Obamacare

You'll Need a Doctor's Note to Dull the Pain in the Ass Caused by ObamaCare

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Attention, all you people in medical savings accounts, the universally lauded reform that helps inject market forces into health care: ObamaCare is screwing you twice (in one night!):

Workers for years have been able to set aside tax-free dollars into an account that could be used within the year to pay for everything from insurance deductibles and eye surgery to Advil and allergy pills. But starting in 2011, the accounts will no longer pay for over-the-counter medicines unless a doctor writes a prescription for it. By 2013, contributions will be limited to $2,500.

Thanks, President Obama, you've chiseled down one of the few things that has helped to force doctors and patients to discuss pricing in medicine. For those of you not familiar with MSAs, participants park money in a tax-free account that is used to pay out of pocket medical costs. Insurers typically issue a charge card that allows users to pay for all health-care-related spending—office co-pays, prescriptions, basically any out of pocket cost. While I'm no fan of giving preference to one sort of spending over another (why is health care sacralized?), the system works swell all the way around partly because it allows users to keep track of costs and balances. And it lets users roll over unused money from one year to another, creating a potential pile of cash that can be used as you age and need more health care.

It'll be great to need a prescription to use the handy-dandy MSA credit/ATM card for over-the-counter meds next year. I especially look forward to the stories about kids calling their doctors on Sunday morning to get a note for Plan B, which can be quite pricey (I'm told!).

More here.

Are we on the brink of creating a system where the Doobie Bros. nightmare vision of a world in which "the music is the doctor"? That might work for minor aches and pains, but I'm pretty sure I'm gonna need some pills to cure my ills. If ObamaCare required a prescription to listen to the Doobies, I might be able to get behind it, but until then, I'm hoarding Advil.

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  1. It’ll be great to need a prescription to use the handy-dandy MSA credit/ATM card for over-the-counter meds next year.

    Not me, biotches!

  2. Ostensibly, I am sure they justify this for the same reason as the student loan takeover and the form 1099 nonsense: increase the flow of cash into the federal coffers to “pay for” this shit.

    But as an added bonus, this is nothing but a blatant, “fuck you” to freedom and market forces.

    If the goal is to control people and their health care decisions/activities, then we can’t have people making their own health care decisions/activities, can we?

    1. If? The goal is to control every stinking thing we put in our mouths, on our backs, & probably, when we let it go.

      The conspiracy theorist in me believes that at least part of the med community’s support for the bailout is that people have lost faith & are refusing treatment in greater numbers every year.

  3. I am a user of the MSA system. When combined with a high-deductible insurance plan it makes for a much more affordable way to pay for healthcare. It also re-introduces the cost/benefit calculation to medical expenses. Rather than a flat $15 co-payment, I cover the first $3,000 out of pocket. So any little expense gets scrutinized – since that money would otherwise be mine to keep. If everyone had this sort of plan, I think we’d see a very different health care universe.

    Of course, once I’ve blown through my $3k limit, everything is free from that point on – so I have an incentive to cram every procedure I can think of into the last couple of months of the year if I happen to go over the $3k limit.

    1. Yup. MSAs combined with high-deductible insurance would make the perfect foundation for real health care reform in this country. Alas, I’ve been informed by progressives that MSAs are elitists because only people that have incomes will have basic health care.

  4. I especially look forward to the stories about kids calling their doctors on Sunday morning to get a note for Plan B

    Because kids ask mom or dad for the MSA card when the condom breaks. Sure.

    Anyway, the whole “we need to pass it to know what’s in it” thing is really paying dividends. There’s something fun and new* to discover in Obamacare with every day that passes.

    *Your definition of “fun and new” may vary from the author’s. Mileage may vary.

  5. Is this the same as, or different from the Flexible Savings Account that some of us pay into yearly?

    1. Not the same, but affected in exactly the same way (somebody tell me if I am wrong, but I don’t think so). There are several of these things that vary slightly depending on the structure of the underlying health plan but that work essentially the same way: MSA, HSA, Flex Spending. Obamacare screws all of them the same way.

    2. An FSA is different from an MSA, but the rules for FSA’s are changing in the same way. You’ll need a prescription for OTC medication.

  6. I just found this out when I qualified for my work healthcare plan. And my feelings were the exact same: The one damn thing with healthcare that works as a free-market purchase should is now being strangled for the benefit of a larger, more opaque plan that instates more hassles, more headaches and throttles down what little choice and flexibility was available.
    Well done, government – this is the kind of insanity that needs to be asked of the president. Not those embarrassing fluff pieces he gets to coast through in Rolling Stone.

  7. I had one of those “flex spending” things for one year and I dunno if that’s different from this but you most definitely could NOT roll money over to the next year – it was strictly use it or lose it. So naturally I wound up losing a couple hundred and dropped the stupid thing. But yes, the new prescription requirement for Advil and TUMS is moronic and even a bit evil.

