Healthcare / Insurance Perceptions

[goldberry]

I was reading on another discussion board where people were sharing their stories about their conditions being excluded, hospital stays not being covered, etc.  There were actually several people pretty much accusing them of making it up, or "just not knowing their rights".  These were the same people who thought our healthcare system was "the greatest ever", people could totally get treated when they needed it, that was just scare propaganda to get us to go to socialized medicine.  

 

Ten years ago DH and I became self-employed.  Prior to that, I worked for a medium sized company (75 people) that had decent health insurance.  The only time I gave much thought to the health insurance was when deductibles and copays went up.  Wow, that copay went from $20 to $50!  Our deductible went from $500 to $1000!  Oooh!

 

When we entered the individual insurance market, it was a shocker.  I'm curious about the different perceptions of the health insurance problem our country is facing and how they vary by what your personal experience has been. 

 

And yes, this is referring to the current situation in the United States. 

Edited April 27, 2017 by goldberry

[mlktwins]

I don't know what the answer is, but my DH is self-employed and we are paying an arm and a leg for insurance for 4 every month.  AN ARM AND A LEG.  I worked for the Federal Government before the kids and I didn't give a second thought to insurance other than to know it was relatively affordable and reliable.  Thisis one topic that is causing me a lot of anxiety these days...

[goldberry]

When we entered the individual insurance market it was eye-opening. Pre-ACA:  I was totally paranoid filling out the application, because I had read news articles about people being denied cancer treatment because they didn't disclose a random yeast infection.  I had post-partum depression after DD was born, I took an "as needed" migraine medicine (not daily), and I occasionally took zyrtec or whatever for seasonal allergies.  All the insurances that would cover us had exclusions for depression, migraines, and allergies, and anything related to those conditions.  They weren't just going to not cover them for a year or whatever, they were not going to cover them at all.   In addition to the cost of the insurance being much higher than I was expecting, I was surprised that they had the right to basically exclude whatever they wanted.  But yes, at that time, private individual insurance could reject whoever they wanted, charge whatever they wanted, and not cover whatever they wanted.  It is reality that people were scammed into buying coverage that had ridiculously low caps and did not even include hospital stays, for example.

 

Only because I am a bookkeeper and still worked contract for my previous company, I saw that their premiums kept getting more and more crazy ridiculous.  But I would GUESS that the average employee at that company did not know that so much.  They complained when their employee contribution when up from $25 a week to $75 a week.  But I don't know that they had any idea the astronomical amount the company was trying to absorb to keep taking care of them.

[Arcadia]

Our insurance is through my husband's employer but I pick choice one (my employer) as that is the closest fit. We had Blue Cross, Aetna PPO and the Blue Cross PPO by current employer is better than the Blue Cross PPO by his first employer. His current employer adds on a HSA to the PPO which makes our medical costs lower. Kaiser HMO plan has the most clean cut billing and has been great for my husband's colleague's wife who had chemotheraphy for her cancer. So even under employer subsidized insurance, the financial cost varies by plan offered. I think my husband pays more than $300 per paycheck last year and I know it is higher this year even with employer paying more too.

Edited April 27, 2017 by Arcadia

[Carrie12345]

I can't tell whether you consider my policy to be private or gov't.  We have an ACA subsidy, but paid almost all of it back at tax time.

Edited April 27, 2017 by Carrie12345

[LarlaB]

We are self-employed (DH & I each run a small business) and have used Christian medical sharing for the last 5 years.    Prior to that, individually insured.  So I'm not sure how to reply to your poll options. :) 

We have never had insurance provided thru employer- always sought individual insurance.  DH worked for a church and small business which offered minimal compensation via HSA contributions and/or dental insurance.  

[HTRMom]

My perception is that my insurance plan is great through an employer. Most employer plans are good or mediocre but not terrible. Medicaid is mediocre or good depending on location. Insurance exchange is truly terrible, but less than 3% of Americans get their insurance there if I'm remembering correctly.

 

The real problem as I see it is the government meddling way too much to have a decent free market but not enough to have socialized medicine. I would prefer a mostly free market with state funding for the poor and excluded, but that's not realistic at this point and socialized medicine would probably be an improvement over the current situation.

