9 ms·

A big factor here seems to be lifetime limits to benefits: > Financial toxicity led Fumiko Chino to co-write a research letter in JAMA Oncology last November.

by gred 8y ago

A big factor here seems to be lifetime limits to benefits: > Financial toxicity led Fumiko Chino to co-write a research letter in JAMA Oncology last November. After her husband surpassed his insurance policy's $500,000 lifetime limit, Chino drained her savings to pay for his treatment. When he died, she was left hundreds of thousands of dollars in debt. However, these limits were outlawed by the Affordable Care Act, even for grandfathered plans: https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/...

zrail 8y ago
Yeah, the study appears to be looking at 2000–2012. The lifetime limit ban started on March 23rd 2010, according to this Vox article: https://www.vox.com/policy-and-politics/2017/2/15/14563182/obamacare-lifetime-limits-ban https://www.vox.com/policy-and-politics/2017/2/15/14563182/o... Thanks Obama.
- mikeyouse 8y ago
  And before people get too comfortable -- Every single "Obamacare replacement" plan does away with the ban on lifetime caps either directly or indirectly. These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated.
  - dragonwriter 8y ago
    > Every single "Obamacare replacement" plan does away with lifetime caps either directly or indirectly. You mean, does away with the ban on such caps, right?
    - mikeyouse 8y ago
      I did indeed, thanks for the proofread.
  - deleted 8y ago
    [deleted]
  - rayiner 8y ago
    > These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated. I don't understand why you'd phrase it this way. Under the ACA, 80% of premiums have to go to medical care. A dollar saved providing care disproportionately benefits the premium payers, not the company. People act like all this money comes out of insurance companies' profits. Cigna's (to pick a random example), operating profit margin is 6.5%. There isn't this fat margin that insurance companies can use to offer additional benefits without raising rates. That's just the math. Saying that this is about what "benefits the insurance companies" is gas lighting the public. Lifetime caps insure that you, the ratepayer, aren't on the hook for unlimited liability. Now, I personally am willing to pay higher rates so people don't die when they hit their lifetime limit. But don't piss on my leg and tell me its raining, acting like the money isn't coming out of my pocket.
    - zrail 8y ago
      The scenario the parent poster is describing is where ACA is repealed and replaced, and presumably that replacement would also do away with the 80% medical loss ratio. In that scenario the insurance companies will likely just not reduce premiums from what they are today, netting them a huge windfall. This is also why states like Alaska have seen ACA premiums fall over the past year or two. They instituted a state-wide reinsurance program, which means insurance companies' losses are capped at a reasonable amount per claim, then the state comes in and pays for the rest. This reinsurance program is funded in sort of a complicated manner, but basically it funnels the ACA tax credits that would have been paid to taxpayers, absent the reinsurance program, into the reinsurance program. Rates go down when insurance company losses are capped, either by a lifetime or annual benefit limit or by legislation that says they'll be made whole, because losses are predictable.
      - rayiner 8y ago
        Even before the ACA, most money from premiums was paid out in benefits: https://www.healthaffairs.org/do/10.1377/hpb20101124.949788/full/ https://www.healthaffairs.org/do/10.1377/hpb20101124.949788/... > According to an April 2010 report prepared by the Democratic staff of the Senate Committee on Commerce, Science, and Transportation, the nation’s largest health insurers in 2009 had medical loss ratios ranging from 68 percent to 88 percent in the individual market; 78 percent to 84 percent in the small-group market; and 83 percent to 88 percent in the large-group market.
