Originally Posted by The Wonkette

I dunno. They said the same thing about Reagan. Just sayin...

I would "just say" though, that Reagan didn't retire after one term as governor. Hillary retired as Secretary of State partly from "exhaustion."

And of course I have my cosmic reasons for saying this. A change of administration is more likely than not in 2020, and yet odds favor the Democrats winning both 2016 and 2020. Hillary would seem to fit that scenario. Biden might too, but Biden is not doing too well in the polls. But his raw score is at least as good as Hillary's.

It would be truly ironic if HillaryCare replaced the term Obamacare.

Originally Posted by Marx & Lennon

Agreed. I'm assuming that PW, cheerleading Dem that he is, is merely carrying political water for his party. As a not-Dem, I'm among the disgusted who would send that party to the showers permanently, given even a small chance of success. We need a major party that is left-of-center, we don't have one today, and we'll never have one until the Dems die or change. If Hillary gets the nod in 2016, the right-of-center Democrats will lock-in there for the duration.

When the time comes, just try to remember how much fun it was to trash the Dems when we get Bush 2 redux or worse, and they start to rip the social safety net to shreds and invade a couple countries and kill hundreds of thousands for the sole purpose of looking tough. Remember the luxury of being disgusted with the Dems.

I guess some folks need more than one lesson.

Originally Posted by Marx & Lennon

No, you've moved the marker into horseshit territory. This is not a happy program, no matter how many people may sign-on for help. Is the ACA an improvement? It helps many, and hurts some too. I can't be happy with that. With the ongoing equivocation, it's getting worse, not better. If it crosses the line into net-worse space, I'll actively join the crowd to kill it.

It will help 10s of millions. It will 'hurt' no more than 1.5-3.0%, most of whom are relatively affluent healthy males in their 30s. They get 'hurt' because previous to the ACA their policies, unlike the employer-based and the govt programs, were biased against women and those with pre-conditions. Some of these dudes will get sick and become part of those that will benefit from the ACA; others are going to get a woman pregnant (or, hope that she has medical ways to avoid that).

I see it as social responsibility.

Kind of funny how you see yourself as Left of me and the Dems.

Originally Posted by The Rani

Oops:



http://www.npr.org/blogs/health/2014...sits-in-oregon

Just god awful, the peasants seeking more healthcare.

Why can't they just eat cake?

What a privileged little twerp.

Originally Posted by Bad Dog

Glad to know that the subsidy is applied at time of premium payment.

I'm still stuck with a bronze plan of some kind. I am trying to select the least suicidal one, as I am, for the moment, an independent business person, with no guarantee of a monthly income.

That $500+ a month cost, passed on to customers, means $15-$20 bucks a day that need to be raised. Or, for a full work day of eight hours, at least $2/hr. Employers will happily offload these costs on to the employees. I see a lot of employer benefit plans dying, real soon, now that they have the cover to do so. Salaries, of course, will not be raised, as the employers treat themselves to the full benefits of the admin cost savings. Neither will prices be lowered.

I'm a little confused here. The $500 is what you pay AFTER the subsidy, and you're only on the bronze plan?

If the govt is paying most of that, then there is no need for you to pass it on to customers.

Can you clear this up for me?

Employers have been dumping employee insurance as an accelerating trend for a decade. The ACA is actually a response to that.

Maybe prices will not go down, but for the first time EVER, the insurers are limited to only 15% (group plans) or 20% (individual plans) of the premiums going to non-health care expenditures. That 15-20% has to pay for all the overhead of running their business. Contrary to a lot of myth-making on this forum, insurers are one of the least profitable businesses - they'll get a pop on this transition but eventually they are going to squeezed hard. Then what....

- it is still really funny and I relish it.

http://talkingpointsmemo.com/edblog/...rightwing-rage

As Obamacare Sign-Ups Surge, So Does Conservative Rage

It is amazing to witness the sheer depths of rage, denial and disgust many people experience as they see millions of people gaining access to affordable health care for the first time. Back on the 31st I wrote this overview which outlined how more than 9 million people now have health care coverage because of the Affordable Care Act (aka Obamacare). It now seems like the number is more like 10 million (more on that in a moment).

This evening I mentioned this number on Twitter and saw the full force of denial and outrage as many anti-Obamacare diehards made first contact with the actual number of Americans who've gained coverage under the program. More though, it was clear how in the absence of a dead in the water website to cry crocodile tears over, anti-Obamacare hardliners have suddenly gotten a whole lot angrier about Obamacare.

Join me after the jump and we'll review the numbers.

After an expected surge of sign-ups in late December, just over 2.1 million people have purchased ACA-compliant health care policies through the federal and state health care exchanges. A bit more than half came through the now-mainly-functional healthcare.gov website (which covers 36 states) and the rest came from the 14 states which established their own exchanges. That relative disparity is due both to the early problems with the federal website and active efforts to sabotage enrollment in private insurance in Republican run states.

Next there are currently rough 4.3 million people who have been enrolled in Medicaid through Medicaid expansion. A 3.9 million number is still being used in many reports. But that's a number as of 11/30. Charles Gaba is compiling together publicly available reports from different states and currently has the number at 4.3 million - not a surprising number given how much sign-up activity there was in December. The state by state breaks in this spreadsheet are very illuminating.

Notably, we also know the number of Americans who have been prevented from getting coverage because Republican governors and/or state legislatures who refused to participate in Medicaid expansion. That's 5 million people.

So if the Supreme Court had decided differently or if most but not all (Kasich, Snyder, Brewer, et al.) Republican governors had not refused to participate we might be talking about a number in the neighborhood of 15 million newly covered people.

Next there's a number that's been in effect for a couple years now and no one seems to want to discuss: roughly 3.1 million young adults under the age of 26 who now remain covered under their parents policies under a key provision of the ACA. This went into effect in September 2010. And the number of covered young adults in that age bracket grew steadily over the next two years. Here's a good overview from Money magazine from June 2012.

So let's do some simple math. 2.1M + 4.3M + 3.1M = 9.5 million covered.

