And the Democrats Wonder Why They Lost the Election?

And the Democrats Wonder Why They Lost the Election?

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Now I have insurance. But I can’t use it. What am I supposed to do? I know this one is long but it’s worth a read if you want to understand issues pertinent to the Affordable Care Act. My personal story illustrates many of the problems with the ACA.

I started taking notes on the Health and Human Services Secretary hearing, and I will share more as I scrutinize the hearing in more detail but let’s start with the breakdowns below and my experience with Obamacare.  Here goes:

These are the breakdowns of who gets what coverage in the United States:

Medicare 18% – 52m

Employer 61% – 178m

Medicaid 22% – 62m

Individual 6% – 18m (exchanges cover 4% of the 6%–these are the people who have been forced onto the Obamacare plans)

Note: this writer is in the BOTTOM of the barrel here (Individual). Most of the individuals in the “Individual” category are either the upper contingent of the working poor, those who work for small businesses like restaurants or family owned grocery stores and the like that don’t provide health insurance benefits (more and more common these days), and/or sole proprietors like myself. Many health care providers are self employed hence we have been forced into the Obamacare exchanges if we are not high earners. High earners won’t buy on the marketplace and will purchase individual plans outside of the marketplace.

I find it interesting to note that the 22% who pay little into the system get better coverage than the 6% who actually work and pay taxes into the programs that support their health while much less is paid into the healthcare for those who work and earn between adjusted gross incomes of $23,540K (yes, exactly) and $45K per year. Adjusted gross income versus gross income are pertinent here but not necessary to go into detail about this at this point.

I have no objection to the poor being covered by Medicaid. However, I do find it OUTRAGEOUS that the United States is paying less for healthcare costs for those individuals who are actually working and paying into the system and making every attempt to rise above their circumstances. This seems to be shortsighted — at the least — as workers need to be kept healthy otherwise they wind up in the category of non-workers who will wind up on Medicaid anyway (or dead and then voila! They won’t cost the taxpayer a dime).

Before Obamacare came into existence, I had coverage through a New York State program (thankfully) that assisted sole proprietors. I paid for that program and at that time, I paid much more than anyone who had an employer-subsidized plan (a $400-$500 monthly premium was unheard of for an employer-subsidized plan but not for an individual plan; most of my clients on employer-subsidized plans did not pay anywhere near this amount for their plans monthly, at least not directly). I had Oxford Health Insurance and a decent network of doctors that I could visit a ten minute walk from my home through New York Presbyterian Hospital at 168th Street & Broadway (I live off of 181st Street). 

My benefits were more limited than employer-subsidized plans (for example, I did not get outpatient physical therapy, mental health, or post-surgical inpatient rehabilitation coverage). Without inpatient rehabilitation coverage, I was screwed when I had lumbar spinal fusion surgery (L4&L5 discs) in April of 2013. 

I was essentially partially crippled by an “equipment failure” and thus endured two surgeries within 48 hours. I was in bad shape and was recommended from two to four weeks of inpatient rehabilitation by the doctors. Because my insurance did not cover inpatient rehabilitation, I was sent home barely able to function. I managed for three years with little if no support from family (which is usually what socialized medicine counts on to plug in the gaps caused by nursing and other staff shortages). If one is alone and with no family support, one is essentially SOL.

I went to my first medical followup appointment alone. I could barely walk or stand. The doctor’s office found me on a bench across from the reception desk nearly passed out. That was my first visit to the doctor following major spine surgery — no help, no aid, no support. 

Then Obamacare came into being approximately 8 months later and my life became a shit-show. I lost every single one of my doctors whilst in the middle of this healthcare crisis. I still could not walk more than a quarter mile, I could not even drive my car, and I’d had to shut down my midtown office due to the fact that I couldn’t physically get there. I was unable to use buses and subways since I could not manage to go up and down stairs.

I had supported Obama’s vision of providing health insurance for all notwithstanding my doubts about government sponsored healthcare. However, had I known that I would be lied to (told I wouldn’t lose my doctors), been provided with the skinniest network of doctors imaginable, and that my local Democratic party representatives would not lift a finger to help me when I could not obtain care, I NEVER would have supported this plan.

