Older Ohioans obtaining insurance

Almost 40,000 Ohio residents have successfully picked health insurance plans through the new online marketplace created by President Barack Obama’s law.
Associated Press
Jan 14, 2014

A report released Monday by the U.S. Department of Health and Human Services details enrollment numbers from Oct. 1 through Dec. 28.

Ohio is among the 36 states relying on the federal website, HealthCare.gov.

Monday’s figures show a significant spike in sign-ups compared with October, when the troubled website wasn’t working properly. Just 1,150 Ohioans had managed to select a plan then, compared with 34,283 last month.

Most Ohioans obtaining coverage are older. The department said 41 percent of those with plans are between ages 55 and 64. Eighty-one percent are getting financial help to pay their monthly premiums. At 56 percent, more women have selected plans than men.

Comments

The Hero Zone's picture
The Hero Zone

"How would you suggest that we make health care and health insurance affordable and fair to all with total coverage for all Americans?"

Fair is your trick word in this question because your perception of fairness is different than others' as is mine. Why is it do you think women were charged more for health insurance? Is it fair that men now pay for maternity care they will never receive? How about for a woman paying for that "free" yearly prostate exam? I'm throwing out the word "fair" because there is no such thing to all people. I am sure it was as well meaning to say as one party thought this bill was to everyone to impose on them, but as it's not, let's not include it.

That said lets look into why medical care costs what it does.

1. Cost of training in that skill set. How much does it cost a doctor or nurse to complete their schooling? Hundred thousand, two?

According to the Department of Education's National Center for Education Statistics (NCES), the average cost of a doctorate degree at a public school in 2008 reached $48,400 each year. Private school tuition during the same year rose to $60,000 annually. A typical doctoral program takes five full-time years to complete, bringing the total cost to $242,000-$300,000 (nces.ed.gov). NCES reports that over half of all doctoral students attend school full-time and 93% receive some form of financial assistance.

In 2010, Payscale.com estimated the median salaries for Ph.D. degree holders based on type of employment. University professors earned a median salary of $87,169 per year. Outside of academia, corporate employees grossed a yearly median income of $94,528, followed closely by self-employed entrepreneurs who earned approximately $92,000 annually. In addition to the education and training a doctoral degree provides, salaries are also contingent on the number of years of experience an employee brings to the position, with entry-level doctoral graduates starting out at less than $60,000 per year.

2. Overhead. How much do you think it takes to lease/buy a building? On top of that the building needs furnished with mundane and specialty equipment. Add in the extra/sanitary/safety features a medical office needs that aren't found in traditional commercial venues. Computers, desks, tables, medical devices, electricity, trash (including bio-hazard service), etc. This doesn't even include the cost to staff the place.

3. Staff. How much does a nurse make? According to the Bureau of Labor Statistics record for May 2012, the mean annual registered nurse salary is $67,930, which translates to $32.66 per hour. The lowest ten percentile in the field earns an average of $45,040, while the top ten percentile makes $94,720 annually. Usually, the registered nurses with the highest salaries are those that have extensive experience in the field for 20 or more years. Nurses possessing only an associate’s degree can earn more with more years experience over those with a bachelor’s degree.

Registered nurses employed in general medical or surgical hospitals earn an average of $69,490, while those in nursing care facilities make an average of $61,220 each year. Some of the highest paying industries for nurses are the federal government at $79,270, universities at $74,540, and outpatient care centers at an average of $71,200.

This doesn't even mention the fact that you may have non-medically-trained clerical workers that earn about $30-35,000 per year.

4. Malpractice insurance (among others). The costs can vary widely from an example of $4,000/yr. for a general practitioner to ten times that for an OB/GYN (we'll go back to the issue of "fairness" above, maybe urologists should be forced to pay the same?). So the office not only needs this covering its medical staff but the building I presume needs liability/mortgage insurance. Let's not forget Errors & Omissions Insurance on the clerical workers. Of course I imagine that there is a health insurance policy for the office staff. And vehicle insurance if only on the doctor's own car he pays for himself.

Tort reform can help answer the medical malpractice portion.

5. Multiple tests and other overcharging. This is a double-edged cause. For tests, part of it is a CYA move by doctors to avoid potential malpractice suits. Part of it is a patient may need these tests or at least like to know the whole health picture. In my meandering research there was an anecdotal tale that has a doctor quoted as saying, "“I bet 60% of the labs are unnecessary."

