Mechanical vs Tissue - need help deciding

[Mister_James]

I am a heart person, birth defect of the aortic valve with murmur, replaced in 2001 with a St. Judes' valve. I am also a type 2 diabetic, gene pool from family and surgery triggered and not clogging up my hospital visits over it. You know nothing about the true Americans , except for what you read and listen to in the news media.
I am proud of my country. No need to be nasty to us. Have a nice day and be kinder to people here.

It will surprise you that I am in NYC and I work in healthcare.
There is no wait only because Americans CANNOT afford healthcare. If you doubt me, go to the emergency room of your local hospital and see the wait there. Emergency care has to be provided without consideration of ability to pay.
Every surgery scheduled is pre-approved. The hospital knows they will get paid. You get treatment because you can pay.
The sad part is most Americans are blind to this fact. But when every one is seeking care at the same time like with this pandemic, your insurance means nothing, you will wait in long lines.
Be grateful that your ability to have insurance is what keeps you ahead of the line ONLY because many others cannot access healthcare.

 

[pellicle]

It will surprise you that I am in NYC and I work in healthcare.

personally I have an alteration of the old phrase that I use. Instead of:
"when you assume you make an *** out of you and me"

I say to people :
"when you assume you make an *** out of yourself, mmmmm"

(sadly I probably wont get to see the angry face)

 

[Superman]

I’m taking the power of the angry face and making it an acknowledgment of humor.

 

[pellicle]

this is very Kung Fu

I’m taking the power of the angry face and making it an acknowledgment of humor.

 

[tom in MO]

What gets forgotten is that not having insurance or having poor insurance is for many or maybe most, a choice too, particularly in today's labor market and with the Affordable Care Act.

 

[Mister_James]

What gets forgotten is that not having insurance or having poor insurance is for many or maybe most, a choice too, particularly in today's labor market and with the Affordable Care Act.

YOU CANNOT BE SERIOUS.

Average ACA premium is $575/month, subsidies kick in with income of at least 100% of Federal poverty level or 140% for states that expanded Medicare.

I pay less than $150/month for my company based insurance.

We would go a long way with understanding and empathy. Be grateful and glad for your blessings.
A man sleeping on cold NYC pavement does not enjoy the cool alfresco winter nights.

 

[RAS]

Average ACA premium is $575/month

That's the unsubsidized average. Per HealthInsurance.org...
"As of September 2021, there were 12.2 million people enrolled in plans through the exchanges nationwide, and the vast majority were receiving premium subsidies. For those enrollees, premium subsidies covered the bulk of their premiums: The average full-price premium in early 2021 was $575/month, but the average subsidy amount was $486/month. And again, that was before the ARP made subsidies larger and available to more people."

So the average subsidized premium was $89 compared to your company $150/mo. That's before the American Rescue Plan (ARP) changes. The average would be even less now. Still there are people who for whatever reason choose not to be insured even though they qualify for ACA. Sadly others are not insured because they fall into the coverage gap between Medicaid and ACA in states that chose not to expend Medicaid.

I have paid $125 to $210/mo. on ACA. The range of plans available and corresponding costs is broad and varies quite a bit by location. Nearly everyone on an ACA plan qualifies for a subsidy of some amount now that the 400% FPL income cap is removed (for 2021, 2022 at least).

Employer sponsored insurance costs vary significantly as well. Your $150/month is a good rate. I paid $860/mo. the last year I worked (covered me and my wife). That was half of the total premium. My employer paid the other half. Many employers pay two-thirds. Some pay an even higher portion. Seems like you have a good deal on your employer plan cost plus you get the tax deduction advantage as well.

 

[carolinemc]

Hello – I am a US citizen and agree more with Pellicle’s view on our system. I’m guessing that you most likely have a good job with good insurance, and probably have had such, your entire working life. Before that, your parents took care of your needs. When you have top tier insurance especially when working for large Corporations, the patient can usually get whatever they want.

As an aside, this situation causes some people to stay in jobs they hate because of the great insurance. That causes other issues impacting our economy.

