An Obamacare Day

A friend who is older, but not quite old enough for Medicare, is on Obamacare through the Mass Health Connector site. It took about 20 phone calls to get her established and it was supposed to be free, but lately they have decided that she needs to pay $5 per month. So every month they mail her a hardcopy bill and every month they want to receive a hardcopy check.

I am on Obamacare too, though without a subsidy. The web site didn’t make it at all clear that I would have to pay for the first $2,000 of my medical care. One would think that after more than $1 billion in IT spending (the Massachusetts site is built by the same contractor as the federal site) the comparison shopping tool would have shown total likely payments under the various plans, but it did not. I went to see the doctor a few weeks ago. There was no way for the front desk workers to find out that I had to pay out of pocket due to the deductible and collect the money at the time of the visit. They, or their billing service, submitted a $250 bill to Harvard Pilgrim. Harvard Pilgrim then knocked this down to $188 for undisclosed reasons, but paid the doctor nothing due to the deductible. I was informed of this via a hardcopy letter sent in the U.S. mail. Now the doctor will have to chase after me for $188 via hardcopy bills sent in U.S. mail.

Speaking of U.S. mail, I have the insurance set up on autopay from the government’s site. Despite this, every month I am sent a hardcopy bill via U.S. mail that says “do not pay.”

We went to the hospital recently with our 10-day-old baby. His color is now perfect so he shouldn’t need a bilirubin test but the protocol calls for one anyway due to the fact that the earlier results were not ideal. After a 30-minute wait he was tortured with a heel stick. Then the nurse managed to get a drop of his blood in her eye while doing the test. Now she will be tested for HIV every year for 10 years, despite the fact that the mother was tested for HIV prior to the child’s birth and would, if asked, agree to have another HIV test. After the blood incident the staff at the hospital wanted to have a doctor talk to us for permission to look up the mother’s medical records (the baby was born at the same hospital). But no doctor was available and we had to leave to get to the pediatrician for a scheduled checkup. On the way out they were looking at various screens from the IT system and also some printouts saying “But we need to know your name and phone number.” There was confusion as to the baby’s name and the mother’s name that took a while to sort out.

Mother’s summary: “We can’t have another child. I can’t handle another touchpoint with the American medical system.”

17 Comments

  1. J. Peterson

    August 16, 2015 @ 1:05 pm

    1

    Interactions with our local clinic soured after Obamacare kicked in. Prices for routine visits nearly doubled in some cases. Support staff were laid off, making scheduling, routine queries for information, and straightening out billing mistakes much more difficult.

    Obamacare was supposed to bring crowds of new paying customers into the medical system. The clinic responded by raising prices and lowering the quality of service.

  2. fd

    August 16, 2015 @ 2:16 pm

    2

    Now we know why Obamacare: to support the USPS.

  3. David

    August 16, 2015 @ 3:35 pm

    3

    I think these issues will get sorted out over time. I also think we have a good health care system. I was just in Canada where the price is right but you wait for anything that isn’t an emergency, including cancer surgery.

  4. Brian Gulino

    August 16, 2015 @ 5:16 pm

    4

    Yesterday I was talking to a woman in section 8 housing next to my own property. She was about 50, kind of worn out looking, but I complimented her on her beautiful white teeth. She told me, “Obama got me these teeth”. Gave her dentist $1500 for a set of dentures. Now she can eat solid food.

    Obamacare? How about “large insurance company monopoly care”? Or “greedy MD cartel care”? Both make about as much sense as blaming Obama. What you need to realize is that it kind of sucked before, and a lot less of your fellow citizens had any kind of health care. We got the medical system our democratically elected congress gave us. If you don’t like it, start improving it. Make sure that little town you live in has a health commission and volunteer to serve on it. If you live in California, switch to Kaiser, which has been doing this longer than anyone else and has a lot less problems.

  5. SK

    August 16, 2015 @ 6:30 pm

    5

    Philip, aren’t using Romneycare actually?