As for overcharging, in the same article:

"Like, for example, gauze pads. Following a patient’s diagnosis of lung cancer, he was charged $308.00 for four boxes of sterile gauze pads each containing twenty-four 4 inch by 4 inch dressings, which can be bought over the counter at Walgreen’s for $3.99 a box. These were tacked onto his $348,000.00 bill.

Another patient was charged $18.00 each for Accu-Chek diabetes test strips. Amazon sells boxes of 50 for about $27.00 or 55 cents each. For the price of one Lipitor pill in the US you can buy three in Argentina. One hospital charged $1.50 for one 325-mg acetaminophen tablet. You can buy 100 tablets on Amazon for $1.49. That’s a 10,000% markup."

6. Reimbursement rates. Dovetailing into the overcharges above, you have to understand that private insurers don't pay what doctors ask to cover their service. To be fair, government insurance pays even less! So, in order to make what you "need" you have to ask for more than that so your insurance payout at the reduced rate equals the amount your office needs to pay bills and be profitable. It's a ridiculous but necessary dance especially with the government which tells doctors what they will make like it or not.

Some of the information above I know and remember from when I was a licensed insurance agent. Others I learned by keeping up even not when in the profession. For everything else there is the power of Google and a discerning eye for reading. So the problem with medical costs?

NOBODY KNOWS WHAT ANYTHING ACTUALLY COSTS! So it's a free for all and the ACA doesn't make any of this better by requiring things for people who don't need them, subsidizing a cost that is already inflated to cover other costs, and making the insurance pool unnecessarily lopsided with those who can't otherwise afford the costs of insurance (both going back to AND not addressing your argument that they already make your premiums higher for some reason).

Let's even say that I am an anti-corporate type of person. You know, down with Walmart and the like. With the ACA our government has GUARANTEED PROFIT for companies ON YOUR BACK with YOUR TAX DOLLARS through those same subsidies. How is any of this "fair"? How does any of this guarantee coverage/care/affordability for ALL when there are still going to be millions of people who can't/won't buy it?

My solution?

Tax-advantaged HSA's for all paired with a high-deductible catastrophic plan. TRUE freedom of choice to use your money (or subsidies, perhaps) on the products and services YOU want. You can shop around for doctors and services who now must compete for your dollar instead of you being fed to them no matter what. Paired with compelling doctors/hospitals to display "menus" of common services to make shopping easier this can greatly help reduce costs by encouraging true competition. It also will help educate the population on market forces, economics, budgeting, and get price awareness out there so we can find out what things ACTUALLY cost.

The Hero Zone's picture
The Hero Zone

Why not make charity medical service illegal, then? Or, rather, all doctors and hospitals must pay tax on the income (collected or not) for all services provided. That'd do it, eh? A lot less paperwork is needed here than individual exemption and it would let us jail and/or fine greedy doctors and hospital administrators who withhold money from the government by simply giving away their service. They have a lot of money anyway, am I right? They can afford to pay taxes on things they never collected. It's only fair to save you $1/month.

Or is my freedom of choice to be forced to serve your perceived convenience else live in societal abandonment? With that I humbly present an even simpler solution to those who oppose a distant, inept government forcing private citizens to enter into private contracts with private companies.

Though on a slightly less sarcastic note I will reply to your question of how to otherwise reduce costs below.

looking around

I don't speak to everyone, however the representative group that I have indicate that what has been offered and in most cases signed up for appears to be a good fit for those unlike yourself or myself have actually chosen coverage.

Your continued misidentification of the program as Obama Scare points out your disdain for the program that by all accounts you have no participation in, so I doubt anything I or anyone else offers would change your course of thought. I have no crystal ball and you don't either so the outcome at this point is unknown and your personal opinions unproven. You have no answers to the problem, only more questions. You are correct in that seniors over 65 are covered by medicade, however here in Florida we begin recognizing those over 55 as senior. Why don't you spend some time at the local coffee shop or campus speaking with some folks yourself who have participated in signing up.

grumpy

If the "representative" group that you speak to, is truly representative you would be speaking to hundreds of people, since stats say that it is about 1% of people, even less if you include seniors, and since you say you are in Florida I would expect that number on medicare would be even higher. So you would have to speak to even more people to get a "representative group".