But when you become unemployed (after ridiculously expensive COBRA coverage runs out) the resulting options are very poor. The premiums are based upon your most recent tax year, not your current zero income, so if you were making good income previously, the premiums with even very high deductibles, are insane like $25k / year with $10k annual deductibles.

The affordable care act was a good idea, but it really only works well for the poor who are paying next to nothing, and as you said it varies widely by State. The middleclass gets screwed.

Then when you hit 65 and retire and go on Medicare, your choices will be limited by what is covered. You will not have the luxury of choosing whatever you want and get it for free.

The recent handling of Covid in the US is a good example of how medicine works in other countries. You need a test, go in, get it done, free. You need a vaccine, go in, get it, and it’s free. You need monoclonal antibodies, (first try to get them as they are allocated) but say you are fortunate enough to get, they are free to you. This is how the system should work. We are all paying for it thru different means either way, but our friends in Washington will never change it as they personally benefit from the current system.

Home testing in my (limited) experience, is not well known nor encouraged. My PCP who is close to 60 years old and has been practicing medicine for at least 30 years with a very successful practice, has zero patients home testing. I had to educate his office on how it’s done. Again, our system encourages patients to use more expensive methods such a Coumadin Clinics, Quest diagnostics etc. to bill more and keep that system humming along. They do not believe in efficiencies.

Look at drug pricing. I worked in the pharmaceutical industry for over 20 years. See what manufacturers charge for the exact same drugs across different countries. We are getting screwed and helping subsidize the other countries lower prices, and all of the nice direct to consumer drug advertising you see on TV every night.

There is so much room for improvement! I’m just scratching the surface.

Sorry, but that’s my opinion.

This reminds me of that great Jeff Daniels clip. No, we are not the greatest. But could be…….


[/QU

It will surprise you that I am in NYC and I work in healthcare.
There is no wait only because Americans CANNOT afford healthcare. If you doubt me, go to the emergency room of your local hospital and see the wait there. Emergency care has to be provided without consideration of ability to pay.
Every surgery scheduled is pre-approved. The hospital knows they will get paid. You get treatment because you can pay.
The sad part is most Americans are blind to this fact. But when every one is seeking care at the same time like with this pandemic, your insurance means nothing, you will wait in long lines.
Be grateful that your ability to have insurance is what keeps you ahead of the line ONLY because many others cannot access healthcare.

I only have Medicare and no wait to see a doctor, a specialist. So no other medical insurance and does not put in me in front of any line. I have to call in to make appointments and wait like everyone else. There was a time, a few years ago, no job, no medical insurance and off warfarin and metformin for three months. I decided to see about getting back on the meds for my St. Jude's aortic valve and type 2 diabetes. They had to put me in the hospital to do bridge therapy for the warfarin. Did not know that three nights before, had an eye stroke in my left eye, vision blurred.
So, this was before covid in 2017. Now I am doing better, but now have an irregular heartbeat. On SSDI and regular Medicare. And there are people having to be treated for side effects from Covid that is making it hard to get an appointment at the moment.
Surgery was always pre-approved, emergency rooms are crowded due to the spread of the covid, Etc.
No sense in complaining about what you cannot control. Inflation on prices have been going up for the last two years before covid hit. And many have access to medical care, if they would go get it. It is free to get if you look hard enough and go to it.
Just thank your lucky stars to be in America, it is harder on many countries like the UK. Count your blessings and live. Complaining does not solve anything.
Have a nice weekend, destress and relax.

 

[pellicle]

that I decided to restore ... which broke down me over time

this should have read "broke me down over time"

 

[Unicusp]

That's the unsubsidized average. Per HealthInsurance.org...
"As of September 2021, there were 12.2 million people enrolled in plans through the exchanges nationwide, and the vast majority were receiving premium subsidies. For those enrollees, premium subsidies covered the bulk of their premiums: The average full-price premium in early 2021 was $575/month, but the average subsidy amount was $486/month. And again, that was before the ARP made subsidies larger and available to more people."

So the average subsidized premium was $89 compared to your company $150/mo. That's before the American Rescue Plan (ARP) changes. The average would be even less now. Still there are people who for whatever reason choose not to be insured even though they qualify for ACA. Sadly others are not insured because they fall into the coverage gap between Medicaid and ACA in states that chose not to expend Medicaid.