So how does it get to 10 million? What none of these tabulations take into account are people who bought ACA-compliant policies directly from insurance carriers as opposed to purchasing them from private carriers via the exchanges. A lot of people did this and there was actually an aggressive push to get people to do so while the federal exchange site remained basically dead in the water. There is no tally of this number yet and will require a survey of carriers throughout the country. But I suspect it is certainly in the hundreds of thousands. And thus the round number of 10 million.

Now, as I said up at the top, there are a lot of Obamacare dead-enders out there who just blow a gasket when they make first contact with these numbers. The first claim is that Medicaid expansion somehow doesn't count. Or it doesn't count if a 24 year old is now covered under their parents policy because well that happened a while ago or well, something.

The best dead-ender argument is that well, maybe these people who've signed up for subsidized private insurance policies won't end up paying their premiums. When the arguments get down to this level you know you're dealing with a deep and intense form of denial. I mean, what if all these people change their mind next month and decide they don't want the coverage after all? What if Obamacare is so bad they all die in the Spring? What if Spartacus had an airplane? If you really, really are hoping for bad news you can come up with anything to keep hope, as it were, alive.

And then finally, these numbers are just more administration lies. Because, well, because. Here's where Gaba's spreadsheet is so helpful. It has the breakdown for private insurance and Medicaid expansion in numbers in every state with a link to an independent news source reporting the numbers.

These are the numbers. Lots of people have partisan or ideological or in many cases deeply emotional needs not to believe them. But these are the numbers.

Remember how both Karl Rove and our own JPT were certain on election eve 2012 that Obama would be soon packing his bags and going home last January?

Seems like we're in for another round of unskewering madness and echo chambers followed by disbelief -

http://talkingpointsmemo.com/edblog/...skewing-crisis

Right Facing New Unskewing Crisis?

I still think Rani's croaking is the 'best' -

"OMG, these untouchables are coming to a clinic near me! The horror. The horror."

Originally Posted by playwrite

I'm a little confused here. The $500 is what you pay AFTER the subsidy, and you're only on the bronze plan?

If the govt is paying most of that, then there is no need for you to pass it on to customers.

Can you clear this up for me?

Employers have been dumping employee insurance as an accelerating trend for a decade. The ACA is actually a response to that.

Maybe prices will not go down, but for the first time EVER, the insurers are limited to only 15% (group plans) or 20% (individual plans) of the premiums going to non-health care expenditures. That 15-20% has to pay for all the overhead of running their business. Contrary to a lot of myth-making on this forum, insurers are one of the least profitable businesses - they'll get a pop on this transition but eventually they are going to squeezed hard. Then what....

Ah, I should have explained more. I have to meet the out of pocket before benefits apply. Since I cannot determine when I get sick, I have to allocate the cost over the year. I will now give the example plans I am allowed access to.

There are only two providers serving St. Louis County- Anthem BCBS, and Coventry. The subsidy for the plan varies by income. My projected income, based on past years, is greater than the $28,000 turning point for subsidies.

The cheapest plan is Coventry's deductible only plan, at about $90/month for me. Nothing, I say again, nothing, is covered until you have spent $6350 out of pocket. $6350/12= $529.17/month. Or, $6350/52 weeks/40 hours= $3.05/hr. This is with my projected income, greater than $28,000/yr.

So, I spend $90 a month, plus what I now pay without insurance, until I hit the $6350 limit. A truly catastrophic care plan (pun intended). $7430/yr, including premiums, $619.17/month, $3.57/hr.

If I change my income to $28,000 (the limit for subsidies), the premium goes to $43/month. Same plan.

OK, lets do the airline fare thing... the following monthly and hourly costs include premiums, which must be paid in addition to the out-of-pocket costs.

If I keep my income to $28,000, single person, my age (50+), St. Louis County resident (Greene County/Springfield gets a $354/month tax credit, STL County gets a $257/month credit, why? Jesus, and the 7th Congressional district, that's why), the plans look like this:

Coventry, bronze, deductible only, nothing paid until out of pocket reached, $43/month. Must spend $6350 to get benefits. $572.17/ month before benefits apply. $3.30/hr.

Coventry, bronze, $10 doctor visit (in-network), $15 generic prescription (only one of my two meds is generic, full price for the other is $100/month), $500 copay for ER/urgent care, $75 for in-network specialist, $62/month. $591.17/month, $3.41/hr (but, see below).
A host of charges for other services applies. Way too much variance to discern an accurate monthly comparison. So, a cold is treatable, but an attack of pneumonia, or a kidney stone is tough luck. Both have hit me in the last two years. I paid full frieght, out of my own pocket. The cost was close to that yearly out of pocket.

Anthem/BCBS, bronze, $200 ER/urgent care, otherwise no coverage until out of pocket reached, $99/month. Charming. That makes it $7538/yr, $628.17/month. $3.62/hr. The Coventry bare-bones is cheaper.

Anthem/BCBS, bronze, generic prescription $20, $350 ER/urgent care, deductible $6000/6350 (gee, thanks), no coverage until deductible met, $129/month. $629/month, $3.62/hr. Something funny going on here...I'm paying $30/month more for a generic prescription that costs more than Coventry's, and has the same limits that the other Anthem plan does. Hmmmmm... cheaper to buy my own meds, maybe.

One wonders what makes up the difference between Coventry's $62 plan, and Anthem's plan, which is similar, but has double the monthly cost. Nazi labor camp medics? It may be called Coventry for a reason.

The bronze plans essentially end here for me. They are all I can afford.

The other plans range from $150-$400/month. There are no platinum plans available. Hope that helps explain.

Originally Posted by The Rani

Hooray for playdude!

You should make that your signature line.

(of course, I like mine )

Originally Posted by The Rani

Oops:



http://www.npr.org/blogs/health/2014...sits-in-oregon

Part of the problem is shortages of primary care doctors. If you need stitches and you call your doc and he's booked up, he'll tell you to go to the emergency room. Which implies that we need more of those walk-in clinics to accept the Obama care plans and for docs to refer patients to them rather than the ER.