I have known people who have compared my situation to their purchase of so-called COBRA plans (those are plans negotiated by employers with much larger networks than Obamacare plans). THERE IS NO COMPARISON BETWEEN AN OBAMACARE PLAN AND AN EMPLOYER-SPONSORED HEALTH PLAN. None whatsoever. 

First of all, the network of providers in Obamacare plans are — and I’m guestimating here but don’t think I’m far off — somewhere between 10-20% of the size of the network of employer-sponsored plans. Not only did I lose ALL of my doctors, the ten minute walk to my previous medical doctors’ offices became 45 minutes to 1-1/2 hours of travel to get to whatever new providers I was able to find.

I have yet to replace all of the doctors I lost. When you rip the rug out from under a sick individual by taking away all of her doctors, she is not physically capable of replacing those doctors (particularly when travel to those new doctors’ offices is near impossible and is time-consuming). Yesterday, I traveled 1-1/4 hours to get to my endocrinologist’s office from my home in Washington Heights to 59th and Park Avenue. Theoretically that trip should have taken less time however trains were slow yesterday and so a minimum of a 45 minute trip took half an hour longer. 

How would I have been able to make this trip when I couldn’t walk? I couldn’t get to the midtown area in New York City for at least ONE YEAR. How was I to manage with no support at all? 

Now, this is where left-wing Democrats start explaining to me that some people will “fall through the cracks.” The people who say this aren’t usually the people who do the falling so they are more than content to watch others fall. 

It was egregious enough that the President I voted for betrayed me by lying to the public about the costs of these plans (my premium costs were $600 per month with the government subsidy covering roughly a quarter of that cost; my copays and medication costs were anywhere between $100-$200 per month). I met my out-of-pocket limit of $2000 which means I spent an additional $167 per month for my medical costs. This adds up to $767 per month – roughly a $150 subsidy for a network that initially didn’t even exist because BCBS had not even completed its contracts with providers, and then when it did exist, it was so thin to be practically negligible.

The only providers in my neighborhood in Washington Heights that take Obamacare policies are doctors you would not send your children to much less yourself.

I was offered “assistance” by a local church whose prayer leader met with me. The assistance she provided was a piece of paper. It was a copy of the New York State of Health’s Official Healthplan Marketplace. She could not understand why, a few months before the Obamacare plans went into effect, I was worried about losing my doctors. She thought I should “wait” until it actually happened to be concerned. This was the “help” offered me by the local Liberal-oriented church. It was more than my local congressman or senator’s office would do.

When I called my local congressman’s office to complain that I could not access care in January of 2014 because I had no insurance identification and the insurance company did NOT ANSWER THEIR PHONES for three weeks (!!!), I was told that they had no power to do anything about a “private” insurance plan. I said, “Private? I bought this policy on a New York State government website! Private? Are you kidding me?” They maintained this position and essentially blew me off.

When I attempted to find information on the internet and essentially just said “I’ve lost my doctors, does anyone have any ideas as to what I should do,” I was viciously attacked by Democrats who assumed that this sick person without any medical care was a closet Conservative attempting to knock the Affordable Care Act. I was accused of presenting a false story in the guise of a Conservative-hater of the ACA, and it was also suggested that I had a mental health disorder. 

And the Democrats wonder why they lost this last election. This is what’s called willful ignorance and I direct my fury at the party that I was loyal to and that betrayed me. The Democrats have betrayed all of us and now we get this racist, misogynistic moron in place of probably the best president we have had in generations. Democrats, he couldn’t do it alone.

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23 Comments on "And the Democrats Wonder Why They Lost the Election?"


Member
Feb 7, 2017

Our focus for the last 50+ years on curative solutions rather than preventative solutions has resulted in the “sickcare” system we suffer under today.

