Consulting and the Affordable Care Act 11

[Mr168]

I'm curious as to the thoughts of the Eng-Tips community as to whether we will see the Affordable Care Act have a significant impact on the Engineering Consulting industry.

For a moment, lets put aside the turmoil associated with Obamacare, and operate under the assumption that the ACA won't be repealed any time soon.

The single greatest factor in me not venturing into the world of private consulting has been healthcare. As someone with a number of preexisting medical conditions and a history of cancer, any sort of private health insurance is either a pipe dream, or tremendously cost prohibitive. As much as I hate to entertain the though, Obamacare does provide at least some inkling of a possibility that I could leave the big Fortune 100 EPC's and venture off on my own, with premiums and care much worse than my corporate policy, but not unbearable.

If the ACA manages to stick around, do the folks here anticipate any sort of significant influx of private consultants? Any other anticipated consequences or thoughts on the matter?

 

[cranky108]

Actually it's not the plan that I object to, it's the details in the plan. For example the fact that it specifies what type of contract I must have with my insurance company. Also the changing date requirments, which looks like congress is doing a bad job of managing. Then there is no rime or reason behind the exemptions, except political.

The other issue is that, requiring people to buy it, will in itself make the price go up, not down. The opt-out is the single most valuable way to bring down the cost of medical insurance, and the whole medical cost struture. After all doctors should not be perscribing the latest drugs to people who can't afford them. Last years drugs (not out of date) should still work even though the patent has run out.

The shortage of doctors should not be a bearing on all of us, it should be a bearing on people who don't visit them.

And why is the US health insurance only good in the US? After all health care is less expencive in other countries. US insurance companies should be encuraging people to go on health holidays.
I know for a fact that having a dentest that dosen't speak english is better, because it cuts the chit-chat while his hands in your mouth.

 

[beej67]

If you have another plan that would have even an outside chance of working AND WHICH COULD GET THROUGH CONGRESS, please be my guest...

I reiterate:

Here's a quick lesson: Nothing will ever get through congress that takes money away from the people who've bought congress.

You cannot expect the very people who profit from something's brokenness to willingly fix it.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[JohnRBaker]

There are so many problems with your response I don't know here to start.

As for the so-called "type of contract" I assume you're talking about the extents of coverage and such. That was part of the problem with the current health insurance system, too many people were being sold plans which were nothing more than legal scams. Everything was fine as long as you never actually had to be treated for something serious because if you were your policy was automatically cancelled no matter how many years you had been paying premiums without any big claims. That's NOT a 'health insurance' policy, it's a 'you better not get sick' policy.

As for the so-called 'opt-out' idea, this would cause several problems. First is that people would continue to not be treated for preventable conditions leading to poor outcomes and impacts on society in general including more people walking around with communicable diseases and/or missing work thus increasing the cost to businesses for time lost and productivity impacts. And then there would still be the costs imposed on the system by people going to the ER for non-emergency care or would you suggest that we make it illegal for hospitals to treat uninsured individuals? And then there's the problem that someone might just wait until they become truly ill, like with cancer or after being involved in an accident, and they suddenly decide that YES they really do need to buy insurance. That will not work if preexisting conditions no longer prevents people from getting insurance or would you be willing to allow insurance companies to deny insurance to anyone they chose, because if so, we'd be right back to where we were. In fact, this was the rational for the recommendations made by the Heritage Foundation, you know, that 'ultra liberal' think tank, that there be be NO opt-out and that insurance coverage had to be mandatory, what they themselves called the 'Individual Mandate', or this would not work since insurance companies would go bankrupt if people could simply go ON and OFF coverage anytime they wanted to. And this is what conservatives and Republicans in general liked about this propsal (at the time), this idea of 'individual responsiblity', which is always a big deal with the Right, except of course when it's being promoted by someone they consider as being an 'illegitmate' president.

As for proscribing generic drugs versus patented ones, have you looked as what's happening in the pharmaceutical industry lately with the abuse of the patent system? There's been cases where formulas were changed by adding some totally inert ingredient which technically changes the 'formula' and thus means that s new patent can be applied for another 21 years. Or the big companies buying up the little guys making the generics and simply shutting them down or reducing the production to a level where only the patented ones are readily available. Also convincing doctors, with kickbacks and other 'considerations', to only prescribe the patented drugs.

