If Wisconsin truly already has 90% of our citizens with healthcare coverage, do we really need the ACA? What additional benefits are we really getting from the ACA to justify the higher costs we all will be paying?

I keep on hearing that ACA would increase costs. Can anyone specifically show what those increases are? Hard core, specifics, detailed, line by line examples? I simply have not seen the statements saying it would cost more actually justified. Can anyone provide this, hopefully, objective conversation this information? I'm not looking at broad generalities.

Heather: State-centered and CONSTITUTIONAL reforms

• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).
• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.
• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state.
• Repeal government mandates regarding what insurance companies must cover.
• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.
• Make costs transparent so that consumers understand what health-care treatments cost.
• Enact Medicare reform.
• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

"In Wisconsin, Obamacare to Increase Individual Insurance Premiums by 30%, Says Obama Adviser"

http://www.forbes.com/sites/aroy/2012/10/29/in-wisconsin-obamacare-to-increase-individual-insurance-premiums-by-30-says-obama-adviser/

"Contrary to claims made by the Obama administration during the fight to pass the Patient Protection and Affordable Care Act (PPACA), government actuaries are now predicting President Obama’s law will result in increased costs, instead of lowering them."

http://news.heartland.org/newspaper-article/cms-actuaries-obamacare-increases-costs

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state.

**********************************
It's a federal law: McCarran-Ferguson Act (1945); grants states the right to regulate health plans within their borders

CowDung:

I asked for a detailed line by line example not one which clearly stated:

"(DISCLOSURE: I am an outside adviser to the Romney campaign on health care issues. The opinions contained herein are mine alone, and do not necessarily correspond to those of the campaign.)"

Does anyone have some hard facts?

I suppose you could read through the CBO cost estimates.

http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf

Hang on and see what happens to your healthcare costs, Rees. At this point most of what's out there amounts to opinions. If you can't logically make the connection between covering more people who use medical care more often, covering things that weren't covered in the past (pre-existing conditions), insisting on more paper shuffling, decreasing the amount the government is willing to pay through Medicare, etc and an overall increase in the cost of healthcare as a result of those mandates, then I guess that's all you can do.

Bob McBride

You hit on the major part of what I felt all along. It's opinion not fact based. The following link is the only one I have found that is based on fact and has real sources.

www.medpac.gov/chapters/Mar11_ch01.pdf

It is a document titled "Context for Medicare payment policy". A report to Congress: Medicare Payment Policy, March 2011.

In the summary at the beginning it states:

"...the Boards of Trustees project that growth in Medicare
spending will be slower for the coming decade than the previous decade’s growth
rate. From 2000 to 2009, annual growth in total Medicare spending averaged 9.7
percent. In contrast, the Trustees estimate that total Medicare spending will grow
by 6.0 percent annually from 2010 through 2019, due in part to changes made by
the Patient Protection and Affordable Care Act and the Health Care and Education
Reconciliation Act of 2010 (PPACA). The CMS Office of the Actuary estimates
that the Medicare provisions in PPACA will reduce spending by $575 billion over
10 years, resulting in Medicare spending that is 9 percent lower by 2019, compared
with prior law (Foster 2010, Sisko et al. 2010)."

So, while everyone is upset about the increase, pundits seem to never want to understand that the rate is actually reducing NOT increasing.

Politics. I hate it when it is not fact based. We do ourselves harm by not looking at the facts.

Rees, you do understand that, as of now, you're paying for the lower payments physicians already receive from Medicare/Medicaid, right? Those costs don't disappear, they're shifted elsewhere.

And you do understand why those payments from Medicare are going down, correct? It's because they lower the rate of compensation they're willing to pay for services. Just because Medicare expenditures decrease by that amount of money doesn't mean that, overall, the cost of those procedures go down. The costs are shifted elsewhere.

Again, if the logic escapes you, you'll just have to wait and see and cling to whatever hope reducing Medicare payments by reducing compensation rates gives you.

@Jay, the mcCarran act doesn't give states the right, the constitution does. The federal government has no right to regulate the healthcare industry within state borders. However a federal law could allow people to engage in the interstate commerce of purchasing health plans outside of the state. It would be a simple lot with a simple disclosure making it clear that consumers could not be penalized for buying a plan that gave them better Access to healthcare.

That would actually be the case of true interstate commerce. Not the bastardizatin the federal government usually uses as an excuse to trample on state sovereignty.

The other option would be simply going state to state and creating exemptions. If states are serious about tackling health care reform they must be willing to embrace true reform. So the existence of a 1945 law does not preclude true reform or the point that was made.

We shouldn't need a 'new' law. Repeal of McCarran-Ferguson would free the health insurance providers to sell healthcare insurance coverage across state lines.

McCarran-Ferguson is essentially a commerce clause exemption for health insurance companies.

I understand the Commerce Clause as written(intended), 'to make trade regular' not 'to regulate trade'.

@Jay

I don't know where we are disagreeing here.....
A "repeal" is a new law, and for those worried about violating the right of states to regulate their own industries, a second law could be considered that fits the definition of the commerce clause.