  6. philg

    August 16, 2015 @ 9:47 pm

    6

    SK: I think that most health insurance plans previously offered in Massachusetts are illegal under Obamacare, e.g., because they don’t provide a free breast milk pump to new mothers (a mom of six kids will end up with six pumps in the closet). So whatever the Legislature approved during Mitt Romney’s time would have been replaced with Obamacare.

    (And of course “free” means that median-income taxpayers will pay for it while potentially wealthy people will get pumps that they don’t want or need.)

  7. Mark

    August 16, 2015 @ 10:03 pm

    7

    @Brian,
    I live in Virginia, so to say the uninsured previously had no health care is simply wrong. There isn’t a non-profit hospital or clinic in Virginia that could refuse anyone services based on their inability to pay or produce evidence of insurance coverage.
    NOW, we have watched our average health insurance premiums double to triple (on average) with deductibles that are much higher than pre-ObamaCare. So I’m still waiting on my liberal-leaning friends to explain how that could possibly be called “affordable”…

  8. Sam

    August 17, 2015 @ 12:08 am

    8

    Mark –

    Making something more affordable for some means making it less affordable for others.

    My premiums more than tripled with slightly higher deductibles under ACA.

  9. George

    August 17, 2015 @ 1:12 am

    9

    @Brian: Yes, it sucked before, and now sucks worse. For that I blame Obama. Most of our elected representatives do not even agree with the plan.

  10. Robert

    August 17, 2015 @ 9:07 am

    10

    Due to a glitch in the NY Obamacare system, my poor doctor just sent me a bill trying to get paid for service provided one year ago. I wonder when she’ll ever get paid.

  11. lvl

    August 17, 2015 @ 9:34 am

    11

    SK, Phil:
    http://www.politico.com/story/2014/05/massachusetts-romneycare-health-care-exchange-106362.html
    This says MA, hired a different contract to rebuild their exchange, not the one that built the Federal one… why they needed to rebuild?

    I don’t know about O’care being the problem here – I dread touching American healthcare system now as much as before Obamacare – all your issues, we had before. The idiotic incomprehensible, billing, incompetent administration, bouncing between “departments”, comparison of prices (for straightforward procedures like MRI’s) The lack of any sort of workable technology – eg. a directory of doctors in network, has never had a listing that had a correct up to date, phone numbers (directed to fax), addresses, new patient status, etc…

  12. Anonymous

    August 17, 2015 @ 10:31 am

    12

    As Philip pointed out in a previous post ( https://blogs.law.harvard.edu/philg/2015/03/31/can-i-buy-individual-health-insurance-except-through-obamacare-or-the-massachusetts-equivalent/ ), the only thing worse than dealing with the US healthcare system is dealing with it without insurance. What Obamacare has done for those of us who buy insurance as individuals is ensure those policies will be renewed at reasonable prices even if we get sick. It ensures that we will be able to buy coverage when the COBRA runs out even if our cholesterol is a bit high. Despite incomplete implementation, millions of Americans who didn’t have insurance before now have it.

    If we can’t figure out a way to ensure that all women who need a breast milk pump get one without putting six into the closets of wealthy women then so be it.

  13. Ed

    August 17, 2015 @ 10:35 am

    13

    I agree with lvl. The ACA essentially bailed out/ congealed the existing US healthcare system. It certainly wasn’t “socialized medicine” and was designed to block socialized medicine (as was the Heritage Foundation proposal it was based on). It can be criticized from the left, it can be criticized from the right (in favor of having an actual free market with healthcare), but the idea that it massively changed some system that was working fine before is strange.

  14. mark

    August 17, 2015 @ 10:53 am

    14

    “If we can’t figure out a way to ensure that all women who need a breast milk pump get one without putting six into the closets of wealthy women then so be it.”

    The pumps are little more than molded plastic and a very small motor – the same parts and technology used for cheap toys, yet they cost $300. Get the insurance industry out of it and I’m certain (or, pretty sure) that the price could fall to under $30.