 

 

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[Guest]

I don't consider our current plan insurance,not with a 15k annual family deductible.Frankly it appears to be a large tax to cover the costs which are inflated to recoup from the sick for the indigent or medicare/medicaid. I spent more out of pocket for noncovered care than for covered care last year. Had major issues two years before AFA...cost me more in parking and bridge tolls than oop, same care now would cost me two years of annual deductibles.

I don't see free care helping the poor. The ones in my extended family had close to that with hmos when copays were low and refused to change their habits to stay healthy. the attitude that a drug or free surgery fixes everything is too entrenched.

Edited April 27, 2017 by Heigh Ho

[regentrude]

I am personally fine, but I am appalled by the fact that sickness is a leading cause of bankruptcy in this country. It is disgraceful. 

The health care situation is an urgent problem and needs to be solved; this is long overdue.

 

[goldberry]

We are self-employed (DH & I each run a small business) and have used Christian medical sharing for the last 5 years.    Prior to that, individually insured.  So I'm not sure how to reply to your poll options. :) 

 

We have never had insurance provided thru employer- always sought individual insurance.  DH worked for a church and small business which offered minimal compensation via HSA contributions and/or dental insurance.  

 

I would call the sharing plans private individual.  Coverage, but not from a large group employer plan.

[Guest]

We were mostly self insured the years before the ACA and the first few years of it before we were priced out of the market. Our costs were much more manageable pre-ACA and our coverage was much more what we actually wanted.

 

I'd absolutely go back to the pre ACA times and stay there compared to where we are now, but I think there are better solutions to be had overall with restructuring from the ground up and a change to the regulatory climate. So pre ACA was better but a complete overhaul that involves a lot less regulation and tax incentives to individuals instead of employers would be better still.

Edited April 27, 2017 by Arctic Mama

[goldberry]

I can't tell whether you consider my policy to be private or gov't.  We have an ACA subsidy, but paid almost all of it back at tax time.

 

ACA plans are private plans.  But they were different before ACA than after. 

[SparklyUnicorn]

I've always been personally well taken care of in that department, but I absolutely think costs and access are major major problems.  I've known many people personally who have gotten some pretty lousy care or who cannot afford their care. 

 

 

[creekland]

Health share fits us just fine, but I see way too many problems IRL from those on insurance and those without insurance (cost reasons) for me to think all is well, esp Pre-ACA.  Health shares don't fit everyone.

 

Count me in those thinking we really need to join the other first world countries and have universal coverage for all.  If one wants more than that, then they can pay for it (similar to other systems - or K-12 education).

 

No system is perfect for all, but ours is pretty darn crappy.

 

Otherwise, what I hear in my circles is folks think everything is perfectly fine - until a health situation hits home (or someone close to them) and they see what it's really like.

[Carrie12345]

ACA plans are private plans.  But they were different before ACA than after. 

 

Okay. So, for just about as long as it's been around, we've been private/ACA.  Our coverage has declined every year, and our costs have gone up.

 

But our current employer option is SO much worse.

 

Before ACA, we had good employer insurance, but that was also nudging upward, except for one employer that happened to be awesome in all ways - paid time off, vehicle reimbursement, bonus structure, AND good health insurance.

 

Costs are outrageous all the way around, but I have to admit I prefer not being trapped into whatever option an employer feels like offering.  We only have an out because of the insane price of the policies chosen by this employer.  They could offer to pay 100% and we'd be stuck with their crappy plan.

[MEmama]

I worry about this every.single.day.

 

There is no "being fine". We have essentially zero safety net in this country and I'm beyond appealed that anyone doesn't think it's an utter disgrace.

 

We should be as ashamed for ourselves as the rest of the world is for us.

Edited April 27, 2017 by MEmama

[G5052]

I don't know quite how to respond either.

 

We have significant medical bills every year even with excellent insurance. The volume of claims and the need to go out-of-network is the major factor for us. When I filed our 2016 insurance statements, the folder was 4" thick. DH is retired, and I need to work mainly to keep up with the medical bills and local college tuition.

 

We're waiting to see what insurance does with an air ambulance bill from March. It's unlikely we'll have to pay the full amount (which would be enough to buy a brand new vehicle BTW), but we're holding off several things until we get that. No doubt that it was medically justified, but the large claims section of our insurance says we probably won't have a ruling until June.

