Aetna Slowly Bailing out of ACA Public Health Insurance Exchange

[kewb]

That's just all kinds of wrong.

His first duty should be to his patient to "First, do no harm".  Not to his insurance contract.

 

The patient should always come first.  Why do we Americans put up with this nonsense?

 

I mean I do what I can in our family and we often go outside of the norm, but we are only one family.  We can't change anything. 

 

Americans put up with this nonsense for multiple reasons.

1. Health care is a for profit industry.  That means as a society we value profit over people.

2. People consistenly vote against their own best interests.  Social programs are bad, except for medicaid and social security. And even those should go away becasue people should be able to manage their own finances.  People who are barely able to put food on the table buy into this thought process.  Ignoring the fact that they don't have the money to manage now.

3. There is big money to be made in a lifetime of treating symptoms versus a cure.  Inusrance or no insurance I have to shell out big bucks for some of the meds my husband nees.  Even with insurance my copays add up to thousands.

[ChocolateReignRemix]

I agree.  We are still pending waiting for a hearing date.  Dh has been unable to work for 3 years now and it will probably be at least another year before he gets his hearing date which can be a year from when they tell you the date. It is absolutely ridiculous.

 

Everything around our disability coverage is a complete mess as this time.  It was never efficient, but some court rulings in the mid-2000s through a wrench in the works and opened a flood of possible disability claims.  I know for certain there is a process in place that is (eventually) supposed to streamline the process and make it easier for those with legitimate claims to make their case, but I am not overly hopeful about it.

[ChocolateReignRemix]

expanding medicare universally was a real possibility during Nixon's administration. It was seen as a logical step. The system is already in place and everyone gets enrolled eventually.

 

I'm not saying it's the only answer. If it were to happen tomorrow there would be work to be done first, but it is there to be built on. Much easier than starting from scratch

 

Expanding Medicare would definitely be one of the easiest of the possible solutions.  It would cripple the for profit companies so we know the likelihood of that happening is very, very small.

[FaithManor]

Expanding Medicare would definitely be one of the easiest of the possible solutions. It would cripple the for profit companies so we know the likelihood of that happening is very, very small.

Yup. So long as the insurance lobby can buy politicians, the for profit by killing people system is nor going away.

[Murphy101]

Except none of that is true. If it is a noncovered service, the provider can accept cash for the service.

 

There are even forms that the patient has to sign acknowledging Tricare is not responsible for the associated fees.

http://www.humana-military.com/library/pdf/non-covered-services-waiver.pdf

Two things:

 

One, there's the truth and then there's practice. Maybe that's not how the provider does it. Idk. I just know it does happen to people I know. They fight it but it gets exhausting and frustrating.

 

Two, I was also mostly referring to the general question of how would a provider know you have insurance if you are paying cash. Though the electronic records keeping/data sharing is a crap shoot for accuracy ime so I wouldn't go by that, but many facilities do. I had an argument just last week with a provider who insisted I had Aetna. I have not had any form of Aetna in over 10 years. It wasn't even the last insurance provider I had. I have no idea where they pulled that data from on their screen.

Edited August 16, 2016 by Murphy101

[GoodGrief]

Even if Medicare were expanded, the pool of providers who will work with the various government medical plans is small and getting smaller, which is why our family is paying $1500/month out of pocket for our oldest daughter's medical care...in a major politically progressive city...despite having supposedly decent healthcare coverage through the military. Sure, there is coverage, but good luck finding a specialist (or soemtimes even generalist) who works with your plan.

 

And, for what it's worth, I don't blame the providers. The governement regs and reimbursement for those who cooperate with them are ridiculous.

Edited August 16, 2016 by Gr8lander

[ktgrok]

Even if Medicare were expanded, the pool of providers who will work with the various government medical plans is small and getting smaller, which is why our family is paying $1500/month out of pocket for our oldest daughter's medical care...in a major politically progressive city...despite having supposedly decent healthcare coverage through the military. Sure, there is coverage, but good luck finding a specialist (or soemtimes even generalist) who works with your plan.

 

Yes, but if the ONLY plans were a version of Medicare/single payer, that would no longer be a real issue. If that's the only option, doctors will take it. 

[mommytobees]

Are people on medicare and Tricare currently forced to do things?

 

Nope. My PCM and I regularly argue how often I need a pap.