  15. Les Elkins

    August 17, 2015 @ 5:41 pm

    15

    Couple of anecdotes from Maryland way:
    -My premiums seemed to go up more in the years before ACA than they have since. (At least, my out-of-pocket doesn’t seem to have gone up much, and the HR staff of the small company I work for isn’t soliciting many bids annually trying to get better rates- a few years back that was a regular thing)
    -Several of my self-employed Maryland friends have coverage now, and didn’t pre-ACA.
    -The Maryland exchange can be a disaster to deal with. (Aren’t they all?)
    -Several out of state friends have seen big increases.

    I do wish there was a more coherent Republican response. Surely there’s a better path than getting rid of it all/Green Eggs And Ham.

  16. philg

    August 17, 2015 @ 10:44 pm

    16

    Commenters: You are raising some great points. The U.S. health care industry was already perhaps the world’s most inefficient and consumer-unfriendly. And Obama now has the bad luck to have his name attached to it!

  17. Ted

    August 19, 2015 @ 3:04 pm

    17

    Phil, I think you’ve concisely summarized the problem. Obamacare patched a few of the most egregious inequities in the American health care system (in the way that most benefits the insurance companies that are largely responsible for those inequities), but left a very broken system unchanged.

    What we have in this country is not a health care system, at least not in the way health care is defined in other countries. We instead have a unique system that has evolved to increase the wealth of executives and shareholders in corporations that collect enormous rents on the administration of health care, but provide no actual health care. If anything, they do what they can to impede and prevent the delivery of health care to patients, as that is defined as a “loss” of rent. The system puts profit first and patients last.

    To service the rent-seeking corporations, numerous parasitic bureaucracies have evolved that siphon still more money while again providing no health care. Every doctor’s office, medical group, or hospital needs legions of their own administrators who prepare coded bills, fight with insurance companies when they reject coded bills, and collect co-pays and coinsurance from patients after the insurance companies finish paying their share. That’s a complicated costly task because every patient has a different plan, with different companies imposing different rules and standards.

    Doctors are no longer professionals, but “providers” at the bottom of the corporate food chain. They’re constantly taking orders from clerks at the various insurance companies, who dictate what treatments a patient is allowed under his or her plan. Or they’re obtaining permission (“prior authorization”) from other clerks at pharmaceutical benefit managers to use drugs that might be different from the “preferred” formulary options on a patient’s plan, which are chosen because the pharmaceutical benefit manager got the best deal.

    If you’re unfortunate enough to need hospitalization, don’t expect care from nurses. That’s delegated to aides and assistants. Nurses’ skills are needed for the much more important job of continually entering data into Electronic Medical Records systems, to ensure that the various bureaucracies have all the data they want.

    In other words, the “American Exceptionalist” health care system is devoted to tracking, moving, and managing money as the various bureaucracies and rent-seekers take their share. The patient is just a troublesome piece of meat that accompanies the records, codes, and bills that really matter. That’s the way it was before Obamacare.

    Obamacare merely made buying insurance (which is NOT the same as health care) a requirement, freed insurance companies from the costs of underwriting and “cherry-picking,” and diverted some taxpayer money into their pockets so that people with lower incomes could meet the requirement. It guarantees insurance companies more revenue from captive customers, but does nothing to provide actual quality health care.

    The real goal of Obamacare, of course, was to eliminate the threat of any true reform that would displace insurance companies from their position as apex predators in the health care food chain. They used their considerable resources to push a Heritage Foundation plan that maintained the status quo that serves them so well. Obamacare was the crumb they allowed the American people to have, but the real cake they bought was to make “health care reform” so toxic that no politician will touch it for the foreseeable future.

    If you’re going to blame Obama, blame him for squandering the only opportunity to attempt the real reform this country desperately needs. And even then, Republicans are duty-bound to destroy it for partisan reasons, even though it originated from their own think tank and implements conservative ideology.

Log in