Originally Posted by The Wonkette

Part of the problem is shortages of primary care doctors. If you need stitches and you call your doc and he's booked up, he'll tell you to go to the emergency room. Which implies that we need more of those walk-in clinics to accept the Obama care plans and for docs to refer patients to them rather than the ER.

Nah, I just call my brother or my aunt; Both can do the job quickly. Sure it's more painful and not as clean but it's a hell of a lot cheaper than an ER visit.

Originally Posted by Bad Dog

Ah, I should have explained more. I have to meet the out of pocket before benefits apply. Since I cannot determine when I get sick, I have to allocate the cost over the year. I will now give the example plans I am allowed access to.

There are only two providers serving St. Louis County- Anthem BCBS, and Coventry. The subsidy for the plan varies by income. My projected income, based on past years, is greater than the $28,000 turning point for subsidies.

Huh? That's strange, I plugged in my projected income , which is $31,000/yr and I got a subsidy of $111/yr with a silver Blue Cross/Blue Shield plan which costs $300.41/month.

Here's how the income/subsidy works as I understand it:
http://www.financialsamurai.com/subs...act-obamacare/


Now, the ACA is still totally FUBAR wrt to prescriptions as I found out yesterday. I went to get my meds and presented the pharmacy with my new card. The damn thing didn't go through with my new insurance card, but the old one which I cancelled out did go through. [So I think health insurance companies are just fucking stupid. ] I called BC/BS -> maybe they should rename themselves to be Bull crap/Bull Shit since the hold time was > 1 hour. So.... I went home and called the damn number again while I was by my computer and put the cell phone on speaker and waited. That way I could just log into Bovada and play poker while I waited for a real live person to answer the damn phone. When a person finally answered the phone they said the prescription stuff wasn't working and to just get them filled for free at CVS or Walgreens until they get their shit together. OK, y'all been warned, if your prescriptions don't go through, it's because your insurance company has its head up its ass. The only good thing about this is that I found just where Bovada's donks are. Go and play the $1 pot limit Omaha sit/go tourneys. I don't admit to knowing much about Omaha, except to see if my hand is [coordinated]. By coordinated, I sort of see how many good hold'em hands I can make out of the 4 cards I get dealt.

The cheapest plan is Coventry's deductible only plan, at about $90/month for me. Nothing, I say again, nothing, is covered until you have spent $6350 out of pocket. $6350/12= $529.17/month. Or, $6350/52 weeks/40 hours= $3.05/hr. This is with my projected income, greater than $28,000/yr.

Does MO have it's own marketplace or is it like Oklahoma where you have to use the national exchange?

So, I spend $90 a month, plus what I now pay without insurance, until I hit the $6350 limit. A truly catastrophic care plan (pun intended). $7430/yr, including premiums, $619.17/month, $3.57/hr.

If I change my income to $28,000 (the limit for subsidies), the premium goes to $43/month. Same plan.

Perhaps you can run some numbers and see which is better.
1. Work for what your income actually is vs. if you can fuck off and get your income down to $28,000 and add in the additional subsidy and see which way nets the most $/year.
2. However, according to the link, there seems to be a bug or feature someplace. Perhaps if MO has its own website, it has the bug or you logged into healthcare.gov at some point it was totally fucked up. [ I know about this. I encountered lot's of bugs when I spent 12 hours trying to get something to go. I got Oracle errors, I got timeouts, I got lock ups, you name it. Maybe when you tried it, there was a fucked up if statement that put your income in the wrong bucket.
3. You can call the toll free number of course
1-800-F1UCK-YO

The "1" of course is the symbol for the middle finger.

OK, lets do the airline fare thing... the following monthly and hourly costs include premiums, which must be paid in addition to the out-of-pocket costs.

If I keep my income to $28,000, single person, my age (50+), St. Louis County resident (Greene County/Springfield gets a $354/month tax credit, STL County gets a $257/month credit, why? Jesus, and the 7th Congressional district, that's why), the plans look like this:

Ah, maybe that explains the difference between you and I. The ACA has a feature called ZIP code bingo. If you live in certain ZIP codes that got bingos, you get special treatment.

Coventry, bronze, deductible only, nothing paid until out of pocket reached, $43/month. Must spend $6350 to get benefits. $572.17/ month before benefits apply. $3.30/hr.

Coventry, bronze, $10 doctor visit (in-network), $15 generic prescription (only one of my two meds is generic, full price for the other is $100/month), $500 copay for ER/urgent care, $75 for in-network specialist, $62/month. $591.17/month, $3.41/hr (but, see below).
A host of charges for other services applies. Way too much variance to discern an accurate monthly comparison. So, a cold is treatable, but an attack of pneumonia, or a kidney stone is tough luck. Both have hit me in the last two years. I paid full frieght, out of my own pocket. The cost was close to that yearly out of pocket.

I have one of those "pre existing conditions". My main cost is my "crazy meds". I have 4 of those.
1. quientapene
2. tranxene
3. depakote
4. Cymbalta , I wish this damn thing would go off patent, it's expensive.

Anthem/BCBS, bronze, $200 ER/urgent care, otherwise no coverage until out of pocket reached, $99/month. Charming. That makes it $7538/yr, $628.17/month. $3.62/hr. The Coventry bare-bones is cheaper.

Anthem/BCBS, bronze, generic prescription $20, $350 ER/urgent care, deductible $6000/6350 (gee, thanks), no coverage until deductible met, $129/month. $629/month, $3.62/hr. Something funny going on here...I'm paying $30/month more for a generic prescription that costs more than Coventry's, and has the same limits that the other Anthem plan does. Hmmmmm... cheaper to buy my own meds, maybe.

One wonders what makes up the difference between Coventry's $62 plan, and Anthem's plan, which is similar, but has double the monthly cost. Nazi labor camp medics? It may be called Coventry for a reason.

The bronze plans essentially end here for me. They are all I can afford.

The other plans range from $150-$400/month. There are no platinum plans available. Hope that helps explain.