 

We had better coverage before ACA because more of our doctors and facilities were in-network.

 

We know a lot of people for whom ACA was a complete disaster in many ways, and others that have been fine with it.

 

Our insurance premiums are reasonable, and going to one of the sharing programs isn't an option. DH has too many pre-existing conditions, and the price for family insurance isn't that much more than for a single person. So it wouldn't make sense to keep insurance for him and put the three of us on a shared program.

[Guest]

How would you qualify Tricare (military health insurance program) for purposes of this survey? Employer provided insurance (because it is run by private insurance companies contracted with the govt, ex, Humana is our company), or government program?

 

ETA: Nevermind. It actually doesn't matter for this poll if I pick #1 or #2.

Edited April 27, 2017 by Kinsa

[goldberry]

 

Otherwise, what I hear in my circles is folks think everything is perfectly fine - until a health situation hits home (or someone close to them) and they see what it's really like.

 

This. It's so sad it has to take that to spark empathy.  

[MEmama]

This. It's so sad it has to take that to spark empathy.

And yet it's so pervasive in certain circles--those who scream the loudest to take things away from others suddenly reverse course when someone close is affected. SMH. Over and over and over.

[6packofun]

Today was not a good day to ask me about healthcare.   :cursing:

 

We've been insured through dh's employer for most of our marriage, with a short stint on COBRA and then no insurance while he worked PT before going FT after a job loss.  I don't know what to think of *insurance*, I only know that COSTS are too high for medical care.  

 

Our 23yo is on our insurance because he can be until 26, of course.  So we pay for his insurance premiums.  Is the benefit that we're also supposed to  be able to pay for the care he gets??  Because he nor us can afford it!!  Part of this is reaching deductibles, true, but ours in not terrible compared to most.  But he just brought all of his bills together for me to see what he's being charged by the lab, the doctor/medical group, AND the surgeon for a SIMPLE outpatient cyst removal.  No hospital stay.  It's over $3000.  His part is about $1200 (I have NO idea how this works with what's left on our deductible because there are 8 of us and dh needed an MRI which was $4000 and our part is $2100...).  We have less than $500 in savings and ds would EMPTY his bank account just to cover a damn cyst removal procedure.  HOW is this affordable??   And I think our insurance policy is pretty good!

 

*Editing to add that we have no problem with the concept of paying for our medical bills and not relying on others to have to help us.  We're probably an average family in an average situation, not special circumstances by any means.  But when health issues DO arrive, we just can't EVER be prepared for the huge-to-us bills.  Dd is having a laparoscopy next month and I assume we'll meet our deductible and then be paying monthly for years to come.  I'd like to say it shouldn't be like this, but I don't agree with full on single payer, either.  I just don't want to have to pay so MUCH when we've been paying in so long!

Edited April 27, 2017 by 6packofun

[Bootsie]

I do not like a system where health care is typically tied to employment.  I would prefer that my employer not be involved in my health care decisions and funding. The US system of employers providing health insurance is the result of post-WWI wage controls and tax code advantages. 

[mamaofgirls]

Today was not a good day to ask me about healthcare.   :cursing:

 

We've been insured through dh's employer for most of our marriage, with a short stint on COBRA and then no insurance while he worked PT before going FT after a job loss.  I don't know what to think of *insurance*, I only know that COSTS are too high for medical care.  

 

Our 23yo is on our insurance because he can be until 26, of course.  So we pay for his insurance premiums.  Is the benefit that we're also supposed to  be able to pay for the care he gets??  Because he nor us can afford it!!  Part of this is reaching deductibles, true, but ours in not terrible compared to most.  But he just brought all of his bills together for me to see what he's being charged by the lab, the doctor/medical group, AND the surgeon for a SIMPLE outpatient cyst removal.  No hospital stay.  It's over $3000.  His part is about $1200 (I have NO idea how this works with what's left on our deductible because there are 8 of us and dh needed an MRI which was $4000 and our part is $2100...).  We have less than $500 in savings and ds would EMPTY his bank account just to cover a damn cyst removal procedure.  HOW is this affordable??   And I think our insurance policy is pretty good!