 

Kris

[bethben]

I cringe when people suggest single payer healthcare or everyone should be on Medicaid/Medicare.  It's only because we have dealt with Medicaid for years with my son as a secondary insurance and have been on a couple of state Medicaid plans.  You get the brochure in the mail about how you can get dental care for yourself and your children now with this wonderful plan!  Then, after calling ALL the dentists on the list they provide of available dentists within 30 miles of your house, you realize that because Medicaid doesn't pay enough, all the offices have limits on how many patients they will allow in their practice and you will not be able to make an appointment but will be allowed on their "waiting for services" list.  My sister who is in the poor/poverty range has resorted to free dental clinics at her local school.  It was similar for doctors when we moved to a new state and were still in the poor people range.  Lots of doctors on the list, lots of doctors with limits on their Medicaid patient load, and long waiting lists for services.  My friend is having trouble getting an appointment for an issue her mother-in-law is having (who is on Medicare) currently.  The closest appointment she could get is 4 months out for a problem that will only get worse if it's not treated right away.  Why?  Because the doctor has limits on how many Medicare patients he will take.  

 

Also, my son needs incontinence products supposably paid for by Medicaid.  Of all the companies that were nearby to ship the products to us, only one was able to do it.  Why?  Medicaid didn't even pay enough to cover the cost of the supplies.  

 

Yes, you could say all these doctors are greedy or the health care agencies are greedy, but a one payer system is not the answer.  I agree that something needs to be done, but single payer will only make the problems we see MUCH MUCH worse.  I've only seen a small portion of what would happen.  

[ktgrok]

Again, if the ONLY option is the single payer option, doctors will take it. They won't have a choice. Right now, they can choose to take a patient with medicare or one with private insurance that pays more. Of course they want to take the one with the insurance that pays more. But if that goes away, and it's take the medicare patient or no one, they will take medicare patients. 

[mommytobees]

I currently have Tricare prime for insurance; I'm not forced to do anything. However, if I want something done, I do have to go through their gate keepers first. This is reasonable to me. One thing Tricare does which is asinine is that if I want to go to provider and pay cash for something, Tricare forbids the provider from accepting me as a cash patient if I am covered under Tricare. That is going too far into my business, IMO.

 

 

But I think that has something to do with federal health care regulations.....I'm too tired to go look it up, so don't quote me, but I think there is something about it being a federal health insurance.

 

There are a number of asinine rules like that. Because my kids are on a federally funded health insurance plan (Tricare, active duty), they can't accept (re: I can't accept) payment help for high-cost drugs, even for the co-pay. I don't mind. Ky is on a drug for Multiple Sclerosis that costs $6400 per 28 days. I pay $20 for 3 months of drugs through Express Scripts. The company that makes the drug, Genzyme, offers a copayment plan for low-income families, but because he is on a federal insurance, he can't use it. No biggie for a $20-for-3-month drug, but when the copay is $250 a month or more....THEN I'm a bit more interested.

 

Kris

[kewb]

Again, if the ONLY option is the single payer option, doctors will take it. They won't have a choice. Right now, they can choose to take a patient with medicare or one with private insurance that pays more. Of course they want to take the one with the insurance that pays more. But if that goes away, and it's take the medicare patient or no one, they will take medicare patients.

I mostly agree with this statement. However, dh sees a couple of specialists who don't take any insurance. We pay out of pocket for them because they are not in our network. I suspect a single payer system will lead to more doctors to opt out of insurance all together.

That said, I am still in favor of universal healthcare. It will be a painful conversion to a single payer system but in the long run a healthy populace helps us all.

Edited August 16, 2016 by kewb

[Arcadia]

Yes, but if the ONLY plans were a version of Medicare/single payer, that would no longer be a real issue. If that's the only option, doctors will take it.

My mom as a foreigner visiting us paid a cheaper cash rate for specialist treatment for rheumatoid arthritis than my elderly friend does with her insurance. I was quoted a cheaper cash rate for a doctor near me if I don't use insurance. it happens. We paid for a psychologist that was cheaper because we paid cash instead of going through insurance. We have learned to ask for price without insurance because it can be lower than out of pocket with insurance.

 

ETA:

Blue Cross Blue Shield was much worse with billing than Aetna for us.

Edited August 16, 2016 by Arcadia

[Murphy101]

Again, if the ONLY option is the single payer option, doctors will take it. They won't have a choice. Right now, they can choose to take a patient with medicare or one with private insurance that pays more. Of course they want to take the one with the insurance that pays more. But if that goes away, and it's take the medicare patient or no one, they will take medicare patients.

