Sadly I’m on the wrong end of the stethoscope recently - and from what I can tell the number of people CHOOSING to not get a supplemental policy is horrifying. I’m not talking about the percentage of seniors who can’t afford one logically due to their financial situation at retirement (which would be another rant for another time) but the cost in my area ranges from $50 to $200 a month including vision/hearing and CRITICALLY skilled nursing care. And they’re “nah, I’m good”
We’re now navigating this stuff since I’m turning 65 end of October - so far beginning Jan 12 I’m in roughly 125K, in costs, with at least the same amount coming, and that doesn’t count my meds which are on an possible experimental (read free) protocol. In passing, though, they mentioned that I may be on maintenance meds for who knows how long, and no one can tell me how much it’s going to cost OR if medicare will cover it - so we’re scrambling to figure out if I need to stay on my current policy and pay for it or if it’s OK to go on medicare. Anxiety provoking, for sure.
Lastly, the whole “you can keep your doctor” is a pile of horseshit, anyway. 90% of the time, soon to be 99%, you’re never going to see “your” doctor unless he/she waves at you in the office hallway because they’re wrangling half a dozen NP/PA types because it’s the only way you can make a general practice run and not starve to death, and if you DO need specialty care, you’re going to have essentially no way of knowing who’re going to see you because you’re going to be slotted to an appt. by a specialist. (Probably the biggest advantage of knowing who to see if you’re sick is that I know the one or two people I’d avoid, rather than the big majority of people I’d be fine seeing) The “keep your doctor” stuff is feel-good nonsense, and has been for at least a decade.
Would like to note that the very first thing in Bernies M4A plan is to expand medicare for the elderly to include all that. Dental, vision, hearing, and I think at home care if you need it.
Then the next year expand that to people over 50, then over 40, then over 30, then everyone year by year.
On the topic of unions and Medicare for All, it seems to me that there are two clear options to appease the unions and get the policy through:
Require their employers to switch that compensation to the cash value it’s costing the employers, and give the employees an option to buy the plans themselves at the same rates as supplemental insurance. Could be some issues here with death spiraling on their plans, though.
Grandfather them in for now. They get to stay out of the Medicare for All system until their next round of negotiating, at which point the cost of the plans must be made available to all negotiators and they can negotiate their compensation going forward, at which point they will be on Medicare for All. I don’t know how often union contracts get renegotiated, but I would assume it’s gotta be <10 years. There are about 15 million union workers in America, so the single payer system should function fine without them for a few years.
I’m so sorry this happened to you and your wife, and I really hope she’s okay and makes a full recovery. Obviously this should never happen to anyone, let alone anyone in America. The fact that even people making an upper middle class income are at-risk of this is a great example of how fucked the system is for damn near everyone. When people are forced to make free market decisions on the wrong side of the leverage, these are the types of things that happen.
With all that said, and I don’t mean this to be judgmental of you and your wife who tried to make the best decisions for you two and couldn’t have known what was coming, this story reads as a cautionary example for people who will have to make similar decisions in the future of why they should seriously do everything they possibly can to be insured even if the cost seems prohibitive if they can at all swing it. It’s fucked up, but that’s what we’re stuck with for now. Sometimes what seems like an impossible cost to bear paying the full out of pocket max in logical terms when buying the insurance is quite different when faced with a critical medical situation, especially if you make enough money to have enough borrowing power to get it done. You might be able to take out a second mortgage, borrow from family, do extra work on the side, etc… If you can afford the premiums on the cheapest ACA plan, I believe that carrying it is almost always going to be better than not carrying it in terms of the risk-reward equation for the average middle class to upper middle class person.
Again, I hope you don’t take that as judgment of the decisions you made and I think it’s totally fucked that people have to even make those decisions. I just want anyone reading who may be faced with a similar decision on whether to carry insurance to weigh all of that.
For me, the first couple years after the ACA passed, I got gold or platinum plans, if I recall I was spending $400-500/mo on it, had great coverage, and didn’t end up having to use it that much anyway. Luckily for me, as the coverage has gotten worse and the cost has gone up, I’ve also increased my earnings and net worth enough to where it seems reasonable to get a lower level plan that functions not to cover my general doctors visits but as calamity insurance if something horrible happens.
So I pay about $400 a month (note I’m paying the same now for shit coverage that I was paying for good coverage when the ACA first passed, great job GOP well done!), I have a $5,750 deductible so everything is out of pocket up until then except like the one preventative checkup, and I have like an $8,100 out of pocket max. The result of this is that I try to avoid going to the doctor for basic stuff that I know is going to directly cost me money if I can help it. I do have somewhat chronic shoulder pain related to how I sleep, it gets worse when I golf which is my favorite leisure activity in the spring/summer/fall. I have a lot of left ankle pain when golfing, as well. I’ve never gotten either checked out, because I know if I needed surgery or something it’d just cost me $8,000 right away. I’m inclined to wait a few years and see what happens politically, and perhaps try to stack everything into one year and just get good coverage off the exchange that year.
