Breakfest meeting at our local gardening group

[bobm]

Just came back home from a breakfast meeting at our local gardening group with 17 members attending ( most are retired ). Today's jobs report came out at 148,000 new jobs. So part of the conversation was about gardening, however most was regarding the jobs report. Most were saying that someone that they knew or their relatives experienced a cut in weekly hours that they were allowed to work from full time to less than 30 or less than 20 hours per week so that the small employers could opt out on health insurance for their employees as they don't have to provide it to those employees working less than 30 hours per week. They also said that to make up for the slack , they were hiring someone else for less than 20 hours per week. How many of these 148,000 are the new underemployed ? My next door neighbor was working full time of 40 hours / week + tips, 3 months ago reduced to 30 hours /week + tips at a restaurant as a waitress. Last Friday, she was informed that all waitresses and others were allowed to work for 20 hours + tips and that for every 2 employees they were hiring 1 other. All were expected to sign up for the new affordable health care. Our own affordable ( in reality unaffordable ) insurance will increase by $ 187 / month with a $ 3,500 deductible. ( we currently don't have the deductible. This is the least expensive and less coverage then our current policy. ) One has to buy the insurance or pay a fine. Now, how can those folks afford to buy any health insurance with their new reduced income? What are you experiencing or hearing from others ?

 

[Jared77]

It's going to fail. It's a good idea in theory however there are too many loopholes (as you pointed out by cutting hours) that businesses are going to exploit. And they have to or they go from employees working 20 hrs a week to 0 hours a week as te businesses go under from excessive operating costs.

The real problem in this country is we have something like 52% of Americans paying taxes. Until we close those loops and decrease the amount of money going out things might be more affordable for everyone.

 

[dickiebird]

bobm
Actually you don't have to pay a fine if you don't have health ins.....that would be illegal. What you will pay is a tax!!!!

THANX RICH

People say I'm getting crankier as I get older. That's not it. I just find I enjoy annoying people a lot more now. Especially younger people!!!

 

[bj taylor]

our business is providing nice clean low income housing for people (mobile home community). we've run this place nearly thirty years & have worked hard to provide a nice safe community for people to live and raise their families. I hear it from these people all the time now. their hours are cut, they're trying to find two or three jobs to make ends meet. this "affordable care act" is anything but affordable for these people. my dh & I will hang onto our health ins for as long as we can. it's expensive & it's going up in an effort to push family members off their insurance.

 

[catjac1975]

I woman I know processes applications for heat assistance for the poor and elderly. They cut her hours and she brings the work home to finish. She says otherwise some poor old person will go without heat.

 

[Ridgerunner]

People have been working two or three jobs to make ends meet for a while, or both spouses work. Its not that new. Lots of businesses have been letting people go and contracting for those jobs so they dont have to pay benefits. That was going on in the 80s when Texaco went from 85,000 employees worldwide to 15,000 true employees with the rest of the jobs contracted out to reduce costs. This health plan is going to add to this, but its not new.

Jared I think you are right. It cant work the way it is. There are too many loopholes. Its too complicated. The only way it can work in my opinion is the way it has been working for decades (and working pretty well in some countries like Scandinavia and less well in others) is for it to be truly universal, paid for by an across the board payroll tax, income tax, or something like that. Its not just to pay for health care costs either. Its a system. Education is cheap so there are no crushing student loans. Students take tests to qualify for that cheap education. Doctors make a good living but arent instant millionaires. Salaries are kept under control. Medical costs are highly regulated. Its a form of socialism. If you have money and your kid does not pass the tests to qualify for the cheap education you can still pay to get them educated, maybe going out of country to the US or maybe the Caribbean. And you still have to pay those payroll taxes or however they do it to cover everyone else.

I cant see that coming to pass in this country in the foreseeable future. Not sure Id want it to. But the system we had before was not working and I cant see the new plan working either. Id love to hear suggestions what people would be for, not just against.

 

[bobm]

One of my son's inlaws are from Canada, where they have socialized health care with very high costs and rationed medical care. So they lived in California for the past 25+ years.

 

[Jared77]

The reason nobody wants to offer alternatives is socialism is a dirty word. That's why this plan was created because if we went to a true universal health care system there would be blood in the streets. It would NEVER fly.

Part of the problem is the govt which funds Medicaid & Medicare opt to how much they will pay for a procedure. That's what the hospital gets & that's it. Say it costs $10,000 to have a surgical procedure done. Well Medicaid or Medicare decide they are only going to pay $7,000 well that still leaves 3,000 on the table unpaid. The facility where the procedure was done has to write that off as a loss. So those costs are passed along to those who can pay by raising the cost of procedures for the next year to people who have insurance which raises the rates of everybody else because the insurance companies have to turn a profit or they go under.

Now the hospital can't legally turn anyone away which is a good thing. However that means that we have to bear the burden of making up for these shortcomings. The idea is to make everybody carry insurance to help overcome these shortfalls but I see this as closing the barn doors after the livestock is already running loose. That will not decrease the hospitals operating costs. All that does is make it so people with existing conditions NOT be able to be denied insurance. That's important but it just passes the costs onto everybody else, which many simply can't afford. So we put them on Medicare & Medicaid which goes back to the problem above. Now we've got even more people taking out and less putting in which means we have to increase our contributions and the cycle continues as we go further down the spiral. So at what point does it implode? Then what?