Most of our Drs don't take ANY insurance, Medicaid or private. So no, they will still have the choice to not accept insurance. It's happening more every year. 10 years ago, we'd have had to look hard for a dr who was cash/direct pay only. Now, there's dozens in several fields in our area. And they are no where near going out of business. All of them are Drs who used to accept Medicaid/private insurance and have stopped.

 

That said, I am still for a genuine universal healthcare program. (ETA: But I'm against Medicare/caid for everyone. That's just going from scarier to scarier to me.)

Edited August 16, 2016 by Murphy101

[mommytobees]

That said, I am still in favor of universal healthcare. It will be a painful conversion to a single payer system but in the long run a healthy populace helps us all.

 

It is interesting....

 

I did an extensive study on how Australia introduced and implemented their single-payer system (post 1984) a few years ago for one of my classes. (Side note: this is an interesting and, more importantly, concise article: http://pnhp.org/blog/2015/08/06/what-single-payer-advocates-can-learn-from-australia/ ) 

 

I don't think it would be that hard IF the US were to go into a Medicare-type insurance policy. Planned out into steps, it would take several years and would cost us through the nose in taxes, but it is do-able. 

 

Just my thought,

Kris

[Haiku]

a one payer system is not the answer.

Yet most if the rest of the developed world has one.

 

Where I lived overseas, doctors were employed by the government and were paid a salary. They didn't have to worry whether, how, or how much they would be paid. They already knew.

 

Here in the states, we used to have government-funded secondary insurance for our kids with chronic health issues. It was awesome. Go see the doctor, the government program paid the bill. With only private insurance now, I'm constantly being hassled about what and how much they will pay, and they're always trying to get out of things they are contractually obligated to pay for. It's awful.

[NoPlaceLikeHome]

Even if Medicare were expanded, the pool of providers who will work with the various government medical plans is small and getting smaller, which is why our family is paying $1500/month out of pocket for our oldest daughter's medical care...in a major politically progressive city...despite having supposedly decent healthcare coverage through the military. Sure, there is coverage, but good luck finding a specialist (or soemtimes even generalist) who works with your plan.

 

And, for what it's worth, I don't blame the providers. The governement regs and reimbursement for those who cooperate with them are ridiculous.

If there is only one insurance around for everyone, then doctors will most likely take it. As for re-imbursements for doctors, IMHO I feel they make more than enough money as it is. I do think though there should be subsidized medical education though in addition to subsidized college for all perhaps on a sliding scale based on need.

[NoPlaceLikeHome]

I cringe when people suggest single payer healthcare or everyone should be on Medicaid/Medicare.  It's only because we have dealt with Medicaid for years with my son as a secondary insurance and have been on a couple of state Medicaid plans.  You get the brochure in the mail about how you can get dental care for yourself and your children now with this wonderful plan!  Then, after calling ALL the dentists on the list they provide of available dentists within 30 miles of your house, you realize that because Medicaid doesn't pay enough, all the offices have limits on how many patients they will allow in their practice and you will not be able to make an appointment but will be allowed on their "waiting for services" list.  My sister who is in the poor/poverty range has resorted to free dental clinics at her local school.  It was similar for doctors when we moved to a new state and were still in the poor people range.  Lots of doctors on the list, lots of doctors with limits on their Medicaid patient load, and long waiting lists for services.  My friend is having trouble getting an appointment for an issue her mother-in-law is having (who is on Medicare) currently.  The closest appointment she could get is 4 months out for a problem that will only get worse if it's not treated right away.  Why?  Because the doctor has limits on how many Medicare patients he will take.  

 

Also, my son needs incontinence products supposably paid for by Medicaid.  Of all the companies that were nearby to ship the products to us, only one was able to do it.  Why?  Medicaid didn't even pay enough to cover the cost of the supplies.  

 

Yes, you could say all these doctors are greedy or the health care agencies are greedy, but a one payer system is not the answer.  I agree that something needs to be done, but single payer will only make the problems we see MUCH MUCH worse.  I've only seen a small portion of what would happen.  

Medicaid reimbursement is determined by the states so the low reimbursements are the fault of the states but IMHO I don't think that re-imbursements are always too low. I think OTOH that doctors/dentists sometimes tend to want too much IMO. One solution would be single payer coupled with subsidized medical education with the caveat that they must take insurance. You could also make licensing of doctors require that they accept insurance in order to practice. Problem solved.

[ktgrok]

Also, with the MASSIVE savings in overhead, there'd be more money to reimburse doctors properly. Or, as others have said, simply salary them. 