    1. Re: Rhywun,

      I had one of those “flex spending” things for one year and I dunno if that’s different from this but you most definitely could NOT roll money over to the next year – it was strictly use it or lose it.

      That is correct – it is a “use it or have it stolen from you” deal.

      So naturally I wound up losing a couple hundred and dropped the stupid thing.

      If you have an ongoing prescription, it makes sense to set aside a FSA, or if your wife or girlfriend (or you, if you’re a woman) is having a baby, it makes sense as it spreads the cost of care for a year, or until the FSA runs out. Otherwise, if you happen to be single and fit, not expecting to have more than the sniffles, then it makes no sense to waste your money on an FSA.

      But yes, the new prescription requirement for Advil and TUMS is moronic and even a bit evil.

      Why do you hate the poor so much?

      1. Yeah, I’m not any of that but I did need a lot of dental work that year, plus I go through a decent amount of OTC stuff too. Besides the losing a couple hundred bucks thing, it was already a pain in the ass if your drugstore wasn’t “signed up” – they make you fax in receipts every month. I probably would have dropped it for that annoyance alone – and now it’s even more annoying.

    2. I have asthma and allergies. My wife has migranes. Together we go about a grand a year (deductible and co-pays) on maintenance meds. So FSA is great — we can avoid taxes on a thousand a year (at least).

    3. The flip side of “use it or lose it” is that, if you quit your job before paying the full amount into the FSA, you can still use the full amount of the FSA. I just did this last week. The employer doesn’t deduct the difference from your final pay. Not a big comfort but some.

      1. Yeah, I quit halfway through the year I used my FSA for LASIK. Nice little bonus from the former employer.

    4. An MSA and an FSA are two different things. A Medical Savings Account is usually paired with a high deductible medical insurance plan and can be carried over. An FSA cannot.

  8. You’ll Need a Doctor’s Note to Dull the Pain in the Ass Caused by ObamaCare

    Ouch!

    But starting in 2011, the [Flexible Spending] accounts will no longer pay for over-the-counter medicines unless a doctor writes a prescription for it.

    “We saved millions of jobs . . . of prescription booklet manufacturers.”

    By 2013, contributions will be limited to $2,500.

    We can’t have people spending their hard-earned cash in so-important medicines without knowing the sweet delight of having it taken by us!

  9. As noted above, flexible spending accounts, which can also cover expenses such as childcare, are more restricted than MSAs or HSAs–especially in the fact that unspent money can’t be rolled over into the next year. Which goes to my point in passing deriding all these weirdo carveouts. It’s like a full employment act for HR types or something.

    1. It gets really cazy. The PPO plan comes with an optional HSA. The EPO plan (which my wife and I use) comes only with FSA.

      1. How does the HSA from the PPO compare with the FSA from the EPO, versus an HMO with ADA PPACA-AMA-POTUSA-A-A-A-aaaa *Brrrrzzzzttttt* *Blue smoke and the smell of burning plastic*

        Acronym Overload.

        1. PPO = higher deductibles; HSA allows roll-over & investment in interest bearing accounts

          EPO = smaller deductibles; FSA no roll-over.

          1. Is it odd that I want even less to do with healthinsurance than I did before you posted that?

            1. The company is trying to push younger people into PPO/HSA. The argument is that if you put $2k a year into a interest-bearing account, you’ll have more than enough money to handle everything short of a catestrophic injury or illness as an old dude.

              This of course runs exactly 180 degrees away from the progressive’s ideal of single-payer health care.

              So Obamacare is in the process of cutting the balls of these innovations.

              1. The company that I work for offers a cash incentive deposited into the HSA. Some of the younger employees were actually using it in lieu of our 401K (we don’t match shit).

        2. Kirk should have just fed Landru a boilerplate HR benefit plan option sheet.

          1. If the logic didn’t jam up its circuits, all the pages would definitely jam up the manual feed tray.

        3. PPO prefered by young, healthy engineers

          EPO prefered by middle-age engineer that consumes in excess of $1k in maintenance meds {its shocking how easy it is to spend a thousand buck on inhalers and prescriptions for allergies}.

          1. There are a lot of ways to spend a thousand or three on maintenance.

            That’s what we get for living in the kinda-sorta future: more treatments than cures and a distinct lack of flying cars or jet packs.

            The good news is that were working on the oppressive dystopia thing.

            1. Yes; they’re working on making it more oppressive and dystopic.

              1. Once again I learn that Hit & Run doesn’t support the <humor type=”dark”> tag.

                Humor style tags are a human right, damnit!

    2. MSAs also do not allow for rollover. Which, with a 5k annual cap and a family of 4, including 3 asthmatics, doesn’t matter anyway.

      1. not true.
        Flexible Spending Account = no rollover
        Medical/Health Saving Account = rollover

  10. But starting in 2011, the accounts will no longer pay for over-the-counter medicines unless a doctor writes a prescription for it.