BTW, yes, "regulate" does mean "to make regular," but the feds only have the Constitutional right to interfere if it crosses state lines. This would fit the bill under portability rights.

@Rees -

Hoffa's premium on his catastrophic care policy actually doubled since the ACA was signed into law. Hoffa's provider directly cited preparation for implementation of the ACA as the reason for the premium increase.

Obama promised that his health care law would lower premiums by an average of $2,500/yr.

Hoffa has yet to meet a single person who's rates haven't gone up since the ACA was signed into law.

Obama LIED - and that's a FACT.

Rees, since Obamacare was passed, my premiums have gone up almost $2,000, will go up $1,000 next, and will likely go up another $800 in 2014.

That's a $3,800 increase, not a $2,500 decrease. AND my deductible has gone up!

Wow, I might as well add my own anecdotal horror story....

My HSA plan went up over 90% since the ACA was passed. It just went up again, so I changed my deductible from $2,500 to $7,500

it's all I can do to afford it. And I'm paying it three weeks late, which makes me really nervous....

Obama lied, and more people will die because of it

I truly feel for those of you who have experienced higher premiums. In my opinion, those are conservative insurance companies sticking it to their clients prior to actually seeing what healthcare costs are really going to be. Waiting to get real numbers would have been the right thing to do and then looking at alternatives.

Think of it this way (just once). How can covering just 10% more of the population push such a higher premium onto individuals? It just doesn't make sense. I honestly believe it is greedy insurance companies using ACA as an excuse to raise premiums. I would complain to the State of Wisconsin Insurance Commissioner. There is absolutely no way they can forecast with any accuracy the additional premiums you "should" be paying before ACA actually is implemented. Why? Simply because it hasn't been done before. I hate business practices like that. Have any of you looked at other insurance companies to compare rates?

More evidence:

People who work at local hospitals have not seen their rates raised by the amount you guys are noticing. I know, I have talked to them. I think hospitals, who are self-insured, would have a pretty good idea of their costs too. That leads one to conclude my views in the prior comment might very well be spot on.

Best to see what other insurance companies would quote for your healthcare insurance needs.

@Rees.... The ACA regulates that 80% of all premiums are spent on healthcare for individual and small plans, 85% for larger plans. An insurance company can only be passing along actual increases in the costs.

How can they be sticking it to their customers in this precise and highly regulated environment?

@Rees.... in one post you are screaming for facts and complaining about opinion... in another you cite your own opinion..... in yet another you cite a fact about decreased "growth" in costs and mention that costs are decreasing........ you are a trip. decreased growth are still increases. You cited "growth in Medicare
spending will be slower for the coming decade than the previous decade’s growth
rate" and then claimed "So, while everyone is upset about the increase, pundits seem to never want to understand that the rate is actually reducing NOT increasing." lol....

@Mike in OC:

I suppose you "could" say those things, taken out of context to spin what someone says. They were responses to what others were saying at the time. You are a hoot but more like an attempt at being master manipulator. But taken at face value your comment does not provide anything useful to our community of readers.

Rees Roberts wrote: "I truly feel for those of you who have experienced higher premiums. In my opinion, those are conservative insurance companies sticking it to their clients prior to actually seeing what healthcare costs are really going to be..."

Rees, the insurance industry uses highly educated and trained people called actuaries to crunch numbers and come up with cost estimates based on all the available data they can gather. For example, they can calculate the chances of your car being stolen in the area you live and can adjust your car insurance appropriately.

Thanks to B.O.care, the health insurance industry will get flooded with new clients, primarily those with can't afford it and those that have pre-existing conditions. As the actuaries look at the data they have, they estimate how much money will be needed to cover their health care. Those calculated increases then get passed onto other clients of the insurer. As far as your friends that work in the hospitals, if the hospital is self insured, they won't be adding any clients unless they hire someone new. Therefore, almost all of the data is already known.

While I can appreciate everyone now being able to get coverage, the cost will ultimately be paid by the middle class, whether through higher premiums, or taxes.

@Rees -

The part that gets Hoffa upset is that his catastrophic care policy isn't good enough for Obamacare, so Hoffa would either have to buy an additional policy, change policies, or be subjected to the government fine. That's BS and Hoffa isn't going to pay it!

Hoffa has ALWAYS paid cash out of pocket for U&C care as he utilizes services and has never stiffed any health care provider on a bill. But that's not good enough for Obama.

Well, as far as Hoffa's concerned, Obama can shove his health care up his @ss! Hoffa will just declare a large amount of dependents for withholding purposes and pay in at the end of the year, less the Obamacare tax of course. Hoffa will then fight this BS in court if the IRS decides to come after Hoffa - they have no idea who they're dealing with!

Dennis you are inaccurate. They voted for Obama care and are now implementing it. The state run exchanges will still be federally regulated and the products offered in them even more so.

But, if we lose control by not retaining a state based exchange, then we would have to follow a Federally controlled one. That is the law of the land. With Walker deciding not to create a State based exchange, hasn't he just given away control? How then is that in Wisconsin's best interest?

Rees I think you missed Jay's point.

