they cant even get that right and theyve been waiting for this for 7 years

...until they get a Democratic president they can blame it on.

In the meantime, the rest of us get to return to Spaghetticare...which is where everyone throws spaghetti feeds to raise money for their heart transplant operations.

I'd laugh but it's such a damned shamed that we are currently governed by such heartless assholes.

I print several weekly papers, and in the days before Obamacare every one of them had in it, every single stinking week, announcements of at least three spaghetti feeds being set up to help pay for Ma's open heart surgery or Frank's cancer care. I note that when Obamacare really got going good, spaghetti feeds just stopped being held. Perhaps there's a correlation.

they will substitute it with a worthless savings account and claims of more market competition. They will use doublespeak, call it something that sounds great but in the end 50 million Americans will be without, again, and 30,000 a year will die.

Start the big national discussion while the ACA's still healthy, while people are still enjoying its benefits, like lifetime coverage of all conditions, including preexisting. The GOP plans to damage it enough to lend credence to the claim that it's doomed before they actually take it away.

Btw, we should all always refer to it as the ACA--just while this battle is on. Solid conservative majorities like and support the ACA. It's "Obamacare" they want to get rid of.

And, of course, earnestly advise all our friends and relatives to get all the medical issues they possibly can taken care of before it's repealed and we go back to cancellations and denials of coverage.

reading there was a poll where it was liked when labeled ACA and disliked when labeled Obamacare.

Makes sense, when the replacements discussed are often quite similar to Obamacare. They know they will lose big due to the people now on it losing it. Hard to push that toothpaste back into the tube. They just don't like Obama's name on it.

their employers have to be made to understand that they themselves will lose big, that they CANNOT HAVE unlimited lifetime coverage of all conditions regardless of health history without a big socialized program that makes it affordable.

Also that the same extremists who've taken over their party and who plan to repeal the ACA also intend to fulfill the dreams of decades of destroying/"privatizing" the VA, Medicare, and Social Security. With more to come.

Most of these people have closed themselves off from normal information sources and have no idea what they've brought down on themselves. The fights over these things need to be so noisy no one can miss them.

I wish I still went out to the "workplace" every day. I'd be speculating casually about life after the ACA.

Wondering how to protect our savings from profiteering fees and market crashes once SS is privatized.

How much of our annual healthcare premiums a Medicare voucher might cover and how long we could get by on catastrophic coverage at our ages, etc. And thank goodness we at least have a home to sell if needed.

Speaking of, how great it is that almost all homes these days have 3, 4 and even 5 bedrooms these days so that family members in trouble can live together and share expenses.

Sadly, I work at home in the country, because I'm especially fond of the idea of rhapsodizing over lunch to a table of women about how good it will be for society for our elders and chronically ill vets to be cared for at home, 24-hour care provided by some member of their loving families who quits her job -- the happy synergistic result of rest home care becoming as completely unaffordable as it absolutely would in a nation where government programs that spread these costs among many were abolished in favor of "independence" and self reliance.

(Thank in advance, Charles Koch.)

that people supported the ACA but not Obamacare. One woman even caught on & said, "Oh God, don't tell me - they're the same thing!" The host said, "Yeah they are." She at least had the grace to say "I'm embarrassed that I didn't know that." A lot of them, though, looked at the host in disbelief. Some even said, "I don't believe you." I wonder how many looked it up later? None, I'll bet.

That's the level of ignorance we're up against.

it will either survive this outright, or it will come back within the next ten years), then it should ALWAYS be called Obamacare so that he eternally gets the credit for it. He deserves it.

not to say "Obamacare," but it's only temporary. The pubs meant it to be an insult, we mean it to be a monument.

until we reach our $4000+ individual deductible. It is insurance against catastrophic medical situations. And that's it.

Three years until I'm eligible for Medicare, assuming they haven't destroyed it.

This past October, my wife was diagnosed with a rare form of cancer her surgeon said was called "the Murderer," because it is rarely detected until it is too late. Her hospital stay was 3 weeks, the operation was 5 hours, over 70 biopsies, lots of post-op visits and procedures, and she gets a month-long stay at a cancer-rehab spa as part of her prescribed treatment. Cost to us, except for my monthly premiums? Zero. We never even saw a bill.

She is taking this better than I am. She was not exactly corpulent to begin with (5'10" and weighed 130), and she lost 10% of that in the operation and aftermath. She is not allowed to lift anything heavier than 2 Kg until they tell her otherwise. The upside is that they think she is in the 1.2% percent that get her particular form of cancer and catch it early enough to not need chemo and radiation. She will have to get frequent checkups to make sure none of it is still lurking somewhere, but if one of the top specialists worldwide in this field (just happened to be local) thinks so, we'll take his assessment until we hear otherwise.

