Healthcare / Insurance Perceptions

[luuknam]

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/

 

 

Aside from what Crimson mentioned, there's also micropremies who are surviving now (at great expense) who wouldn't have survived before, and who often have lifelong high cost issues. Also (unrelated), doctors often have no incentive to try low-cost treatments before trying the latest and most expensive treatment (which often isn't any better) - heck, most doctors don't even seem to know how much various medications cost - but the difference between $600/month and $4/month really adds up when a lot of people do that. And, probably most importantly, end-of-life expenses - it's crazy to pay $$$$$$ to survive a few more weeks (often at great suffering) when you're certain to be terminal, and people generally wouldn't pay that out of their own pocket even if they could (unless they're so rich it wouldn't make a dent in the amount their kids inherit), but when insurance companies pay for it, delaying death by even the tiniest amount seems to be the most important thing out there.

 

But anyway, the we were just commenting on the ridiculousness of paying for your medical care by trading eggs - that ship sailed before I was born.

Edited April 28, 2017 by luuknam

[DawnM]

Something needs to change.  I am still not in favor of ACA because, like medicare, it only really helps those who are really low income.  I can't say more without being political though.

 

We have always been fine.  My work, DH's work......they both have good care.  

 

 

[kroe1]

Not only would I go back prior to ACA, I would go back way prior to ACA. Back in the day, when health insurance was called major medical, it basically only covered hospitalization in an 80/20 proportion. Routine healthcare, immunizations, etc. were not covered because they were predictable expenses, thus, no reason to insure them. Insurance was designed to cover the unexpected, not the expected.

 

What if we had insurance to cover our car payments, our groceries, etc. That is just paying a middle man a fee to pay our bills for us. Insurance is no different.

 

And, then, we must have tort reform. We can no longer have million dollar lawsuits for unpredictable diagnoses and outcomes. This one fear adds ridiculous unnecessary testing to everyone, not just those few who are directly affected. I remember the day when a CT scan of the head was reserved for those who had a neurological deficit on a physical exam or a suspicious mechanism of injury. Now every old person who bumps his head, every simple head injury at a basketball game, and every toddler who rolls off the couch is getting radiated with very few actually having anything of note.

 

And, how can we talk about healthcare costs without talking about the mountains of government regulations that impede the process. For example, back in the day, administrative costs for running a physician's office or even a large hospital were minuscule to those costs today. I recently met a woman who has the job of quality control over the administrative employees who oversee that government guidelines are met for hospital admissions. Wow, I could get an extra nurse for that cost who might have given blankets to the frozen feet because no one turns the heat on in the ER. Or how about a nurse who has time to actually sit and explain things to the patient instead of the harried one who has to type for hours into a computer saying she did explain things when in reality she only had time for 45 seconds of explanation.

[Guest]

 

 

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 $$$$$$?

The general population doesnt want to pay for the research. The patients of the past essentially paid to become research subjects, even after the Jimmy Fund was established. The scientists who do the work didn't get rich. Anyone who hasn't read The Emperor of All Maladies should.

 

And the old meds had their rates renegotiated for the Affordable Health Care Act. Tamoxifen for ex, was on the low cost list at 100 per year (remember the walmart $4 list...anyone still able to.get anything for $4???), went up to 100 a month or more for those not on medicare/medicaid on day one of the aha. I know older women with breast cancer who went back to work so they could afford their meds at the new prices, until medicare age is reached. Relay for Life brings out a lot of details.

[FaithManor]

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.

Agreed. Most people are really naive. We have death panels already called insurance companies and they permanently injure and kill people every day due to denying treatment, and while hospitals and doctors argue with them about payment, someone pays the price. Every.Single.day. What I always find so frustrating in these discussions is the colossal cognitive dissonance. It is perfectly okay for insurance companies to ration your care and kill you, but not the government. Human loss at the feet of profits is apparently A Okay for some, and loss of life amongst the uninsured is also acceptable just so long as the gubmint keeps its dad gum nose out of it. I cannot wrap my brain around it.