 

*Editing to add that we have no problem with the concept of paying for our medical bills and not relying on others to have to help us.  We're probably an average family in an average situation, not special circumstances by any means.  But when health issues DO arrive, we just can't EVER be prepared for the huge-to-us bills.  Dd is having a laparoscopy next month and I assume we'll meet our deductible and then be paying monthly for years to come.  I'd like to say it shouldn't be like this, but I don't agree with full on single payer, either.  I just don't want to have to pay so MUCH when we've been paying in so long!

 

Have you talked to the hospital/clinic directly? One by us will allow you to file a financial hardship form - it lays out your income and monthly debts (home, cards, credit) and disclose your bank account information from the past 3 months. This is brought to a board which votes on if you can receive some 'credit' or grant towards your bill. It may make the amount owed less than half, it has for us when we had a $10,000 deductible and only made $30,000 a year... yeah, who can afford to have a child when it costs so much?! We are blessed with better insurance now and DH will not even consider leaving his job because of the benefits (even if his salary would go up).

 

[gardenmom5]

dh is in the non-employer market (ranges from medicaid, medicare, to private selfemployed) - and works with a wide variety of people including low--income, and people who are barely making ends meet and have dropped insurance because they can't afford it.

 

the system is a complete disaster.

[AmandaVT]

Have you talked to the hospital/clinic directly? One by us will allow you to file a financial hardship form - it lays out your income and monthly debts (home, cards, credit) and disclose your bank account information from the past 3 months. This is brought to a board which votes on if you can receive some 'credit' or grant towards your bill. It may make the amount owed less than half, it has for us when we had a $10,000 deductible and only made $30,000 a year... yeah, who can afford to have a child when it costs so much?! We are blessed with better insurance now and DH will not even consider leaving his job because of the benefits (even if his salary would go up).

 

 

That's really nice of your hospital. Ours just lets us make payments, forever....it took a few years to pay off my emergency c-section. 

 

Right now we buy off the exchange and the prices are outrageous. A semi-decent plan costs almost $2,000/month and still has a deductible that needs to be met. And we have to pay it out of our net pay, not gross. Almost a third of our take-home pay goes to health insurance premiums and I have outstanding bills currently with the eye Dr (because eye care isn't covered when you pay $2,000/month), dentist, DH's Dr, the hospital and the pediatrician. They're all amenable to me making monthly payments, but that's another $250/month going out to pay down those debts. It sucks. 

 

Prior to last year, we were covered under DH's work and had been since we've been married. He paid about $300/month towards his premium (pre-tax) and his employer paid $23,000 to cover us yearly. It was a good plan though.

[HTRMom]

I do not like a system where health care is typically tied to employment. I would prefer that my employer not be involved in my health care decisions and funding. The US system of employers providing health insurance is the result of post-WWI wage controls and tax code advantages.

Totally agreed. Give me the money and I'll buy my own insurance. Part of the reason health care costs so much in the first place is that it is taxed at a much lower rate on various levels which drives up the cost significantly to those who don't get the same tax advantages.

[Farrar]

I chose 1, but the "my" here is actually "dh's". Before I stopped working, we did use my insurance, but that's now been almost ten years ago.

 

Most people I know, like me, have decent insurance through employment of a family member, but agree that there's a problem and that universal coverage, probably through single payer, is the best solution. However, since we all are covered, most of us aren't out there spending out time lobbying on this issue.

[kewb]

Over the last 30 years I have gone from employer based benefits to the marketplace.  There have really been no significant differences between my employer insurance and my marketplace insurance.  The only difference is now I pay all of the cost instead of my employee contribution.

 

In terms of coverage:

Same copays.

Same drug coverage. The usual "this is no longer preferred. We want you to mail order instead of using local pharmacy for maintenance drugs. The same preapproval for a controlled substance.

Same emergency room coverage

Same doctors, other than the usual changes of a doctor deciding to no longer participate in a plan.  Nothing new and has happened with both kinds of insurance.

Same difficulty dealing with the insurance company to get procedures approved.

Same difficulty appealing a decision.