In our neck of the woods, they make these decisions by conference of specialists anyway, sometimes by worldwide video. They all agreed that chemo would probably do her more harm than good, so she will try to eat her way back to 130 slowly but surely. Her particular form of cancer is a fairly rare one, and not one that most oncologists are used to dealing with on a regular basis. The last time she had cancer, the stay at the rehab spa did her a lot of good, so she will probably go for that once we get back home later this month. Her insurance not only covers the stay at the rehab spa, it even covers the cost of her transportation there and back. Well worth the €400 monthly premium I have been paying for the last 4½ years.

As if she's getting excellent care. Sending positive vibes to you both.

And that's half the battle. unlike many top surgeons, this guy takes the time to visit his patients and explain to them what is going on with them. In his field, I'm sure that means delivering a LOT of bad news, so when he told us we had every reason to be optimistic, we took it at face value.

My wife comes from a long family history of women with cancer. Many of her aunts had it, and her mom has had it twice, just like she has, although she had it in other places. Her mom will be 90 this fall, and is in as good health as can be expected of a 90 year old woman who has beaten cancer twice. Of course, she also survived her family's existence (as well as three of her brothers) being blasted into oblivion during the Second World War, so its not like she is a stranger to adversity. I think she passed some of her fortitude on to her daughter and granddaughters.

gathered by tumor registries on real-life experiences of virtually all patients across the nation, and as you say, other nations in many cases, and analyzed to determine the most effective treatments for individual people. It's wonderful, and it may be why your wife is alive. No fooling around with very imperfect notions of what seems to be working. They know what's working how much for whom in just what circumstances.

I'm not sure you have what is usually called catastrophic coverage, though. The other name for it is "high-deductible" insurance. The insurance marketplace sells plans with a $6850 deductible to people under 30 or who obtain an exemption, but I believe deductibles tend to start around $10K/year for free market insurance not obtained through the exchanges.

Whatever you do have for your 400 pounds/month--congratulations!

There seemed to be a widespread mistaken impression that Germany had some kind of single payer system, when nothing could be further from the truth. It has a patchwork system that divides most of the country into first class (around 10% or less) "private" care, and second class treatment. My wife is second class, but got lucky, since in cases of urgency, where specialists are needed, SOMETIMES you can get referred to a top specialist immediately. Far from always. And there are hundred of thousands of Germans without any health insurance at all, although the percentage is tiny compared to the USA. Since my employer is still in the USA, I checked into a quote for "private" coverage in Germany, the only kind I, as an American with no German employer, could get there. With my pre-existing condition (heart trouble), they quoted me a "mere" €2500 a month. At today's exchange rate, that comes to $31,500 in insurance premiums per year, a bit more than I would like to handle, especially on top of my wife's €4800 euros a year, which I also pay. We are very partial to heating the house in the winter and eating, and would hate to have to start picking and choosing. Our younger daughter had the luck to land a job that promoted her to mid six figures a year starting this year, but German taxes take half that, and it would be humiliating to have to ask her for a handout now that she has "made" it on her own. Can you imagine the proud parents coming to their little girl asking her to contribute to their health insurance premiums? Kinda humiliating.

What my wife has is not ONLY catastrophic coverage. It is comprehensive. I only wanted to point out that catastrophic coverage, while insufficient for normal circumstances, is nothing to be sneezed at if you ever need it.

When she retired at age 60 after a nasty thyroid tumor, she was without health insurance, though for €400 a month, I could enroll her back into the program she had been in before she stopped working. With her history of cancer and other ailments, there was never any question of an interruption of coverage. The situation we were presented with in October would have cost us at probably $150,000 in Germany, and three times (at least) that in the USA. As it is, being kept on her former plan, although it meant sometimes waiting to get a doctor's appointment, all care and medicine was 100% covered except for the occasional token €10 co-pay, instituted to discourage hypochondriacs overloading their medical care system with unnecessary treatment requests--not a small issue when everything costs nothing.

interesting and informative post. Thank you. I looked up first and second class. Is the @10% "first" then all private-paid, whether through employer and/or individually, and the "second" through government programs at lower rates, like Medicare here?

The doctors' list at a fairly nearby medical center (a large, good one) looks like the directory at the United Nations must. Does Germany bring in physicians the way we do to make up for insufficient domestic training?

I have never heard of an employer getting involved in "Privatversicherung," though I can imagine that there are cases where some top employee doing a stellar job might get an exceptional offer from an employer wanting to tie him or her to the firm permanently. Knowing the Germans, I'm sure there are thirty rules governing that, half of them contradicting the other half. For "Kassenpatienten (second class)" it's is usually, if not always, half and half (employer/employee contributions), unless it's a 65-or.older person, when their version of Medicare kicks in. There are more complicated convolutions, such as self-employed or foreign employer with a German office, but I'm not familiar enough with them to accurately describe them. Like I said before, it's a patchwork system, with a few holes.