 

The first go to move of every claim we make on our insurance is "no". Always. They have not one time paid a damn cent without a fight, and dh was denied treatment for a life threatening ailment by the hospital because of cost, and insurance being buttheads. I almost lost him. If I had not called my attorney and put them on the phone with the hospital administrator, Dh would not be here.

 

We all have a price tag on our heads, and the dollar amount is a lot lower than most think it is.

 

For what it is worth, my father figure had better healthcare through Medicare than we have ever had through employer insurance.

[JFSinIL]

For as long as we have been wed, we have had insurance through hubby's work, and always been in great PPOs.   Then he lost his job almost 4 years ago and paying for insurance ourselves was an eye opener.  At present, our monthly payment is a tad more than our mortgage payment/property taxes :-(   and we are facing a lot of just paying cash for one son with major mental health issues once he ages off our insurance in September.  Not Mr. AutismMan, he is on Medicaid, but his twin.  We are trying to get him on Medicaid by Sept., but even if they take him, we will need to pay the non-Medicaid psychiatrist  he currently sees since not rocking that boat.

 

Don't get me started on insurance companies trying every trick in the book to NOT pay a claim or to illegally put liens on folk's insurance settlements.  They get away with it a lot of the time since folks either do not know the law or can't afford a lawyer to fight for them.  Hubby is one of the TWO most experienced lawyers in Illinois in dealing with insurance companies, in particular BCBS, and they even tried to pull their illegal liens on him for almost two years (he prevailed, eventually) after our car crash and half a million dollars in medical bills between the two of us.  Which BCBS put a lien on.   Twats.

 

BTW not all lawyers make a lot of money.  After job loss no one wanted to hire an attorney closer to 60 than 50 (so true in many fields) and he has had to try and revive his dad's old small family practice, which consists of him and one secretary, to make ends meet.  That is a lot of writing wills and going to closings etc. for mostly poorer clients, since his dad worked mostly with lower income folks (lots of Polish folks) in the west side of Chicago.  One of the "good guy" lawyers, not a shark. :-)

Edited April 28, 2017 by JFSinIL

[SparklyUnicorn]

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. 

 

That doesn't seem fair. 

[SparklyUnicorn]

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?

 

It's not hard to believe when there is no control over those costs.  For example, other countries set reimbursement limits for medical procedures and drugs.  They don't do that here. 

[Crimson Wife]

It's not hard to believe when there is no control over those costs.  For example, other countries set reimbursement limits for medical procedures and drugs.  They don't do that here. 

 

And we Americans with private insurance end up subsidizing all those patients in other countries plus all the Medicaid, Medicare, VA, and uninsured charity care cases here in this country as a result.

[QueenCat]

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. 

 

It's only tax free through the employer up to a certain amount. If the policy value is over a certain amount, you do pay taxes on it.

[SparklyUnicorn]

And we Americans with private insurance end up subsidizing all those patients in other countries plus all the Medicaid, Medicare, VA, and uninsured charity care cases here in this country as a result.

 

How do we subsidize patients in other countries? 

[Alessandra]

It's only tax free through the employer up to a certain amount. If the policy value is over a certain amount, you do pay taxes on it.

That is very cold comfort for people who pay for their own insurance, lol. Employees only pay for a 'luxury' plan, so to speak. In my state, even the costliest gold plan offers very plain benefits. For example, you cannot purchase, at any cost, an individual plan that has any out of network benefits.

 

And the networks are shrinking. The last time I checked, there were only two in-network child psychiatrists for the all the plans from the largest insurance provider in the state.

 

Then, when it comes to taxes, an amount equal to the first 7 or 10 percent of your income is not deductible. But new tax proposals would be even worse.