I have paid $125 to $210/mo. on ACA. The range of plans available and corresponding costs is broad and varies quite a bit by location. Nearly everyone on an ACA plan qualifies for a subsidy of some amount now that the 400% FPL income cap is removed (for 2021, 2022 at least).

Employer sponsored insurance costs vary significantly as well. Your $150/month is a good rate. I paid $860/mo. the last year I worked (covered me and my wife). That was half of the total premium. My employer paid the other half. Many employers pay two-thirds. Some pay an even higher portion. Seems like you have a good deal on your employer plan cost plus you get the tax deduction advantage as well.

Ahh, I just love the use of averages. We used to use a simple example in planning: You have one hand in boiling water and the other hand is in freezing water, but on average you are warm.

The ACA average numbers shown above are way off from reality. The employer sponsored ones are much closer to actual. We are currently paying at least that amount ($860/month) for a employer sponsored BC/BS plan for 2 people, with a family out of pocket amount of $17.1k and family deductible of $1k. But, every visit has co-payments that do not apply to the deductibles.

I tried getting a quote from the ACA site and found that where I am in PA I would get a zero subsidy.
So, like I stated earlier, the people close to the poverty level, benefit from the program.
But on the upside, I just discovered that I can get the prescription Warfarin for $1/month thru mail delivery!

 

[Mister_James]

Ahh, I just love the use of averages. We used to use a simple example in planning: You have one hand in boiling water and the other hand is in freezing water, but on average you are warm.

The ACA average numbers shown above are way off from reality. The employer sponsored ones are much closer to actual. We are currently paying at least that amount ($860/month) for a employer sponsored BC/BS plan for 2 people, with a family out of pocket amount of $17.1k and family deductible of $1k. But, every visit has co-payments that do not apply to the deductibles.

I tried getting a quote from the ACA site and found that where I am in PA I would get a zero subsidy.
So, like I stated earlier, the people close to the poverty level, benefit from the program.
But on the upside, I just discovered that I can get the prescription Warfarin for $1/month thru mail delivery!

America is great in a lot of things just don't get laid off and don't get sick.

 

[pellicle]

America is great in a lot of things just don't get laid off and don't get sick.

Or get sick, loose your job then go downhill more (actual member experience)

 

[Croooser]

Ahh, I just love the use of averages. We used to use a simple example in planning: You have one hand in boiling water and the other hand is in freezing water, but on average you are warm.

The ACA average numbers shown above are way off from reality. The employer sponsored ones are much closer to actual. We are currently paying at least that amount ($860/month) for a employer sponsored BC/BS plan for 2 people, with a family out of pocket amount of $17.1k and family deductible of $1k. But, every visit has co-payments that do not apply to the deductibles.

I tried getting a quote from the ACA site and found that where I am in PA I would get a zero subsidy.
So, like I stated earlier, the people close to the poverty level, benefit from the program.
But on the upside, I just discovered that I can get the prescription Warfarin for $1/month thru mail delivery!

I'm not smart enough to figure this out but here is what I think anyway:

I retired early at age 56 by choice. Was not eligible for ACA due to means testing - fair enough. Bought $5000/pp deductible individual policies for my wife and myself from AARP/United Healthcare - thinking that I could manage premiums by self insuring for all but major illnesses or injuries which I correctly believed we might avoid. Badly miscalculated there. Over 12 years paid approx. $120,000 in premiums and, due to good overall health, never collected a $.01 in claims. Had monthly premium increased 19 times in 12 years - sometimes by $100/mo. Once called AARP/United Healthcare to complain about monthly increases despite $0 claims. They blew me off. My conclusion was that insurance companies know that individual policies are a gold mine that can be leveraged since the individuals have few options and all companies (at least in FL) play the same game.

I have nothing but good things to say about Medicare, although I chose to not use AARP/United Healthcare. Our annual out of pocket runs a few thousand $/year. Our out of pocket last year which included my OHS at CC and all preop and postop was $3600, not including travel costs to go to Cleveland.

