As a single man with limited culinary skills, I eat out frequently and as a result waiters and waitresses know me as a regular customer. Those who serve me often talk about their work and I ask about their working conditions. They have tough jobs—on their feet for many hours at a time, wages are not generous, and customers can be demanding.

Now many of them are having their hours cut to less than 30 hours a week so their employers will not have to give them healthcare as the new law requires. For some it means they will have to look for a second job to make ends meet and will still not have health care. I have talked to a waiter and a waitress at different restaurants about this and have the impression it is becoming widespread.

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I think the proper way of stating this fact is,  "...employers are cutting the workers' hours to less than 30 hours a week so that they (the employers) won't have to give them (the workers) health care as the new law requires".

So a law is passed to provide health care and employers are looking for loopholes to get out of providing health care.  How is this specific to Obamacare, one might ask?  You still frequent that establishment?

One I still go to occasionally, the other not at all.

You are quite right that the situation is not limited to Obamacare or even to health insurance generally. In San Diego the school system only hires temps now to save money on benefits. Good teachers who can move have left the system for the smaller surrounding cities that do hire full time with benefits.

For quite a long time the advantage of a government job at any level was not in the salary, but in the benefits and job security. That has changed and it means that government service will only get worse as time passes.

 I seem to remember a time when the government experts were the best in the business.  Now the perception seems to be that the best are in the private sector.

Why is this a surprise.

It's about time that government stop wasting on unnecessary expenses at a level that wouldn't stand up to scrutiny in the real world. I remember a dinner discussion among some friends talking about the amazingly generous free maternity coverage they have and my thought was "great, you're bragging about how much you get other people to spend on your care".

And when it comes to excessive pension funds .. we've got cities and counties being driven to bankruptcy by hugely expensive costs that they are prohibited from re-negotiating (sort of like the auto industry of a few years ago)

Those in lower management of many businesses, though given benefits, are exempt to protected worker regulations and are worked to the bone. My brother endured it under Wal*Mart and he endures it under Kraft Foods, which works him 12 hours a day, 6 days (and even sometimes more than 7 days straight, the way his day off may fall) a week. Corporations don't care, because they're like the borg and have no conscience. Support your smaller businesses, if and when you can.

Actually young males are expected to see the highest jump in insurance rates. This is caused by the limiting of age related costing and the requirement that males and females be charged at the same rate (statistically young men cost less to cover, they spend less time at doctors).

[Funny about applying the demand for gender rate equality in this situation is not matched by a similar demand in auto insurance... I guess equality works in only one direction.]

By the way, is it going to be possible to get high-deductible catastrophic health insurance, perhaps backed up by some kind of medical savings account, with Obamacare?

The thought of being forced to get health insurance for everyday medical expenses, makes me want to throw up! 

I hate insurance companies.  A lot of the medical problems I've had have NOT been the sort of thing that insurance helps with!  If I were forced to buy health insurance for everyday medical needs, I would be paying other people's bills AND my own. 

And health insurance causes all sorts of headaches with their forms, sometimes refusal to pay, etc. etc.  Forcing everyone to deal with insurance companies on a daily basis is a demented Democrat's dream. 

The problem lies in designing a system that works well for everyone in a country where even routine medical costs are high. Half of all bankruptcies are the result of medical bills.

The idea of high-deductible catastrophic health insurance is appealing, but it doesn't work for those with chronic conditions such as asthma and diabetes. Routine medical costs for diabetics run five times as high as for those without diabetes, but that routine care prevents later catastrophes and saves money. People with chronic conditions and only catastrophic insurance tend to avoid regular medical care that causes out of pocket expenses and to use hospitals because hospital visits are covered.

All insurance works by distributing risk over a population of subscribers. Everyone pays a little—the premium—so that those who would pay a lot are covered. This is true of auto insurance as well as health insurance—you pay and less careful drivers are covered for the damage they cause.

Are you saying that it isn't going to be an option to have catastrophic health insurance + maybe medical savings account?  I shudder to think of HAVING to routinely cope with health insurance!

Having "coped" with health insurance all my life, I don't find it onerous at all. I have been fortunate always to have insurance provided by my employers—universities and research foundations. The paperwork is done by the service providers and all I have to do is show my insurance cards once a year at the physician's office and I have not found that taxing.

Catastrophic insurance policies cover hospital visits, but nowadays many expensive diagnostic procedures are done outside hospitals and are not covered—things such as MRI, diagnostic x-rays, cardiac stress tests, bone density scans, EKG, endoscopies, and colonoscopies. 

Catastrophic insurance and a medical savings account may work well for you, but the problem for most people is that they do not save enough. Saving for retirement, health care, and sending the kids to college would require most to save more than half their income and they simply cannot do it.

If you choose to go the route of a medical savings account, you will pay more for the same services than an insured patient pays through his insurance. The reason is that insurance companies, having large volume, can negotiate discounts for most procedures and services, but an individual pays the full price.