Edited April 28, 2017 by Alessandra

[EKS]

My husband has excellent medical insurance through his employer (almost 9 years now).  Before that, we bought insurance ourselves and it went up about 30% each year.  Every time it reached a certain threshold, I would reduce our benefits.  Letting go of our prescription benefits really scared me--we could easily absorb the cost of the few prescriptions we were getting regularly at the time and stuff like antibiotics or whatever, but I dreaded what would happen if anyone got really sick and needed something exotic.

 

That experience makes me appreciate my husband's insurance every single day.  It also makes me think that the people who are making decisions about other people's healthcare need to purchase insurance on the open market circa 2008 (when, for example, an autism diagnosis was a disqualifying condition), live with it for several years, and then see if they feel the same way about single payer healthcare.

[J-rap]

We supposedly have a very good plan through our employer, a private plan that allows us to go anywhere in our state.  Also, the employer pays the premiums, which is also great.  The problem is that our deductible these past five years has quickly escalated from about $1,500 to $14,000/year.  Last year, we were within $500 of reaching that level, but then the year ended.  So essentially we paid for all of our health needs all year even though we have good insurance.  (except for the premiums, of course, but that comes out of the employer's pocket)

 

Seems kind of crazy to me, but I can't figure out a way around it.

[Wheres Toto]

MOST of the past 10 years we've had employer based insurance.  Mostly through dh's work but for a while through mine - it's why I went back to work.

 

But we did have a couple years where dh was self-employed and we paid for individual insurance or had no insurance.

 

I definitely think there is a problem and that we are not such special snowflakes that the universal healthcare that works in every other developed country wouldn't in some form work here.

 

I think it's telling that our law-makers don't have to worry about insurance coverage.  They think it's important when it comes to the health of themselves and their families.

 

I think universal healthcare would do a lot to encourage people to start their own businesses.

[EKS]

I think it's telling that our law-makers don't have to worry about insurance coverage.  They think it's important when it comes to the health of themselves and their families.

 

I think universal healthcare would do a lot to encourage people to start their own businesses.

 

Absolutely to both of these statements.

 

We (as a society) talk a lot about how expensive health insurance is, how high healthcare costs are, how healthcare costs don't respond normally to market forces, but we rarely talk about the role of health insurance as a form of indentured servitude.    

[Crimson Wife]

How do we subsidize patients in other countries? 

 

Pharmaceutical manufacturers spend huge sums doing the clinical trials necessary to bring drugs to market because they know they can charge high prices to Americans with private insurance. Those countries with socialized medicine are paying lower-than-fair prices because we are paying higher-than-fair prices.

[Crimson Wife]

  It also makes me think that the people who are making decisions about other people's healthcare need to purchase insurance on the open market circa 2008 (when, for example, an autism diagnosis was a disqualifying condition), live with it for several years, and then see if they feel the same way about single payer healthcare.

 

I think people who advocate for single payer should be stuck using totally cr*ppy Army healthcare for 5 years like we were and THEN tell me about how much better single payer would be. BTDT and while I don't like the high costs of our private PPO plan, no way in H-E-double-hockey-sticks would I want single-payer.

 

[Serenade]

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

Wow! That is fantastic. I agree, all medical procedures should have a published price, with pricing changes only allowed due to unplanned emergencies during the process.

 

And maybe I need to take a vacation to Oklahoma for my total knew replacement...

[creekland]

I think people who advocate for single payer should be stuck using totally cr*ppy Army healthcare for 5 years like we were and THEN tell me about how much better single payer would be. BTDT and while I don't like the high costs of our private PPO plan, no way in H-E-double-hockey-sticks would I want single-payer.

 

 

So perhaps we don't copy that one, but rather copy a model that works with fewer complaints - say, Canada.

 

No system is perfect - not in the least - but it's well proven that universal works better for more people than what we have - or had.

 

FWIW, we were on military health back in our military days (more than a couple of decades ago now) and it was just fine - if we're comparing anecdotes rather than stats.

 

My mom is on medicare now - so is my dad - and those are both working well for them too.