Rees, you are failing to realize that the State-based exchange has no defined terms on it right now, and the feds would essentially run it as well. Any opinion or rule written by the DHS director would force Wisconsin to comply.

This is a Constitutional issue, not just a policy issue. It's also a fiscal issue.

Walker did not give away control. And btw, Walker didn't give up hi right to create one later. THIS IS IN WISCONSIN'S BEST INTEREST BECAUSE OBAMACARE IS UNCONSTITUTIONAL. And, we are still fighting it legally. The best way to stop the law, or slow it down is to refuse the authority of the feds to make us do anything.

The Feds creating their own is fundamentally the same as WI doing it.

Excuse me but didn't you get the news item from the Supreme Court which clearly stated Obamacare IS constitutional?

http://www.thedailybeast.com/articles/2012/06/28/explaining-the-supreme-court-ruling-on-obamacare.html

@rees

Excuse me but didn't you ever read the Constitution? No matter what the MINORITY of the SCOTUS said (it was a 4-1-4 decision, sir), the constitution does not change because a majority says so. Roberts did not in fact say the law was Constitutional. He merely said that it could possibly be as a tax. However quite the contrary Roberts decision actually said that the entire basis of passing the law was in fact unconstitutional.

Here you go buddy, in case you haven't read it: http://www.usconstitution.net/const.html

That's the limitations, the full extent of federal power. Btw, Something tells me that prior to the 1950s you would have said that segregation was unconstitutional despite previous Supreme Court rulings to the contrary.

Because of an amendment that was written into the law, if a state refuses to take it over, the feds have NO right and no ability to enforce the federal mandate (fines) on businesses and individuals.

http://news.investors.com/ibd-editorials/070912-617564-states-start-to-revolt-against-obamacare-mandates.htm?p=full

That's because, under the law, the insurance subsidies can only be run through state-administered exchanges, not federally operated ones. And the penalty only applies if employees can get subsidized coverage through an exchange.

I would rather have more choice and to keep jobs in the Medical Equipment Industries.....like G E Medical

http://hotair.com/archives/2012/11/15/this-medical-device-tax-is-just-not-going-to-end-well/

http://www.politico.com/news/stories/1112/83853.html

http://hotair.com/archives/2012/07/30/surprise-obamacare-medical-device-tax-killing-jobs-in-the-industry/

Or democrats for that matter.... Any federally regulated exchange is bad news for any state

> Which is why it is opposed by 53 plus % of Americans.

no, not opposed by 53%
just because 53% voted to keep Walker in,
doesn't mean they were all opposed to the health care act.

Joe todor,

Most Americans oppose Obamacare. His point was accurate

Keith nothing you just said made any sense.

Scott Walker has no responsibility to obey an unconstitutional federal law

Keith Jackass, Please list the programs that Doyle shouldered that Governor Walker could not handle.

How is this passing Walker's responsibilities upward. It was Obama and the democrats who wanted the federal government in control of health care, met behind closed doors, kept the Republicans out of the decision making, passed a piece of legislation where the rules were written afterward..... Now that they have it they don't want to run it.

@low life POS scum bag Schmitzy -

"The Jim Doyle"

WOW, just wow! Did you start hitting the bottle a little early today by chance?

You're correct, Keith...Doyle did have a lot of "rob Peter to pay Paul" programs that Gov. Walker would not put up with - to the tune of $3.6B in the hole. Well, now that the ship has been put back on course, Gov. Walker is attempting to keep that same thing (this time, federally mandated) from happening again. Like all federal programs, they'll throw a bunch of money at the state to get something going, but gradually pull that money away, forcing the state to fill the gaps. No thank you, sir. This way, the feds are stuck with their mess.

Yeah, they ruled it is a tax. So, when we get taxed, it costs us more money. Just what this country needs right now. Obama is an idot, he will bring this contry down!

@kate

The Supreme Court did not say that the law was constitutional. It was a 4-1-4 decision, striking down the very basis of the law's passage - the commerce clause - as a constitutional avenue. Meanwhile, Roberts suggested it could be used as a tax.

Nonetheless a slight majority of any Supreme Court does not determine whether a law is constitutional. We the people do. Something tells me that you would have said the Supreme Court was not correct in allowing segregation policies to stand as constitutional before the middle of the last century. Am I right?

Which is why this imposition of federalism, subtle as it may be, could kill the entire act.

Because congress could simply refuse to fund those increases and programs. ;) which is why conservatives were wrong in saying a state run program wasn't a bad idea...

It's predatory federalism to allow the Feds this inroad

He does actually.

Now, you use your feet and hands to work. That's the way it's supposed to work.

Btw, this has nothing to do with state-based healthcare. And it doesn't change it at all.

News the time for REAL reform. Not this crap we've been dealt

*now's the time... Grrrr

"Now, you use your feet and hands to work. That's the way it's supposed to work."

Yes, that IS the way it's supposed to work. You find a full-time job, your employer provides health insurance. Except it doesn't work that way and hasn't for quite some time.

I find that statement about using my hands and feet to work incredibly offensive.

