Hellobee Boards

The marketplaces are failing because health insurance companies are for profit businesses and they shouldn't be. I don't believe the root of the problem is not enough healthy people in the pool. The majority of Americans are one health emergency away from bankruptcy. A serious health issue or accident can happen to anyone at any time. Until we make a cultural shift that believes health care is a right, not a privilege, and take the big $$ and greed of insurance companies (and pharma), we will continue to go around and around with this.

We had family that was uninsured but it was before the requirement.

- Young mother - 25-30 age. Two small kids qualified for coverage. She had spotty employment so never qualified that way. She delivered the kids at the hospital but no idea how she paid that (or maybe she didn't). She has no credit I'm sure (car repo, bank overdrafts, evictions, etc) so I'm sure she wasn't worried about not paying a medical bill if she went to the hospital.

- Single Male 18-25 was employed with a small employer (just one or two employees) who didn't offer health care. I believe at this time he was covered under workers comp. However when he started his own business to be self employed I believe he even waived workers comp coverage.

- Older couple 55-60 - Long term smokers. Got coverage for things they needed (gallbladder surgery) covered through vocational rehabilitation.

I do not know of anyone that doesn't have health insurance, most people in my circle have coverage through their jobs. I think this is part of the problem and I would love to see a system where the government mandates that everyone have insurance, employers do not subsidize it, but the insurance companies are required to offer plans at all price points. This is another flavor of universal healthcare that works quite well.

I was uninsured for a year after I graduated from college (2007). I was working part-time as a hostess and my husband was a student. There was no way we could afford insurance. It was stressful, especially because we had an emergency room visit for my husband, but there was a nurse practitioner who saw us and would only charge $50 for a visit and did her best to only prescribe generics. Any time I needed something more, she would give me samples. I gained insurance three months after I started my full-time job and then my husband gained coverage a year later (my insurance would not cover him for a year because of his diabetes).

I only know of one person. He’s a self-employed, single man in his 30s and is the type that doesn’t ever go to the doctor anyway. He's perfectly content to pay the tax penalty.

@ShootingStar: I'm sorry, I must not have worded it correctly. I didn't mean that people expect benefits to be able to pay for medical expenses, just that it's sort of the culture around here to wait until your extremely sick, then to depend upon the generosity of others to help pay your bills. I was mostly trying to demonstrate the mind set of the area I live in.

My sister's bf is uninsured, he works at his dad's restaurant, and since he's young and healthy doesn't feel the need to pay $500/month for insurance. He gladly pays the penalty.

I went without insurance for a year when I moved to Florida. My job didn't offer health insurance and I couldn't afford it on my own. I went to a walk-in clinic for bc, and was lucky enough not to need to go for anything else.
DH didn't have insurance for several years.
It's a gamble that a lot of healthy people are willing to take, or simply feel their money is better spent elsewhere (or NEEDS to be spent elsewhere).

I do feel more employers (or all) need to offer health insurance as a basic benefit. I was surprised when I lived in Florida that not many employers (or at least the ones I applied at) offered it.

I can totally understand skipping insurance as a healthy single person/couple. Since Obamacare went into place premiums have skyrocketed. I work for an LLC where it's just 3 of us, and my 2 partners are both old enough for Medicare, so we don't have a health insurance plan for the firm. My husband works for a company of about 50 people, so they have coverage but it's not great. As a family of four we pay $1,500 a MONTH for health insurance though my husband's plan. And that's for a high deductible plan! Granted, part of that is going to fully fund our HSA so essentially comes back to us if/when we need it, but it still comes out of his paycheck on the front end. My husband does well so we can afford it, but it's sure as hell not fun. Earlier this year my husband had a cancer scare and had to have major surgery and my son had some heart issues necessitating an extensive cardiologist exam, not to mention regular sick visits, annual exams, etc. Even with these complications we probably still would have been better off financially to have been uninsured and pay out of pocket than to pay the insane premiums and meet the deductible. But if my husband had turned out to have cancer, and needed further treatment/surgery, that's when the insurance would have helped us out. It really sucks paying out the nose for something that only financially benefits you in the absolute worst case scenario.