 

And as mentioned several times by various posters, universal provides the basics with low or no cost at point of service. Break an arm and get an ambulance ER trip?  No worries about whether you've met a deductible or have a co-pay - or even have insurance.  Ditto that with pretty much anything from cystic fibrosis (where Canadians live on average 10 years longer than Americans) to cancer.  If anyone wants more, they can pay for it.  That's not restricted at all.

 

http://www.cbc.ca/news/health/cystic-fibrosis-survival-rates-1.4022970

[EKS]

I think people who advocate for single payer should be stuck using totally cr*ppy Army healthcare for 5 years like we were and THEN tell me about how much better single payer would be. BTDT and while I don't like the high costs of our private PPO plan, no way in H-E-double-hockey-sticks would I want single-payer.

 

 

Medicare is single payer.  My parents are very happy with it.

 

That said, there is no reason people couldn't have insurance on top of a single payer system.

[maize]

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.

There is a difference between single payer and single provider. The VA system has been largely it's own provider, as has the military system. Medicare is a much better example of single payer with private providers. I do not think it is impossible for us to put together a decent single payer option; start by expanding Medicare.

 

Also, for those like your family and mine who currently have high quality private insurance plans, I think the fear that a single payer plan would mean we would lose the premium aspects of our own plans is overblown. Most countries with single payer systems also have thriving secondary top up insurance markets, and I am confident such plans would be available here as well. If your husband's employer currently offers a high quality plan there is a very good chance they would continue to offer such as a top up plan should universal coverage under a single payer plan be implemented; if not you would have the option of purchasing such a plan for yourself. The overall cost savings of single player should leave plenty of room within our current national healthcare and insurance spending budgets to pay for secondary private insurance.

 

"I don't want universally affordable healthcare for everyone because I am afraid of losing my own personal premium coverage" is I think a fear that is being gleefully promoted by the health insurance industry who don't want to lose any share of their market, but I believe it is seriously overblown.

[EKS]

There is a difference between single payer and single provider. The VA system has been largely it's own provider, as has the military system. Medicare is a much better example of single payer with private providers. I do not think it is impossible for us to put together a decent single payer option; start by expanding Medicare.

 

This.

[scholastica]

We supposedly have a very good plan through our employer, a private plan that allows us to go anywhere in our state. Also, the employer pays the premiums, which is also great. The problem is that our deductible these past five years has quickly escalated from about $1,500 to $14,000/year. Last year, we were within $500 of reaching that level, but then the year ended. So essentially we paid for all of our health needs all year even though we have good insurance. (except for the premiums, of course, but that comes out of the employer's pocket)

 

Seems kind of crazy to me, but I can't figure out a way around it.

I am no fan of health insurance companies or our current system, but I do like to be fair.

 

Did anyone in your family go in for a well-visit? Your insurance was required to pay the whole cost.

Did you get a mammogram? Your insurance paid the whole cost of that.

Did you only pay a copay for a sick visit? Your insurance paid the rest.

Did you pay only a co-pay for prescriptions? Your insurance company paid the rest.

 

If not, then you truly did pay for all your health care, but if so, your insurance kicked in for some of your needs.

 

Now, none of those even come close to what the premiums paid in were, but still the insurance company would have had to pay for some of those things.

 

Unfortunately, those are precisely the requirements the current powers-that-be would like to let insurance companies remove.

[scholastica]

This.

But doctors can only take Medicare if they take other patients as well, the reimbursement rate doesn't cover their costs. So unless the reimbursement rates go way up, and hence the cost, Medicare for all is untenable. I'm totally open to a single payer system, but we have to be very clear about the true costs and benefits.

[luuknam]

Not only would I go back prior to ACA, I would go back way prior to ACA. Back in the day, when health insurance was called major medical, it basically only covered hospitalization in an 80/20 proportion. Routine healthcare, immunizations, etc. were not covered because they were predictable expenses, thus, no reason to insure them. Insurance was designed to cover the unexpected, not the expected.