I don't think you will ever have 100% coverage with any plan, 97% would be more realistic. So we are really talking about 7% in Wisconsin. 7% could have easily been covered without the complication and costs of the ACA. I predict, in the end the percentage of uninsured will actually go up not down. As will the costs. The people that are too well-off for Medicaid or not well-off enough to afford insurance on their own, in most cases, will have to buy insurance or pay a fine.

Pre-existing conditions not being a factor in price or acceptance anymore makes it possible to get by without insurance coverage until one wants to go to the doc. Many will choose to pay the relatively small fine and pick up insurance only when they need it.

http://www.dhs.wisconsin.gov/publications/p4/p45369.pdf

Some stats here.

@Randy

"I find that statement about using my hands and feet to work incredibly offensive."

Too bad. I find your violation of our constitution and my rights as a producer to give free care to those who aren't offensive as well.

Your premise is wrong. People should be able to address their own health care needs and costs without employer benefits. Health care is too expensive. THAT is where the reform needs to be:
http://www.foundersintent.org/2012/11/16/pursue-conservative-health-care-reform-fighting-predatory-federalism/

Greg:

Good info. Thanks for sharing.

@patchreader 123 -

Your assessment of this situation couldn't more spot on!

I'd "say" Scott Walker's decision puts to bed any reasonable doubt that Wisconsin's needs and best interests are his lowest priority.

"I'd "say" Scott Walker's decision puts to bed any reasonable doubt that Wisconsin's needs and best interests are his lowest priority."

No Bren, YOUR interests and priorities are not in line with those of the majority of the people in Wisconsin. Insisting that you are #1 does not make it so. It just makes you insistent.

.Do you mean "determined"? It's called State's Rights, a cornerstone of a Republic.

Fred, why do you wonder? Did you learn American history at all when you were younger? As AA said it's a cornerstone of a republic. The president is elected by states (electors), and the reason his position exists is to execute the laws passed by the people through Congress within 18 enumerated powers (that means, nothing beyond those powers) in Article One, Section Eight of the Constitution.

Read that section, then ask yourself how any of this fits that limitation. The federal government has it's role. The states have theirs.

The President is the "governor" of that equal, but separate government, elected by states.

Willing - I liked it when the Federal Government stepped in to end segregation, for example, when many States were unwilling. How about you?

Who's this "WE"?

YOU - it's YOU. All that stuff must be funded. Let the funding and agencies go away - local communities handle it better on their own!

What exactly are "French benefits"...higher taxes? I know actually reading the U.S. Constitution is beyond 60% of the U.S. population's mental capacity, but you think some of you may have picked up something from "School House Rock".

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

Remember that little ditty? It wasn't just some song written by a hippy in the 70's, it's the Preamble (kind of like a thesis statement) of the U.S. Constitution.

Don't confuse the order of promote and provide.

Keith, even better.....

It's already not funded. :) It's an unfunded mandate, and Congress would need to pass a NEW law to fund it. If we keep the pressure on Congress, it will fall apart because they could refuse to fund it, causing the exchanges to never materialize. :) This is our goal. Nullification by default, not direct withdrawal. Pretty clever of Walker, IMO.

$$andNonsense...I await your usual "brilliant" analysis as to why the 14th amendment could get in the way of a rebellion.

As for myself, I am an American. I will fight for the betterment of Wisconsin, and the United States as a whole. When we make mistakes like we did on November 6th (by re-electing a President who has a 180 degree turn on his promises from 4 years ago) I will work to get things on the right path. If it means thousands will lose their jobs, I will sympathize, but continue to get the right people in office.

I will continue to do this until they take THAT right away, at which time the United States will officially be dead.

$$andNonsense's nonsense is on full display tonight - the 14th Amendment?!?!

What does the 14th amendment have to do with anything in this thread?? lol

And I don't want secession. federalism is all we need. If we practice federalism, we will send this law back to hell, and restore the balance we need.

Sigh.....

The 14th amendment could be used by the president to legitimize federal debt load shifting to individual states "based on their political leanings" on a supreme court ruling if it goes there. State secession petitions would weigh in. Given Obama is again in charge, with justices to appoint in the next four years, he has the podium to go there. Penalize any state considering/filing secession papers and they may pay the price of fed tax dollar sharing reduction.That is so much yesterday news. Research it if you don't buy my post. It is not my place to educate the uneducated. You get it now DF's?

Saul and Doofa like simple word bytes. This isn't simple you simps and I am sure my post will bring out the best in your attacks but do your homework first. I do not need to provide proof of what the Constitution states or the courts may decide in the coming years.

Saul and Doofal. You are hyprocrites beyond belief with no understanding of Constitutional law. Doofa, Mr. Phd. or whatever.

"When WE make mistakes like we did on November 6th.. "

So you voted for Obama. Well then you as part of WE will harvest the consequences as there is no "I" in WE.

$$andNonsense wrote: "...legitimize federal debt load shifting to individual states "based on their political leanings" on a supreme court ruling if it goes there. State secession petitions would weigh in..."

$$andNonsense, where did you pull that analysis from? The 14th Amendment dealt with emancipation and the needed legislation in the aftermath of the Civil War. The only part dealing with debt is Section 4 that states the United States, and individual states would not be accountable for debts incurred by the Confederacy, or other future rebellions.