[Murphy101]

If there is only one insurance around for everyone, then doctors will most likely take it. As for re-imbursements for doctors, IMHO I feel they make more than enough money as it is. I do think though there should be subsidized medical education though in addition to subsidized college for all perhaps on a sliding scale based on need.

Normally I'd agree medical staff tend to make plenty, but the Medicaid/care reimbursements are too often crazy low even to my admittedly penny pinching self. I sure wouldn't do it for those prices.

 

I think the problem IS insurance. So to me, having one insurance isn't an improvement. Universal healthcare does not have to be set up like insurance and I would be all on board if it wasn't.

 

Even in countries with single payer insurance programs, there is usually other insurance options too. There isn't "just one insurance for everyone." There are other options people can choose if they have the money and want it.

[Guest]

Most of our Drs don't take ANY insurance, Medicaid or private. So no, they will still have the choice to not accept insurance. It's happening more every year. 10 years ago, we'd have had to look hard for a dr who was cash/direct pay only. Now, there's dozens in several fields in our area. And they are no where near going out of business. All of them are Drs who used to accept Medicaid/private insurance and have stopped.

 

That said, I am still for a genuine universal healthcare program. (ETA: But I'm against Medicare/caid for everyone. That's just going from scarier to scarier to me.)

 

I think there is a definite trend this way- cash only, no insurance- at least here. I can't blame them. They can cut their staff by over half because they have to have so many clerks etc. for insurance. Also, I do wonder how a single payer system will change the number of people going into high degree required health careers. Medical school cost a fortune. The gamble is you will eventually make enough to more than offset the cost of medical school. I don't see anyway a single payer system would provide the salaries that attract many people into specialty fields or to be doctors in the first place. Medical school would have to become substantially cheaper to attract people to take the type of salary single payer would be able to provide it would seem. It's such a complicated issue.

[Josh Blade]

I agree that something needs to be done, but single payer will only make the problems we see MUCH MUCH worse.  I've only seen a small portion of what would happen.  

 

Somehow the rest of the developed world manages it...

 

It kills me that we have concrete proof that Single Payer or Public Option works literally all over the world and the same people that tell you the US is the greatest country on earth will say we can't implement a system that most of the world has had for years. 

Edited August 16, 2016 by Josh Blade

[ktgrok]

Keep in mind, if we had single payer, a doctor wouldn't have to pay a zillion full time people to deal with insurance companies. Their overhead would go down significantly,w which might help balance out lower payments. 

[Arcadia]

Where I lived overseas, doctors were employed by the government and were paid a salary. They didn't have to worry whether, how, or how much they would be paid. They already knew.

I have friends back home working in govt. hospitals. They do not have to worry about lawsuits because the govt. would defend their doctors and only obvious cases of negligence or malpractice goes through. My parents and my brother are under govt. insurance but there are many tiers. The ministers and members of parliament are top tier. My parents are on a middle tier as retired civil servants. My brother is on the bottom tier as being just above poverty level. My brother don't need to worry much about cost but the waiting time is crazy depending on what kind of care they need and which hospitals or outpatient clinics they are willing to travel to. My parents and my brother can still go to private doctors and just pay.

 

Hubby and I are under our own country's compulsory healthcare insurance for people over 40 years old. Three big insurance companies covers the scheme. Our govt. auto assigns us to one of the three when we reach 40 years old.

[Murphy101]

Keep in mind, if we had single payer, a doctor wouldn't have to pay a zillion full time people to deal with insurance companies. Their overhead would go down significantly,w which might help balance out lower payments.

I think that is exceedingly optimistic.

 

If anything I'd fully expect a combo of everything we hate about insurance and govt bureaucracy. Nothing our government has done suggests to me it would be otherwise.

[mommytobees]

Somehow the rest of the developed world manages it...

 

It kills me that we have concrete proof that Single Payer or Public Option works literally all over the world and the same people that tell you the US is the greatest country on earth will say we can't implement a system that most of the world has had for years. 

 

I agree with this! My cousin (a few times removed here and there....but we have the same family name...or did before we married  :closedeyes: ) lives in Sweden. We regularly compare healthcare differences.

 

It took her longer to get into see a rheumatologist and be dx'ed with Lupus (6 months after I did), BUT, she pays pennies for her drugs, that cost me 5-6x's, and can see him within a few weeks or see his PN within a few days if she is having a flare, while it takes me weeks to months to get into see the PN, forget the Rheumy herself. 