 

 

Immunizations are a public health issue - if you make people pay for them themselves, a lot of people won't, because they either can't or because they just want to save some $$. If the percentage of immunized people drops below a certain threshold, it would lead to the return of epidemics of preventable diseases (not *everybody* has to be immunized to prevent this - if enough people are immunized sporadic cases are unlikely to find enough new hosts to turn epidemic) - and that wouldn't just affect the people who didn't get immunized... immunizations are not 100% effective, so some people would get polio or w/e despite being immunized, and some people have health problems that mean they can't get immunized, so they would get it too. 

 

And insurance/medicaid/etc covering routine healthcare for children is useful for the same reasons that public schools are useful - some parents suck, some parents are poor, etc, but some kids would not get health care or education if it weren't for it being free - and certain health problems could cause kids to be less employable as grown-ups, which would basically cost society a lot of money. For example, if a kid has frequent migraines, then that could be treated with fairly cheap prescription drugs... but if it's not free, some of those kids won't get treatment, which means they can't learn as much in school, which means that as grown-ups they're likely to make a lot less money over their lifetimes, meaning they'll pay fewer taxes and use more government services. This doesn't just hold true for kids either - grown-ups are more likely to pay for the necessary meds for themselves, but if they're already unemployed with no money, it can be impossible to pay for a doctor to prescribe meds that cost like $10/month - and many depressed, bipolar, schizophrenic, etc people could make above-average incomes, if medicated. And you don't want to have those people say "hm, money is tight this month, let me skip my meds" - because then they're likely to end right back up at losing their job and not having the money to get back on those meds. 

 

Anyhow, routine health care and immunizations aren't why health care costs in the US are so high - like you said, they're expected expenses, so you'd be paying for them anyway... the amount the middle man takes on those things is not the big problem.

 

ETA: I did want to agree about lawsuits (and insurance against them) adding to the cost.

Edited April 28, 2017 by luuknam

[Crimson Wife]

 If anyone wants more, they can pay for it.  That's not restricted at all.

 

That's the situation in places like India. There is a completely cr*ppy public option for the masses and the elite get good private care. Do we really want to be moving in that direction in this country?

 

I think something needs to be done to cap the percentage of people's income that they spend on healthcare to a reasonable amount, but not through single-payer.

[Crimson Wife]

There is a reason why the global elite come to the U.S. when they need specialty care rather than using their own country's public option. We truly have the best healthcare available in the world, it's just not financially accessible to all our citizens.

[J-rap]

I am no fan of health insurance companies or our current system, but I do like to be fair.

 

Did anyone in your family go in for a well-visit? Your insurance was required to pay the whole cost.

Did you get a mammogram? Your insurance paid the whole cost of that.

Did you only pay a copay for a sick visit? Your insurance paid the rest.

Did you pay only a co-pay for prescriptions? Your insurance company paid the rest.

 

If not, then you truly did pay for all your health care, but if so, your insurance kicked in for some of your needs.

 

Now, none of those even come close to what the premiums paid in were, but still the insurance company would have had to pay for some of those things.

 

Unfortunately, those are precisely the requirements the current powers-that-be would like to let insurance companies remove.

 

Yes, I understand what you're saying.  But I know our premiums are high, so our employer is paying a lot too.  Between what our employer pays and what we pay, it seems that would easily cover the things you mention.  We don't have a co-payment plan at all, not on prescriptions, not on sick visits, not on ER visits, not on rehab visits, not on lab tests, etc.  We pay 100% of everything, until the deductible is reached, with the exception of a few vaccinations, birth control, and one preventative visit/per year.

[creekland]

Not only would I go back prior to ACA, I would go back way prior to ACA. Back in the day, when health insurance was called major medical, it basically only covered hospitalization in an 80/20 proportion. Routine healthcare, immunizations, etc. were not covered because they were predictable expenses, thus, no reason to insure them. Insurance was designed to cover the unexpected, not the expected.

