After great expectations over Obamacare, we are in a worse position than before. Many of those who held individual health insurance policies found their policies were being cancelled. Millions of those with group health coverage are being told theirs may also be cancelled. All this despite promises that they would be able to keep their existing coverage and their current doctors.
For those not familiar with the concept of “out of network,” if your insurance plan does not list your doctor as a “preferred provider” payment of claims will be limited. Your share of the cost goes up. For those with chronic health issues, getting used to another doctor may be difficult. There is also a difference in the way a doctor will treat a chronic health condition. If you watch any of those tv ads for medications, you are probaby fully aware of possible side effects. As a result, doctors are careful when prescribing drugs. If your condition is mild, they choose something that also is mild. If your condition is more serious, strongere drugs are used. Monitoring the patient for any changes is an ongoing process. Switching doctors could mask those changes until serious damage is done to the patient.
There is also the increase in insurance costs. When an insurance company issues a health insurance policy, part of the premium payment goes into reserves. This assures that there is money available to pay claims, even when premium payments are late. An insurance company also allocates some of that premium payment to a fund called “incurred but not reported.” This is to cover those claims that might not have been paid during the policy year when the treatment took place. There could be any number of reasons why a claim has not been presented. Sometimes treatment is delayed because damage is not recognized at the time. Consider students who play in sports. What seems like a minor head bump could be a slow brain leak that is not discovered till a year or two later.
A factor that is not considered is the lack of predictability for certain events. Several insurance companies went belly up during the beginning of the AIDS outbreak. They based their marketing efforts on what they perceived to be low risk occupations such as florists, interior designers, hair dressers and the like. Serious flu mutations cannot be predicted either. A strain that has a higher than normal mortality rate should not be laughed at. Each such event helps the actuary plan in advance.
There is a presumption that folks who are not insured do not see the doctor unless the problem becomes serious. For some health problems, waiting can cause the condition to become worse so that the cost for treatment is greater. This is seen in patients suffering from cancer. By the time some of them see the doctor, the stage has gone up. The survival rate for the later stages is not as good as it is when caught early. But, if you do not have insurance, you may not have that colonoscopy recommended after certain ages or under certain conditions. The same goes for mammograms and pap smears.
There is also the new requirement that certain procedures or services be free to the consumer. A lot of people don't realize that the doctor, the hospital, the pharmacy all get paid. If the consumer isn't paying for this, then who is. EVERYONE. Yes. Everyone being insured by that company are paying those costs. So the premiums for everyone go up. Paying a co-pay or certain minor costs in full would reduce the premiums.
In the long run, it might have been healthier to tweak plans like Medicaid to handle the uninsured. Each state could determine the extent of health care needed for their own participants. The demographics are different for each state. Those states with a large senior population have more cases of multiple organ failures. The diabetic winds up having heart problems and kidney issues. States with a large agri-business can provide fresh fruits and/or vegetables more easily to their citizens.
So those who need to sign up through the exchanges are having problems doing so because the website seems to have been designed by a company whose claim to fame seems to be a connection to Mrs. Obama. No one bothered to see if successful companies like Amazon or Blizzard Entertainment could offer some assistance. If millions of users can play World of Warcraft at a time, surely that expertise would have helped here. Learn how to play, nubs.