I had group health insurance in one job.  At one point I noticed that over and over again, the insurance had reimbursed based on a "reasonable and customary" charge that was a lot lower than the actual charge. 

I challenged an underpayment that was especially dramatic, through several stages of appeals at the insurance co.  I got quotes from miscellaneous other providers for the same service - an imaging study - also much higher than the insurance co.'s "reasonable and customary" charge, and forwarded them to the insurance co.  Still they denied full payment.  Finally someone told me the AMA had an insurance board and I wrote a letter to them, the insurance board agreed with me, and the insurance co. finally paid up. 


That sort of struggle is very emotionally draining. 


I've found the opposite, that often I can get a self-pay discount, because the office or lab is relieved of the hassle of dealing with insurance co.'s.  It's worth a lot of money to them!

The problem you describe is common. A medication is approved for use in treating one condition and the insurance company will reimburse only when it is prescribed for that condition. However, doctors often find that a drug useful in treating conditions for which it has not been approved. The difficulty is that pharmaceutical companies may not find it appealing to have the drug re-tested for a new condition unless there is a large patient population to use it.

Yes, and it's a very big deal if you have medical problems, as I have, that are not well understood and require an innovative approach.  I think there are clinical trials of Xolair underway for allergic rhinitis - but none for local allergic rhinitis which seems to be what I have. 

I also have many, many food allergies of a kind which many people describe but are very little understood - delayed food reactions where the main symptom is a foggy state that comes on 1/2 hr to 4-5 hrs after eating the food.  No positive blood tests for food allergy.  I found out that the food allergy reaction is much reduced by taking cromolyn 1/2 hr before eating a pill (that contains allergens).  Cromolyn is a mast cell inhibitor so that means the food reactions probably involve mast cells, and they might be local IgE allergies in my GI tract (mouth, gut ...)

I probably have celiac disease, it often causes delayed food allergies. 

It was crucial to use the cromolyn because with its help, I can take a useful allergy medicine. 

But again, cromolyn is extremely expensive.  I got a quote from a pharmacy for about $900 or so for a 12-day supply ....

I DID find recently that I could get the cromolyn from a compounding pharmacy for a reasonable price - only about $130 per month.  But without that lucky break ... Insurance would likely not cover cromolyn for me either, since I don't have positive tests for food allergies. 

If you have a condition that makes you chronically ill, you probably ought to have health insurance if you possibly can get it.

Health insurance that covers everyday medical bills would only impoverish me.  It wouldn't pay many of my medical expenses!  It wouldn't pay for $800 Xolair shots every 3 weeks.

It would cost something like $10,000 per year!  Which would go to pay OTHER people's medical bills.   Because of my efforts to achieve good health, I actually have excellent health parameters for the chronic, expensive illnesses that kill most people in the developed world.  My blood pressure is low-normal, I don't have metabolic syndrome, my weight is normal, I've never smoked ... So I'm relatively unlikely to get heart disease, cancer, diabetes, stroke. 

I wouldn't object if Obamacare forces me to get catastrophic health insurance.  I would think it a serious injustice if the govt. forces me to pay tons of money for full health insurance to a huge health bureaucracy, which goes to pay for other people's chronic (mostly avoidable) health problems - and does very little for my severe health problems!

And if Obamacare did address this problem - if compulsory insurance would respect doctors' freedom and their judicious decisions in little-understood areas of medicine - then I would dread it less.  But I doubt it. 

Our medical care is incredibly expensive, and Obamacare isn't addressing the underlying causes.  There is an obesity crisis for example - that raises medical expenses a lot.  The underlying causes for the obesity crisis seem to be in our society - fast food restaurants, stressed people eating a lot, driving instead of walking/biking, farm subsidies that lower prices for junk food, etc.  It would require a lot of political capital - more than anyone has, I guess - to address those societal problems.  For example the dysfunctional farm subsidies are firmly entrenched, a kind of political sacred cow that can't be abolished. 

Also, health insurance tends to force conventional medical care.  People with problems that require innovative care are left out.

For example, an allergist in NYC has been giving me Xolair, which is an injectable medication for severe asthma.  I don't have asthma, but I have allergic rhinitis that is so bad I'm chronically ill and can't lead a normal life. Xolair has helped, far more than anything else I've tried. 

I also haven't had positive allergy tests for several years.  I have allergies anyway - researchers have long known this happens, as I mentioned in my blog post on local allergies. 

But when I consulted an allergist more local to me to see about prescribing Xolair, he said it wouldn't be reimbursed by insurance without positive allergy tests.

Thus an insurance company - not a medical expert - in this case and I'm sure many other cases, is dictating medical care.  And in their ideas about what is reimbursable, they are lagging behind current research, as many doctors do. 

So Obamacare would likely be oppressive for me - charging me thousands of dollars in health insurance premiums, while the care I actually need isn't reimbursed.


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