Seriously, what are you thinking with these posts?

Section 4. ...But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.

The answer to that is, the patient pays until he has no more money, and then the rest of the cost gets spread around to the rest of us.

...or they buy insurance when they find themselves in such a position and then the insurance companies will have to pay.

When that happens it's the people who pay premiums to that company who end up paying. It all gets spread around.

So, in other words, the problem isn't fixed unless we assume that a) ACA is going to actually make health insurance affordable for those who don't have it now and b) those who don't have it now will opt to pay for it rather than paying the penalty. The same factors apply for those currently on employer provided insurance and who are thrust in the pool marketplace thanks to the government incentivizing withdrawal of coverage by employers.

The assumptions that seem to drive this program are that, all of a sudden, businesses, including insurance companies, aren't going to do things that maximize profits and minimize costs and that people on an individual basis are going to making wise, responsible decisions and do what's best for themselves over the long run rather than over the short term. When have those ever been reasonable, realistic assumptions?

"they out of luck if Walker gets it's way"

Well, Frederik, you can always return to the Netherlands and pay a 52% income tax rate on an income greater that about $70K in support of Dutch socialized health care.

Or, you could remain in the U.S. and pay a lower income tax rate while not complaining about the health care yiou receive here.

The choice is yours.

@Bren -

"Our country really needs a national health care plan, taking the middle man health insurance industry out of the mix."

We already have one - it's called being personally responsible and paying cash out-of-pocket as you utilize services. Honestly, why can't you and others seem to get your "collective heads around" such a relatively simple concept?

Hoffa:

Get real. Who can honestly afford almost any medical care in a hospital today? God forbid that you would need any type of surgery. $100,000 bills are common place. So, your comment "it's called being personally responsible and paying cash out-of-pocket as you utilize services." is just plain undo-able and unreasonable for the typical person. How do you justify such a comment. Can you afford a $100,000 bill?

Right. That works right up to the moment they diagnose you with cancer, and then it's good-bye to your house and your savings whether you live or lose your battle. For people with a spouse and children that's a horrible risk to take.

Mr. Hoffa, major medical issues can cost over a million dollars. $50,054/annum is currently the median household income rate according to USA Today: http://usatoday30.usatoday.com/money/economy/story/2012-09-11/median-household-income/57757352/1

How is a million-dollar illness, or even 1/3 of that to be paid with a $50,000 income? Mortgage/rent, food, transportation, utilities, health insurance premiums eat that income up very quickly. Let's keep it real.

@Bren, Rees, and Randy1949 -

That's why you get a catastrophic care only insurance policy, for contingent and uncertain situations, as insurance was originally meant to provide. And such policies are extremely affordable (or at least they were prior to Obamacare). For everything else, why pay a middle man when you can pay cash direct out-of-pocket as you utilize services? Set some money aside in a HSA, and you're good to go!

Hoffa's been doing it ever since he came off his parent's policy 15 years ago.

And as a cash paying customer for U&C care, you can usually negotiate prices that are up to 90% cheaper than what the same health care provider charges back to an insurance company! Why everyone doesn't do it Hoffa's way is beyond Hoffa.

To provide proof of Hoffa's assertions, and to not be accused of right-wing bias, Hoffa found the most liberally biased source that he could find to back him up - the Daily Kos:

http://www.dailykos.com/story/2012/05/29/1095722/-The-problem-with-health-care-what-it-costs-vs-what-insurance-companies-have-to-pay

But no, just because most people are lazy and dumb, unable to save up a couple bucks for health care despite having money for cell phone plans, 24" spinner rims, flat screens, fancy kicks, bling, cruise vacations, etc, we have to subject ourselves to being treated like children by our government instead of being treated like the adults we are.

And you all support this!?!?

Sorry, but that's just SAD and pathetic!

@Hoffa, as I have said before, catastrophic coverage for a couple both in their sixties costs a bit more than the same for a single thirtysomething like yourself. A ten thousand dollar deductible would bleed me dry and leave me unable to afford the out of pocket expenses for our yearly exams and the mammogram. In this regard, the ACA helps us, because at least now one could have those things paid for without the deductible and co-pay.

@Randy1949 -

Perhaps we're not on the same page here. Could you distinguish between catastrophic care and U&C care for Hoffa? If you contracted strep throat and had to go the doctor, would you expect that to be covered under a catastrophic care policy?

@Hoffa -- To me, catastrophic is when you have over ten thousand dollars worth of medical bills in one year. I think that rather than 'catastrophic' you might mean 'major medical' and indeed, there are policies that cover that sort of things with varying deductibles.No, I do not expect insurance to cover it every time I see the doctor for a strep throat. However, if I'm paying thousands of dollars per year for the coverage, I would like the office visits and the tests to at least count toward the deductible.

Not to mention that some preventive tests can be expensive. A colonoscopy costs over $3K, and mammograms can go over a thousand if follow-ups are required.

I always paid for my office visits back in the day. but that was before fifteen minutes in the paper gown cost you $200 a shot.