A combination of 1) Membership medicine (Direct Primary Care) 2) high-deductible catastrophic insurance 3) expanded availability of HSAs 4) price transparency and 5) product transparency will finally get is headed back towards a true healthcare system. It will restore the physician/patient relationship, put the choice of services back in the hands of the consumer, lower cost of care both at the primary care level as well as downstream cost (due to earlier diagnosis of potential problems), provide easier access (via secure text, email and asynchronous video) and remove government and insurance intermediation, which affects both providers and patients.

Member
Peter
Feb 7, 2017

“and remove government and insurance intermediation”

WOW! Just how will that happen?

Member
Steve2
Jan 27, 2017

“THERE IS NO COMPARISON BETWEEN AN OBAMACARE PLAN AND AN EMPLOYER-SPONSORED HEALTH PLAN.”

Stuff like this intrigues me. Employee plans vary quite widely. Ours is pretty good. A survey of my employees, family and friends found employers that offer no insurance, mini-med plans that provided a set number of dollars of coverage ($5000 for my sister in law, so your out of pocket for your 2 back surgeries with that plan would have been over $100,000) and a number of high deductible plans where the employee contribution was large. An example would be the guy I hired who had an HSA/catastrophic plan with no employer contribution and IIRC about a $4000 deductible. The employee contribution was about $400/month (family plan). I am unsure why some people think all employer based health plans are necessarily good plans, or even very cheap.

Steve

Member
Steve2
Jan 30, 2017

In a recent Health Affairs study, researchers from CHOP’s Policy Lab used Medical Expenditure Panel Survey data from 2008 through 2013 to look at levels of insurance for children from various sources over that time. They tracked the coverage rates of low and moderate income families where one or more parents were offered employer-sponsored health insurance (ESI).

Over this time period, they found that in families where parents were covered by ESI, the percentage of kids who were not covered by that insurance increased from 22.5% in 2008 to 25.0% in 2013. The percentage of such children who were covered by Medicaid or CHIP also increased from 12.1% to 15.2%. In other words, in families where parents were covered by job-offered private insurance, more and more of their kids were being covered by public insurance.

Member
gvenkat
Jan 27, 2017

First of all Allison – as a physician – let me start by saying this was horribly tragic. There is no excuse for Democrats (or anyone) dismissing your legitimate complaints. But, that said I think (and I was a Republican-leaning surgeon) what Obama attempted to do was noble. The solution is to repair and make sure that folks like yourself are covered, not abandon you wholesale by repealing it. The ACA was imperfect – a lot of middle class, healthy beneficiaries fell into the black hole (A colleague of mine spent $20000 in premiums and had a $8000 deductible). I know plenty of people who voted for Trump because of this very reason….as the father of two young daughters I could not bring myself to vote for him but I understand the rationale for doing so.

Admin
Jan 27, 2017

I agree–it was terrible that this happened to Allison. But the rational alternative of Medicare for all covering all doctors was denied Americans over 55 directly by Joe Lieberman. The ACA was the least bad option that could be got through a Senate dominated by right wing Democrats like Nelson, Baucus & Lieberman. And yes the implementation was a shit show, but again that was because of tooth and nail opposition from the Republicans who ran Congress after 2011, and the fear of the Obama administration that doing anything to highlight it would cost them the 2012 election. I hope for the sake of people like Allison that Trump does something better, but realistically you know it’s going to be worse.

Member
[email protected]
Jan 27, 2017

I hear you, Matthew, however that does NOT justify the treatment that I received at the hands of Democrats and the complete and total lack of care and sensitivity shown to me. I accept that the implementation was, as you call it, a “shit show.” What I do NOT accept is that my own party discarded me as a human being and when they could have lifted their pinkies to help me, they refused. Much of this was a knee jerk reaction to perceived criticism (that I was not making — I was simply desperate and asking for assistance).

I am better now thank goodness but that’s no thanks to the party I departed from as a result of their despicable behavior (and their lies about the problems that continue to this day). I can now be counted among the disillusioned. I didn’t vote for our new King either; couldn’t bring myself to do that.