- njarboe 8y ago
  Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap on what people can get in a lifetime. Not every possible, super-expensive procedure is approved to be available to people through the public healthcare system. (Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible). Everyone can't get the best possible care unless those experimental and expensive procedures are just banned and we give up on expensive procedures becoming cheaper in the future. Cancer is the biggest reason for this. If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Health care already is 17% of the US GDP and the US government spends more % of GDP on healthcare in America than almost all European countries. Not sure the best way to a better health care system in the USA, but just uncapping how much can be spent under insurance plans, while fixing one problem, won't work in the long run (as we are already seeing).
  - sangnoir 8y ago
    > If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Is there a public example of a rich person that 'beat' cancer this way?
    - bluGill 8y ago
      Not really (that I know of). Andy Grove did spend a few months researching cancer before forcing his doctors to give him a new treatment that was showing better lab results than the traditional one, and the cure he got was probably better than the transnational one (less side effects). However from what I can tell the only thing he spent was his own time which means nothing a poor person couldn't do. The option is open to anyone who is rich, and if you have an slow incurable cancer it is reasonable to try: you don't have anything to lose and it might work. Of course if your cancer is already curable focus on the existing cure. If the cancer is fast you don't have enough time to for research to produce results. At best it is a long shot, but it is what you have. If you are young and healthy you actually have a better chance of your small donation making a difference. Just figure out what cancer you are at risk for and start regular donations to that research now. While your donation alone won't do much, the regular source of income helps those already doing the research keep going for the years required to get results. Your smaller donation along with others goes farther because time is a factor. The only problem is which: the cancer mom's mom had, the cancer dad's mom had, the cancer mom's brother had, the non-hereditary cancer both dad's brother and sister had, the cancer someone else in the family will get in two years?
pasbesoin 8y ago
The ACA significantly shored up benefits for members of group plans. It also, I hear and read, provided significant cost controls that helped put the brakes on group policy premium increases. Just one aspect of that: Hospitals' uninsured treatments dropped from the mid-teens or worse to around or under 5%. Costs that no longer had to be "spread around" to insured coverage. But a lot of group policy members have no... pardon me, "fucking" clue about this. Study after study has demonstrated this lack of knowledge. And politicians have been complicit in furthering it, along with outright lies casting the ACA in worse light. Not to mention deliberately sabotaging it through their actions, such as not providing promised transition funding written into the law. (For those who don't know, this is a common political ploy: You can write any law you want; if you don't, through the separate appropriations bills, fund it, that law effectively accomplishes little or nothing.) Still, even a superficial examination of the U.S. medical field inclusive of insurers, shows it to be awash in money. Every fucking middleman (that includes many providers, from products to services -- and the suits who now own them) pushing to grab as much of it as possible, before the rest trickles down to the patient (actual care). Pardon my vitriol, but I've encountered far too much of this, first hand.

