A flowchart I just threw together, to explain Obamacare

[xiphias]

Is this more or less accurate? If it is, feel free to share it. Or clean it up first, whatever.

Comments

On the "get insurance" box

[redbird]

Unfortunately, they are legally allowed to let you die. The notorious cases are women with ectopic pregnancies who find themselves at Catholic hospitals (sometimes because that's the only local option), but poor and uninsured Americans are also dying because an emergency room isn't cancer treatment, and it may get you a prescription for blood pressure medicine, but you still have to pay for the pills. For that matter, few if any doctors (or most of the rest of us) would argue that it's unethical for a doctor to spend their time doing facelifts instead of having specialized in emergency medicine, infectious disease, or cardiology.

It's more "get insurance, you schmuck. Otherwise, if you do wind up in the hospital, you'll bankrupt your family."

[undauntra.livejournal.com]

I am questioning the "Get insurance, you shmuck. Doctors aren't ethically or legally allowed to let you die, and it's not fair to put them on the hook for the cost of your medical care."

You seem to be assuming that insurance is the only possible way to pay for medical care. It's also possible to pay out of pocket. Many people can afford to pay out of pocket for routine medical care and would only need insurance to cover low-probability catastrophic events. Some people can even afford to pay for catastrophic medical care out of pocket. If someone is willing and able to pay out of pocket, then the only party benefitting by forcing them to buy insurance is the insurance company.

[tceisele.livejournal.com]

The thing to watch out for is that one can easily be *mistaken* about their ability to pay for certain things out-of-pocket. For example, I had been under the impression that appendectomies were relatively inexpensive surgeries that a reasonably well-off person could pay for fairly easily, and so during the years that I was uninsured, I thought that I'd probably be able to cover a short hospital stay in a pinch. But when I had my appendix out a couple of years ago, I looked at the bills to see what it cost my insurance company. Turns out it was about $20,000, which would have been - pretty bad for me to pay out of pocket.

Maybe it should be reworded as, "Get insurance, you schmuck, medical care costs way more than you likely expect that it will. Get a high-deductable plan if you want, but if you don't have *something* then even a minor medical emergency is likely to ruin you."

Another thing: there should be an arrow for, "are insurers refusing to sell you insurance?" Because that was why I didn't have insurance for some years. When I tried to buy high-deductable major-medical insurance as an individual, they turned me down flat because I had borderline-high blood pressure (and *no other medical problems*). I couldn't get insured because of that until I got insurance through my employer.

[rebmommy.livejournal.com]

Another thing: there should be an arrow for, "are insurers refusing to sell you insurance?" Because that was why I didn't have insurance for some years.

Good point - does Obama's healthcare deal with the issue of pre-existing conditions? Are health insurance companies still allowed to refuse to cover someone because they have a health issue that requires care?

[theletterelle.livejournal.com]

In 2014, insurance companies cannot refuse to sell coverage or renew policies to anyone based on a pre-existing condition. Thanks Obamacare!

[bemused-leftist.livejournal.com]

Last I heard, there is no limit to the premiums the insurance companies can charge, based on your pre-existing conditions.

So if you can't afford the premiums, then as now you have no insurance, plus some sort of tax penalty for not having insurance.

[(Anonymous)]

and let's not forget the traditional way of paying for our medical care. How many chickens for an appendectomy? If things keep going the way they are, at some point we'll be forced back to the old ways. Eggs and milk for house calls, chickens for procedures and a cow or two for major illness

dod

[xiphias.livejournal.com]

I was wondering about that: I believe that, in Massachusetts, you are required to have car insurance, but you can handle that requirement by keeping, like, a million bucks in escrow in case you injure or kill someone.

[bemused-leftist.livejournal.com]

Again, last I heard, someone who has been paying out of pocket will have to buy insurance, and the premiums and deductible will add up to some large amount of money before he ever gets anything back from the insurance company.

[greenlily.livejournal.com]

Another thing: there should be an arrow for, "are insurers refusing to sell you insurance?"

THIS. I had a conversation the other day with a co-worker in which we tried to figure out how Obamacare would address this issue. Unsurprisingly, we didn't come up with anything useful.

[quietann.livejournal.com]

It's part of the basic law that you CANNOT be rejected because of pre-existing conditions. (Not sure about paying a higher premium, but here in Massachusetts, they can't do that, either -- as long as you have not gone longer than 90 days without some sort of insurance.)

[vvalkyri.livejournal.com]

is it supposed to be upside down and backward?

ok that's really weird it's only upside down and backward on my flist, not in the post

unfortunately those who are too poor for the subsidy but no longer covered by the medicaid expansion are kinda SOL just now. no penalty, but no new insurance either.

[takumashii.livejournal.com]

For people who are self-employed, especially if they're living in cities where the cost of living is high, I think there can be quite a donut hole between "Obamacare will help you pay" and "Get insurance, you shmuck."

One can easily imagine that a single person making $48000, living in a city like New York or San Francisco, would have a rough time paying $400 a month for a high-deductible plan that barely covers anything. (If that sounds like a high salary, consider that self-employed people pay much more in taxes than people whose employers pay their social security tax, etc.)

I don't think we'll know for sure, until the exchanges are in place, whether the ACA will actually give good and affordable options to people who are making just a little bit too much money to qualify for subsidies.