But when I voted for Clinton, it was not without much fear — fear that the difficulties that I face as a single woman and a sole proprietor making a much less than ideal income in one of the most expensive cities in this country would once again go unheeded, unheard, and unseen (despite how clearly vociferous I can be).

Member
Allan
Jan 27, 2017

Don’t blame the Republicans for the PPACA and how bad it is. That was passed by a Democratic Congress, Senate and President. That means the Democrats had total leeway to pass what they wished. Too many on the extreme left wanted their ideological dream realized rather than to make sure all Americans could get good health care at an affordable price. They took an unproven idea and made the entire nation suffer.

Admin
Jan 27, 2017

I was unaware Nelson, Baucus & Lieberman were Republicans. The point is that Obama left it to right wing Democrats to structure the ACA in an effort to get bipartisan support. Which in the end amounted to one vote in committee from Snowe in the Senate and one vote in the house. Everyone, especially Allison, would be better off with medicare for all, or at the least a buy in to standard Medicare for those over 50. Stopped by Lieberman. There is NOTHING extreme left about Obamacare. Its a Republican idea from 1993 and the ONLY reason the Republicans oppose it is because it came from Obama.

Member
Allan
Jan 27, 2017

What you are saying is that those three Democrats couldn’t be bribed enough to pass something futher to the left and more onerous. Even Harry Reid asked for state waivers. The Democrats were pushed hard by their leadership to let this piece of cr-p pass, but their guts are yellow and blinded by their wishes to be reelected and to please their masters. The bill was passed despite the fact that all the things that pulled it down were written about before passage where what would happen was accurately predicted. Face it. The bill was stupid, the passage non democratic and its implementation was totally flawed. Dumb leftist Ideology will be placed on the ACA’s death certificate.

I won’t defend the Republicans, but the ideas behind the ACA were not conservative ideas whether or not some conservatives agree with them.

You like Medicare for all, which would be fine if only the supporters of Medicare for all fixed the Medicare program something they have failed to do in ~50 years. Those supporters also have to take a course in economics so if they ever get to pass Medicare for all it doesn’t end up as Medicaid for all and spiral downward from there.

You want the same thing as I do, but I have economics on my side along with history..

Member
Peter
Jan 27, 2017

Is Mr. Bowles complaining he wasn’t getting enough government subsidies to pay his insurance? I wonder what he thinks about those, prior to ACA on the individual market, who weren’t getting any subsidies to buy coverage – and were working and paying taxes. When on the state subsidy plan did he also get to deduct premiums from his taxes, cause when I was paying for insurance on the individual market I got no help from anyone.

I hope he’s happy with the subsidies (and coverage) that are coming from Trump and Repugs to cover his medical care. From what they’re saying he’ll pay less, for better coverage – and no narrow networks.

There’s more information needed here.

Member
[email protected]
Jan 27, 2017

Peter, darling, Mr. Bowles is not a mister! Allison (even though John Irvine spelled it incorrectly he has promised to fix it — “Alison”) is a woman’s name. If you couldn’t get that right, I can see how you didn’t get anything else right either. I could give you more information — and will – but if you can’t even get my gender right, I wonder if you’ll understand it.

Member
Jan 28, 2017

Alison, I had the same difficulty with Peter. He refers to me as a male also. Don’t be too offended if THCB does not correct the spelling of your name… it is a common issue for me. So far, they are on four variations and still counting… Nir, Nina, al-Agba, and Al-Agbra 🙂 (Sorry THCB) Keep writing, the most effective way for us to repair this mess is for physicians and patients working together in collaboration to bring about change. Best wishes…

Member
Peter
Jan 27, 2017

“If you couldn’t get that right, I can see how you didn’t get anything else right either.”

Sorry for the error, but I get most things right. So tell us exactly what benefits were in your state subsidized policy that made it so cheap? No pre-exist exclusion, no caps, networks, wellness, etc?

Sorry also if I don’t easily jump on board the, “I feel sorry for you bandwagon”, I’ve learned to get all the information first and have heard all sorts of terrible stories from people with no coverage pre-ACA. Yes, the health care system is an expensive mess, but at least Obamacare made an attempt, over much lobbying by opposing forces, especially the insurance industry, to get a start. It can be fixed, but maybe you’ll find the Trump/Republican “alternate math” repeal/replace easier to use.