The middle class insurance policy holders of my acquaintance are high family deductibles. Between the co-pays and out-of-pockets, an average family's needs don't hit the deductible. So most of those premium payments go right into the insurance company's pockets as profit. Then, if a family has a moderate health need (illness, broken bone, etc.), the costs are nearly unaffordable because they are bleeding out so much in premiums, co-pays, etc. If a major illness or injury comes along, forget it.

This is America. We can do better than this. A lot better. We need a national health care plan.

@Randy1949 & @Bren -

If either of you bothered to look at Hoffa's link, then you'd see that paying cash out-of-pocket for many preventive and U&C care services often result in prices that are 90% less than what the same service costs an insurance company.

When Hoffa says catastrophic, he's referring only to limited contingent or uncertain situations, such as being diagnosed with lung cancer even though you don't smoke or live in a smoking environment.

However, if one is engaging in a risky activity, such as down hill skiing, and breaks a bone - well, there's hardly anything contingent or wholly uncertain about that, is there?

The last time Hoffa saw a doctor, he pre-negotiated the cost of the office visit to a base fee of $150 plus $200/hour that he spent with the doctor, divisible in quarter hour increments, and a reasonable price for any tests that needed to be performed. The total bill was a very reasonable $450 - and far less than a yearly regular health care insurance policy premium.

All the money that Hoffa saves in premium payments goes into a special HSA/investment account.

If everyone managed their health care as Hoffa does, and avoided engaging in risky or unhealthy activities, would there be a problem in this country? And just because people can't be frugal, smart, and sensible, does that honestly mean that Hoffa should be punished and made to help supplement their irresponsible behavior?

Come on guys - let's get real!

About those 'cash prices' listed on Daily Kos -- can you tell me anywhere in the Milwaukee area that does the same? I always pay cash on the day of service, and while I get a discount for being uninsured, it is never 90% off.

I don't ski, I don't climb mountains, but I do have to walk out to my garage in the wintertime. Two years ago I hit a patch of glare ice and went down hard. Judging from how long the pain lasted, I broke my tailbone, but I decided not to go to an emergency room. What would I have gotten for my $2000 other than some x-rays, a little ring pillow and a nice Rx for Vicodin? They can't put your behind in a cast.

Don't always try to make it someone's fault. I agree that if we all paid out of pocket as much as possible and took care of ourselves, prices would come down.

What has ACA done to control the cost of healthcare?

If I read what Randy,Bren and Rees have written, the majority of their complaint about the cost of healthcare. But, their answer is lets shift the cost burden upon others;not lets lower the cost of healthcare. Remember, 80-85% the cost of insurance is the actual cost of the healthcare.

@Jay Sykes -- What does health insurance do except shift the medical costs of a few over a wider group?

We have a problem here, in that people confuse the cost of health insurance with the cost of healthcare.

The cost of medical care also drives up the cost of insurance, obviously. You either allow the market to work out that cost, or you continue to allow manipulation by government which ensures cost will continue to rise.

The rules of economics would change cost for both. When consumers cannot afford a product, those providing the product will adjust to meet the consumer, or they will be replaced by others that will will. It is absolutely the intervention of government that has caused this problem.

We need to shift 'known' costs of 'elective conditions' upon those that 'elect' those conditions. If the known costs of smoking and obesity were allocated to those that elect these conditions, the cost of healthcare for those of us that are non-smokers and have a BMI<30 would be reduced by about 40%. Could more people afford health insurance if it was 2/3rds of the current costs? Maybe Randy would find the costs reasonable then? I know I would like my premiums to go down by 40%.

FYI: Only about 3% of all healthcare dollars are spent in the emergency room.

@Randy1949 -

Hoffa has successfully negotiated cash prices with both Aurora and Wheaton Franciscan in the past. Bottom line is that you must vigorously pursue the negotiation - you can't be lazy about this.

@Bottom Line -- When would you say this government intervention began?

@Jay Sykes -- Did you know that the original Blue Cross plan was one size fits all? The same premium regardless of age, sex, or state of health? It would be interesting to know what that yearly cost would be for all Americans averaged together.

And of course Randy, with a BMI of 24 would love not to be actuarially judged by the poor health and condition of other 63 year olds.

Healthcare spending in the USA is about $9,000/per capta.

Government intervention began before you and I were born. That said, you can either dilute the discussion by trying to minimize my point, or engage it in a meaningful way. The health care industry in the last 50 years has changed a great deal, and if government had restrained itself it would have continued to be affordable.

When I was younger, those that could not afford health care had several options, none of them had cost that was overwhelming. There were Clinics that specifically cared for the indigent. University Hospitals cared for those without funds by utilizing Doctors in training. Many hospitals provided services without cost. Unfortunately, some decided that wasn't good enough. Add the lawsuits, add the never ending regulations, and in these short 50 years we changed a tenable condition into one that is bankrupting everyone.

http://www.usdebtclock.org/

If you look at the bottom of the page, you will see the cost of prescription drugs and medicare now exceed 100 trillion dollars in unfunded liability. The actions of our government have brought this about because they have so contaminated the rules that would have naturally kept those costs in check. Economics would have corrected any hyper-inflation.