A good example is Nexium, a drug that has been on the market for years but it has remained very expense and without any apparent generic subsitute. My wife is on Nexium and even with our very good insurance plan, the cost is running close to $100/month and it's the only thing that works as she has tried all of the so-called 'alternatives'.

And as for this idea that insurance companies should simply tell people to go overseas the get treatment where, as you put it, "health care is less expencive". Well since the United States is the ONLY industrialized country in the world that has NOT had some sort of 'national health care' system or mandatory coverage (remember, only in America is it legal for insurance companies to make a profit selling basic health care insurance) of course it would be cheaper to go to Germany or Switzerland for medical care. But how long do you think that would last if suddenly every plane to Europe was filled with Americans looking for a discount on their medical care?

I'm sorry, but someone's got to do a better job than that if you're going to suggest that the current plan will never work.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[cranky108]

How can you say that some of these plans were nothing but schams? Every one of them was approved by the insurance commission of some state. Are you saying that the goverments could be corrupt, and if so what makes the existing regulation any better? Believe me that corruption will follow, and we will be in the same mess. So if you did not read the fine print of the policy, you might have a problem, still.

Actually many younger people are choosing the opt-out feature of Obamacare, because it is cheeper than the insurance. So the opt-out group still exists. We haven't fixed that.

And the abuse of the patent system is allowed by both the patent office, and the FDA. Such a shame we have this goverment corruption that created this mess.

And the presedent seems to be powerless to correct any of it. What a spineless golfer we have.

The people get the goverment they deserve.

 

[JohnRBaker]

And Congress and the 'loyal opposition' bares no responsibility whatsoever, EH?

The Republican controlled House has just voted for the 50th time to repeal the ACA in totality. Does this sound like a group that could have done better? I think Alan Grayson got it right when he said:

http://www.youtube.com/watch?v=-usmvYOPfco#t=10

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[cranky108]

Where is Alan Grayson when you need him?

 

[CELinOttawa]

I am always curious about the US system, as there are forces at work within Canada which would want to see such a system here. Fortunately opinion polls have consistently shown that attacking the Canadian system would be abject political suicide for any political party.

Only a socialist-style "President for Life" could undo the Canadian system. Anything else would be reversed. For argument's sake, let's say that a government gets in WITHOUT admitting their intension to take apart the Canadian model. The model is, firstly, divided into thirteen parts (each Province and Territory has their own Health Care system)... So you would have to win a goodly number of separate elections, or potentially just attack federal transfer payments. So let's go the more realistic route: Separate transfer payments.

Here we go:

- Election.
- Process starts to convince Canadians that our Universal Healthcare is unaffordable and must go. Eventually a "functional minority" of 35% are convinced.
- Laws passed. Let's get really crazy: Not only is US-style private corporate insurance now mandatory, it is illegal to campaign against this or undo.
- People start dying aka the US uninsured model.
- Canadians demand better. The Loyal Opposition of the day campaingns to "Undo the wrongs of the current administration". No one is confused as to what they mean.
- New government elected. Unfortunately there are laws on the books making it "impossible" to reinstate universal health care. Fortunately this is a Constitutional Monarchy and not a <insert "Banana" as needed> Republic and parliament is supreme.
- Universal Health Care is back and a monument is built to those who died under US style Medi-don't-care.

While I am being perposely inflammatory and hyperbolic, I am not kidding about Canadians and our single-user-pays Universal HealthCare system. It is far less expensive on our Economy than most other options, and EVERYONE gets first-world health care. At that it is criplingly expensive; I'm not going to cheat and look it up but I believe it is now over 30% of our economy... And nearly universally supported. Everyone loves to hate it, but like a cruel and sick mistress who presses ALL of your buttons, we keep coming back for more and will do nearly anthing to keep her.

 

[NorthCivil]

CELinOttawa,

I can't ever see us getting rid of healthcare. As its provincially administered, I'm not sure the federal gov could dismantle it. Even if there was a federal government elected on dismantling healthcare, it would probably lead to successful separatism, and not only in Quebec. That being said, our modern day Conservatives, considered by many to be outright extremists, are mostly left of the US democrats.

 

[CELinOttawa]

NorthCivil: Agreed on each point!