Many people on Obamacare have had their health care disasters covered. And I agree that the subsidy qualifications are too narrow. The real alternative is Medicare for all single-pay with price controls 300 million in the risk pool – but Americans seem to want to hold on to dreams of private insurance fixing this. It ain’t going to happen.

Member
[email protected]
Jan 28, 2017

I had to think about responding to these rather malicious posts but I decided to do so for the benefit of others since a good deal of misinformation was evident to me.

For someone who claims NOT to miss much, you most certainly did (and the article is still posted up above for you to re-read two or three times if you need to). First of all, the state subsidized policy was not necessarily cheap because it had limited benefits although that probably was a factor; it was cheap because someone in New York State, clearly not MY local representatives, decided to try to close the gap between the poor already covered by Medicaid, and the working poor and lower income sole proprietors who were having difficulty affording the minimum $1500 per month policies that were available on the individual market. Since most of those individuals were obtaining care at the public hospitals, my guess is that New York State decided that it would be cheaper to try to cover some people and actually get them to pay SOMETHING for that coverage while at the same time benefiting the state hospital system. I have no issue with paying for my healthcare costs in principal.

It is true that the cheapest of policies in New York State other than the Healthy New York policy that I had were quite expensive. I’ve not debated that point, and I believe I also pointed out that I had supported Obamacare. The cheapest, crappiest policy I could find from a reputable insurer (e.g., Cigna) was at least $1500. I cannot recall what year I priced that policy but it was well before the ACA.

I’m not entirely clear as to the point of your statement about benefits that were not available in the state subsidized plan. As such, I cannot clearly answer that issue other than to say that there were indeed certain benefits available to most individuals on government and employer-sponsored plans that were not available to me. As I had mentioned above, benefits like outpatient mental health and physical therapy were unavailable. I probably did not get the variety of prescription drugs that others got either on employer-subsidized plans or government-sponsored plans. Indeed, the patients I treated at the inner city mental health clinics were able to see me, a psychotherapist, and they also were able to obtain physical therapy. They were able to secure medications I was unable to obtain.

By the way, you seem to be implying that I didn’t work or that at some point I went without insurance. Neither is the case. I always worked and I purchased insurance from the time I was roughly 21 years of age. There is NO difference between you and me my friend in that regard. I have worked since 13 years of age.

Unlike many of today’s young people who seem to believe that they shouldn’t have to buy health insurance until they get sick — which defies the purpose of health insurance altogether — I always had a high deductible plan in the event I became ill. This was back in the 80s and 90s and was relatively affordable at that time (I think I paid about $80 a month for my policy). In fact, you appear to impugning my character on many levels and I’m not clear why. What is your motive here? I had a tough time due to Obamacare changes; why does that bother you so? Why do you become hostile when you learn of those difficulties? Isn’t this information, if you support the ACA, you want to know so that you can, indeed, be a part of the “fix” so to speak?

If you’re sorry for the error regarding my gender, help me to understand how you made that error. My name is “Alison.” It’s clearly female. If you were paying attention to details and really wanted information, how did you miss something as basic as that? It appears that you didn’t read the article very closely or you would have noticed I’m not a man. I am indeed speculating but with good reasons it seems that you read the article rather quickly, drew immediate contrary and hostile conclusions, and went for the jugular for those reasons. I don’t really understand your motives for doing so.

Did you not notice that I said I had supported Obamacare? Did you not notice that my complaint was not that there was a mess per se but that my local representatives who could have helped me refused to? Had they helped me — as is their job — I wouldn’t have been in the mess I was in. Had Obama not been quite so slick about the issue of people losing doctors, perhaps somebody with a brain would have figured out that a transition period could have been placed into effect so that people would have time to replace at least their most important doctors.