Hmmm. You might want to check and see if you can get your meds free for now @Walgreens/CVS. Perhaps that 1+ hour on hold was worth it after all. My guess is that since CVS/Walgreens are big, they bought off congress and get some sort of kickback for each "free" prescription they dole out. Oh, you might want to check out cardplayer.com. You can win real money playing NL hold'em. The only catch is you have to spend time playing tourneys for points, which are used as buy ins for token tourneys. You then use the tokens to buy in to cash games. It's sort of a you pay in terms of time to build up enough points/tokens to enter the cash games. The only other requirement is ensuring you don't go tilt from donks hitting 3 outers and such. You see, from time to time, a donk will shove all in with something like K/3 offsuit and you have pocket queens. The flop had a K which set me back on one of yesterday's tourneys. Note, though, that the donk list I have hardly makes it to the final table. So if you decide to play there make a file called donk.txt and every time you see this kind of stuff , just add the donk's handle to the file.

Originally Posted by Bad Dog

Ah, I should have explained more. I have to meet the out of pocket before benefits apply. Since I cannot determine when I get sick, I have to allocate the cost over the year. I will now give the example plans I am allowed access to.

There are only two providers serving St. Louis County- Anthem BCBS, and Coventry. The subsidy for the plan varies by income. My projected income, based on past years, is greater than the $28,000 turning point for subsidies.

The cheapest plan is Coventry's deductible only plan, at about $90/month for me. Nothing, I say again, nothing, is covered until you have spent $6350 out of pocket. $6350/12= $529.17/month. Or, $6350/52 weeks/40 hours= $3.05/hr. This is with my projected income, greater than $28,000/yr.

So, I spend $90 a month, plus what I now pay without insurance, until I hit the $6350 limit. A truly catastrophic care plan (pun intended). $7430/yr, including premiums, $619.17/month, $3.57/hr.

If I change my income to $28,000 (the limit for subsidies), the premium goes to $43/month. Same plan.

OK, lets do the airline fare thing... the following monthly and hourly costs include premiums, which must be paid in addition to the out-of-pocket costs.

If I keep my income to $28,000, single person, my age (50+), St. Louis County resident (Greene County/Springfield gets a $354/month tax credit, STL County gets a $257/month credit, why? Jesus, and the 7th Congressional district, that's why), the plans look like this:

Coventry, bronze, deductible only, nothing paid until out of pocket reached, $43/month. Must spend $6350 to get benefits. $572.17/ month before benefits apply. $3.30/hr.

Coventry, bronze, $10 doctor visit (in-network), $15 generic prescription (only one of my two meds is generic, full price for the other is $100/month), $500 copay for ER/urgent care, $75 for in-network specialist, $62/month. $591.17/month, $3.41/hr (but, see below).
A host of charges for other services applies. Way too much variance to discern an accurate monthly comparison. So, a cold is treatable, but an attack of pneumonia, or a kidney stone is tough luck. Both have hit me in the last two years. I paid full frieght, out of my own pocket. The cost was close to that yearly out of pocket.

Anthem/BCBS, bronze, $200 ER/urgent care, otherwise no coverage until out of pocket reached, $99/month. Charming. That makes it $7538/yr, $628.17/month. $3.62/hr. The Coventry bare-bones is cheaper.

Anthem/BCBS, bronze, generic prescription $20, $350 ER/urgent care, deductible $6000/6350 (gee, thanks), no coverage until deductible met, $129/month. $629/month, $3.62/hr. Something funny going on here...I'm paying $30/month more for a generic prescription that costs more than Coventry's, and has the same limits that the other Anthem plan does. Hmmmmm... cheaper to buy my own meds, maybe.

One wonders what makes up the difference between Coventry's $62 plan, and Anthem's plan, which is similar, but has double the monthly cost. Nazi labor camp medics? It may be called Coventry for a reason.

The bronze plans essentially end here for me. They are all I can afford.

The other plans range from $150-$400/month. There are no platinum plans available. Hope that helps explain.

take the fine. It's probably cheaper from the looks of things you'd be able to save up to pay up front for your medical needs and still be buying your own medicine. without the need for new medicine to combat the migraine that looks like it would cause.

Good Luck

Missouri uses the federal marketplace. I'm already using the Walgreens program.

Thanks for pointing me to the poker sites.

Originally Posted by The Wonkette

Part of the problem is shortages of primary care doctors. If you need stitches and you call your doc and he's booked up, he'll tell you to go to the emergency room. Which implies that we need more of those walk-in clinics to accept the Obama care plans and for docs to refer patients to them rather than the ER.

One of the responses of "the system" is to keep driving the actual work of healthcare to "lower" levels of professionals. Work for many decades has been divided up into pieces and the pieces turned into new "professions" which then do the work.

Examples are:

Nuclear medicine Technologists.
Oncology radiation technologists.
Respiratory care technologists.
Pharmacy technicians.
Phlebotomists.
PICC line technologists

And one can go on and on and on.

In the emergency rooms, doctors mostly preside. The actual work is done by an army of techs, clerks, nurses, CNA's, paramedics, EMTs and others.

Your stitches might possibly be done by an M.D., but my money in the vast majority of cases is on a non-M.D. doing the work. Obvious exceptions are stitches that impact function or cosmetics in a big way. There you'll get a plastic surgeon or a hand surgeon or whomever.

When I first breached a hospital front door, for pay, back in the 1960s, it was still commonplace for one's actual personal doctor to do almost everything. He, and it WAS mostly a he, would make hospital rounds twice a day and then see patients all day in the office. If one of his patients had a heart attack, it was up to him to come trucking in to the hospital to attend to it.

Frankly, it would not suprise me in the least to see a lot of primary care delegated to PA's, NP's and even paramedics in the near future. Heck, already there are many, many NPs and PAs practicing side-by-side with M.D. and D.O. partners, even in metropolitan areas. Heretofore, the NP and PA realm tended to be underserved and/or rural areas that could not attract a "real doctor."

Home health agencies are hiring EMTs at the BASIC level to do routine care!! Not even paramedics!! BASIC EMTs!! In this state it takes one semester and a couple tests to get a license as an EMT-Basic.