 

 

 

[ashfern]

When we were self-employed we chose a high deductible catastrophic plan which was affordable for us because we don't see the doctor very much. My DH got a private sector job and we went to their insurance. We would have been happy to pick the type of plan we had before but the ACA made those go away. Our deductible was double what we had been paying with the high deductible plan. :confused1:  First two years the premium was great. Third year it doubled. This past year it went from $125 per month to $650 per month!! That was BC/BS so we switched to Cigna which was around $125. The kids pediatrician is on this plan but not my Gyn who I've been going to for 20+ years.  :glare: Oh, we just found out that the ER's of the two big hospital chains (whatever they're called) are not on this plan. If we need to go to the ER it's into downtown Atlanta to Grady (1 hour with no traffic, Ha) or 1 hour to the next county NW of us. Not the hospital 20 min away.  :cursing:  At least the Children's hospital is on plan.

[G5052]

Have you talked to the hospital/clinic directly? One by us will allow you to file a financial hardship form - it lays out your income and monthly debts (home, cards, credit) and disclose your bank account information from the past 3 months. This is brought to a board which votes on if you can receive some 'credit' or grant towards your bill. It may make the amount owed less than half, it has for us when we had a $10,000 deductible and only made $30,000 a year... yeah, who can afford to have a child when it costs so much?! We are blessed with better insurance now and DH will not even consider leaving his job because of the benefits (even if his salary would go up).

 

 

We've done this too many times to count. Even if you have good income, call them because there are other options.

 

One surgeon offered to cut his fee by 50% if we signed a form allowing him to present DH's case in his seminars for a year with no identifying information. Of course we agreed. At the time we had a plan with zero out-of-network benefits, and DH needed that surgeon and only that surgeon. They also put us on a zero-interest payment plan with two years to pay.

 

Another time we couldn't afford a mandatory test that insurance didn't pay for. DH called, and they cut the bill by 60% and gave us a year to pay with no interest.

 

The local hospital is tighter, but will give you three months to pay with no interest. They also offer financing which you can apply for right away or after trying to get the balance down over three months. It's zero interest the first year, and then goes up, but it remains reasonable.

 

The zero interest credit cards are rare now, but we once charged a $7,000+ out-of-network surgery on a zero percent card that I had just gotten. We thought that they were in network, but it turned out that they had just dropped that insurance plan the month before. DH had dropped 30 pounds and needed his gallbladder out. He no longer could eat solid food and was very miserable. Insurance refused to waive the out-of-network part because it wasn't an emergency. I talked to supervisors and filed an appeal, but it would be 30 days before they'd make a decision. The in-network surgeons we called couldn't even see him for 3-4 weeks. The out-of-network surgeon saw him on a Friday and was willing to schedule it for Monday. I argued with his financial person on the phone for 30 minutes in the waiting room (she was at another office), and she wouldn't budge. So we charged it and booked the surgery because they wanted payment up front. Ultimately we found out that they were actually on a secondary network we didn't know about, so we got 70% of it refunded and paid the rest over the year that the card had no interest.

 

It pays to ask!

[cjzimmer1]

We get insurance through DH's work.  For the last 6 years or so (and he's switched jobs and we had a period of private insurance as well) has pretty consistently been pay $20-25K per year before you start getting coverage.  By this I mean, the monthly premium plus the deductible.  Those costs have been consistently in that range.  Prior to that, the number before the insurance starting covering things was closer to 10K (premium + deductible) and since most of that was the premium  we would actually go to the doctor for something less serious than imminent death because the deductible was a reasonable number.  

[Loowit]

We were very fortunate that our kids qualified for a subsidized through the state medical plan until last year.  It covered important medications, hospitalizations, and surgeries completely.  But DH now makes too much to qualify.  Adding the kids to his work plan more than tippled what we had been paying each paycheck for just DH and I.  We can handle that increase fine as long as no one was sick or injured.  Sadly we have in the last six months had three ER visits that we are still paying off and now DH is facing cancer and all that comes with that.  I am not sure how we are going to handle the medical bills from that.  We met our family deductible for the year in March, but the co-pays and coinsurance percentages are going to be very expensive.  I don't think we will end up in bankruptcy but it will make things very tight.

[creekland]

I'm thinking we're the only first world country where folks have to worry about making ends meet or going bankrupt if medical issues strike.  Am I correct?

 

It boggles my mind that so many are ok with this as long as they (think they) have decent insurance for themselves.

