Category: Affordable Care Act

A Pre-existing Dilemma


Tom is a forty-three year-old self-employed painter and father of two.

He’s currently in remission from lung cancer, having been first diagnosed five years ago. At the time of his diagnosis, he did not have health insurance.  Thankfully, for him, American law had finally made it illegal for health insurance companies to discriminate against individuals with preexisting conditions.

This means Tom had to be offered insurance at community rates. And, this was a good thing for him. His medical expenses exceeded $100,000 annually for his first two years of treatment. No one deserves to go without care for a serious medical condition.

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Jenny is a married mother of two.

She in employed by a local small business where she has worked for the last 12 years. Her daughter has an uncommon but treatable blood disorder that requires occasional laboratory testing and infrequent blood transfusions.

Jenny’s employer has provided for the health insurance of both Jenny and her daughter for the last decade. It has been a part of Jenny’s benefits plan.

Unfortunately for Jenny, over the last few years, the cost to her employer to provide this plan has risen dramatically. The small business she works for has had no choice but to pass down many of these rising costs to her.

Jenny now pays her employer a markedly higher monthly premium for her family to be included on her plan. Her medical deductible is 10 times what it was just six years ago. And, her coverage is far worse.

Forced to cut costs even further last year, her employer only offered insurance options with more narrow networks of physicians. Jenny is currently driving 90 minutes for her daughter to receive the specialist care she requires. Five years ago, she drove four miles down the street.

Thankfully, Jenny has still found a way to make ends meet despite these obstacles. But, next year is looking to be even worse regarding the cost and quality of her insurance.

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Healthcare is once again a major focus of political conversation, so it’s important we understand a few things.

Our President-elect has said he will work to repeal “Obamacare,” but at this point, the details are not clear. Will his replacement product be better than what it’s replacing?

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Less-is-More… for Tortillas


There is a single CT scanner in town.

A certain number of scans are done with it each month.

Suddenly, a second scanner is installed at a new location across town.

True or False:

The total number of CT scans being performed will remain the same with two scanners now available.

The answer is false… at least within our current system. Someone has studied it. Adding another scanner increases the utilization of scanning.

Is this a good thing or a bad thing? Careful, now. It’s an entirely different question. The answer, of course, is maybe, or maybe not. You need more information.

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Understanding What You Pay For


Many health insurance plans will see double-digit rate increases this year. Whether it’s Obamacare or employer-based commercial insurance, it doesn’t really matter. Your monthly premium will likely go up. Even if your employer pays it for you, your deductible will probably skyrocket yet again.

People want you to believe that YOU are finally paying for healthcare.

And, it’s a lie.

You are not.

You are paying for insurance.

And, until you understand the difference, you will never understand the problem.

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Regulate THIS!


Pharmaceutical drugs cost too much. The new ones are always so expensive.

Hence, we need more regulations. And, the government should impose them. Set price limits. Cap drug-maker profits. This will make it better for all of us. The paternalism of our government should be the strongest when we are ill. Because we may need that medicine.

The government should regulate things more so we can get it cheaper.

Case in point. One new medication now available to cure a chronic liver disease costs about $84,000 per treatment course. The actual production cost for the company that makes the drug is supposedly around $100. Granted, the company paid $11 billion for the patent rights, and then took a risk that the drug would even get through Food & Drug Administration (FDA) approval. But, ultimately it did, and this year alone, the company will likely receive over $17 billion in revenue from it.

Wow. Then, they likely will make more profits next year.

And, the year after.

Why isn’t the government protecting us from such pharmaceutical price gouging? Where are the regulations? We need them.

Here’s the bitter irony.

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More Data, Less Logic


Deaths from high blood pressure should plummet under Obamacare.

That’s the title of a recent news story that got my attention.

The article was a press release about a study performed by several non-physician investigators with a background in public health. For those less familiar, public health relates to the science of population medicine, or what’s good for the group is good for the individual. Basically, four non-physician investigators sought to analyze the impact that the Affordable Care Act (ACA), also known as “Obamacare,” will have on deaths in this country due to high blood pressure.

“Deaths should plummet,” says the story.

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The American Way of Pseudo Health Insurance


You’re 56 years old. You’re one of the 30 million people (give or take a bunch) that you hear have received health insurance in this country as a result of the Affordable Care Act. You are a positive number in the New York Times headlines the Department of Health and Human Services (HHS) have been wanting you to read. And, this is how it’s working out for you.

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