It is sad that so many understand so little ... this is a problem that cannot be solved until the government gets out of the way.

@Jay Sykes --so that means every man, woman and child has to pay $9,000 per year (averaged out, of course) to hospitals, physicians, and drug companies? Or does that include the cost of insurance as well?

Good question Randy, it is not clear if the insurance overhead is part of the number. If it is included, we could shave about 2%-3% off that number by moving to single payer system, since most healthcare dollars flow from the government.

65% healthcare $dollars flow from government(Medicare/Medicaid/VA...)
25% self insured large group@ 10% OH (Approximate Canadian overhead rate)
20% Small/single plans @ 20 overhead

10% X 20 % = .02 or 2%

@Jay Sykes -- If we're to believe JR Hoffa's link to hospitals that provide expensive $2000 tests for $250 if you pay cash, it's worth 90% off just to avoid the hassle of having to bill an insurance company. I'm not sure I believe those figures entirely, but we know that countries with single-payer manage to spend half what we do and cover everybody. I think there's a lesson in that.

The relationship between the healthcare 'list' price and that which is actually accepted "paid-in-full", is kind of Monty Hall -- 'Lets make a deal'.

I have no experiences negotiating directly with healthcare providers;I have always contracted with the insurance company to be my negotiating agent. Of the many medical bills I have reviewed, all 'processed'(must pay deductibles) through insurance, the 'allowable' amounts range from 80% to 15%, of the 'billable' amount.

Tests/xray/scans seem to be 'allowed' near the lower percentage and Dr. charges tend to pay-out at the higher end. I cant find any 'logic' to the variances. Averaged all of it out, over time, it ends up around 50% of the billable is allowed(including deductible).

Based on my experiences with the 'allowable amount', Hoffa could negotiate a 90% discount. Although, one would expect the discount to vary widely.

Tell you what -- I'll try negotiating with Waukesha Memorial/Prohealthcare to get them to agree to a $400 colonoscopy ahead of time and see how successful I am. I expect peals of laughter from them, frankly.

I'm also currently attempting to get an elderly relative a bed in a rehab/skilled care facility and discovering that they want a check in hand before we can even come in the door. I think any attempt at negotiation will result in my being told to try elsewhere.

@Randy1949 -

If you're serious about negotiating prices for medical care, then you have to do it right. You have to be ready to cite the real cash prices of competitors and provide proof of such prices. You have to know the price of test machines, the number of patients that annually use the test machines at the facility you're negotiating with, the total number of annual patients, the per patient overhead expenses that the facility experiences, etc.

You just can't go blindly in to negotiations with no negotiating power. You should start by preparing a fair itemization of the costs/expenses/profit margin of the procedure you're negotiating over, with the best available information that you have. So long as you start out with a relatively fair offer, and can back up your notion of fairness with facts and numbers, instead of trying to dick around with unrealistic low-balls, Hoffa has found that most care providers are at least willing to talk numbers with you.

And you also must be willing to shop around, as not everyone will negotiate and there are variances amongst those who will, sometimes substantially so.

And when Hoffa says cash, he means $100 bills - not a personal check, cashiers check, money order, etc.

Good luck and be sure to let us know the results from your attempted negotiations

Right...

@Bren -

Where is Governor Walker's signature on the ACA, as Hoffa can't seem to find it anywhere? However, Obama's signature is very prominently present.

Is it so hard to admit that Greg is right about this?

Bren said that I'm right, I prefer the word "correct".

There are several governors who, in a fit of partisan pique, are refusing to establish state-based exchanges. It's not that they don't know how (with the possible exception of Walker). The "mess" is electing people who put partisan and/or special interests in front of the best interests of their constituents.

In Wisconsin's case, we are better off with the federally-established exchange in my opinion as our state leadership is incompetent. The loss of customization is unfortunate, but this is too important a task for our governor. It's too bad we're paying a fat salary and benefits to this guy when we could have had competent, qualified leadership in Tom Barrett. A shame.

Greg, the ellipse was used to denote deepest sarcasm. I'll be more obvious next time. ; )

Right ...

Bren - Tom Barrett? Really? Where is Tom Barrett on Palermo's? Hiding? Where is he? Under your desk? He has this issue in his city and he is no where to be found?

Ima, what should Tom Barrett be doing about Palermo's, precisely?

Bren, your answer says it all. This exemplifies the shallowness that is Mayor Barrett. (and his followers)

So you think the "healthy" people will bring in enough to offset the cost of those with pre-existing conditions? How about the ones that can't afford the plan they choose? The other plan members will have to pay for that as well.

But the bottom line is insurance premiums, mine and others, have gone up since B.O.Care was passed.

"We crafted legislation outlawing pyramid schemes because we see them for what they are ... clever temptation to participate in a scheme that will cause the majority to lose while the clever few advantage their ignorance, and win. Yet, we are allowing our government to force another pyramid scheme on us, and we are doing it at a time we can least afford the expense."