 

NOTE:  This is NOT aimed at any post on this thread or any boardie.  It's just my thoughts reading about people who need to worry about money as well as worrying about whatever is wrong medically.  That's just so not right in the world I want to live in.

[Tap]

I work in pharmacy and bill insurance for a living.

 

I think that something has to change!!!  DH and I both work for Large national companies and our insurance/medical costs are getting so expensive we are at the point that most families would have one person quit work and go on Medicaid.  I am a pharmacy tech and dh is a district manager.  We aren't in entry level positions, but the cost of medical care in our family makes us live paycheck to paycheck!  Our expected cost for premiums and out of pocket expenses for just medical (not dental/vision/pharmacy) is $17,000 this year. (Almost Half of my gross earnings).  It will near $20,000 with those added in.

 

 

I work full time and so does dh. What I pay out of pocket for coinsurance/copays uses up almost a third of my income each month. We pay $500 month in insurance premiums (no one is double covered ).  I can't remember a year when I paid less than $5000 OOP for health care on top of premiums, and that is only because my insurance used to have a lower OOP cap.  My insurance is changing in June. We now have a $1000 deductible per person and my OOP will go up to $5500 per person, so my anticipated out of pocket medical expenses are going to be in excess of $11000 next year for just 2 of us who will hit the max (3 will hit it, but dd10 has state insurance to pay for part of hers).* Plus the $6000 we pay for premiums. I can't imagine what will happen if either dh or ds get sick too.

 

I say that to illustrate that we are a family who HAS to have medical insurance or none of this would be possible. 

 

I would love to see us have national health care.  Between what I see at work and what I live, I can't imagine what others are going through who don't have coverage.   Actually I know what would happen.....none of this! 

 

 

 

 

Just incase you are wondering how we use so much insurance....

 

I have a special needs daughter (my great niece) who  is rarely sick, but sees medical specialists a few times per year. She has had some expensive procedures.  3 sleep studies,2 neuropsych evals, vision therapy eval, tonsil/adenoid removal, Brain MRIs and extensive regular blood work.  She also sees BT/OT monthly and a psychiatrist monthly.  Her medical care before insurance averages $50,000 per year. (one year it was $100,000). Her pharmacy bill before insurance is apx $10,000.  (Due to the guardianship, she also has state insurance to pay portions of her care- but I am well aware that other families like mine wouldn't have that option)

 

I have an 18yo daughter who has chronic health issues.  She routinely sees specialists in cardiology, pulmonology, neurology,.  She has seen geneticists and specialists at Shriners. She has had probably 10 MRI/bone scans/CT scans. Has standing appointments with a chiropractor/PT/massage and IV infusions weekly.  Her medical expenses easily run $100,000 per year before insurance. Her pharmacy bill before insurance is $7000.

 

I have a chronic back issue and usually go to PT weekly. I choose PT to keep out of chronic debilitating pain.  I refuse to use narcotics due to my job and seeing the devastation that addiction brings with it.   I stopped PT recently due to $$.  I know I will have to go back at some point, but am trying to wait a while to save money.

 

 

 

[Katy]

I can't vote.  I'm not employed, but DH is, and my insurance has been through his job.

[luuknam]

I think health insurance companies have RUINED the way we pay for healthcare in this country.  I think if we could go back to pre insurance days where people paid their doc when they showed up to have a cut stitched, things would have gone a lot more smoothly. 

 

 

You mean, back when only 0.1% of the population could pay for anything more than something like having a cut stitched?

 

FWIW, before my wife got this job we went through a time period where we were uninsured due to financial problems. There was a doctor in the closest city who didn't take insurance and didn't take medicaid/medicare. He cost pretty much the same OOP for us as stuff costs through our employer-paid health insurance... but... he wouldn't do cancer treatments or c-sections or heart surgery either. I really like having insurance for those kinds of things.

[Crimson Wife]

There is no option for having employer-based coverage as primary and a government coverage (Medicaid, Tricare, etc.) as secondary.

 

Pre-ACA, we had what I thought at the time was a very good plan through my DH's then-employer. Reasonable premiums, deductible, and co-pays. It might've had a lifetime limit, however. I'm not sure because at the time that was not something I was at all concerned about as it was long before my youngest received her diagnoses.

