Question about Obamacare

[Sbane]

*--People who make less than 250% of FPL, if they buy insurance on the exchange, get their copays and deductibles subsidized by the government in addition to their premiums.

In some states. Mine does not allow subsidies for people making less than 100% of the FPL.

Right. If you make less than 133% of FPL and your state doesn't expand Medicaid, you get nothing.  *facepalm*

Expect this to be a major issue in every governor election in the next few years.

I think the figure is 100% of the FPL from what I have read. I could be wrong though. They included the 100%-133% leeway because they knew some people wouldn't be sure of what their income would be, and if it went below 133% and they chose an exchange plan, they wouldn't get screwed. Of course they didn't account for the fact that Republicans are vindictive retards. Very unfortunate.

[Sbane]

When we talk about health insurance, we are actually conflating two different aspects of health care management. One aspect involves the risk management, the traditional role of insurance. This part of a plan involves the unlikely but costly need for medical procedures like surgeries and serious illnesses. The other aspect involves budget management where one might anticipate a certain number of medical expenses for wellness care and minor illnesses over the course of a year.

The different plans allow the user to balance these two aspects. A person who is willing and able to handle their own budget management can opt for bronze and just cover their risk. Another person who has more budget constraints or has a more uncertain budget might choose a higher level plan.

An analogy with car insurance would be a bronze level plan with liability coverage only meeting the state minimum mandate for coverage. The silver plan might add collision coverage to the liability, but still have a significant deductible. The gold plan then adds a maintenance contract on top of the regular insurance for collision and liability. The analogy is not exact, since all levels of the exchange health insurance include some "maintenance", but it gives the idea. A better analogy would involve setting coverage and deductibles for all three parts of car insurance then prepackaging them into only four choices.

That's the issue for me... why the hell should it be that complex?

I have a private health insurance supplement to cover things that our system doesn't cover (unless you're young or really hard up) such as dental and optical, but I also have it for private hospital.

BUT, I don't think my private insurance is anywhere near that complicated.

Benefit : you can claim up to $xxx in a 12 month period and you will get back xx% of what you paid. Oh and pre-existing conditions are covered after 12 months.

I get Muon's point, but you can't really compare traditional 'insurances' like car and house and contents - because most people will only call on them a few times in their life... but most people are sick or require some cost-related health activity on semi-regular basis.

Mind you, the issue has to be significant cost controls, that is where a huge whack of the problem comes from.

I agree with things like copays, and the countries with universal health coverage really should look into instituting them. It makes you think twice about accessing healthcare. When there is a limited supply, it makes sense to make sure only those who really need it are accessing it. If you are just a little sick, maybe you should wait it out a couple days and take some OTC medications before you go to the doctor. In many countries there is no incentive for people to wait. Of course there should be an out of pocket cap to make sure sick people don't get hurt by this. Obamacare has it too, but disturbingly, only for in network costs.

[Sbane]

For example - my GP charges $80 for a consultation and I get $36 back from Medicare.

One big reason for people going to the GP for less serious complaints is for medical certificates for work/school absences. The Federal Government passed a law two years ago to permit pharmacists to provide medical certificates for periods of no more than 2 days and they must be accepted by employers/schools.

Your point actually is more anecdotal, I don't know people who run to the doctor when they've got a cough or things that can be sorted out OTC or with rest.  The overwhelming majority of pay something in addition to their benefit. Granted, we're not on the same level as the UK... but even there, I don't know of anyone who has as lax an idea about seeing a doctor.

Hypochondriacs Polnut. And I hope I don't seem like an asshole, but sometimes people get a little too concerned about the kids. Especially if they want the day off from school.....

[Sbane]

For example - my GP charges $80 for a consultation and I get $36 back from Medicare.

One big reason for people going to the GP for less serious complaints is for medical certificates for work/school absences. The Federal Government passed a law two years ago to permit pharmacists to provide medical certificates for periods of no more than 2 days and they must be accepted by employers/schools.

Your point actually is more anecdotal, I don't know people who run to the doctor when they've got a cough or things that can be sorted out OTC or with rest.  The overwhelming majority of pay something in addition to their benefit. Granted, we're not on the same level as the UK... but even there, I don't know of anyone who has as lax an idea about seeing a doctor.

Hypochondriacs Polnut. And I hope I don't seem like an asshole, but sometimes people get a little too concerned about the kids. Especially if they want the day off from school.....

Is hypochondria really that big of an issue to structure health policy around them?

There is an overutilization of health resources, yes. People need to think twice about visiting the doctor.