 

Her mother was dx'ed with MS from an inpatient stay, just as my 17yo son was last year. It took days to get the MRI's, non-emergency CT's, the spinal tap, blah blah blah approved for my son. For her mom, it took a matter of waiting until the machine opened up, which for the MRI meant waiting for the emergency cases to be finished first. Past the diagnosis stage, it took us more than 6 months to get a maintenance medication approved. That is 6 months where the MS ran rampant. During that time, 7 new lesions formed and 3 formally active lesions scarred. My cousin's mom had to wait 2 weeks for a blood test to come back, which came back opposite what they wanted, and then another week to start the second choice drug.

 

Final point: my cousin's mom is on the SAME drug and the SAME dosage as my son. My son's drug costs $6400 for 3 packages of 28 days, with a copay of $20 for 3 months. In Sweden, this drug is (about) $3100 SEK to USD; her copay is (again, about) $100 per month. A higher copay, but since it is a new drug in Sweden, if they find that it works, they will make it a permanent drug and the cost should go down.  However, why do we in the US have to deal with these horrid drug costs?

 

I'll pay higher taxes to have no worries about IF my child will have medical care.

 

Kris

[JumpyTheFrog]

Also, I do wonder how a single payer system will change the number of people going into high degree required health careers. Medical school cost a fortune. The gamble is you will eventually make enough to more than offset the cost of medical school. I don't see anyway a single payer system would provide the salaries that attract many people into specialty fields or to be doctors in the first place. Medical school would have to become substantially cheaper to attract people to take the type of salary single payer would be able to provide it would seem.

Maybe we could offer free medical school (and education for nurses and other health care practitioners) for anyone willing to work on a salary at a government owned facility. Maybe we should also drop the requirement of a bachelor's degree before medical school. We also need more residencies available. I've read there aren't enough available for all medical school graduates.

 

Maybe we could revamp the system in some way that has the med students start out as nurses or something and gradually gaining more responsibility as they go through school. (Maybe this idea is nuts. Someone working in the medical field will need to chime in.)

[Lanny]

There was a segment tonight on the 6 P.M. (EDT) TV News program that I watch. When the segment was ending, they raised a question. "Was this planned in advance?" (that the private insurance companies would lose millions of dollars on these policies and bail out).

 

If Aetna was in some other industry, building cars or computers or something else, and one of their businesses was bleeding money, people would think it sad, but necessary, if they shut down that business and concentrated on other segments of their business that were profitable, or, could become profitable.

 

If we lived in the USA I would be one of those who was previously uninsurable, because I have P.T.S.D.

 

When I look at the huge deductibles people are paying (out of pocket) and the huge premiums they are paying in addition to that, for most people, unless there is a catastrophic illness, they are possibly better off being self insured.

 

And where does that leave those who are in the position where they cannot afford to cover those expenses out of pocket?  Possibly the solution eventually will be to put all of the people who are like me, uninsurable, into Medicare or Medicaid.  If it is Medicaid, that would put the budgets of many states into a catastrophic situation and the Federal Government would then need to bail them out.  So, possibly, with time, those people will be put into Medicare.  And, then,we have fewer and fewer doctors treating Medicaid patients, and fewer treating Medicare patients so who will treat that group of patients?

 

There are never simple easy answers to complex issues.

 

Going to a Single Payer system looks nice, but when push comes to shove, many Canadians go to the USA for treatments that would require waiting many months in Canada so how to implement that efficiently is very tricky. Rationing is a requirement for that to be viable.

 

The U.S. Government does a poor job taking care of Veterans in V..A. Hospitals.  How would they do if they were taking care of everyone's medical care?  Probably not as well as they do with the Veterans.

 

 

 

 

Edited August 16, 2016 by Lanny

[ChocolateReignRemix]

Two things:

 

One, there's the truth and then there's practice. Maybe that's not how the provider does it. Idk. I just know it does happen to people I know. They fight it but it gets exhausting and frustrating.

 

Two, I was also mostly referring to the general question of how would a provider know you have insurance if you are paying cash. Though the electronic records keeping/data sharing is a crap shoot for accuracy ime so I wouldn't go by that, but many facilities do. I had an argument just last week with a provider who insisted I had Aetna. I have not had any form of Aetna in over 10 years. It wasn't even the last insurance provider I had. I have no idea where they pulled that data from on their screen.

 

There is no fight to it.  Really.  If it isn't covered, then you either pay for it yourself or you don't.  I have no idea why you think that is some type of red tape nightmare.