I am semi-retired, I retired a year ago from a construction trade and "work" doing one of my hobbies. I am now under my wife's policy at work which is acttually better than mine was. Most people I talk to have their healthcare from work like the vast majority of people in this country. They are not under obamaScare till next year, unless it is further delayed so it gets past the coming mid term election. Those few I have talked to that are covered by obamaScare are divided 1 happy with the deal, but then they are getting a taxpayed subsidy, and one whose coverage is worse and payments went up slightly and out of pocket went up considerably from paying the first $1000 to paying the first $6000 his old cap was 2500,000 per person per year and total family capped at 500,000 per year. He also had a $1,000,000 catastrophic policy per year besides.

I would have little problem with it if we had been told the truth about it from the beginning. When it started out with one party getting kicked out of the talks, not publishing the bill till 24 hours before the vote after the Pres promising it would be online for 5 days before voting, no amendments allowed, 8 hours limited debate after the Pres promised it would be open fair debate on C-span, and every vote for it came from ONE party, it was not a good way to start. Then we were told it had to be passed so we could see what was in it? Then the pres promised over 50 times that we could keep our old plan if we liked it. Then the Pres promised numerous times we could keep our doctor if we liked him. Then the Pres allowed nearly a thousand groups to opt out for a year or two, that being something not included in the tax (it was deemed a tax by the SCOTUS so I can't correctly call it a law). That has all been before the website problems. They had over 2 1/2 years to get the websirte up and running and have spent nearly $1 billion on a site that you can't even pay for the insurance on, can't tell the public how many have signed up, how many have actually paid. It has gone way up in the estimates as to how much it will cost the taxpayers already and it hasn't even gotten off the ground. I suppose I could go on but those are some of the problems and broken promises just off the top of my head. I guess those things are meaningless when you see how well some "think", "claim" or "know" it will work in time. I am sorry but I just can't suspend my disbelief quite THAT much.

grumpy

As to what I would do for healthcare insurance? First I would open it up for buying across state lines, make HSA's more available, do away with employer paid health care. Do away with existing conditions, and put the worst cases into a group for gov't taking that expense over.It would open a can of worms for some people but it would also limit and control the expense. Much of the rest I would agree with Hero Zone on much of his ideas along with the few I mentioned. Put the power into the individual instead of the employer or group insurance. Let the doctors compete for the dollar. Pay for the quality you want , need or can afford. For a simply yearly check up I don't need a world class surgeon, and don't need to pay for one.

The Hero Zone's picture
The Hero Zone

I forgot the part about allowing insurers to go across state lines. Good catch, grumpy, and thanks!

It's so frustrating that many people have no idea what things actually cost to make, buy, sell, or acquire. Our government doesn't do anything to help that, either. That goes for Republicans who wear "all tax breaks are good" blinders. No, those also distort prices. Either a good or service is paid for or not. That's why I'm not against raising taxes as long as it is going to a specific cause or account and not the black box of general funds.

Economic forces are just like those of physics, and as I see it, water specifically. It is fluid, freezes, thaws, and boils. It is a tide that comes in and out and supports and snuffs life. It is a bed of creation. But just as well, there is the old adage that "water always wins". All these tweaks and subsidies and regulatory agencies all claim to control the flow of water...but for how long? At what cost? And when water wins as it ALWAYS will...what then?

Being locked in a padded room is pretty safe and you have ultimate freedom as long as it fits in a monitored 10x10 space allotted to you. That is unless you are flooded in which case you will drown in the "freedom" you were given.

grumpy

It isn't just the cost of making and acquiring. It is also the cost of interest from loans you have. My parents were in their 40's before they got most of the loans for business, house and so forth mostly paid off. It taught me a lesson, borrow as little as you can pay little interest and save. When you save YOU get paid interest. The only loans I have ever had were either business or mortgage, both which you can deduct the interest on from taxes. Well I did take one car loan when I was 18, and paid it off in a year, so I would have a credit history. Another thing about economic forces, unlike water, don't go with the flow. You get caught in bubbles (like the tech or housing bubbles) and can sink when they burst.

grumpy

doubled

looking around

First let me address the comment that the number of people I have spoke to is not large enough to be representative, I have read other accounts of surveys being done on a larger scale that seem to indicate a fair amount of success in folks signing up in the markets and being satisfied, these in addition to my own findings in personal conversations.

Making comparisons to my own coverages I find that they are on par with mine for the most part.

I am glad to at least finally see a few people who have additional ideas of how costs could be reduced. I don't see the Affordable Health Care Act being repealed, however I don't see why some of these ideas still can't be implemented. I will offer this, you will find the same degree of opposition from those in the medical profession as well as their suppliers and financial benefactors regarding many of your ideas as many of you have opposed the ideas within the Affordable Health Care Act.