I don't see this trend slowing down. In fact, if there is more pressure on the "Healthcare System" from ACA, the tendency to use ancillary and lesser-trained individuals to perform routine medical care will only accelerate. And, to some degree, the care might even turn out to be better! Why would one want to deploy one's $500,000 M.D. to put in a couple lousy stitches? How would one even stay awake during the procedure? While on the other hand, an EMT-Basic/"routine stitch expert" at an urgent care would consider it a great honor and would approach his/her work with enthusiasm and pride!

TNT, you need to tell this to the chorus screaming for more STEM programs. Same thing happening in engineering, in reverse. More certs and quals needed to do lesser work. Either way, STEM education is more and more a sucker bet. It is all about driving down labor costs to third-world levels.

Originally Posted by Bad Dog

TNT, you need to tell this to the chorus screaming for more STEM programs. Same thing happening in engineering, in reverse. More certs and quals needed to do lesser work. Either way, STEM education is more and more a sucker bet. It is all about driving down labor costs to third-world levels.

and

Originally Posted by TNT

Pharmacy technicians

Uh, yeah.

http://www.bls.gov/ooh/Healthcare/Pharmacists.htm

Now, this is interesting.

Now, this is doable except for

Originally Posted by Southwestern State U tuition

	Tuition rates listed are per credit hour
Tuition Lock	$192.50	N/A
1-2-3-4000 Level	$173.00	$385.00
5000 Level	$212.00	$468.00
Pharm.D.	$477.00	$900.00

Obviously, any sort of midlife career switch which may or may not be needed to to being outsourced hits the above brick wall. I did check the actual course work. That is also a no sweat deal. It's mostly natural sciences of biology, microbiology , chem I/II [done here], organic chem [I,II], organic chem I, done. So there isn't really a curriculum difficulty issue either. I also see this as Millies being flies and the education system being some huge spider which sucks all the financial blood out of them. I mean the pay is good , ~110,00/yr, but getting there is obviously problematic.

Now, wrt pham tech. Well, that option is much easier, but the pay, not so good. I checked that out and that may work better for a retread job. Anything pays better than my current gig, so the $13.00/hour for pharm tech gig is enticing. So one dressing to the 9's and all, but the actual gig essentially boils down to counting pills , answering the phone, and other assorted clerical work. The only hard part and important part is to make sure you count the *right* pills and know how to compound stuff the *right* way so you don't cause some adverse health problem. Drug companies don't make that easy because they all like to use endings like -ol, -tine, -el, -ate, . The other problem is that prescription writers all have really lousy hand writing for some reason.

Originally Posted by The Rani

Oh noes, my neurosurgeon boyfriend pays for us to get concierge medicine.
No privileged little twerp goes without it, and I'm assuming that your own trust fund must cover that sort of thing, so that's quite the careless error on your part!
Other than that minor oversight, your posts are rockin', as always. Don't let the naysayers deter you. Being ascaired of Republicans is the Right And Proper way to live.
Hooray for playdude!

The difference, dreay, is that I don't keep bringing up horseshit to denigrate the millions that will be benefiting from the ACA, with this latest attack of yours being the horror of the great mass of 'untouchables' coming to grab your privileged doctor's appointment from your busy calender.

Oh, and it is a bunch of horseshit -

http://www.washingtonpost.com/blogs/...doctors-ready/

Six million people get Obamacare on Wednesday. Are doctors ready?

....At the same time, many doubt that these patients, who account for less than 2 percent of the population, will cause sudden capacity issues. For the 6 million people gaining insurance coverage Wednesday, their new plan is certainly a big deal. At the same time, for a health system that sees hundreds of millions of patients already, this increase could amount to a drop in the bucket. (And, one caveat: Some of those 6 million people already have insurance right now, and are renewing their policies under Obamacare, so we're not necessarily taking about 6 million newly-insured Americans.)....

... but thanks for playing.

Originally Posted by The Wonkette

Part of the problem is shortages of primary care doctors. If you need stitches and you call your doc and he's booked up, he'll tell you to go to the emergency room. Which implies that we need more of those walk-in clinics to accept the Obama care plans and for docs to refer patients to them rather than the ER.

We also need more primary care doctors. Currently there are medical students who are put on hold because there are not enough residency programs. When hospitals are not getting enough funding for resident programs. like they are now, there will continue to be a shortage. From what I've read and heard, NPs will take over the slack, and eventually replace primary care doctors.

Originally Posted by TnT

One of the responses of "the system" is to keep driving the actual work of healthcare to "lower" levels of professionals. Work for many decades has been divided up into pieces and the pieces turned into new "professions" which then do the work.

Examples are:

Nuclear medicine Technologists.
Oncology radiation technologists.
Respiratory care technologists.
Pharmacy technicians.
Phlebotomists.
PICC line technologists

And one can go on and on and on.

In the emergency rooms, doctors mostly preside. The actual work is done by an army of techs, clerks, nurses, CNA's, paramedics, EMTs and others.

Your stitches might possibly be done by an M.D., but my money in the vast majority of cases is on a non-M.D. doing the work. Obvious exceptions are stitches that impact function or cosmetics in a big way. There you'll get a plastic surgeon or a hand surgeon or whomever.

When I first breached a hospital front door, for pay, back in the 1960s, it was still commonplace for one's actual personal doctor to do almost everything. He, and it WAS mostly a he, would make hospital rounds twice a day and then see patients all day in the office. If one of his patients had a heart attack, it was up to him to come trucking in to the hospital to attend to it.

Frankly, it would not suprise me in the least to see a lot of primary care delegated to PA's, NP's and even paramedics in the near future. Heck, already there are many, many NPs and PAs practicing side-by-side with M.D. and D.O. partners, even in metropolitan areas. Heretofore, the NP and PA realm tended to be underserved and/or rural areas that could not attract a "real doctor."

Home health agencies are hiring EMTs at the BASIC level to do routine care!! Not even paramedics!! BASIC EMTs!! In this state it takes one semester and a couple tests to get a license as an EMT-Basic.

