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[–] Planet_Terror 0 points 1 point (+1|-0) ago 

I used to work in health-care field, specifically insurance.

The ACA was offered (voluntold) that all people would need to have insurance or pay a fine (tax). The first year I believe the tax was $95 per person, it went up over the years and I think last year it was 2.5% of your total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum of $2,085 Some people qualify for exemptions under certain circumstances (income being the big one) and do not have to pay the tax.

You said in your post you are 21, I'm assuming you are healthy and probably just go to the doctor for regular check-ups, nothing serious. Insurance generally is all deductible driven (similar to car insurance). You pay the first $X,XXX.XX dollars (typically about $1,500) PLUS your monthly premium and then when you meet the deductible you typically pay 20% of the bill after the deductible is met up to your out of pocket maximum, if you have a max otherwise you keep paying the 20% until your policy renews and then you start all over again. The catch is your doctor needs to be in network otherwise you will pay a lot more because your out of network doctor does not have a contract with your insurance company and can basically charge whatever they see fit.

The reason The ACA failed is most healthy people would rather pay $695 tax and get a regular check-up for about $100 one time a year than pay a monthly premium PLUS deductible and out of pocket maximum considering the costs is probably lower. (I've seen deductibles as high at $10k a year for a certain popular retailer and you know those employees do not make enough to cover that deductible). The tax I would imagine is the lesser of the two choices depending on the coverage you choose via ACA.

So while it was great that everyone could sign up for and have insurance, the only people who did were those who were already sick. That placed the insurance companies in a precarious position as they were loosing money (greedy bastards). They thought that the cost of the insurance for the sick people would be offset by the healthy people signing up who would not use the plan but still pay the premiums.

I'm not a proponent of entitled health-care for everyone, what I am for and what should be done is to regulate the costs of health-care procedures. You can call your insurance company and they can give you an estimate of what a procedure will cost with an in network doctor but it all depends on your doctor and what price they negotiated with the insurance company for each procedure and typically it can be different for each doctor sometimes by thousands of dollars. There needs to be more transparency on the actual cost not the wait and see what I'm being billed approach (hospital stays are a fucking nightmare where billing is concerned).

I also believe that me being older and unable to have kids, not having gender re-assignment surgery or will never need fertility treatments should not have to pay for these services in my premiums but that's a different topic.

To give you an example, I had gamma knife surgery last year when all the bills came in the total racked up was over $100k. It was great that I had insurance and my max out of pocket was $5k due to employer sponsored coverage. However, for the time that surgery took (it was an out patient procedure)3.5 hours for prep and waiting and maybe 30 minutes for the actual radiation treatment, it should never have been that much money. If I did not have insurance I would have been fucked..... Again, I strongly believe we need to regulate the prices and not make everyone have insurance.

I'm now in HR and it is an absolute headache to process the forms for all employees not to mention the calculation to figure out if an employee should be offered coverage if they don't work XX amount of hours... again another topic.

TLDR: Mandatory insurance is not the answer, regulating pricing on procedures, office visits, and medication is what is needed.

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[–] Malthrax 0 points 1 point (+1|-0) ago 

I agree with most everything you said, except "regulating pricing on procedures ..." because government price-fixing DOES NOT WORK, because the people who would be setting those prices are too easily influenced by lobbyists.

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[–] AncientArachnid 0 points 1 point (+1|-0) ago 

Industry lobbyists are a big part of the reason prices are so high now.

What do we do? Serious question.

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[–] Planet_Terror ago 

Thanks, I should have been more clear on the definition of regulating but my post was already long. I agree the government should be left out of regulating the prices with those damn lobbyists. One idea is the insurance companies can definitely provide an average of costs for each procedure as we already know it's different from doctor to doctor and state to state. That could be used to set pricing. Perhaps have a percentage increase every 3-5 years or so so long as incomes do not remain stagnant.

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[–] AncientArachnid 0 points 1 point (+1|-0) ago 

Excellent comment, thank you.