 

Post-ACA, the costs to us skyrocketed. The current plan doesn't have a lifetime limit and birth control & mammograms are now co-pay free. The former is important to us and the latter saves us much less than the increase in our deductible and OOP co-pays. :glare:

 

I think my family has access to some of the absolute best healthcare in the world but at a very steep cost. And that's even with my DH's employer picking up a large share of the tab.

 

I am against single-payer because I think it would result in rationing and low quality services. Just look at how terrible the VA is if you imagine that single-payer would be better than the current system.

[Crimson Wife]

Medicine has advanced so much since the pre-insurance days. Sure, routine things like getting stitches for a cut haven't changed but that's not what is driving up healthcare costs. It's medical innovations like my youngest daughter's cochlear implant ($125k for the surgery and device alone).

 

Cancer used to be a guaranteed death sentence but thanks to modern medicine now a good percentage of cancer patients will survive. Childhood leukemia now has something like a 90% survival rate. Does anybody really want to give that up even if the treatments are $$$$$$?

[creekland]

No, I mean back when a doc who stitched you lived in the same small town as you and would be perfectly willing to trade those two stitches for a few weeks of eggs from the customer's chicken.  

 

How many eggs do you suppose we would need for my mom's chemotherapy?  Or for the radiation I had?

 

I probably will have to get more chickens.

[Alessandra]

One thing that I find incomprehensible is that people who get insurance (or a portion of their insurance) through an employer get it as a tax-free benefit. But people who pay for their own insurance can only deduct a portion of that expense. If the new tax plan goes forward as proposed, the deduction for medical expenses will be entirely eliminated. 

[RoughCollie]

I have been emailing my congressmen about the healthcare reforms that are in the near future. I know both are big Trump supporters, but they represent the rest of us too.

[Mabelen]

I still don't get how people think that rationing only happens in universal health care systems. Any medical treatment your current insurance does not cover is already rationed! I am not talking about voluntary cosmetic surgery or anything of that sort. I have read the list of excluded services in my policy. Everyone should read theirs too. Besides, even treatments that are supposedly covered can be denied by the insurer, whose ultimate goal and reason of being is making money and a profit. How is that any better?

 

In countries where there is universal health care, you can always also have separate private medical insurance or, you can always go to the private sector and pay out of pocket, just like you would do here for a treatment not covered by your current health insurance plan.

[Crimson Wife]

I have experienced a private PPO plan, a private HMO plan (Kaiser), and socialized medicine (Army healthcare).

 

I haven't experienced any rationing with our PPO plan. I can make an appointment with any provider I choose without needing to get a referral. I just pay more if it's not a network provider. All the tests and treatments the provider recommends have been covered without needing to appeal or go to the state for an Independent Medical Review.

 

Kaiser HMO was lousy and I had to fight them constantly to get specialist referrals, diagnostic tests, and they flat-out denied my daughter the cochlear implant surgery. There was technically an option to go see a non-Kaiser provider but in reality the only time I got them to approve it was by appealing twice and threatening to file for IMR.

 

Army healthcare was even worse. At least the Kaiser providers were competent, even if their job was to keep down costs through rationing care. At best, the Army providers were merely inexperienced. At worse, they were total quacks. The only good thing I can say about it was that it was free to us (no premiums, deductibles, or co-pays). But it truly was a case of "you get what you pay for".

[Mergath]

No, I mean back when a doc who stitched you lived in the same small town as you and would be perfectly willing to trade those two stitches for a few weeks of eggs from the customer's chicken.  Back when the point of service was the point of payment and there weren't about 6 thousand middle men to be paid between the person who took a needle and thread and sewed two stitches and the person who sliced her thumb cutting tomatoes. 

 

Now, don't get me wrong, I fully recognize that those days also were days when access was seriously limited.  Very few docs wanted to practice in what is now fly over country (back then it was maybe termed drive over country?)  So if you had a small town with a doc, you were lucky.  But that wasn't a problem of affordability, it was a problem of accessibility and one that I don't think Anthem and Humana have solved.

 

 

Paying for healthcare is so crazy now a days.  It's a huge complicated MESS.  And all the million middle men in the way drive up the cost.

 

I really don't think anyone has paid for medical care with eggs since medical care advanced beyond trepanning and drinking mixtures involving various kinds of animal urine.