 

This worked for those who could afford that 20% and all routine care.  What about those who can't?

 

Health care has never been a problem for those who can afford it - anywhere - even in third world countries (where affording it can mean traveling elsewhere).

 

Are we content as a country saying health care is only for those wealthy enough to afford it?  (Apparently we are, as that's what we have.)

 

I prefer if health care were like education and available to all in our country with all of us chipping in to pay for it.  It might not be perfect, but it's better than saying "I've got mine - sucks to be them."  Charities can only do so much.

[creekland]

That's the situation in places like India. There is a completely cr*ppy public option for the masses and the elite get good private care. Do we really want to be moving in that direction in this country?

 

Why do you think it's wise to copy systems that don't work rather than those that do?

[luuknam]

That's the situation in places like India. There is a completely cr*ppy public option for the masses and the elite get good private care. Do we really want to be moving in that direction in this country?

 

 

India's per capita income is like $1580/year. You cannot provide an awesome single payer healthcare plan in a country like that, there just isn't the money - it's just not reasonable to compare the US to India in that regard. 

 

ETA: In the US, health care spending is over $10,000/year per person. 

 

http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

Edited April 28, 2017 by luuknam

[creekland]

India's per capita income is like $1580/year. You cannot provide an awesome single payer healthcare plan in a country like that, there just isn't the money - it's just not reasonable to compare the US to India in that regard. 

 

ETA: In the US, health care spending is over $10,000/year per person. 

 

http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

 

Even thinking about it more, if my choice were no care at all due to not being able to afford it, or crappy care, I'd pick crappy.

 

Kudos to India for trying to do something for everyone.

Edited April 28, 2017 by creekland

[SKL]

I answered multiple answers because I do believe we have issues to solve, I don't believe single-payer healthcare is the best way to fix them, and I do believe there is a lot of hyperbole and missing the boat in discussions.

[Joker]

We've always had insurance through dh's employer. First, while he was in the military and now in the private sector. We've never paid much on our end - right now our part is just under $100/month for the four us. Dh's employer part is right around $1100/month so total for the four of us is around $1200/month. Our deductible is somewhat high and we max out our HSA contributions (that his employer also contributes to) every year to try and help with that. Even after the deductible we are responsible for 20% and we have been hitting the deductible almost every year so it does get tough at times. Our biggest expense has been mental health care for oldest. Insurance really needs an overhaul in that department because I can see where many have to give up the care they need because it just gets too expensive. 

 

We've never had claims issues or been denied care while in the private sector. I actually had to fight much more while dh was in the military and one time was told an outright no and had to pay out of pocket. It was actually something that needed immediate treatment but the military insurance wouldn't budge on allowing testing or treatment.

 

In the private sector, we've never had anything denied that I can think of since we've had it the past 17 years. Actually, right now they are covering medicine for ds that our plan actually says is only covered in one specific instance and that is not ds. They are covering it anyway. 

 

I know others have very different stories but our experience hasn't been horrible with dh's employer based insurance. We've never had to get insurance on our own, though. 

[scholastica]

Yes, I understand what you're saying. But I know our premiums are high, so our employer is paying a lot too. Between what our employer pays and what we pay, it seems that would easily cover the things you mention. We don't have a co-payment plan at all, not on prescriptions, not on sick visits, not on ER visits, not on rehab visits, not on lab tests, etc. We pay 100% of everything, until the deductible is reached, with the exception of a few vaccinations, birth control, and one preventative visit/per year.

Then I would have to disagree that your employer is providing a very good plan. Even on a marketplace plan, we have copays.

[Joker]

We don't have copays either and technically we pay 100% of costs until the deductible is met but because we have insurance the amount we pay is always less than the billed amount. I received a bill recently for $400 for a doctor visit for oldest. They forgot to file with insurance which brought it down to $200. So, I'm only paying 100% of the contracted agreed upon cost not the actual cost the doctor bills for those with no, or different, insurance. 