by gred 8y ago

zrail 8y ago

Yeah, the study appears to be looking at 2000–2012. The lifetime limit ban started on March 23rd 2010, according to this Vox article: https://www.vox.com/policy-and-politics/2017/2/15/14563182/obamacare-lifetime-limits-ban https://www.vox.com/policy-and-politics/2017/2/15/14563182/o... Thanks Obama.

mikeyouse 8y ago
And before people get too comfortable -- Every single "Obamacare replacement" plan does away with the ban on lifetime caps either directly or indirectly. These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated.
- dragonwriter 8y ago
  > Every single "Obamacare replacement" plan does away with lifetime caps either directly or indirectly. You mean, does away with the ban on such caps, right?
  - mikeyouse 8y ago
    I did indeed, thanks for the proofread.
- deleted 8y ago
  [deleted]
- rayiner 8y ago
  > These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated. I don't understand why you'd phrase it this way. Under the ACA, 80% of premiums have to go to medical care. A dollar saved providing care disproportionately benefits the premium payers, not the company. People act like all this money comes out of insurance companies' profits. Cigna's (to pick a random example), operating profit margin is 6.5%. There isn't this fat margin that insurance companies can use to offer additional benefits without raising rates. That's just the math. Saying that this is about what "benefits the insurance companies" is gas lighting the public. Lifetime caps insure that you, the ratepayer, aren't on the hook for unlimited liability. Now, I personally am willing to pay higher rates so people don't die when they hit their lifetime limit. But don't piss on my leg and tell me its raining, acting like the money isn't coming out of my pocket.
  - zrail 8y ago
    The scenario the parent poster is describing is where ACA is repealed and replaced, and presumably that replacement would also do away with the 80% medical loss ratio. In that scenario the insurance companies will likely just not reduce premiums from what they are today, netting them a huge windfall. This is also why states like Alaska have seen ACA premiums fall over the past year or two. They instituted a state-wide reinsurance program, which means insurance companies' losses are capped at a reasonable amount per claim, then the state comes in and pays for the rest. This reinsurance program is funded in sort of a complicated manner, but basically it funnels the ACA tax credits that would have been paid to taxpayers, absent the reinsurance program, into the reinsurance program. Rates go down when insurance company losses are capped, either by a lifetime or annual benefit limit or by legislation that says they'll be made whole, because losses are predictable.
    - rayiner 8y ago
      Even before the ACA, most money from premiums was paid out in benefits: https://www.healthaffairs.org/do/10.1377/hpb20101124.949788/full/ https://www.healthaffairs.org/do/10.1377/hpb20101124.949788/... > According to an April 2010 report prepared by the Democratic staff of the Senate Committee on Commerce, Science, and Transportation, the nation’s largest health insurers in 2009 had medical loss ratios ranging from 68 percent to 88 percent in the individual market; 78 percent to 84 percent in the small-group market; and 83 percent to 88 percent in the large-group market.
njarboe 8y ago
Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap on what people can get in a lifetime. Not every possible, super-expensive procedure is approved to be available to people through the public healthcare system. (Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible). Everyone can't get the best possible care unless those experimental and expensive procedures are just banned and we give up on expensive procedures becoming cheaper in the future. Cancer is the biggest reason for this. If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Health care already is 17% of the US GDP and the US government spends more % of GDP on healthcare in America than almost all European countries. Not sure the best way to a better health care system in the USA, but just uncapping how much can be spent under insurance plans, while fixing one problem, won't work in the long run (as we are already seeing).
- sangnoir 8y ago
  > If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Is there a public example of a rich person that 'beat' cancer this way?
  - bluGill 8y ago
    Not really (that I know of). Andy Grove did spend a few months researching cancer before forcing his doctors to give him a new treatment that was showing better lab results than the traditional one, and the cure he got was probably better than the transnational one (less side effects). However from what I can tell the only thing he spent was his own time which means nothing a poor person couldn't do. The option is open to anyone who is rich, and if you have an slow incurable cancer it is reasonable to try: you don't have anything to lose and it might work. Of course if your cancer is already curable focus on the existing cure. If the cancer is fast you don't have enough time to for research to produce results. At best it is a long shot, but it is what you have. If you are young and healthy you actually have a better chance of your small donation making a difference. Just figure out what cancer you are at risk for and start regular donations to that research now. While your donation alone won't do much, the regular source of income helps those already doing the research keep going for the years required to get results. Your smaller donation along with others goes farther because time is a factor. The only problem is which: the cancer mom's mom had, the cancer dad's mom had, the cancer mom's brother had, the non-hereditary cancer both dad's brother and sister had, the cancer someone else in the family will get in two years?

pasbesoin 8y ago

The ACA significantly shored up benefits for members of group plans. It also, I hear and read, provided significant cost controls that helped put the brakes on group policy premium increases. Just one aspect of that: Hospitals' uninsured treatments dropped from the mid-teens or worse to around or under 5%. Costs that no longer had to be "spread around" to insured coverage. But a lot of group policy members have no... pardon me, "fucking" clue about this. Study after study has demonstrated this lack of knowledge. And politicians have been complicit in furthering it, along with outright lies casting the ACA in worse light. Not to mention deliberately sabotaging it through their actions, such as not providing promised transition funding written into the law. (For those who don't know, this is a common political ploy: You can write any law you want; if you don't, through the separate appropriations bills, fund it, that law effectively accomplishes little or nothing.) Still, even a superficial examination of the U.S. medical field inclusive of insurers, shows it to be awash in money. Every fucking middleman (that includes many providers, from products to services -- and the suits who now own them) pushing to grab as much of it as possible, before the rest trickles down to the patient (actual care). Pardon my vitriol, but I've encountered far too much of this, first hand.