I don't see this trend slowing down. In fact, if there is more pressure on the "Healthcare System" from ACA, the tendency to use ancillary and lesser-trained individuals to perform routine medical care will only accelerate. And, to some degree, the care might even turn out to be better! Why would one want to deploy one's $500,000 M.D. to put in a couple lousy stitches? How would one even stay awake during the procedure? While on the other hand, an EMT-Basic/"routine stitch expert" at an urgent care would consider it a great honor and would approach his/her work with enthusiasm and pride!

Most primary care and ER doctors make no where near $500,000 a year. It's more like $150,000, to maybe, $200,000. And, the growing practice for hospitals is to rent a doc from a contracted agency. The winner in that game is the owner of the corporation. Health care in this country is joining the race to the bottom.

Originally Posted by Bad Dog

Ah, I should have explained more. I have to meet the out of pocket before benefits apply. Since I cannot determine when I get sick, I have to allocate the cost over the year. I will now give the example plans I am allowed access to.

There are only two providers serving St. Louis County- Anthem BCBS, and Coventry. The subsidy for the plan varies by income. My projected income, based on past years, is greater than the $28,000 turning point for subsidies.

The cheapest plan is Coventry's deductible only plan, at about $90/month for me. Nothing, I say again, nothing, is covered until you have spent $6350 out of pocket. $6350/12= $529.17/month. Or, $6350/52 weeks/40 hours= $3.05/hr. This is with my projected income, greater than $28,000/yr.

So, I spend $90 a month, plus what I now pay without insurance, until I hit the $6350 limit. A truly catastrophic care plan (pun intended). $7430/yr, including premiums, $619.17/month, $3.57/hr.

If I change my income to $28,000 (the limit for subsidies), the premium goes to $43/month. Same plan.

OK, lets do the airline fare thing... the following monthly and hourly costs include premiums, which must be paid in addition to the out-of-pocket costs.

If I keep my income to $28,000, single person, my age (50+), St. Louis County resident (Greene County/Springfield gets a $354/month tax credit, STL County gets a $257/month credit, why? Jesus, and the 7th Congressional district, that's why), the plans look like this:

Coventry, bronze, deductible only, nothing paid until out of pocket reached, $43/month. Must spend $6350 to get benefits. $572.17/ month before benefits apply. $3.30/hr.

Coventry, bronze, $10 doctor visit (in-network), $15 generic prescription (only one of my two meds is generic, full price for the other is $100/month), $500 copay for ER/urgent care, $75 for in-network specialist, $62/month. $591.17/month, $3.41/hr (but, see below).
A host of charges for other services applies. Way too much variance to discern an accurate monthly comparison. So, a cold is treatable, but an attack of pneumonia, or a kidney stone is tough luck. Both have hit me in the last two years. I paid full frieght, out of my own pocket. The cost was close to that yearly out of pocket.

Anthem/BCBS, bronze, $200 ER/urgent care, otherwise no coverage until out of pocket reached, $99/month. Charming. That makes it $7538/yr, $628.17/month. $3.62/hr. The Coventry bare-bones is cheaper.

Anthem/BCBS, bronze, generic prescription $20, $350 ER/urgent care, deductible $6000/6350 (gee, thanks), no coverage until deductible met, $129/month. $629/month, $3.62/hr. Something funny going on here...I'm paying $30/month more for a generic prescription that costs more than Coventry's, and has the same limits that the other Anthem plan does. Hmmmmm... cheaper to buy my own meds, maybe.

One wonders what makes up the difference between Coventry's $62 plan, and Anthem's plan, which is similar, but has double the monthly cost. Nazi labor camp medics? It may be called Coventry for a reason.

The bronze plans essentially end here for me. They are all I can afford.

The other plans range from $150-$400/month. There are no platinum plans available. Hope that helps explain.

One needs a degree in deciphering, not only the price while purchasing through the marketplace, but also those loopholes and exceptions. For instance, not covering ambulance service, even when your unconscious.

Originally Posted by Bad Dog

Ah, I should have explained more. I have to meet the out of pocket before benefits apply. Since I cannot determine when I get sick, I have to allocate the cost over the year. I will now give the example plans I am allowed access to.

There are only two providers serving St. Louis County- Anthem BCBS, and Coventry. The subsidy for the plan varies by income. My projected income, based on past years, is greater than the $28,000 turning point for subsidies.

The cheapest plan is Coventry's deductible only plan, at about $90/month for me. Nothing, I say again, nothing, is covered until you have spent $6350 out of pocket. $6350/12= $529.17/month. Or, $6350/52 weeks/40 hours= $3.05/hr. This is with my projected income, greater than $28,000/yr.

So, I spend $90 a month, plus what I now pay without insurance, until I hit the $6350 limit. A truly catastrophic care plan (pun intended). $7430/yr, including premiums, $619.17/month, $3.57/hr.

If I change my income to $28,000 (the limit for subsidies), the premium goes to $43/month. Same plan.

OK, lets do the airline fare thing... the following monthly and hourly costs include premiums, which must be paid in addition to the out-of-pocket costs.

If I keep my income to $28,000, single person, my age (50+), St. Louis County resident (Greene County/Springfield gets a $354/month tax credit, STL County gets a $257/month credit, why? Jesus, and the 7th Congressional district, that's why), the plans look like this:

Coventry, bronze, deductible only, nothing paid until out of pocket reached, $43/month. Must spend $6350 to get benefits. $572.17/ month before benefits apply. $3.30/hr.

Coventry, bronze, $10 doctor visit (in-network), $15 generic prescription (only one of my two meds is generic, full price for the other is $100/month), $500 copay for ER/urgent care, $75 for in-network specialist, $62/month. $591.17/month, $3.41/hr (but, see below).
A host of charges for other services applies. Way too much variance to discern an accurate monthly comparison. So, a cold is treatable, but an attack of pneumonia, or a kidney stone is tough luck. Both have hit me in the last two years. I paid full frieght, out of my own pocket. The cost was close to that yearly out of pocket.

Anthem/BCBS, bronze, $200 ER/urgent care, otherwise no coverage until out of pocket reached, $99/month. Charming. That makes it $7538/yr, $628.17/month. $3.62/hr. The Coventry bare-bones is cheaper.