[Mergath]

I still don't get how people think that rationing only happens in universal health care systems. Any medical treatment your current insurance does not cover is already rationed! I am not talking about voluntary cosmetic surgery or anything of that sort. I have read the list of excluded services in my policy. Everyone should read theirs too. Besides, even treatments that are supposedly covered can be denied by the insurer, whose ultimate goal and reason of being is making money and a profit. How is that any better?

 

In countries where there is universal health care, you can always also have separate private medical insurance or, you can always go to the private sector and pay out of pocket, just like you would do here for a treatment not covered by your current health insurance plan.

 

I have Medicaid right now because I'm pregnant, and it covers far, far more than my dh's insurance through his employer. I could even go get acupuncture if I wanted to. Dh can't even get a pair of glasses covered.

 

[Cecropia]

I chose "I think the free market would solve the healthcare problems if the government got out of it," but that doesn't really reflect my opinion.  I want lots of government involvement in enforcing existing antitrust/monopoly laws against pharmaceutical companies and hospitals, and I want government to require "flat rate" price transparency for all procedures, services and drugs, easily available before, during and after treatment.  At the same time, government has to stop banning the re-importation of prescription drugs, stop requiring certificates of need and remove other self-made obstacles to competition.  Once all that is done, then I look to the free market... and that doesn't mean I'm a "no social safety net, let them eat cake!" person... The prices are the problem, they are criminal!  We can get back to a sustainable system which includes medical aid/debt forgiveness only after we wrangle the costs back down to something based in reality. 

 

I would love to see more facilities like the Surgery Center of Oklahoma springing up across the country.

Edited April 28, 2017 by Cecropia

[MomtoCandJ]

Dh and I don't have insurance. What we would pay in premiums alone on the exchange costs much more than we actually use let alone the added expense of the the deductable and copays. We payed $72 a month last year (not great but affordable) this year they wanted us to pay over $300 a month for a plan that has a $13000 deductable. We have the girls covered under MICHILD where we pay $10 a month and everything is covered like Medicaid. If we could get coverage as a family like what we have for the girls, we would be more than happy to pay that $300

[Cecropia]

Medicine has advanced so much since the pre-insurance days. Sure, routine things like getting stitches for a cut haven't changed but that's not what is driving up healthcare costs. It's medical innovations like my youngest daughter's cochlear implant ($125k for the surgery and device alone).

 

Cancer used to be a guaranteed death sentence but thanks to modern medicine now a good percentage of cancer patients will survive. Childhood leukemia now has something like a 90% survival rate. Does anybody really want to give that up even if the treatments are $$$$$$?

 

It's hard for me to believe that innovation is a valid reason for average healthcare costs to more than triple since 2001 and continue on a similar trajectory into the future.  You can't have a ~2% annual increase in household income and a 4-9% increase in medical costs and not expect to hit a wall.

http://us.milliman.com/mmi/

 

My question: are the prices really reflecting the cost to bring the product to market or the value of the physician's time and skill... or is the perceived value set as high as the market can bear, which is quite high when we are talking about a major difference in quality of life, or perhaps a life-or-death condition?

[Crimson Wife]

It's hard for me to believe that innovation is a valid reason for average healthcare costs to more than triple since 2001 and continue on a similar trajectory into the future. 

 

Aging of the population, the obesity epidemic, the substance abuse epidemic, and the autism epidemic are big healthcare inflation cost drivers. Government has mandated insurance cover expensive treatments for the latter two in recent years (the Feds for substance abuse rehab and most but not all states for autism). The first two increase the demand for treatments for cancer, cardiovascular disease, diabetes, etc. that were always covered but far fewer people needed when the population was overall younger and more fit.

[Guest]

One thing that I find incomprehensible is that people who get insurance (or a portion of their insurance) through an employer get it as a tax-free benefit. But people who pay for their own insurance can only deduct a portion of that expense. If the new tax plan goes forward as proposed, the deduction for medical expenses will be entirely eliminated. 

 

Its totally messed up.  And one of the cornerstones of setting up a reformed insurance market is taking that tax incentive and giving it to the individual and never the employer, so that there is personal benefit to carrying coverage and less incentive to couple insurance with employment status.  It's double useful.