Question about Obamacare

[Tender Branson]

So, I didn't spend too much time following US politics in the last months because of the Austrian and German elections, but recently I read an article that the Obamacare website was launched and broke down right after it started (which is bad, because the people behind it could have known that millions will hit the page within a few hours after the start and the US has one of the best IT people out there who could have tested the page before the start ...)

But that's not what I'm interested in really:

After looking through those "marketplaces" (weird for an Austrian who has the evil socialist health insurance) where you can "shop" for individual "plans", I was reading something about "Bronze" plans, "Silver" plans, "Gold" plans and whatever other metal there was.

So, if you earn only a little each month and want the basic "Bronze" plan, you have some basic stuff/care included ? Are frequent surgeries included as well, because that's not what I found in the "10 essential care things" in the bronze plan.

I've also read that even though you HAVE a bronze plan, you still need to pay 40-100$ all the time you visit a doctor ? WTF ?

Can anyone explain this to an Austrian with an evil socialist health insurance where you don't have to pay anything to go and see a doctor or for repeated surgeries ?

I've also read that there are high "out of pocket costs" if you only have the "bronze" plan, while paying a lower share of monthly premiums (but still about 50-200$ a month).

Yet when you have a "platinum" plam, you have almost no "out of pocket costs" - but pay higher premiums.

If you already pay a monthly premium of 50-200$ a month on health insurance, why would you still have to pay ridiculously high amounts of "out of pocket costs" ?

How is that fair ?

Wouldn't it be better if everyone gets the same health care services (and by same I mean all), no matter if you pay a health insurance premium of 100$ a month or 500$ a month ?

...

Well, in the case of the US I guess it's a start for the 50 Mio. or so without insurance and better than nothing.

[Tender Branson]

Interesting.

A fee just to see the doctor has never existed here. But some form of it was introduced for the first time by our conservative/nationalist ÖVP-FPÖ government in 2001, but was scrapped after just 2 years because of massive criticism. The "outpatient center" fee (around 10$ per visit) was considered a burden on low-paid members of the society such as single mothers who work part-time and discouraged them to see a doctor, which led to the opposition calling it asocial. In the end, the Constitutional Court voted to scrap them.

Since 2004 again, every medical visit here is free of charge again (doesn't matter if you visit your personal doctor, or the outpatient center).

Not only that, the state health care carriers are also running surpluses each year.

That doesn't mean problems like crowded outpatient centers do not exist here: There have been reports in Vienna for example that outpatient centers are often full on weekends, because people don't want to wait until Monday to check their problems (the overwhelming majority - like 90% - of Austrian GPs are not open on Friday afternoon/Saturdays/Sundays).

In the meantime, this has been mostly solved with a combination of an information campaign by the doctors chamber/union that people should only visit if they have a serious problem and not because of a simple cold etc. and by requiring more doctors to open on weekends.

In general, it can be discussed to introduce a small fee of let's say 1-5$ to see a doctor, but certain segments of the society should be exempt: low-income persons, minimum-pension-receivers, unemployed persons, people on welfare, students, etc.

I'm generally against a level- or "metal"-based "car insurance like" health care system like Obamacare offers, because a life is not comparable with a car that can be bought again when it's fully damaged.

The SAME health care services must be available to ALL people, no matter if they are low-income or if they earn 1 Mio. € a year. Otherwise you are creating a class-based system in which, using a famous quote, "all people are equal, but some people are more equal than others".

Because I would be interested in what happens in the Obamacare system, if you are a low-income receiver and apply for a Bronze plan and get cancer ? Do you get the same care as someone with a Platinum plan ? Or do you have to pay more OOP costs than the other, if you need a ton of radiation sessions, chemo sessions, surgeries, therapy etc. ?

Don't you think a system like this is strange and "asocial" ?

[Tender Branson]

Because I would be interested in what happens in the Obamacare system, if you are a low-income receiver and apply for a Bronze plan and get cancer ? Do you get the same care as someone with a Platinum plan ? Or do you have to pay more OOP costs than the other, if you need a ton of radiation sessions, chemo sessions, surgeries, therapy etc. ?

One aspect of Obamacare is that your OOP costs are limited to $6350 a year.  After that, the insurance company picks up everything.  So if you have a bronze plan and you get cancer, you won't end up paying more than $6350 for it.