    Talk about bending the cost curve; you’ll have to spend a hundred bucks at the doctors office to put your over-the-counter pills on your HSA. What is the likelihood the doctor will write that prescription without trying to convince you there’s “something better”(thanks, Lilly!) available?

    1. Bullshit. We don’t want to write scripts for things that you can get off the shelf. It’s a waste of our time and the reimbursement sucks. Sorry, but we as physicians really don’t have many avenues for pharma to bribe us. They can’t even give us free pens. It’s not them driving the “something better” wagon. Mostly, it’s our patients demanding the drugs (i.e. Viagra, Cialis, and all those other “ask your doctor about me” meds) that are constantly pushed on television. I lose count of how many patients a day that tell me Tylenol, even with codeine, just “doesn’t work for me”. People come to the doctor, they expect to go home with a prescription for something that they can’t get under normal circumstances (even if it’s completely useless for their condition: antibiotics for your kid’s viral syndrome). Believe me, I don’t see another dime if I prescribe an over the counter medication versus the generic versus some name brand med. So yes, I take issue with your characterization.

  11. It’s for our own good, you morons.

  12. Only a right-wing Christ-fag would hate Obama’s health-care reforms.

    1. How about just loathing it?

  13. But it’s the good kind of ass pain right?

  14. Oh well at least his intentions were good… Right, all you hip, young, rock-the-voters? Who cares that it’s less freedom and more of your money taken away that you have no say on? It’s change we can all believe in!

    I keep waiting for the groundswell of voters who rue the day they ever bought into Obama’s marketing campaign. Or do people honestly just think that in spite of the onslaught of botched features this thing keeps displaying, something will magically make everything turn out hunky-dory at the end of the day?

    1. In casual conversations, I am constantly shocked at how little most folks know about these things. The level of ignorance is astounding. And if I try some subtle(I hope) education, alot of times I get, “oh that’s right, you’re into politics”. So no I don’t think most folks honestly believe much of anything one way or the other.

  15. While I’m no fan of giving preference to one sort of spending over another (why is health care sacralized?),

    As one would expect from a libertarian. You know what those public administration majors at our finest academic institutions like the Kennedy School of Government are really being taught? While the typical libertarian only sees an astronomical amount of resources being soaked up into the useless activity of paper pushing, what you miss is that these bright eyed and bushy tailed future public servants are being taught how to save lives, Nick.

  16. one of the few things that has helped to force doctors and patients to discuss pricing in medicine

    Nobody ever thinks of just asking what the cash price for treatment would be? I do it every time, because I don’t have insurance and I want to know the cost beforehand. Not surprisingly, they tell me. This really isn’t hard.

    1. It’s like playing poker for chips you can’t cash in. The real price of something is just a factoid if you aren’t going to be paying it. It’s the bite in the wallet that spurs price negotiation.

  17. Nick, you’re a little off. These changes (Rx script for OTC meds and $2500 contribution limits) are for Flexible Spending Accounts, not “MSAs”. MSAs really don’t exist in the market anymore, although I suppose a few people still have them.

    FSAs are kind of dumb. Their “use it or lose it” features means that people who mis-estimate their out-of-pocket medical expenses for the year go nuts in December trying to spend up all of their FSA dollars on goods and services that are probably really low-value at the margin – OTC meds, Lasik, acupuncture, reading glasses, whatever.

    Your point about giving health care spending a separate tax status is a good one. On that note, why should taxpayers be footing the bill for those with FSAs (who tend to me wealthier and work at larger companies with good HR departments) to spend tax-free dollars on chiropractor appointments, braces, “alternative healers,” contact lens solution, diaper rash ointment, etc? It’s absurd. (See here for more examples of allowable expenses for an FSA: http://www.wageworks.com/emplo…..es/fsa.htm)

    1. WTF are you talking about? I have an H/MSA this year & would have one next year if it was offered. My premiums $200 for the year, and my deductible was $1500.

      http://healthinsurancepost.org…..-grounded/

      They’d be growing in popularity if it wasn’t for Obamacare.

    2. Aren’t MSA’s what they call(ed) cafeteria accounts?

  18. Where are our resident lefties, to explain how wonderful this really is?

  19. You’ll Need a Doctor’s Note to Dull the Pain in the Ass Caused by ObamaCare

    Most doctors just put a band aid over the wound to stop the bleeding. At least that’s the procedure at my local psychiatric hospital when they forcibly inject patients with mind altering drugs. Now, everyone gets to know what it’s like to have no control over one’s own healthcare choices.

    1. Considering that direct pressure is the most effective way to stop bleeding, perhaps you’d like us to do something a little more flashy? How about I cauterize it with a laser? Would that be better to you?

      1. Depends… how much for the flashy stuff?

  20. I always thought it was a little bit silly to cover the OTC shit, but I don’t understand why they would want the amount that low. I could pay $3600 in premiums next year, & that’s all tax deductible. It even comes out before payroll does.

    It’s like they’d RATHER I do the pre-pay thing instead of pay as I go.

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