And the exchanges certainly could have been set up to give more assistance to those who were ill and who had lost doctors rather than just leaving them flapping in the wind. My criticism is not necessarily of Obamacare as you appear to believe but of the rollout, of the problems, the lack of attention to the problems, and the hostility of people like you that is rather inexplicable to me.

You appear to believe that I am inherently opposed to Obamacare and this also appears to make you angry. You then address me as a man and you imply that I am looking for the audience to “jump aboard the ‘I feel sorry for you bandwagon'” as you so rudely put it, and you don’t seem to understand that there were problems, and that these problems alienated voters from the Democratic party. And in fact, it is attitudes like yours that have ushered a good deal of Americans into the arms of the likes of Donald Trump. Your lack of empathy in the face of any person’s difficulty accessing healthcare is puzzling to me.

I don’t expect Republicans to come up with a better solution. They never appeared to care enough to come up with anything prior to the ACA or after. Yet, the problems with Obamacare are significant and cannot be underestimated if it is to be corrected. Low cost premiums for high deductible plans are NOT low cost, and this was deliberately misleading because anyone with a brain who can do math would figure out that if one actually had to use a high deductible plan, the actual monthly costs (if one takes the total deductible say of $3000 and spreads it out over 12 months) are significantly higher than advertised. If I buy — and have to use — a $100 a month plan (figure that cost with the government subsidy included) and my deductible is $5000, then the actual monthly cost is 5,000 divided by 12 months or $416.67 plus the $100 premium (and only the premium applies to the tax credit).

THAT’S NOT CHEAP and never was. It was a lie that these policies were ever cheap. I will give you that they were CHEAPER than the marketplace plans, but a monthly cost of $500-$800 a month for a working class individual is just as much out of reach as a $1500-$1800 a month plan. This makes me wonder if the Democrats knew all along that many people would not be able to figure this out because basic math is not that easy for a lot of people, and understanding what these terms actually refer to (i.e., copays, deductibles, out of pocket limits, coinsurance, networks, allowed amounts, in-network vs out-of-network, etc., etc.) is incredibly difficult for the majority of individuals.

Do you have to take such a tone with someone who challenges something you believe? Why? This is what I don’t understand. I can more easily speak with a Trump supporter about these kinds of issues because if they find I’m open to their complaints, they’re usually open to mine. You, on the other hand, seem to need to vilify me and imply that I am looking for sympathy rather than learning something, perhaps a lot of things, things I personally believe important for the American public to digest.

My friend, I am alive and well and thriving despite Obamacare, despite a serious bus accident in 2005, despite four herniated discs in 2010, despite a two-level spinal fusion in 2013, and an equipment failure that almost crippled me, and then 3-1/2 years from April 2013 to November 2016 on massive doses of painkillers that almost killed me. In sum, ten fucking horrible years of back pain that leave me, now recovered, wondering how I lived in the cave that was my body for those ten years and still managed to maintain some semblance of a practice and actually feed myself! I am alive and well despite the fact that ten years of my life was taken from me, and that I was in that hell. I do not blame the ACA or President Obama for that misfortune. I need not your sympathy. Do not shed crocodile tears for me.

Please don’t worry for me. If you can’t tell by now, as the terminator said, “I’ll be back,” and I AM BACK. I believe now you ought to know what you can do with whatever purported empathy or sympathy you could manage to muster.

And by the way, let’s not be deceptive here. If you were buying insurance on the individual market, recheck your tax returns. You were able to deduct the cost of those premiums from your gross income thereby reducing your adjusted gross income and thus reducing your overall tax burden. I am a sole proprietor who does her own taxes; I happen to know the forms it appears better than you do. You seem to have missed your own tax benefit from the purchase of your health insurance on the individual market. Perhaps you’ll feel less sorry for yourself when you realize that.

Member
Peter
Jan 28, 2017

Your title, “And The Democrats Wonder Why They Lost The Election” was incendiary and ill informed. And as I read your post, is why Trump supporters are delusional denialists, on healthcare and everything else.

People receiving subsidies on the ACA actually like it. You did not get a subsidy, like most employer sponsored plans, and certainly like Medicare. Subsidies are the only way most people in America can afford health insurance.