Anthem/BCBS, bronze, generic prescription $20, $350 ER/urgent care, deductible $6000/6350 (gee, thanks), no coverage until deductible met, $129/month. $629/month, $3.62/hr. Something funny going on here...I'm paying $30/month more for a generic prescription that costs more than Coventry's, and has the same limits that the other Anthem plan does. Hmmmmm... cheaper to buy my own meds, maybe.

One wonders what makes up the difference between Coventry's $62 plan, and Anthem's plan, which is similar, but has double the monthly cost. Nazi labor camp medics? It may be called Coventry for a reason.

The bronze plans essentially end here for me. They are all I can afford.

The other plans range from $150-$400/month. There are no platinum plans available. Hope that helps explain.

Thanks for clearing that up; I was really puzzled by the number, but now I understand your thorough vetting of your ENTIRE costs should you be unfortunate enough to bear it.

I'm sure you fully grasp this but just to clarify, what the $6350 represents is YOUR POTENTIAL MAXIMUM expenditure for ACTUAL HEALTH CARE, it is NOT the cost of your insurance.

The $90 you pay for health insurance is to assure you that you will never have to pay more than $6350; that likely means you will never have to go bankrupt because of a medical condition. At your age, with some preconditions, that would have been a pretty good deal prior to the ACA; if you can get that down to the subsidized $49, that would have been an impossibility prior to the ACA.

Your real complain isn't the cost of the insurance (like I said, you either have a good or an incredible great deal); it's the cost of the actual health care that you MAY need and would have to come out of your pocket.

Let's look at the personal side of that first. By setting aside the $591 a month, essentially what you are doing is "self insuring" against your potential MAXIMUM potential cost of $6350. It's not a bad strategy but you could take it further. Do you really need the full $6350? It's not just a gambling issue (you would obviously do well with that, poker man ) but a financial calculation - do you have access to an asset or even a personal loan of $2-3K? If so, you don't really need to self-insure at the full $6350 (of course, this would be offset by you knowing you have a condition that will get you at or near the $6350 max., then you probable need to set aside the $6350). But if you could turn that $6350 into instead just $4500 or even $3500, you would be better off. Also, do you really need to get the full self-insurance in the first year? It's likely the deduction is going to be near the same in 2015; can you spread out your self-imposed savings over 2 or even 3 years rather than just 1 year. Maybe 3/4 monthly set aside in year one; 1/2 set aside in year 2 and the rest in year 3 to get to your full self-insured level - adding back in, of course, whatever 'hit' you took in a previous year.

Hopefully, you will have a healthy 2014 (my fingers crossed for you, bro) and not much expenditure for care. Whatever you don't spend of your self-insurance in year one can be rolled over to year two; same for subsequent years.

The societal issue, under our present non-MMT collective mindset, is that somebody has to pay that $6350 in ACTUAL health costs (or whatever amount short of that is actually spent). Right now, the system has you paying it. Under single payer, it would be the federal government, and under our current non-MMT world that means raising someone's taxes, cutting someone's federal gravy train, or increasing the federal deficit. The current political landscape says it's not going to come from raising the deficit. It will come from raising taxes and cutting other spending. Under our current landscape of the House being controlled by the t-baggers that means the only way forward would be to raise payroll taxes and cut safety net expenditures likely food stamps, Medicaid, and unemployment benefits.

Essentially, reducing your OPP (or self insuring should you actually not need the money) by going to single payer would be offset in whole or in part by an increase in your payroll taxes. If it is only in part, then the difference would be made up by taking it from people less fortunate than yourself.

I realize that this is not as much fun as the really emotionally satisfying railings against Obamacare that clueless people like Debs has to offer, but it is the reality of the times we live it. And having Bernie Sanders, Elizabeth Warren, or even Karl Marx replace Obama tomorrow will NOT change a bloody thing.

Simply, without a GOP House run by t-baggers, we could make the trade-off with taxes on the rich or by allowing the deficit to get bigger.

But let's go all the way - if we lived in a world without morons in power and MMT was something taught in every grade starting in the 5th grade, and no one would be eligible for dog catcher or any other elected office without a thorough understanding of MMT, then there wouldn't even be an issue or need for tradeoffs.

Originally Posted by Ragnarök_62

Huh? That's strange, I plugged in my projected income , which is $31,000/yr and I got a subsidy of $111/yr with a silver Blue Cross/Blue Shield plan which costs $300.41/month.

Here's how the income/subsidy works as I understand it:
http://www.financialsamurai.com/subs...act-obamacare/


Now, the ACA is still totally FUBAR wrt to prescriptions as I found out yesterday. I went to get my meds and presented the pharmacy with my new card. The damn thing didn't go through with my new insurance card, but the old one which I cancelled out did go through. [So I think health insurance companies are just fucking stupid. ] I called BC/BS -> maybe they should rename themselves to be Bull crap/Bull Shit since the hold time was > 1 hour. So.... I went home and called the damn number again while I was by my computer and put the cell phone on speaker and waited. That way I could just log into Bovada and play poker while I waited for a real live person to answer the damn phone. When a person finally answered the phone they said the prescription stuff wasn't working and to just get them filled for free at CVS or Walgreens until they get their shit together. OK, y'all been warned, if your prescriptions don't go through, it's because your insurance company has its head up its ass. The only good thing about this is that I found just where Bovada's donks are. Go and play the $1 pot limit Omaha sit/go tourneys. I don't admit to knowing much about Omaha, except to see if my hand is [coordinated]. By coordinated, I sort of see how many good hold'em hands I can make out of the 4 cards I get dealt.



Does MO have it's own marketplace or is it like Oklahoma where you have to use the national exchange?



Perhaps you can run some numbers and see which is better.
1. Work for what your income actually is vs. if you can fuck off and get your income down to $28,000 and add in the additional subsidy and see which way nets the most $/year.
2. However, according to the link, there seems to be a bug or feature someplace. Perhaps if MO has its own website, it has the bug or you logged into healthcare.gov at some point it was totally fucked up. [ I know about this. I encountered lot's of bugs when I spent 12 hours trying to get something to go. I got Oracle errors, I got timeouts, I got lock ups, you name it. Maybe when you tried it, there was a fucked up if statement that put your income in the wrong bucket.
3. You can call the toll free number of course
1-800-F1UCK-YO

The "1" of course is the symbol for the middle finger.