@T.H.O.U.: Why do you think universal healthcare should not be a right? It seems to be working pretty well in Canada and Europe. Much better than the current system in the U.S.

@Truth Bombs: We're in a very similar situation; even though my employer subsidizes part of my health insurance, I still pay over $1k a month for a family of four, and still have to meet crazy deductibles ($3k per person, with a max of $9k for a family--that is the lowest deductible option available to me--I pay more for it than I would the "regular" plan which is still over $800 a month) on top of co-pays, prescriptions, etc. This year, not including regular co-pays and prescriptions, I have already shelled out over $6k in addition to the monthly premiums (for fairly routine services--like my youngest getting tubes). Luckily, we can afford to pay; not that we don't feel that out go, or that we hadn't designated that money for other things . . . SO and I have had multiple conversations about how other families would handle such heavy expenses. It's effing INSANITY.

@catomd00: the marketplaces are not failing because of insurance companies only being about profit. Full disclosure: I work at a health insurance company which I think rocks and really cares about people!
1. Don't forget the insurance companies have to pay their employees. We don't work for free! Until I started working at an insurance company I had no idea how complex and complicated it was. It is expensive!
2. There are federal mandates in place that state a certain % of each dollar brought in goes to pay a claim. I think it's somewhere around 87 cents of every dollar goes to pay a claim. Don't quote me on that but it's close. So insurance companies can't be "greedy" and screw people over because they have to spend $ brought in paying claims.
3. The marketplace is failing because of 3 things: the high cost of healthcare, not enough healthy people on the exchange, and the newly insured people are a very sick population. My insurance company lost hundreds of millions of dollars on the exchange because of all the claims we had to pay out.

@alphagam84: I agree. I'm concerned, admittedly, about quality of care dropping, but also I kind of think, we either have insurance or we don't.

I also think we as Americans are partly to blame for giving in to extraordinarily sedentary and unhealthy lifestyles. I am FAR from a fitness fanatic and not exempt from this statement but even with minimal effort can maintain at least a healthy range BMI. Our diets and lifestyles just have to change IMO. I hope nobody is offended by that. Like I said, I'm not exempt, and I also understand some people are in more challenging financial situations, etc. But those of us who at all can, should, and I also think they ought to bring back home economics classes!

@alphagam84: @2littlepumpkins: I agree that health care does need to change, and I honestly have no idea what the answer is, but I agree with you ladies that another huge factor is just how sick we are as a nation. I am a "fitness fanatic" lol, and when I say that what I mean is...I understand how what I put in my mouth effects my overall health. I know soooooo many people who have different ailments, and they are Most definitly directly related to what they put in thier mouths. For example my MIL has some sort of muscle issues, so at 48 years old she essentially has the issues you would see in someone over 70. She smokes a pack of ciggetettes a day, drink Nothing but sweet tea and I doubt she knows what a vegetable is. I've tried explaining what vegetables are, but I'm talking to a brick wall. To even suggest that her diet has anything to do with her circumstances is outrageous!!! Uhhh your body is failing you because you fill it with poison 🙄. I honestly think that her mind set is the same mindset that most of our nation shares when it comes to nutrition. Like it truly doesn't register with people that the food they eat effect that way thier body's perform or lack there of. I didn't mean to get on my soap box but this issue just drives me insane!! As does my mother in Law

@2littlepumpkins: *loud clapping*

Yes this. Exactly. I realize the deck is stacked against some people due to hereditary conditions, injuries which preclude exercise, etc etc. But we are a generally unhealthy society and put relatively little effort into our own health and well-being. A small to medium sized subset of our population cares about health and wellness but the vast majority either A) doesn't care or know they should care B) doesn't have the energy to care because they are stretched so thin they are barely keeping themselves or their families alive, C) or doesn't want to make the effort.
I think A & C are the most rampant. I'm basing this off of my patient population at work. I work with a mainly poor and middle class population. Many only recently gained insurance via ACA, many don't have insurance at all and are covered by "charity care" funded by our hospital, and others have private insurance. The vast majority of my patients, young and old, show zero interest in improving their health, unless it comes in a pill or surgical form. Zero interest.