 

 

[scholastica]

We don't have copays either and technically we pay 100% of costs until the deductible is met but because we have insurance the amount we pay is always less than the billed amount. I received a bill recently for $400 for a doctor visit for oldest. They forgot to file with insurance which brought it down to $200. So, I'm only paying 100% of the contracted agreed upon cost not the actual cost the doctor bills for those with no, or different, insurance.

Actually, sometimes the no insurance cost is lower. My kids' opthamologist would be allowed to charge about $350 to a person on a plan like yours - that's the "negotiated rate". However, cash pay, he charges $225. I only know this because we almost ended up in a plan like that. Also, my ds's orthotics would have cost $365 if we put them through insurance and went to our deductible, we paid $280 cash.

[MomtoCandJ]

When we had insurance through the exchange we had to pay $70 per office visit to our NP, without insurance we pay $35. For us it's cheaper to be without insurance to go to the NP

[Joker]

We've been able to find pharmacies where it can be cheaper without insurance but ds's specialists are not at all cheaper to self pay.

[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!

 

Oooh, update!  Today I got a letter from a debt collector for $1400 of the 3D mammogram I needed to make sure a lump I found last year wasn't cancer!  Thought dh was on top of that, apparently not.

 

We will never ever get ahead.  It's so depressing.  :(  (Dh works so hard and it's like it doesn't even matter anymore.)

[6packofun]

 If anyone wants more, they can pay for it.  That's not restricted at all.

 

http://www.cbc.ca/news/health/cystic-fibrosis-survival-rates-1.4022970

 

This is what I don't understand.  Single payer/universal health care obviously doesn't pay for everything.  So it's STILL a system where people who can afford more/better will get it and everyone else has to suck up and accept whatever they get with the main program.  So 30+ % of people in Canada supplement, I think I read recently. Why?  Because they aren't covered enough?  Because they get special rich people services?  I had a discussion with a friend on FB whose dd has cystic fibrosis.  Without doing much research at all, he's like, "Hey, who wants to move to Canada with us?!" just because of the article that CF patients live longer there.  They brought up getting a home care nurse later in their dd's life and...lo and behold, that is NOT covered under Canada's healthcare along with a few other things they wondered about.  LOL  (That's a somewhat bitter LOL, btw.)

[goldberry]

Pharmaceutical manufacturers spend huge sums doing the clinical trials necessary to bring drugs to market because they know they can charge high prices to Americans with private insurance. Those countries with socialized medicine are paying lower-than-fair prices because we are paying higher-than-fair prices.

 

I don't believe that.  There is no way those manufacturers are willing to LOSE money selling in those other countries just because they make more in America.  Companies are perfectly capable of isolating which markets are profitable.  Are those countries maybe less profitable than America?  Sure.  That does not equal less than fair, it equals "less profitable than the company would like, because they insist on a crap-ton of profit."  

 

They charge what they do in America because they can get away with it.  

[Mabelen]

This is what I don't understand. Single payer/universal health care obviously doesn't pay for everything. So it's STILL a system where people who can afford more/better will get it and everyone else has to suck up and accept whatever they get with the main program. So 30+ % of people in Canada supplement, I think I read recently. Why? Because they aren't covered enough? Because they get special rich people services? I had a discussion with a friend on FB whose dd has cystic fibrosis. Without doing much research at all, he's like, "Hey, who wants to move to Canada with us?!" just because of the article that CF patients live longer there. They brought up getting a home care nurse later in their dd's life and...lo and behold, that is NOT covered under Canada's healthcare along with a few other things they wondered about. LOL (That's a somewhat bitter LOL, btw.)