The state plan was cheaper than the ACA because it had limited benefits and you were subsidized by the state to buy private insurance. The math involved in pricing insurance is based on actuarial calculations and the makeup of the risk pool. The ACA is insurance based plans with subsidies that set a minimum standard for coverage.

The subsidy determinations (along with a weak mandate) in the ACA are it’s weakest features. The risk pools do not contain enough young healthies to offset those sick people, who had no opportunity to be covered before the ACA, who signed up. Another big weakness of the ACA was the stipulation that if your spouse had employer coverage you could not get subsidized ACA coverage. Most employer plans make it extremely expensive for family spouses to get covered. The mandate was waived on that shortly after it became an issue.

So you wanted an ACA plan as cheap as the state plan, but with the richness of the ACA benefits and low deductibles – not going to happen – EVER, with lying Trump or any other politician who wants to keep a private, segregated risk pool, insurance based system, and no price controls or mandate.

So yes, you had terrible luck with your health, and you picked a low pay profession where you could not get employer subsidized insurance – I get that – as did the millions of other non-insured Americans who made bad choices. But unloading on the Democrats, because they somehow did not give you the perfect health plan, is expecting much more from this dysfunctional monied system (political & health) than it will ever be able to give you. And that great cheap plan you had was a result of a Democratic state that did not vote Trump.

The ACA could (can) have been fixed (to a point) if Republicans had not played pure dishonest politics with their refusal to fix it (even after getting congressional control) and their focus on repeal. Republicans have learned the art of wedge issues which take advantage of pure voter ignorance to split the vote.

So get ready for that rabbit-out-of-the-hat cheap premium, low deductible, rich benefits plan that Trump says he can deliver for the individual market. Maybe then you’ll find your promised land.

Member
[email protected]
Jan 30, 2017

Again, you make assertions that are unfounded and assumptions (and you know what assumptions do to you).

Are you assuming that I am a Trump supporter? IF you are, then once again, I refer you to the original article and ask that you reread it because clearly you need to read things a few times to understand them.

The state plan was NOT cheaper than the ACA. In 2014, if would have been exactly the SAME cost to me personally. You did not see me complain about the costs of my premiums either on the state plan or the ACA. I managed. However, individuals who make $25K annually would get ABOUT THE SAME SUBSIDY as I received and THEY would NOT have been able to afford the ACA plan. Thus they would have to purchase a high deductible plan and hence their expenses still would have been about the same as mine — even though there’s no way anyone in New York City making $25K could afford that.

Let’s agree that the “subsidy determinations (along with a weak mandate) in the ACA are it’s weakest features.” We can agree on that. And “young healthies” as you put it appear to think that actually having to pay in is somehow unfair until they wind up in the hospital. You and I are in a position to educate young people as to their own personal responsibilities as it pertains to their healthcare (e.g., they should willing to pay something for it).

My so-called “low pay profession” that you imply was a “bad choice” presents a rather puzzling notion. Would you prefer that we have no psychotherapists to deal with the shortage of mental health care providers in large swathes of the country? Because you’re essentially telling me that my desire to assist those with mental health problems was a “bad decision” and that when my country placed me in a position where I couldn’t do so — when it really wouldn’t have been that hard to help out (pay attention Adriano Espaillat!!!), it was all a result of my personal irresponsibility despite the fact that you’ve been told that I paid for my own health insurance since I was in my early 20s. I am now 53 years old and still have no issue with paying my share and continue to do so.

You assert that I did not get subsidies and that I was unhappy with those subsidies. Not true. Not true at all. Where do you see that in the original article? Please point that out to me.