The problem is that people who would not be able to afford $6350 are the people most likely to pick a bronze plan, because of the lower premiums.  I wish the law included a provision that you can't purchase a plan unless you prove you would be able to pay the OOP maximum, but it does not.

Preferably change the law in a way that people (especially those low-income ones with a Bronze plan) do not have to pay any OOP costs after treatments. Especially not more than 6000$ ... WTF ?

But that would require a Democratic supermajority in Congress and a will to do it (stand up against the Insurance companies). So, no chance in hell.

[Tender Branson]

There is really no difference on which doctors you have access to between the bronze, silver, gold or platinum plans for a given health insurer.  The only difference is the cost sharing when using health care services.  But as pointed out before there is a cap on that cost as well even if one were to go with a bronze plan.

But lets be clear, the plans offered on Obamacare exchange will pay doctors differently from a Medicad, Medicare and company sponsored health insurance.  
On the whole, company sponsored health insurance plans will pay doctors the most so the access to doctors will be the best under these plans.  After that would be Medicare which starting with Obamacare will pay less to doctors so the number of doctors what will take Medicare will start to shrink.  Right behind that would be the Obamacare health exchange plans.  And the worst payment to doctors would be Medicad.  Doctors would often refuse patients on Medicad because they would be treating them for a loss.  The same would also take place but to lesser extent for the Obamacare exchange plans as well as.

Many doctors are now refusing to take new Medicare patients too, so I think that would be less access than the exchange programs.

Tender, how are the state health carriers running surpluses? Who is paying them?

I'm talking about our health carriers, not US ones:

http://www.statistik.at/web_en/statistics/Public_finance_taxes/maastricht_edp_indicators/government_deficit/052873.html

They are running surpluses for years now. They are funded by the social security contributions by each worker/retiree. Social security contributions are automatically deducted from the gross wage you earn and the more you earn, the higher the social security contributions. Social security contributions in Austria means A) health insurance B) pension insurance C) work-related accident and recovery insurance and D) unemployment insurance.

[Tender Branson]

Interesting.

A fee just to see the doctor has never existed here. But some form of it was introduced for the first time by our conservative/nationalist ÖVP-FPÖ government in 2001, but was scrapped after just 2 years because of massive criticism. The "outpatient center" fee (around 10$ per visit) was considered a burden on low-paid members of the society such as single mothers who work part-time and discouraged them to see a doctor, which led to the opposition calling it asocial. In the end, the Constitutional Court voted to scrap them.

Since 2004 again, every medical visit here is free of charge again (doesn't matter if you visit your personal doctor, or the outpatient center).

Not only that, the state health care carriers are also running surpluses each year.

That doesn't mean problems like crowded outpatient centers do not exist here: There have been reports in Vienna for example that outpatient centers are often full on weekends, because people don't want to wait until Monday to check their problems (the overwhelming majority - like 90% - of Austrian GPs are not open on Friday afternoon/Saturdays/Sundays).

In the meantime, this has been mostly solved with a combination of an information campaign by the doctors chamber/union that people should only visit if they have a serious problem and not because of a simple cold etc. and by requiring more doctors to open on weekends.

In general, it can be discussed to introduce a small fee of let's say 1-5$ to see a doctor, but certain segments of the society should be exempt: low-income persons, minimum-pension-receivers, unemployed persons, people on welfare, students, etc.

I'm generally against a level- or "metal"-based "car insurance like" health care system like Obamacare offers, because a life is not comparable with a car that can be bought again when it's fully damaged.

The SAME health care services must be available to ALL people, no matter if they are low-income or if they earn 1 Mio. € a year. Otherwise you are creating a class-based system in which, using a famous quote, "all people are equal, but some people are more equal than others".

Because I would be interested in what happens in the Obamacare system, if you are a low-income receiver and apply for a Bronze plan and get cancer ? Do you get the same care as someone with a Platinum plan ? Or do you have to pay more OOP costs than the other, if you need a ton of radiation sessions, chemo sessions, surgeries, therapy etc. ?

Don't you think a system like this is strange and "asocial" ?

Are the doctors/union a abiding subservient of the rules as you?

Generally not, but in a smaller country like Austria it's much easier to find compromises and not drag out issues so that there is no action. The unions and the government usually always find a way that is acceptable for the doctors and the patients.