We all seem to agree that the cost of services, provided supplies, and redundant or unnecessary procedures or treatments are a driving force in the escalation of cost be it out and out fraud/greed or fear of legal retribution. These are all things that can and should be dealt with moving forward.

I myself have been blessed with good health and over the many years of paying for health insurance have only needed a minimum amount of specialized care requiring the services of a doctor or hospital. The gap now between my current coverage and medicare enrollment is very short, even at that I will need additional coverage to fill the gaps just in case. I would not trade my good health for anything in the world but we can't stop the aging process.

The Affordable Health Care Act is not "Obama Care" or "Obama Scare" this health care plan has been in the making since the Trumman administration and 11 administrations since. It took that long to actually move on making it a reality. Is it that wrong of an idea if all these past administrations and presidents wanted it?

The President was elected and reelected with this act as part of his platform. It was voted in by both houses in Washington. When a few Congressmen weren't happy with this vote, they appealed to the U.S. Supreme Court. The justices upheld this appeal. So now the House of Representatives has had over forty votes to repeal this act. It has not yet got enough votes to repeal. So the question needs be asked: Are the Republicans and Tea Party people against the Affordable Health Care Act or is it President Obama they have issues with?

May you all enjoy good health and prosperity.

grumpy

Re: "We all seem to agree that the cost of services, provided supplies, and redundant or unnecessary procedures or treatments are a driving force in the escalation of cost be it out and out fraud/greed or fear of legal retribution. These are all things that can and should be dealt with moving forward."

Are you talking about the insurance covered by the obamaScare tax or what used to he health insurance, or about how doctors, hospitals, and clinics dispense care? They are different things. You are mixing them together.

As far as what was good about the old way was I only had to pay for the coverages I might use... I didn't need childcare, prenatial care, mental health, and several others that are mandatory with the obamaScare tax. I didn't have to pay for unnecessary things for my family or myself. That increases cost for me. When I buy car insurance I often drop collision insurance after a few years, I saved money doing so. Same with home insurance, I don't cover things I don't have, health insurance should be the same way. It is the problem when gov't gets involved, they write a 2300 page bill and make it "universal", the same for everyone and that takes away the individual's choice. I prefer the individual to maintain the ability to make choices, the gov't needs to make a 2300 page bill that treats everybody the same. Sorry I am not the same as a drug-adicted family of 4 with mental problems that will have more kids. I don't need the same coverage they need. I should pay for what I need and so should they.

Re: "The President was elected and reelected with this act as part of his platform. It was voted in by both houses in Washington. When a few Congressmen weren't happy with this vote, they appealed to the U.S. Supreme Court. The justices upheld this appeal. So now the House of Representatives has had over forty votes to repeal this act. It has not yet got enough votes to repeal. So the question needs be asked: Are the Republicans and Tea Party people against the Affordable Health Care Act or is it President Obama they have issues with?"

I noticed you have walked right around all the lies, half-truths and broken promises made about the ACA tax or obamaScare whichever you prefer. That I mentioned above, I guess those things are meaningless to some. who only look at what his preferred party's president and congress has saddled us with. Or do you wish to adress those lies, half truths and broken promises? Do they seem like reasons not to be so enamoured of a failing plan as some?

grumpy

Re: "
First let me address the comment that the number of people I have spoke to is not large enough to be representative, I have read other accounts of surveys being done on a larger scale that seem to indicate a fair amount of success in folks signing up in the markets and being satisfied, these in addition to my own findings in personal conversations."

Then I must apologize to you. I thought you wrote that you "personally spoke" to a representative group of people about their experience with the ACA or obamaScare, whichever you prefer. I must have either misread or misunderstood what you wrote.

Contango

Re: "I have read other accounts of surveys being done on a larger scale that seem to indicate a fair amount of success in folks signing up in the markets and being satisfied,"

Other "surveys" differ.

"6 major hurdles to implementing Obamacare":

“'Our analysis finds that, on average, Obamacare will increase underlying premiums by 41%, nationwide.

Young men clearly fare the worst under Obamacare, with premiums rising 77% for the average 27-year-old.

Older, and lower-income uninsured will find these increases offset by new federal subsidies, but it doesn’t change the fact that Obamacare is increasing the underlying cost of coverage, not lowering it.'”

http://www.marketwatch.com/story...

grumpy

Thanks for supplying a link to your article . If looking around would also do so we could see what was actually surveyed from the ones who came up with good results. As it is.... we have to guess about his other accounts...

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