As I can recall from what I wrote, there is NO complaint from me about the subsidies OR the cost of the insurance for me personally. I was fine with paying for my insurance and during the first year I paid roughly $500 give or take $50 (with a subsidy from the state of about $200 give or take the same amount). That was not an unreasonable sum of money to pay although I will acknowledge it was difficult when I was beginning a new career and was also ill. The state policy was going to be about that expensive that year anyway (I was probably paying about $425 for it in 2013). So, I got a policy through the ACA that covered MORE and was about of money. Lucky me, right? Only Blue Cross had NO PROVIDERS whatsoever. They hadn’t even completed the contracting with providers when they’d had at least three years to do so. And they didn’t answer their telephone for a three-week period in 2014. And they provided no insurance identification cards so no one who had purchased the insurance could actually utilize it because providers could not even verify who was covered. And the New York State of Health was useless in regard to this problem (when they simply could have provided individuals like myself with letters to give to providers confirming that we were covered). In fact, NYSofHealth recently bumped me off my coverage due to a computer glitch in November, and they couldn’t immediately fix it. So I couldn’t see any doctors in November because they didn’t get around to actually fixing the problem until — wait for it — November 30th!!!!

Impressive display of competence, wouldn’t you agree?

You keep missing the point: the ROLLOUT was the problem, the way it was done, the inattention of local Democrats to the problems with the rollout due to their hostility to anyone that they perceived to be opposed to the ACA, even if that anyone WASN’T opposed to the ACA in principle, and their refusal to acknowledge that a significant percentage of our population is having to empty their retirement accounts to pay for health insurance (this happened to my cousin in New Jersey when he lost his job at 62 years of age due to agism and the fact that bladder cancer was not convenient to his employer). Our politicians are well covered and their inattention to those who are bankrupted by their policies is the issue, NOT the ACA. I like a lot about the ACA.

I reiterate that I am not looking for that “rabbit-out-of-the-hat cheap premium.” You have asserted this with no basis in fact which appears to be a bad habit of yours.

Habits can change. Are you willing, Ms. Peter?

Member
pjnelson
Jan 27, 2017

I join Niran to say thank-you for the effort to report your healthcare disaster. I spent a year at 135 and Lenox for part of my training. I probably understand, a bit more than most people, what travel is like in Manhattan. Best Wishes.

Member
[email protected]
Jan 30, 2017

Thank you, PJ. What was your training?

Member
William Palmer MD
Jan 27, 2017

Thanks for this poignant story. It makes me want to help you.

When I started practice, docs would spend a half day a week giving pro bono services. I used to go to Cowell Hospital, the student hospital at UC Berkeley. Then, a law was passed–or a fed regulation came down–in California: “Thou shall not perform any service for a lower charge than you charge MediCal”. That was the end of this altruistic culture that had probably gone on for fifty plus years.

Can’t you imagine the mind of the young attorney writing this reg: “Why shouldn’t Medicaid be given the cheapest services around? After all, the taxpayers deserve this.”

Lawmakers (and everyone else) cannot imagine all the unintended consequences of their legislation.

Member
[email protected]
Jan 27, 2017

Dr. Palmer, you are indeed the kind of medical practitioner we need and who has been hammered by the American medical system (I blame both parties for this). I believe it was Shakespeare who said ‘The first thing we do, let’s kill all the lawyers” (through Dick the Butcher in ”Henry VI,” Part II, act IV, Scene II, Line 73). Your comment made me think of that oft-repeated line particularly in light of Trump’s mouthpieces who apparently think the rest of us are a bunch of morons and don’t actually understand the English language. I could get more potty-mouth here but I’ve gotten into trouble for it so I will refrain (although I imagine Bill Maher would pardon me).

As a psychotherapist, when my patients lose their health insurance through a job loss, I have the freedom to continue to treat them and I do FOR FREE! I ask that they act responsibly in attempting to rectify the situation, but I do not walk away from them. Eventually, when their healthcare provider has supported them and helped to lift them up, they do rectify the situation and then again I am paid. The bond that is created through this kind of professional relationship is pretty much unbreakable.

Ah, the good old days when the country doctor came to your home and if you couldn’t pay, he’d take a pig instead! 😉

Member
Jan 26, 2017

Thank you for telling the real story of the ACA. There are so many where I live suffering the same way. Healthcare reform needs physicians and patients banding together to make a difference. Do not give up!

Member
[email protected]
Jan 30, 2017