[ChocolateReignRemix]

 

The U.S. Government does a poor job taking care of Veterans in V..A. Hospitals.  How would they do if they were taking care of everyone's medical care?  Probably not as well as they do with the Veterans.

 

The VA was good until its funding started being cut at the same time the demand for services began to grow.

 

 

[Anne in CA]

The fact that the US is doing so poorly by veterans is a super good point I had not thought of. My sis is a nurse and gets LIVID every time she takes our father to the VA. She feels it is a pitiful excuse for healthcare.

[SemiSweet]

I've seriously had every medical insurance experience available, I've been active duty Tricare, dependent Tricare, no insurance, state insurance through Medicaid, and private insurance. I was also a medical biller for several years. Hands down, the worst insurance experiences I've had have been through private insurance, where they paid so little on my near death after ds1 that I had to file bankruptcy. I'm also a disabled vet and have had only wonderful experiences wi the VA. Be careful of the noise and the rhetoric. I'm all for single payer healthcare.

 

When I worked as a biller, the worst red tape was workers comp, followed by private insurance, then Medicaid, Medicare was extremely easy to deal with. No weird requirements that I know of, I have no idea why people would think that.

[MSNative]

The VA was good until its funding started being cut at the same time the demand for services began to grow.

 

 

When I googled I got this article from 2014 stating that annual funding of VA tripled np since 2000 rather than being cut. Can you share your data about VA having its budget cut? I'm curious where the discrepancy is.

 

 

"WASHINGTON—The Department of Veterans Affairs, the agency caught in a political firestorm over its medical care for veterans, has seen its funding grow faster than any other government department in recent years. Since 2000, annual spending has tripled to $63 billion to meet a surge in health-care and other costs. That is on top of the more than $85 billion the VA is set to receive this year for automatic payments such as disability benefits and pensions, a tally that has more than tripled since 2000."

 

http://www.wsj.com/articles/SB10001424052702303749904579580270767613840

[ktgrok]

I hear about waits in Canada. (which has the slowest care out of the western world, it's faster in the UK and elsewhere). But if it was "wait a few months" versus "never get treatment because you can't afford it" the waiting doesn't seem so bad. I'd rather we all have a wait, because everyone gets treated, then not have a wait because a sizable number of people just have to go without. 

[FaithManor]

And part of the issue for Canada is the sheer size of the country vs. population density. It is hard to get practitioners and facilities in every locale or close in to every town and have a reasonable amount of staff available. Some areas do not have wait times at all. Some facilities simply serve a huge geographical area.

 

In this respect, most regions of the US is muxh better off.

[mommytobees]

 

And where does that leave those who are in the position where they cannot afford to cover those expenses out of pocket?  Possibly the solution eventually will be to put all of the people who are like me, uninsurable, into Medicare or Medicaid.  If it is Medicaid, that would put the budgets of many states into a catastrophic situation and the Federal Government would then need to bail them out.  So, possibly, with time, those people will be put into Medicare.  And, then,we have fewer and fewer doctors treating Medicaid patients, and fewer treating Medicare patients so who will treat that group of patients?

 

There are never simple easy answers to complex issues.

 

Going to a Single Payer system looks nice, but when push comes to shove, many Canadians go to the USA for treatments that would require waiting many months in Canada so how to implement that efficiently is very tricky. Rationing is a requirement for that to be viable.

 

The U.S. Government does a poor job taking care of Veterans in V..A. Hospitals.  How would they do if they were taking care of everyone's medical care?  Probably not as well as they do with the Veterans.

 

 

But I think you are comparing apples to oranges, specifically the VA system.

 

The VA system has HUGE problems, but the US Government doesn't run it, the US Department of Veterans Affairs. Do I want the Dept of VA to run our single-payer healthcare system? Oh heck no!!!  There are serious problems happening there; many of which we aren't hearing the actually problem, just the symptoms. 

 

Take a look at the military hospitals and clinics, which are run by the Military Health System and directed by the local CO. Are there problems within those systems: YES! You couldn't have paid me to give birth to my daughter at Portsmouth Naval Hospital and when we lived in HI, the military locals referred to Trippler as "Crippler". But, you are going to find problems anywhere and everywhere. Problems are systematic and dependent on who is running that hospital system. 

 

Individual hospitals are a potential for huge problems. I have a friend with a child (13) with MS in London. GOSH is fantastic, but sometimes they can't get into be seen at GOSH---like when they are visiting her parents in Wales. The alternatives can be horrific. We are going to see individual hospitals with problems anywhere at anytime. 

