[disabled]

> I've read more than enough plan documents, and work with health actuaries every day.

So, part of your job is to analyze health benefits plans (health insurance plans) that Americans get. You also work daily with actuaries in the life sector, who assign dollar values to people's lives.

Yeah, like that really makes you a good source when it comes to the well-being and long-term outcomes of a country.

> In my opinion, the profit motive has nothing to do with America's healthcare ills (no pun intended). It's the fact that it's tied to employment and purchased by employers. No other country is set up that way.

Congratulations on coming up with that point. That is precisely why I left the US, as somebody with a rare disease that requires an orphan drug to survive.

I knew better than to stay in the US, in order to survive. In fact, there may be a major ACA Supreme Court decision coming soon. If not, it will be released in the next session. I refresh SCOTUSblog every morning, worrying for my fellow Americans, who could very well die from the outcome of the decision. Regardless, I never plan on living in the US ever again. It will never be "home" for me anymore.

[bhupy]

> So, part of your job is to analyze health benefits plans (health insurance plans) that Americans get. You also work daily with actuaries in the life sector, who assign dollar values to people's lives.

Yes, exactly like health insurance actuaries at publicly run health insurance providers. We don't sit around trying to figure out how to make people die, like cartoon villains. We try to figure out how to make healthcare sustainable.

If you read what I had written, it's clear that not only do the private sector insurance providers perform comparable with public sector ones like Original Medicare, they can even out-perform them. So we can't conclude the "privateness" as the root cause of our problems, we have to consider other confounding variables.

> Congratulations on coming up with that point. That is precisely why I left the US, as somebody with a rare disease that requires an orphan drug to survive.

Sorry to hear that, truly. In my opinion, the single most effective thing we can do to help folks like you is to decouple health insurance from employment, and I'm sticking around to try to make that happen. Hopefully you'll come back, and stay healthy.

[disabled]

Thank you. Like another poster suggested, I will try to be more considerate next time.

I am off disability, but I can theoretically keep Medicare for life. I was always on traditional Medicare, and my orphan drug (a blood product) was covered under Part D for my condition. I was also insured as a "disabled dependent" via employer-based insurance, through my deceased father's retiree benefit--so it was secondary insurance--which functioned like a supplemental plan.

I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system (one of them being very rare--which means an HMO from a Medicare Advantage plan is a huge problem if I want to stay alive long term in the US--and generally, you cannot go back to traditional Medicare), plus type 1 diabetes. The very rare neurological disease is believed to have caused the autoimmunity leading to my diabetes diagnosis at age 5.

Anyways, I can tell you that the way things were set up in the US (prior authorizations, prescription formulary restrictions, quantity limits, networks, etc.) were certainly harming my health. I studied electrical engineering for undergraduate, and it is not like I am cannot handle bureaucratic and logistical nightmares.

But, there is a baseline level of stress and anxiety that is present in the US, and you do not have the realistic expectation that you will be cared for there. Not only that, it is a part-time job just to deal with insurance matters. This feeling is basically non-existent within most of the EU, including in places like Croatia. Croatians probably do have the best lifestyle in all of Europe, too.

It's just not worth it.

[bhupy]

> generally, you cannot go back to traditional Medicare

You're always able to go back to traditional Medicare, you just have to wait until the next open enrollment. In fact, after the first trial run with MedAdv, you can switch back before open enrollment if you want. Traditional Medicare is always an option.

Great to hear that you're staying healthy otherwise.

[disabled]

Thank you! :-)

True, but the issue is that medical underwriting is allowed on Medigap (Part B supplemental plans). So, once you are on a Medicare Advantage Plan, you basically cannot effectively go back, due to being unable to obtain a Medigap plan (covering the 20% that part B does not cover), due to having pre-existing condtion(s). The financial consequences of not having a Medigap plan are quite severe for somebody who has a rare disease, if you know what I mean.

As you know, it is a loophole in the ACA. Because I was declared disabled before age 22 ("disabled adult child"), there is a way for me to get Medicaid, for life, effectively, through the Ticket-to-Work program, via the PASS (Plan to achieve self support). Even if I "make to much money to stay on Medicaid", at some point, the Pickle Amendment allows me to stay on it for life, due to the age I was declared disabled at.

But, there are issues with that too, since it is a form of "welfare". You can end up having to pay back the US government hardcore overall. You also get punished for being on Medicaid. For example, some states only allow you to have 4 medications covered by Medicaid. After the 4th active prescription, a type of "prior authorization" is sent to each and every doctor--for some government bureaucrat to make an arbitrary decision whether this medication is being "worthy of coverage".

[tptacek]

It feels like this is the point in the thread where you just got frustrated and started casting aspersions instead of making arguments. That happens to me a bunch too, and the strategy I've developed for it is to look at how many question marks I've managed to put in my comments, and try to fit more of them in. The person you're arguing with has some apparent domain knowledge; try extracting it?

[disabled]

This is fine. I will try being more thoughtful next time.