Dems: GOP rollback of HCR would increase the deficit.

[AGDee]

Originally Posted by PiKA2001

I disagree

I think a lot of people realize that we are covering the uninsured and its because of that fact they wonder, "what's the point?". Why reconstruct the healthcare industry when something like opening up eligibility to Medicare would seem like a better solution to dealing with the uninsured. We also can't assume that people WILL take preventative care or see a primary care physician (do they still exist?) VS a hospital or an urgent care if they have any health issues. I'm insured, but I haven't been to an actual Dr.s office in YEARS, but I have been to the hospital/urgent care several times.

If you had my insurance, you would be required to see your primary care doctor at least once per year and get specific tests done annually or else you'd have a huge annual deductible and extremely high co-pays. You would re-think that hospital/urgent care visit because the co-pay is 5 times as much as going to your primary care.

[AOII Angel]

Originally Posted by AGDee

If you had my insurance, you would be required to see your primary care doctor at least once per year and get specific tests done annually or else you'd have a huge annual deductible and extremely high co-pays. You would re-think that hospital/urgent care visit because the co-pay is 5 times as much as going to your primary care.

Your insurance company is smart.

[Drolefille]

Originally Posted by AOII Angel

Your insurance company is smart.

My new coverage requires NO co-pay for preventative care at all. More of the carrot than the stick of AGDee's but it's very encouraging.

[AGDee]

Originally Posted by AOII Angel

Your insurance company is smart.

Originally Posted by Drolefille

My new coverage requires NO co-pay for preventative care at all. More of the carrot than the stick of AGDee's but it's very encouraging.

Our preventative care visits are also free. However, the pediatrician won't bill any of my daughter's visits as "well child" visits because she has asthma so it is always billed as asthma care since it always has to be addressed. That irks me a little.

This is a gradual thing they are implementing, with different pieces of it true in different years, but by 2013, we will have the following requirements to get the "cheap" healthcare:

1) Blood pressure below 140/90 or, if diabetic, 130/90
2) Non tobacco user
3) BMI less than 30 (not in the "obese range") or have lost 5% of your body weight since your last annual visit
4) Fasting blood sugar <120 or A1C <8 (the A1C is if you're diabetic)
5) Cholesterol: Acceptable LDL-C level, which, I believe will be below 159.

And, your spouse or domestic partner must meet all the requirements as well. Children are exempt.

It has caused quite an uproar, honestly.

[Drolefille]

Originally Posted by AGDee

Our preventative care visits are also free. However, the pediatrician won't bill any of my daughter's visits as "well child" visits because she has asthma so it is always billed as asthma care since it always has to be addressed. That irks me a little.

This is a gradual thing they are implementing, with different pieces of it true in different years, but by 2013, we will have the following requirements to get the "cheap" healthcare:

1) Blood pressure below 140/90 or, if diabetic, 130/90
2) Non tobacco user
3) BMI less than 30 (not in the "obese range") or have lost 5% of your body weight since your last annual visit
4) Fasting blood sugar <120 or A1C <8 (the A1C is if you're diabetic)
5) Cholesterol: Acceptable LDL-C level, which, I believe will be below 159.

And, your spouse or domestic partner must meet all the requirements as well. Children are exempt.

It has caused quite an uproar, honestly.

I don't like that, there are a lot of reasons why you can't control some of that. And hard and fast lines are not necessarily reflective of actual health. I understand their reasoning, and I'm not sure I have a better measure of health myself, but I wouldn't be thrilled by it. (Which is why I'm pro single-payer. If you put everyone in the same pool you distribute the risk.)

[AGDee]

Originally Posted by Drolefille

I don't like that, there are a lot of reasons why you can't control some of that. And hard and fast lines are not necessarily reflective of actual health. I understand their reasoning, and I'm not sure I have a better measure of health myself, but I wouldn't be thrilled by it. (Which is why I'm pro single-payer. If you put everyone in the same pool you distribute the risk.)

Which is why it has caused an uproar. Add to it the fact that our employer owns the HMO and people are claiming conflict of interest, concerns about HIPAA, etc. Here I sit with Crohn's Disease, which will cost my insurance company a lot over the years, if I stay with them, yet my co-worker with uncontrolled diabetes will be paying the big bucks. As I said, they are phasing it in. Last year, we only had to agree to follow our doctor's treatment plans for these conditions. Each year the requirements become more stringent.

Last year, when they were first giving us information about this plan (with NO hint of it getting more stringent), I went to an info meeting and asked for information on the deductible and increased co-pays. The representative said "Why? You don't have to pay those, just follow these steps". That really ticked me off...lol. I said "What if I have a spouse who will refuse to quit smoking?" He replied, "Just show him how much more it will cost and he will quit." I said "I was giving you a hypothetical but if you think that those increased costs will get a smoker to quit, you're wrong. Cigarettes now cost %600 more than they did when most adults started smoking but they are still smoking." He said "But smokers cost us a lot of money." I said "I quit smoking a year ago so this doesn't apply to me BUT, I was never in my life treated for a smoking related illness." He said "But if you kept smoking, you would eventually." I pointed out to him that the minute I'm that sick, I'll be on disability and no longer employed by that system and, therefore would not HAVE their insurance anymore. He didn't know what to say to that. Sorry but, my employer's HMO isn't paying for any really, really serious disease of mine.

[AOII Angel]

Uncontrolled diabetics are more likely to cost your insurance carrier more over time than a single patient with Crohn's disease. I think the idea is a good one, but unfortunately, like the weight, there should be some phase in. If you have an A1C of 10, a decrease of 1 point each time you come demonstrating progress is helpful. Patient's don't do well with all or nothing. Saying they must be Less than and A1C of 8 to get the benefits is tough, especially if you are giving the obese a way to keep their lower rates by decreasing their weight over time. The whole point is to encourage improved health over time. For those who can't control it, there are medications that when taken (like for cholesterol) will bring them into those ranges.