I also have chronic difficulty sleeping, have had it for years, and ideally I would be going through a stage-by-stage process to fix it with doctors and specialists and whatever it takes. But that’d be like $8,000 out of pocket for sure, so same problem, I’m waiting and trying to figure it out myself and improve it myself.
I’d like to actually have a snowball’s chance in hell of getting single payer through. If grandfathering unions for a few years is what it takes, so be it. It still beats the shit out of Pete’s plan, Liz’s plan, etc…
I’m not taking it as an insult at all btw. It’s something I pondered myself as all this has unfolded. If my wife dies from whatever is going on I will probably never forgive myself. But we did have insurance for a lot of it albeit terrible bronze coverage. When this problem arose and for 3 years after we had Obamacare. We couldn’t afford the deductible and that was the main issue. Or if we got a silver or gold plan we couldn’t afford the premium. By 2018 a gold plan premium was nearly 2k/mo. for us. By 2018 our county was one with only one insurance company in the marketplace so our options were severely limited.
We also have well over 1000/mo. in student loan payments that further exacerbated the problem.
Forgot to hit reply that was supposed to be @anon38180840.
I mean it sounds like you both made decisions to sacrifice physical well being for each other as a family to try to protect your joint finances, so I don’t think you should blame yourself although I know that’s people’s natural reaction when stuff like this happens. It’s to go look for that one thing you could have done differently that might have changed the outcome, then latch onto it and blame yourself - that’s the natural human response, but there’s always going to be one thing no matter what, so you just can’t drag yourself through that for too long no matter what happens. But hopefully it’s not as serious as you fear, it sounds like you don’t know yet if it’s malignant, so hopefully it’s not and it’s a relatively simple surgery.
The trouble with the deductibles not being affordable is that in reality you can afford them if you really need to (like, if something life or death happens you pay for that and stop paying for the student loans and let that bank come after you), but not if you don’t really need to… and you don’t know whether you really need to until you’ve likely already racked up thousands of dollars in bills getting a diagnosis and early care for whatever problem comes up.
It sounds like she has good coverage now so hopefully she gets good quality care and everything is okay.
Ya pretty much all of that. For the record they think it isn’t malignant but won’t know until they do the surgery and biopsy it I guess. Fingers crossed.
Glad to hear it. Hopefully it’s minor, it’s one surgery and done, and you guys can grow old together and joke about how you didn’t get your ribs fixed and she didn’t get checked out, and then you can both thank goodness Bernie won in 2020 so your future kids can grow up with single payer.
I’m incredibly sorry and sincerely wish you and your wife the best. Your story inspired me to share another story in a similar vein but one where my wife and I ended up on the lucky side of things.
This last year, my wife suffered a workplace injury that ended up covered under worker’s comp. This was something that required surgery and extensive physical therapy, however since it was covered by worker’s comp it was the best medical experience I’ve ever been part of.
At no point did we receive a bill for anything. At no point did a question of cost enter the picture. She was able to select who she wanted to go through for surgery and PT. And at every turn every decision was made based upon what was best medically for her recovery and rehab from the injury.
Now here’s the kicker, if she had experienced the same injury but in a way that wasn’t work related, her experience would have been completely different. We likely would have incurred low 5 figures in direct cost along the way and she would have had less choice in her care and lower quality care. (ex: worker’s comp often will approve payment for more PT sessions than your private insurer even though frequency of PT work for this injury has a proven correlation to the quality of outcome in recovery).
It’s purely on the basis of dumb luck that my wife received amazing care that has returned her to a place where you would never know she suffered the injury she did. We have the ability to provide this level of care to everyone and we don’t. I’ve known someone in my past who suffered an injury and went into work the next day and faked the injury happening at work so it would go under workers comp. I now understand why they did what they did, but that isn’t what our country’s healthcare system should reduce us to.
@Huehuecoyotl
This is probably true for very large employers like for example I heard Papa John’s opposed Obamacare because it would increase the price of pizzas approx $0.13. Small business upto about 100 employees almost certainly hate the hassle of running employee health insurance and would find the change neutral.
If anyone still isn’t sick of reading about how thoroughly fucked up the Iowa caucuses were, there’s a new NYT article.
Weeks later, in August, the national party cited security concerns when it vetoed the Iowa Democratic Party’s proposal to hold a “virtual caucus,” which would have allowed absentee participation by phone.
My God. Can you even fucking imagine.
Also:
Melissa Watson, the state party’s chief financial officer, who was in charge of the boiler room, did not know how to operate a Google spreadsheet application used to input data, Democratic officials later acknowledged.
First I’m all, who doesn’t know how to operate a spreadsheet? Then it’s, wait, the state party chief financial officer does not know how to operate a spreadsheet? lol?