 

[CELinOttawa]

This was featured on our national radio... At least the testimony of the Canadian expert. It was very interesting, as a US Republican Senator tried to twist her submission's facts and had is proverbial handed to him:

http://www.popularresistance.org/testimony-by-experts-single-payer-healthcare-is-the-best/

 

[beej67]

Buddy of mine had his family on a very high deductible plan with a large Health Savings Account. He earmarked his own money to pay for his family's own health care. He had a vested interest in keeping his own costs down, since he was effectively paying for all routine care, and only relying on insurance in true emergencies. His style of plan is the kind of plan that actually reduces the overall cost burden to everyone, because of his own personal incentive to keep his own costs down.

His plan was made illegal by ACA. Obama called his plan a 'sham.' He liked his plan, and his plan wasn't a burden on anyone else, but he can't keep it.

Now he's on a plan like everyone else, where the deductable is lower, his monthly costs are higher, and he's doing everything he can to wring every cent out of it to justify the higher monthly costs just like everyone else is, pushing his costs onto everyone else. And this is somehow supposed to make health care more affordable.

Right.

Our system was dumb before, and all the ACA did was enshrine the dumbness of it and made it mandatory.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[cranky108]

There never was any savings in the ACA. It was always about control. Another tax for you while making someone else rich.

There is a slight glimmer of hope in this. The AMA, and most doctors have a vested interest in you being sick. And it is to a point where you are being recommended things and procedures you don't need. The slight hope is to pull the reigns on this greed.

 

[rterickson]

That's interesting beej67, because my company just introduced a new medical plan option exactly as you describe -- high deductable, (very) low premiums, and health savings account participation. And the benefits lawyers say it fully compliant with the ACA. I'm not aware that the President opined on it personally, though.

Or you can stick with the old (also compliant) plan.

 

[beej67]

Your HSA participation is subject to a new, lower cap than permitted before, and the items covered by your plan, Mr. Erickson, are broader than some prior plans were allowed to be.



Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[AELLC]

There actually is a limit to high deductibles that wasn't there before.

I think the authors of ACA had this in mind:

1) Family A has a very good income, and therefore had a medical plan pre-ACA with a low deductible and high premiums.

2) Family B is the opposite - low income, high deductible, low premium.

Now, if B has a major health calamity, and racks up a $500,000 bill at the hospital, do you think of B will pay that full deductible? Chances are, not, and B will default on payment to the hospital.

Now, since ACA is purely a result of hospital owners being in bed with Nancy Pelosi, and of course Mr. B. O. has convinced the public that ACA is something good for all of us, it was written to force B into a plan where the hospital would be able to take more of B's money...it is that simple.

 

[JohnRBaker]

But if family 'B' had had insurance prior to the ACA, I'll bet it also had a high deductible with a low premium. And if they didn't have insurance at all. which was likely for many in their situation, how is it that things are not going to be better now? After all, if they weren't going to pay their full deductible under the ACA why would they have done so in the past prior to the ACA? And if they had no insurance at all, well, we know what would have happened then, everyone would have paid with higher insurance rates to cover the uninsured and those $500,000 unpaid hospital bills.

And don't be so sure of family 'A' having had a high premium, low deductible policy. Just because they can afford the higher premiums does not mean that they would automatically pay them just to get a lower deductible. There's a lot of people out there who are very willing to take that risk and from the wealthy people whom I personally know, many of them are serial 'risk-takers' even to the point of making it one of their claims for being successful.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[cranky108]

I still predict health insurance will go the way of flood insurance. It will be required, expencive, goverment controled, and won't cover the internals of the insured site.

I just think some people forget where insurance started. It was gambling. You are betting you will get very sick, and the insurance company is betting you won't. And it is usually rigged in the houses favor.
Strange how gambling addicts don't buy loads of insurance. Must be the instant gratification.

The only insurance that keeps going up in cost is what is almost required. We don't see the cost rising so much for self-insured companies. But the goverment has a fix for that.
Also hole-in-one insurance for golf games isen't rising that fast.

 

[AELLC]

JohnR,

I was offering that opinion as my version for the real reason behind ACA, not the reasons expressed to the public.

 

[JohnRBaker]

And only time will tell as to what the reality turns out to be.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[AELLC]

I think it is sort of OK however. There was a "barbaric" aspect to our pre-ACA system, compared to Canada.

Too many people with no insurance, doomed to do die slow painful deaths, not mercy euthanasia allowed.