Germany has a large immigrant community, and I don't know if the immigrant doctors there are doing internships, are on loan, or were brought in for their expertise. I tend to doubt the latter, as Germany is a huge training ground for physicians. My wife had a Persian doctor when she had cancer last time, but the guy had left Iran when the Ayatollahs took over (seemed a better idea than being put up against a wall and getting shot, he said). His German was by now fluent with very little accent, and it was obvious he was now "home." His assistant, however, was from Barcelona (I blew her away when she learned I spoke Catalan), and fully intended to return home to practice in Spain. One of the doctors who attended to my wife this time was a local, but spoke fluent Swedish (so do I) as she had worked at a hospital there for a few years.

Many doctors from "problem" areas do remain in Germany after being educated there, as there are a lot better chances to provide their families with a decent future than back in their countries of origin. This doesn't bode well for those stuck in places like Syria, Libya, Morocco, etc, but it's hard to blame a doctor for not wanting to return to a country where he might be killed for just treating the "wrong" people.

There are also German doctors who leave for jobs abroad. Many choose Scandinavia, Canada, Australia, NZ, the USA, etc. I don't really know enough individual stories to give an answer that would serve as a credible generality.

We pay only $128 a month. Office visits are $60. Prescriptions we get at Costco. Labs vary.

The other option was to go for a plan that cost us $600-1000 a month, which would have meant that we were assured we'd pay that $4000 deductible in premiums. And for what? Lowered costs for doctor visits? I'll take the $60 a visit.

$128 a month seems like paradise to us, but on the other hand, doctor visits and medicines are things she never even sees the bills for, so we don't even know if we're better off for the small stuff or not.

5000 deductible.

The ACA plan is much better.

And California as a liberal state and one of the top ten economies of the world, could float a state plan.

I am in a small state and though it is liberal, it is so small it is on the federal exchange just to share the system.

is if they get rid of all the protections. So while right now we might still have suboptimal plans with high deductibles and high premiums, but at least we can feel confident enough that if things go bad at least the insurance companies won't be able to dig through records looking for excuses to not cover the treatments and there won't be any caps on coverage. Then there's the preexisting condition issue that will knock people out. Particularly people who are currently relying on subsidies to have any coverage. Paying several hundred dollars a month for a plan that you feel confident will have to cover you makes a lot more sense than paying the same for a plan in which the insurance company will be free to screw you over.

For all the flaws with the ACA, I cannot understand why anyone would want to ever go back to the way things were (I'm not saying you are suggesting that)

depending on a person's situation, you may or may not qualify for a subsidy

One thing everyone should have regardless of the deductible is a free yearly physical, and for those that it applies, a mammography should be included.

Ideally, it would be nice if we had Medicare for all. We didn't have the votes in 2008 for that, because the blue dogs wouldn't go for it, and in the current situation it isn't going to happen.

As to your concern regarding Medicare getting decimated, no one knows what will happen. Both Medicare and Social Security are very popular programs. I really believe there would be riots in the street if they tried to dismantle those programs. Regardless, we all need to keep are congress critter's feet to the fire, and let them know there will be hell to pay if they destroy those programs

First there is the $4000 deductible and then I pay 30% until I have paid an additional $12,500. And coming up January first its starts all over again. In a bad situation that's $16,500 per year if they really cover everything (hint: they don,t). And I will have to tell you that this will absolutely bankrupt me if it goes on year after year.
-Airplane

The world outside the GOP bubble gasps when it hears that they're going to deliberately make access to health care difficult or impossible for millions of Americans.

Many Americans will suffer needlessly, many will die. For what? Insurance company profits? Corporate health care profits? Tax cuts for people who don't need them? Serving the public and improving people's lives--including the lives of the needy--sets a bad precedent that could lead to even more responsible government action that benefits the public rather than their wealthy donors and themselves? So they can pretend they are the champions of the world who finally won a big political victory over the black guy and the little people who didn't inherit a fortune or sell their souls to Wall Street? Somebody needs to constantly remind them that this isn't just another football game; they seem to keep forgetting that.

Seems a major feature of the GOP's ideology; they make disastrous decisions based on their doctored info then have no solution to the mess they create.

Is there any group going to run ads about what will happen if Obamacare is repealed?...ads could be very powerful.

If the Democrats would quite pretending this is a game "they win some" "we win some" and act like it's life or death because it IS maybe we'd win again. Until all our old politicians are gone we will never have a real country. Obama's legacy is ashes. Absolute ashes.

As long as they have repealed it in title (so their promise is good)... that might be enough. Once they start trying to figure out a new plan and approach, they might figure out that its the same plan the GOP put forth back in the Clinton days.

Just repeal and then forget about it