NAH, The government crafted that legislation because they hate competition, not that they have anything against pyramid schemes - of which Socialist Security is pyramid scheme #1.

Tss,Tss Greg such words but your right at least partial then again how easy a story takes on life by itself,so instead of Walker his loving minions at the Wisconsin Tea Partiers Want To Arrest Officials Who Implement Obamacare.Such airheads.

http://www.nationalmemo.com/wisconsin-tea-partiers-want-to-arrest-officials-who-implement-obamacare/

What in my statement was I partially right about? It was a survey and not a Bill. So stop trying to support your lies

I finally figured out how to reply, in the correct spot, from my phone.

Speaking of airheads - Fred van der Wal everyone. Fred van der Wal.

*snicker* Who doesn't want to see Pee-Paw yelling into a phone to negotiate either insurance premiums or hospital rates. "Why, in my day, we lay in bed in the spare room until we lived or died. The doctor came and we paid him with a chicken. And hospitals cost ten cents a day -- and we liked it!"

I would never want to do business with a doctor that has the time to dicker a lot with me on the cost of a procedure, and will reduce his prices way down. And I may not be in a state to do that if I have a lot of pain, an emergency, etc. This bargaining would seem to be most applicable to elective procedures like plastic surgery, penile implants, etc., but I do not want a discount heart surgeon, for example.

Wait, did I say airheads earlier? Speaking of airheads, Dirk Gutzmiller everyone! Woo Hoo!

@Dirk -

Unlike you, Hoffa understands that nothing in life is truly free - someone always has to pay. Obamacare provides no cost and subsidized coverage to tens of millions of people. That coverage needs to be paid for by someone. And despite the title and purported purpose of the Act, Obamacare doesn't do a single thing to actually lower the costs of health care in this country, does it? Thus, logic dictates that rates will go up.

Too bad that we elected a President that apparently doesn't even understand such a relatively simple and logical correlation. Remember, Obama promised that Obamacare would lower rates by an average of $2,500. Since it was passed into law, rates have actually gone up by $2,500 and are projected to indefinitely increase into the foreseeable future by all reputable accounts. It's also a fact that both the CBO and OMB estimates of the cost of Obamacare have been revised upwards ever since it was first proposed.

Finally, how can the insurance companies be "making huge fortunes on the medical fears of the middle class, which actually, yes, includes the Hoffa," when Obamacare limits their ability to appropriate premium to overhead expenses and profit? If what you say is in fact true, then how come Obama and Holder aren't suing every single insurance provide that has raised rates in the last 2 years for violating the law?

Dirk, you continue to prove that you're low-information, non-thinking stooge, easily susceptible to propaganda!

You and Mr. Peterson are drawing a conclusions based on headlines only. If you had read through the Bloomberg article that he cited (but failed to provide a link), it even states "...Nicholas Colas,... predicted that risk-averse voters in competitive states may side with the presidential candidate who would extend benefits..." simply put, even if you are in a heavily Conservative county, it is possible for people to receive food stamps and other government entitlements. And both Obama and Romney positioned B.O. as the "preserver of the entitlements"

The Bloomberg article also covered Pitkin County in Colorado (Aspen area) having the largest increase at 463%. But... that was based on going from 48 to 273 households, or going from .62% of all households to 3.57%, still well under the 14.9% for the entire country.

The point to be made though, is that when an area as successful as Aspen has a spike in things like food stamp, we are definitely headed in the wrong direction!

AWD, while your conclusion is waaaaaay over the top, one of the largest problems with Healthcare, before B.O.Care came along was getting that 10% insured. The problem is that when someone needs medical assistance, a hospital has to help them regardless of their ability to pay. It is better to get that 10% onto a plan so their expenses can be covered under insurance.

The problem is that B.O.Care shoveled the burden onto the middle class. I have stated repeatedly how much my payments have gone up. Personally, I don't see why the uninsured can't get catastrophic coverage and take care of their little boo-boos on their own. Unfortunately, they make up a large part of B.O.'s voter base, and B.O. will cater to them for their vote....at the expense of the middle class!

Apparently he believed that Obama would spend more than 3% of the stimulus on infrastructure.

Makes it sound like he had something to fear if he had been here. Did his not being here throw a monkey wrench into the plans of some lefty nut-jobs?

It was a "news dump" along with half of the other states in the nation.

@Greg

More news from Walker. te he. poor scooter.

@katie_foody

Apparently Gov. Walker not happy with coverage of his California speech. Deleted tweets @politwoops: http://ow.ly/fpLzL #wipolitics

You do know that people on this site have the ability to get all the news that we want without you reposting every twits tweets from sites like @bluebunghole.....But you have to be a real twit to post deleted tweets. te he....

Here I'll help:

“@RedState: How Obamacare’s Taxes Will Hit Your Pocketbook bit.ly/ZvmbNk" FSA tax cap of $2,500--families w special needs hit hardest

morn, were you asleep Wednesday, Thursday and Friday? EVERYONE and I mean EVERYONE with any connection with Governor Walker was saying the official notice, which was due on Friday, would pass on creating health care exchanges. They even cited the same reasons he did in his letter.