Our priorities are all kids of *ucked up. Wellness education, profitability of insurers, preventative care, child and adolescent care, mental health care, what to do with the permanently disabled as a long term solution...the list goes on. So many problems and distorted priorities. I for one have no answer.

@Truth Bombs: Yes, I would not say that Canada or Europe are models of a perfect system at all.

@oscarthegoon: @sunny:

Basically, I dont believe that the government needs to supply health care to all people living here. Supply would mean to me taxing the working population to provide services to pay for that. To me, thats like saying, it should be their responsibility to feed and shelter everyone.

Now, I do believe that the government should have some oversight of the health care industry (just like they should over the housing and food industry) to make sure that there are regulations in place to make it safe for consumers.

@Truth Bombs: @T.H.O.U.: No one is saying Canada or Europe is a perfect system. Just much better than what we have in the U.S. My understanding is that in Canada you wait for elective procedures, but it's not like if you break your leg or get diagnosed with cancer you wait months to see a specialist. We all pay taxes for shared services like roads and public education, why is healthcare different? And if you paid hundreds of thousands of dollars in taxes last year, surely you are wealthy enough to put a little more in the pot so that those less fortunate can have affordable healthcare.

@oscarthegoon: Again, I dont mind contributing to the pot so to say for certain things. And we do that now through taxes. But I think we have hit a point in our system/society that its becoming easier to give up and let the system supply services for you (food, shelter, health care) than it is to work hard for those services for yourself.

Also, I dont really love the way government run services are currently offered (education, infrastructure, health services). So I really dont want to continue to expand their role in those areas.

@oscarthegoon: I know you weren't speaking to me, and I'm probably going to regret even saying this, but everytime I read things like this "And if you paid hundreds of thousands of dollars in taxes last year, surely you are wealthy enough to put a little more in the pot so that those less fortunate can have affordable healthcare." I sigh. I don't understand when or where we decided that just because someone makes money, it becomes thier responsibility to take care of everyone else. A little background my husband makes a significant amount of money, he has no college education, no training certification. What he does do is physically work his ass off through hard manual labor, like seriously he will probably die at an earlier age just because of the toll he's put on his body, and as a result we live very comfortably. He wants nice things, so he works for them. He does not work his ass off "for those less fortunate"
Since I'm already here let me get brutally honest, I don't like people. I grew up with a drug addict/ alchoholic mother and Ive worked in customer service in one form or another since I was in high school and in my experience human beings as a whole are terrible, horrendous in some instances. And I don't feel one tiny twinge of regret when I say I don't want to pay for anyone else's shit, but my own. I think this is the fundamental difference between true conservatives and liberals. I know y'all want to help everyone and make the world a better place. I don't, I would gladly help someone to be able to help themselves,(teach a man to fish and all that crap) but 98 percent of people don't want to help themselves, and that's not my problem.

@Littlebit7: @2littlepumpkins: While I agree that people always have some degree of personal responsibility, I think it's a dangerous road to go down to expect all health problems are in some way attributable to a person's actions and they therefore deserve to get sick.

Plenty of people live in "healthy" ways and they still get sick or have accidents.

I'm so tired of this attitude from conservatives that they just want to take care of their own. It's so selfish, and so economically short sighted. So many people in this thread have talked about knowing people that just figure they'll never pay off their medical bills. What do you think that does to the costs for the rest of us? You can either pay the high costs for yourself, or you could pay the same amounts in a system where everyone is covered. Because everyone is covered the risk goes down the prices go down. Less people are financially devastated by having a catastrophic health incident. Or from having a child.