Here is the thing. Universal health care provides health services to all. We all contribute and we all benefit from their services. Yes, usually there are limits to what or how much of it because you also can't bleed the country to financial ruin to cover every single thing, everywhere, immediately. Universal access to care and preventive services limit higher costs down the line. Sometimes you will receive services but there will be a wait time. Other times there will be restrictions to how much of a service you can receive. These decisions are made with the entire nation's well being in mind. Just like you make decisions thinking on what is best for your entire family overall. Not everyone is going to be happy. There is no perfect system, obviously, but I would rather have a system that looks to the nation's well being when making those decisions than a system that looks to the insurance company's financial profits.

 

I have lived for 34 years in two countries with different universal health care systems. I have now lived in the US for almost 20.

[creekland]

This is what I don't understand.  Single payer/universal health care obviously doesn't pay for everything.  So it's STILL a system where people who can afford more/better will get it and everyone else has to suck up and accept whatever they get with the main program.  So 30+ % of people in Canada supplement, I think I read recently. Why?  Because they aren't covered enough?  Because they get special rich people services?  I had a discussion with a friend on FB whose dd has cystic fibrosis.  Without doing much research at all, he's like, "Hey, who wants to move to Canada with us?!" just because of the article that CF patients live longer there.  They brought up getting a home care nurse later in their dd's life and...lo and behold, that is NOT covered under Canada's healthcare along with a few other things they wondered about.  LOL  (That's a somewhat bitter LOL, btw.)

 

It's a bit like public education the way I see it.  Without free to all public education, many people wouldn't be (and weren't) educated.  They didn't have a chance due to costs.  We can look at public education and find its faults and cracks, but overall, having the chance for a basic education without cost at point of service is better for our society than having only those who could afford it educated as happened before.  Yes, there are things that need to be improved, but in general, the masses can read, write, and do arithmetic (albeit by calculator now).  Many even do quite well - just with public education.

 

Not everyone is pleased with PE though.  So, for those who aren't (including many on this board), we can use our own money for what we feel is better - homeschooling, private school, supplementing, whatever.  This isn't available for everyone and is often limited by cost and/or time, but that's just the way the real world works.

 

Medically, anyone can get the flu, a broken bone, cancer, hernias, accidents/falls, or a gazillion other things.  There's no lifestyle that exempts someone.  None.  Prayers have limitations as do home remedies.  I think our society is much better off when everyone has access to fixing these basics without cost at point of service - even with a flawed system - than what we have going on now when many people have to choose between getting something looked at/fixed or paying other bills.  With accidents and other significant issues, one can even end up bankrupt if one prefers health care to "living (or dying) with it."  In a first world nation, that's just not right.  Even India seems to grasp that and is seemingly doing what they can.  But here?  So many are ok with it as long as they have theirs (including many folks in congress).  It boggles my mind.  

 

Many of us live on budgets, but those budgets rarely can increase by the $37,500 I had to come up with up front to get the radiation I had - and honestly - that's cheap compared to many other things going on.  In our health share there are several needs that exceed 250K.  None of us are exempt from the possibility it will hit our family.  None.  And no, hospitals don't have to treat you if it's not immediately life threatening, and yes, if they treat you for that broken bone, they expect to be paid - even if it's in the thousands.

 

Insurance shouldn't be earning profits off people's medical needs - not for the basics.  If those wealthy enough want to Top Up as some of us do with education - then go for it - but have the basics for everyone - paid for collectively.

[MistyMountain]

I could not vote because I had a lot of change in the insurance situation in the past ten years. We went from having decent employee health insurance through a large company to having no insurance for the adults and state insurance for the kids when dh worked for a very small company. We lost the state insurance for just going over the limit but still making below the average for a family in our area and then had no insurance. Then dh worked for a different small company that was slightly larger who provided insurance but they change insurance companies quite often. They have all been high deductible plans some better then others. My kids could never get things like OT or PT when they could have used it. The short stint on state insurance was the most worry free time even though we were earning less because everything was covered and we did not have to worry about health related costs for the kids. Now most of what I would use is not covered.

 

I always believed in universal health care even when I had good insurance during my whole childhood and early marriage.

Edited April 28, 2017 by MistyMountain