 

However, my friend with a 13yo child with MS never has to worry if her child is going to be treated. Or, if treatment is going to bankrupt her family or her child's future. Of, if that child is going to have to go without treatment.

 

My child has no such guarantee. 

 

Going backwards up your post....Canadians with money can come to the US for treatment. Because they have money. People in the US, with money, receive better healthcare. Patients here in the US wait, sometimes months, for everything from appointments to procedures to diagnostic tests. My son waited a week for a spinal tap. Why? Because it wasn't an emergency (no fever), it had to be approved by the insurance first. He has good health insurance. What about middle-class to poor people who do not have good health insurance? I know of a 19yo girl with MS and another auto-immune disease. One of the only drugs that will help both diseases and not hurt either costs about $145,000 per year, plus monthly labs. It took 4 months to receive a denial. They refused to cover the cost. Her options are limited: take nothing or take two different drug that might hurt the other disease. We see rationing here in the US...only it is money rationing.

 

If we leave a single-payer healthcare system to be done at the state level, we will end up with a huge mess. This has to be a federal system.

 

Kris

[JumpyTheFrog]

I don't know much about the VA, but maybe the alleged cuts are not in absolute dollars but in dollars per veteran or patient seen? Think of how many soldiers have come back injured since 2001.

[ChocolateReignRemix]

When I googled I got this article from 2014 stating that annual funding of VA tripled np since 2000 rather than being cut. Can you share your data about VA having its budget cut? I'm curious where the discrepancy is.

 

 

"WASHINGTON—The Department of Veterans Affairs, the agency caught in a political firestorm over its medical care for veterans, has seen its funding grow faster than any other government department in recent years. Since 2000, annual spending has tripled to $63 billion to meet a surge in health-care and other costs. That is on top of the more than $85 billion the VA is set to receive this year for automatic payments such as disability benefits and pensions, a tally that has more than tripled since 2000."

 

http://www.wsj.com/articles/SB10001424052702303749904579580270767613840

Adjust for health care inflation and number of veterans served after our Middle East misadventures. A budget can grow in nominal funding but decease in real funding.

[EmilyGF]

Maybe we could offer free medical school (and education for nurses and other health care practitioners) for anyone willing to work on a salary at a government owned facility. Maybe we should also drop the requirement of a bachelor's degree before medical school. We also need more residencies available. I've read there aren't enough available for all medical school graduates.

 

Maybe we could revamp the system in some way that has the med students start out as nurses or something and gradually gaining more responsibility as they go through school. (Maybe this idea is nuts. Someone working in the medical field will need to chime in.)

This. We get an incredible influx of foreign trained doctors because it pays so well to be a doctor here compared to Europe. My friend's husband looked into practicing in Germany (his wife is German) and the people he talked with said they had never heard of anyone coming from the USA to practice in Germany. 

 

ETA: My college friend practices in CA. Medicaid reimbursement doesn't even cover his overhead, let alone pay him anything.

 

Emily

Edited August 17, 2016 by EmilyGF

[purplejackmama]

Yes, but if the ONLY plans were a version of Medicare/single payer, that would no longer be a real issue. If that's the only option, doctors will take it.

Maybe. Maybe not. My dentist has gone to cash only because he's sick of dealing with insurance. I wonder if MD would follow suit?

[Haiku]

Maybe. Maybe not. My dentist has gone to cash only because he's sick of dealing with insurance. I wonder if MD would follow suit?

I think it's unethical to be a healthcare provider and say "I'll only treat people who can afford to pay out-of-pocket."

Edited August 17, 2016 by Haiku

[purplejackmama]

I'm also a disabled vet and have had only wonderful experiences wi the VA. Be careful of the noise and the rhetoric.

 

 

I'm curious about this. Really? You think the VA system works well? I have so many friends with opposite experiences I'm just wondering why so many would say the system is broken.

[ChocolateReignRemix]

I'm curious about this. Really? You think the VA system works well? I have so many friends with opposite experiences I'm just wondering why so many would say the system is broken.

 

http://www.blogs.va.gov/VAntage/13790/va-rates-high-on-patient-satisfaction-in-national-survey/

[ChocolateReignRemix]

Maybe. Maybe not. My dentist has gone to cash only because he's sick of dealing with insurance. I wonder if MD would follow suit?

 

Cash dentists have always been more common due to dental insurance plans generally not covering much/many not carrying dental insurance at all.

