hopefully) not be ridiculously expensive (if, in fact, that's what the plan is) - like I said, I don't know much about it, but find it interesting and probably one of the biggest issues facing Americans today, along with the economy which I suppose it's all tied to (i.e., companies can't afford to insure employees and their families, etc.).

[rohrer01]

My guess is that "if" it's affordable, it won't be worth having. The insurance companies are in the money making business. What better business than to require everyone to purchase your product. I'm guessing that the deductibles will be so high, that the insurance companies will rarely ever have to pay out anything.

[mariaf]

That makes sense. I figure it will just be another form of not fixing the same problem. And somebody has to pay for those who are uninsured or can't afford insurance - whether we are talking about before the Affordable Care Act or after. To quote a phrase I recently heard someone use regarding another topic, it's sort of like rearranging the furniture on the Titanic.

[rohrer01]

To quote a phrase I recently heard someone use regarding another topic, it's sort of like rearranging the furniture on the Titanic.

I couldn't have said it better myself.

[SpineTime]

I am starting a new thread because I didn't want to hijack Cody's thread "Need Some Opinions". (Cody - I truly hope you can find some relief and answers soon)!

I was following the discussion about the situation that Cody and others find themselves in, basically caught between a rock and a hard place, with a medical condition that requires care but with no insurance. There does not seem to be an easy answer here. If a patient is lucky enough that a parent can carry them on their insurance, that buys them until they turn 26. *That is a result of Obamacare, BTW*

What are everyone's thoughts on this - and do you think the Affordable Care Act, which I believe (someone correct me if I'm wrong) requires folks to be insured by 2014 or, in most cases, be penalized will make things better? worse?!

I think it will make things better. I've read a lot of articles relating to the Affordable Care Act, aka Obamacare. I've "liked" Ezra Klein (WA Post) on Facebook, and he's been talking about the ACA lately, as the rollout starts soon with enrollment beginning this fall. Here are a couple of articles everyone on this thread might find interesting, and they answer some questions that have been brought up.

http://www.washingtonpost.com/blogs/...out-obamacare/ (has a chart showing examples of subsidies)

http://www.washingtonpost.com/blogs/...k-aaron-smith/

A lot will depend on your state and how much they want to cooperate. I'm in California, and I'm optimistic. I have family members here that are uninsured, and I hope they will be able to afford coverage. I worry about them all the time. It angers me that we don't have healthcare for everyone. Other countries with socialized medicine might not have a perfect system, but at least they don't have to worry that one bad accident or illness will devastate them financially and ruin their life. And they don't have to put off going to the doctor or refilling critical prescriptions because they can't afford it. I'm one who didn't think the ACA went far enough, but it's a start, and I do think a lot of people will benefit from it. JMHO, of course.

Lisa

[mariaf]

It angers me that we don't have healthcare for everyone. Other countries with socialized medicine might not have a perfect system, but at least they don't have to worry that one bad accident or illness will devastate them financially and ruin their life. And they don't have to put off going to the doctor or refilling critical prescriptions because they can't afford it.

Well said, Lisa.

I hope your optimism holds true. I am looking forward to reading the articles you posted - thanks for sharing!

[rohrer01]

Just a thought to ponder. I have a friend in Germany, where medicine is socialized. They take a FULL 50% of her wages for taxes. So, is it really any different? Well, except the insurance that we are offered has lower benefits and higher costs and limits who we can see, an insurance companies dream come true.

We, personally, are spending nearly 50% of our income on just healthcare costs, not including the taxes AND I don't have a choice where I want to go for healthcare. There is one and only one scoliosis surgeon that I can see. I'm supposed to be allowed a second opinion, but they find loopholes to prevent that. I will have to take it before the insurance board and fight if I really want a second opinion. On the other hand, if I choose to pay out of pocket I can go anywhere I want and not have to wait years on a waiting list. Unfortunately, for something so costly as a scoliosis surgery, very few people have the funds to do so.

BTW, a person can NOT be turned away in an accident situation where their life is endangered. Follow up care is a different matter.

[jackieg412]

This is a very interesting topic. So far---I have seen large medical groups merging because of the up coming health care changes. My own surgeon's group just did so on July 1st. With the merge brought insurance changes. I was just in the office and was told by insurance personnal that it was a good thing I have an HMO medicare advantage plan. After the 1st of the year it will be hard to get a primary care doctor.I don't know what it is all about but it makes one think. As soon as I can post more---I will post on how my surgery was paid for. It was an interesting way--nothing like I have read here. I donot think there is an easy answer. Also most scoliosis {not all} is not going to take your life. So the debate may continue about coverage--or coverage as an elective surgery. We all have thoughts about function and pain though.
I say choose your occupation wisely as it is so very important.