My conclusion is that low income/net worth individuals have ACA (which has a decent approach to means testing included) or Medicaid. Employed individuals with decent employer sponsored coverage have that. Retired individuals have Medicare.

The gap is individuals who have not yet become eligible for Medicare and don't have a decent company sponsored plan but make a decent living. The insurance companies will take them to the cleaners on an individual policy, so some may decide to go without insurance.

Maybe the solution is to forget ACA and make everyone eligible to opt in to Medicare with appropriate levels of means testing and underwriting for those <65 years old. I would have gladly paid - say half of that $120,000 - to the government instead of AARP/United Healthcare. And since I had no claims to be paid, the government would be $ ahead on insuring us.

Of course the problem with any proposed solution is that our legislators are responsible for the laws that govern our healthcare. IMHO, therein is the real problem - we have no chance. None of our politicians from either major party have the willingness and the ability to craft a solution. They are too busy complaining and criticizing each other and working their self serving agendas.

 

[Superman]

I still maintain that it’s all shuffling deck chairs on the Titanic. Until we figure out some means if getting rising costs under control, it won’t matter if it’s taxes, private premiums, work plans. It’s all going to continue increasing costs.

 

[Unicusp]

America is great in a lot of things just don't get laid off and don't get sick.

Yep. Exactly what happened to me. Big Corporate Downsizing the year before my unexpected valve replacement surgery. Had great inexpensive highly subsidized insurance that I used once in my lifetime.

Luckily my wife was employed, but by a very small Company with small subsidy and high premiums with high deductibles. And that's when I had surgery. Met full out of pocket numbers.

 

[user 15848]

The baraka care is only good for B-B pockets.

 

[dick0236]

............ It’s all going to continue increasing costs.
[/QUOTE

.......... as long as we continue to believe......"we will all live to 150" yet recent stats suggest that US life expectancy is actually going down......go figure!

 

[pekster11]

I'll never complain about the NHS again after reading this thread

 

[RAS]

My conclusion is that low income/net worth individuals have ACA

Fortunately, ACA (unlike Medicaid) does not consider net worth. Generally Adjusted Gross Income + any Social Security that was excluded from AGA is the bulk of the income considered.

It takes advance planning to structure personal financials to retire early and be able to live off savings without having to withdraw from retirement accounts (which counts as income), avoid significant realized capital gains in taxable accounts, collect early Social Security, or pension until at least age 65 when Medicare kicks in.

Also ACA bases the subsidy on the second lowest local Silver plan. So to minimize the premium, the strategy is to get the bottom of the barrel "Bronze" plan. The high deductible is probably not suitable for someone who is a heavy user of healthcare, but so far it works for me. That said - Medicare overall will cost less than ACA once I get to 65.

The gap is individuals who have not yet become eligible for Medicare and don't have a decent company sponsored plan but make a decent living. The insurance companies will take them to the cleaners on an individual policy, so some may decide to go without insurance.

I agree. I suspect a lot of uninsured are in this gap.

I still maintain that it’s all shuffling deck chairs on the Titanic. Until we figure out some means if getting rising costs under control, it won’t matter if it’s taxes, private premiums, work plans. It’s all going to continue increasing costs.

Yep. There's a tremendous amount of unnecessary complexity in the multiple fragmented health insurance systems we have in the US. I would guess there is a lot of non value added admin cost as a result.

 

[Luckyguy17]

Maybe the solution is to forget ACA and make everyone eligible to opt in to Medicare with appropriate levels of means testing and underwriting for those <65 years old. I would have gladly paid - say half of that $120,000 - to the government instead of AARP/United Healthcare. And since I had no claims to be paid, the government would be $ ahead on insuring us.

Crooser, much of what you are describing above is actually the Universal Health Care standard of most developed countries other than the USA, for the <65 age group.

Canadian Universal Care is not perfect, but is a great equalizer for providing access to a good level standard of healthcare to all citizens. It also regulates lifegiving drug pricing.
No diabetic in Canada must choose between food or insulin, irregardless of their age and i personally am happy to have financially contributed to and benefitted from a very good level of healthcare for all.