If they want to fix things they should require transparency within the healthcare system. That's universal healthcare to me. The price to do a procedure should be nearly the same regardless of what facility you have it done at geographically. Granted there are some exceptions like bigger hospitals can buy in bigger bulk so they save $ that way, but at least that can be shown when someone audits the books. And maybe that means that your local hospital doesn't offer certain things because they just can't justify it since they don't do many of that kind of procedure or service. So that may mean you get transferred to another facility to have something done.

It's not that the hospital you went to is bad but the one our being sent to is that much better. Joint replacement, or pediatrics, or an advanced heart & vascular center for example. But there is no reason for the cost to be that much higher on one side of the state vs the other for a procedure or even within the same city. IF that's the case then WHY? Where does the money go?

If there is then there better be an evaluation as to why. Is it because they have a bloated and expensive administration? Is it because they have more complications after a procedure? Like infection, or other kinds of issues? If so then let's look at what's going on and reduce the problems. Maybe one hospital isn't as advanced and doing that procedure the old way and more patients are having complications which increases stays, requires more treatments, and ultimately raises costs. Well lets see how the other hospital is doing it and improve so everybody is doing it the right way, which decreases patient complications, decreases admission times and lowers costs. If they want to pay their administration more that's fine but that should come out of their profits instead of from raising the costs passed onto the patients. Maybe they think next time and not hire such expensive people.

Maybe it's expand the urgent care hours or set up an urgent cafe inside the ER & send patients there if its not a big deal. Many hospitals have "fast track" which is like that but many don't staff it 24/7 which might save money and free up beds in the ER.

It's not about who does things cheapest but just doing them better. More efficiently, smarter, and with less complications.

Here's one if you choose to make poor lifestyle choices then you deserve to pay more. If you smoke, if you drink excessively. Why should healthy people who make smart healthy decisions pay more for people who continue to make poor ones? If your blood work is nicotine free or your hair sample is nicotine free you should get a break. Manage your blood pressure or your look sugar you get a break. You shouldn't be punished for being a diabetic HOWEVER it's your failure to manage it by poor diet choices or lifestyle choices that need to be addressed. That will encourage people to not smoke, and use a blood pressure cuff, or a glucometer. I deal with these folks all the time who choose not to care for themselves. Yes it's not fair that I get to drink regular coke and you have to drink diet coke. Yes its not fair that you cant have 3 pieces of pie a la mode or gorge on you kids halloween candy. Yes you may have gotten a rotten deal, but it's the cards you were dealt. What's not fair is making everybody else pay for your bad decisions because you choose not to take care of your condition. Suck it up buttercup. Take responsibility for your health and manage it.

 

[Chickie'sMomaInNH]

i was thinking that the rate of reimbursement for these hospitals should be on a scale based on their success rate of procedures they perform. if they do good at certain procedures they get a higher reimbursement. a poor success rate, i.e. patient dies, gets serious infection, or for some reason drs. have to go back in to fix something they missed, there is a lower reimbursement.

the crummy part for me in NH is i don't have insurance at the moment. the only company offering insurance to individuals is Anthem BCBS and at the moment around 20 of the biggest hospitals are not going to be part of Anthem's Exchange Providers. i'm sure it's not all Anthem's fault they didn't want to include those hospitals in their Exchange, i think part of it is the hospitals in this area have been fighting the reimbursement rates being lower than what they want them to be. so these hospitals will take you in if you have insurance, but Anthem will not reimburse them. so you end up paying your entire bill to the hospital, and so much for paying premiums you won't be able to use for what they were intended.

instead of making certain people sign up for a subsidy, they should make it so everyone gets a little piece of this money back at the end of the year when they file their taxes. premiums should be counted in the 'out of pocket' expenses when you have to fill in that line, along with the costs for copays. they also need to bring back the part where you can use your HSA/FSA to purchase over the counter medical stuff like they used to allow a few years ago. some people can't live without allergy meds and now all that stuff is mostly OTC. 'oh, you didn't use this service this year? well, you get some money back for being good and not having to use that!'

 

[so lucky]

For me, this whole health care fiasco is so distressing that I can barely stand to think about it anymore. It started out as a good idea, a wonderful idea, and by the time the greedy powerful people got through with it, it is now just one more way to rape the middle class.
The only hope for most of us is to learn and do all we can to avoid going to the doctor or hospital. I have insurance, but it has such a high deductible I won't ever use it unless I have a catastrophic health issue. I can still afford to get the blood tests and few meds I take, without using insurance. And now I find that my chiropractor's office does the blood testing I need for $50 instead of $273 that the lab charges.
I don't want to get started here on my love affair with the AMA, or this will turn into a rant. Jared, I hope I don't offend you with my comments. I know EMTs are in a special class by themselves, not having ulterior motives as some in the medical management world seem to have.