 

The most recent numbers I could find on concierge/cash only only doctors was from 2014, and there has been a small growth in the number of those practices, with most of the doctors being in family practice or internists.  As of 2014 close to 95% of all doctors were still accepting insurance.

[redsquirrel]

I cringe when people suggest single payer healthcare or everyone should be on Medicaid/Medicare.  It's only because we have dealt with Medicaid for years with my son as a secondary insurance and have been on a couple of state Medicaid plans.  You get the brochure in the mail about how you can get dental care for yourself and your children now with this wonderful plan!  Then, after calling ALL the dentists on the list they provide of available dentists within 30 miles of your house, you realize that because Medicaid doesn't pay enough, all the offices have limits on how many patients they will allow in their practice and you will not be able to make an appointment but will be allowed on their "waiting for services" list.  My sister who is in the poor/poverty range has resorted to free dental clinics at her local school.  It was similar for doctors when we moved to a new state and were still in the poor people range.  Lots of doctors on the list, lots of doctors with limits on their Medicaid patient load, and long waiting lists for services.  My friend is having trouble getting an appointment for an issue her mother-in-law is having (who is on Medicare) currently.  The closest appointment she could get is 4 months out for a problem that will only get worse if it's not treated right away.  Why?  Because the doctor has limits on how many Medicare patients he will take.  

 

Also, my son needs incontinence products supposably paid for by Medicaid.  Of all the companies that were nearby to ship the products to us, only one was able to do it.  Why?  Medicaid didn't even pay enough to cover the cost of the supplies.  

 

Yes, you could say all these doctors are greedy or the health care agencies are greedy, but a one payer system is not the answer.  I agree that something needs to be done, but single payer will only make the problems we see MUCH MUCH worse.  I've only seen a small portion of what would happen.  

 

Providers didn't take your health care because it literally didn't pay enough to cover expensies? You get booted from practices where you have been for years because they have stop taking your plan due to the low payment. The only providers who do take it are hours away or have years long waiting list?  that happened to us with Empire Plan.  It's not just Medicaid. 

 

And a single plan also requires that providers take that plan.  They can't turn you away because that is the way they get paid. Its a system and everyone is in it.

 

 

[purplejackmama]

Cash dentists have always been more common due to dental insurance plans generally not covering much/many not carrying dental insurance at all.

 

The most recent numbers I could find on concierge/cash only only doctors was from 2014, and there has been a small growth in the number of those practices, with most of the doctors being in family practice or internists. As of 2014 close to 95% of all doctors were still accepting insurance.

That's interesting. I had never heard of only cash dentists. Guess my Dr. was rare.

[MaeFlowers]

Providers didn't take your health care because it literally didn't pay enough to cover expensies? You get booted from practices where you have been for years because they have stop taking your plan due to the low payment. The only providers who do take it are hours away or have years long waiting list? that happened to us with Empire Plan. It's not just Medicaid.

 

And a single plan also requires that providers take that plan. They can't turn you away because that is the way they get paid. Its a system and everyone is in it.

 

 

Unless the drs go cash only and don't take that single plan. I **think** many drs would go that way.

[redsquirrel]

That's interesting. I had never heard of only cash dentists. Guess my Dr. was rare.

 

As an adult I've never had a dentist who took my health insurance as payment. I've always had to pay up front and get reimbursed later on, from the insurance company. I have been responsible for submitting the paperwork to the insurance company. It's been a challenge with the kids, we can't schedule their cleanings in the same month b/c I can't afford two cleanings in a month.  My current dentist doesn't take credit cards, for his up front payment, only cash or cheque. The no credit cards is unusual, I am guessing, but the not taking insurance seems to be everyone in the area. It's the same no matter where you go around here.

[ChocolateReignRemix]

Unless the drs go cash only and don't take that single plan. I **think** many drs would go that way.

 

Doubtful.  A single payer would have streamlined processing and guaranteed reimbursement.

[Murphy101]

I think it's unethical to be a healthcare provider and say "I'll only treat people who can afford to pay out-of-pocket."

Why is it not also unethical to say they will only treat people who can afford premiums and deductibles and copays?

 

Either way, it's saying they won't treat people who can't pay.

 

I don't see how a person pays would be the point of why it might be unethical.

 

And also, most of the Drs who are going to no insurance are doing so bc it allows them to serve more people for a more reasonable price. All of the Drs we use that no longer take insurance are cheaper than copays and deductibles and premiums.