Ah, maybe that explains the difference between you and I. The ACA has a feature called ZIP code bingo. If you live in certain ZIP codes that got bingos, you get special treatment.



I have one of those "pre existing conditions". My main cost is my "crazy meds". I have 4 of those.
1. quientapene
2. tranxene
3. depakote
4. Cymbalta , I wish this damn thing would go off patent, it's expensive.



Hmmm. You might want to check and see if you can get your meds free for now @Walgreens/CVS. Perhaps that 1+ hour on hold was worth it after all. My guess is that since CVS/Walgreens are big, they bought off congress and get some sort of kickback for each "free" prescription they dole out. Oh, you might want to check out cardplayer.com. You can win real money playing NL hold'em. The only catch is you have to spend time playing tourneys for points, which are used as buy ins for token tourneys. You then use the tokens to buy in to cash games. It's sort of a you pay in terms of time to build up enough points/tokens to enter the cash games. The only other requirement is ensuring you don't go tilt from donks hitting 3 outers and such. You see, from time to time, a donk will shove all in with something like K/3 offsuit and you have pocket queens. The flop had a K which set me back on one of yesterday's tourneys. Note, though, that the donk list I have hardly makes it to the final table. So if you decide to play there make a file called donk.txt and every time you see this kind of stuff , just add the donk's handle to the file.

Your question of whether MO is like OK is an example of what is gong to prove the death knell of the GOP.

Smart people are taking what they can get through their exchange and then comparing that to what they could get in other states like CA, NY, KY. If individuals are not doing this for their own enlightenment, I can assure you that operatives on the Left have it furiously underway; in particular, taking those Obamacare 'horror' stories and playing them out in the more Progressive states.

What will be clear is that the lack of ACA effort by Red states not only was a Medicaid Expansion issue, but hit hard-working people as well by screwing the shit out them on what policies were approved and offered on their state's exchanges.

The results of this are going to be very clear, very dramatic, and very pocketbook hard hitting. Perhaps no other program and data will make clear how utterly bad the GOP and the Right more broadly are for the vast majority of people's financial well-being. It's going to be a killer in November.

Originally Posted by Deb C

One needs a degree in deciphering, not only the price while purchasing through the marketplace, but also those loopholes and exceptions. For instance, not covering ambulance service, even when your unconscious.

Subject to the deductible, ambulance service is one of the mandatory requirements of the ACA, little Miss-information.

Originally Posted by playwrite

Your question of whether MO is like OK is an example of what is gong to prove the death knell of the GOP.

OK, and can it please do something about Faux Propaganda channel? Every time I visit my parents they have that POS on their TeeVee . The folks on that channel have a bad case of Randism. I'll be more than pleased if we could arrange for them to take the required meds of Haldol or even quientapine since Randism is a mental illness defined by the delusion that the private sector is the answer to ALL provisioning of goods and services. The medical code is 666.69.

Smart people are taking what they can get through their exchange and then comparing that to what they could get in other states like CA, NY, KY. If individuals are not doing this for their own enlightenment, I can assure you that operatives on the Left have it furiously underway; in particular, taking those Obamacare 'horror' stories and playing them out in the more Progressive states.

Actually, I wouldn't have to go that far. Before ACA, the answer the private sector had for me was "you have a pre existing condition", therefore , "NO SALE". I had to resort to Oklahoma's expensive as hell "High Risk Pool" to get something in the way of coverage. I think the idea that insurance is for the most part provided at the whim of your employer is also a case of Randism.

What will be clear is that the lack of ACA effort by Red states not only was a Medicaid Expansion issue, but hit hard-working people as well by screwing the shit out them on what policies were approved and offered on their state's exchanges.

Yes, Oklahoma's government is stuffed to the brim with folks who have Randism. That is the result of course due to the majority of the electorate here. Perhaps we're not treating our water properly and there's some unknown parasite in the water that infects brains and causes Randism. It's like any other disease, some folks are resistant to said parasite, while others get an infection.

The results of this are going to be very clear, very dramatic, and very pocketbook hard hitting. Perhaps no other program and data will make clear how utterly bad the GOP and the Right more broadly are for the vast majority of people's financial well-being. It's going to be a killer in November.

How about presenting a "stupid model", to say police coverage. Perhaps that would turn on a few light bulbs.

We model police coverage just like health coverage.
1. Policemen are employees of some insurance company.
2. You buy a police policy from some insurance company.
3. If you need the police , the insurance company decides how to provide the service.
4. So you call 1-800-EAT-SHIT when you need police services.
5. You have a menu presented.
Press 1 for English, 2 for Spanish, 3 for Cherokee, ...
Police options menu
1. Home invasion
2. rape
3. assault
4 fight in progress
5. shop lifting in progress
... and so on
After you press the option, the phone will prompt you for your policy number. You then enter it
The insurance computer will then check if you're covered for the option selected. [After all, this is free enterprise so you have the "freedom" to pick which sorts of police coverage you want! ] That what free enterprise nits always sell their ideology on, you get to pick stuff, no matter how informed you are about some good or service.
5. If you don't know police coverage in intricate detail, you might not have picked the service you need and get a "claim denied" message over the phone. If you get that message you're screwed or even if not, the time it takes to mess with the phone might screw you as well. [ Say, imagine you have chest pains and have call for an ER preatuth or something...]
6. Since all of this stuff is all complicated and stuff you can always press 0 for live person. You'll then be put on hold for at least an hour. Insurance companies always give short shrift to customer service because you have to spend $ for each agent.
7. You're policy cost will vary by ZIP code (ZIP code bingo again). If you live in Compton, CA, you're gonna pay out the ass. If you live in Boonyville OK, you get a policy for a song.
8. Now when you experience a police call, you have a copay to make as well.