Healthcare premiums to rise about 20%

[Barb_]

Maybe it's fair to compare high deductible plans to catastrophic plans pre-ACA. Even high deductible plans cover certain things 100% and they are there in case of an accident or heart attack or cancer.

[Spryte]

Maybe it's fair to compare high deductible plans to catastrophic plans pre-ACA. Even high deductible plans cover certain things 100% and they are there in case of an accident or heart attack or cancer.

I think that's a fair comparison.

[Sandwalker]

 

 

I'm not disagreeing they are struggling. Healthcare systems across the developed world are struggling as populations age due to the post war baby boom and the reduction in population growth in the younger generations. But this article is written by people who take their good healthcare largely for granted. They view it as a right and are understandably frustrated when it isn't working the way it always has. They are still stunned and appalled to hear what we go through here. One cannot support the statement that our system is better, even in crisis, than the NHS

Stunned? Maybe the young people there are. In the '90s, the NHS almost tanked financially, and was in horrible shape.

[Sandwalker]

Maybe it's fair to compare high deductible plans to catastrophic plans pre-ACA. Even high deductible plans cover certain things 100% and they are there in case of an accident or heart attack or cancer.

Except for the price of high-deductible plans vs the old catastrophic plans.

[Homebody2]

But isn't it true that so many people don't use their insurance because they can't afford the deductibles? I'm not sure that more people being insured is proof that health care has improved. Of course more people are insured, because now it's law that they have to be!

Believe me, when someone has a health crisis and has to use their insurance, they will be grateful that these essential health benefits are covered!

 

Some of the 10 essential health benefits:

Prescription drugs (one of our son's cancer drugs was $600 without insurance)

long term care for chronic conditions (covered our son's treatment for 9 yrs and will cover any new conditions that result from long term treatment)

No lifetime maximum (our cap used to be $2 million. Our insurance has already paid out $1.5 million. Our son can stay on our insurance until 26. He's 11 and has a high probability of having other chronic conditions. You do the math)

 

Who isn't using their insurance if they are experiencing a medical crisis? I don't understand this. Speaking from experience, I'd rather pay the deductible than the hundreds of thousands of dollars that cancer treatment costs. We've spent about $5000/year for 9 years for long term treatment for cancer. That's way better than the almost $1.5 million that our insurance has paid out!

 

This is why I am so passionate about everyone having relatively affordable access to health insurance. Everyone will experience a health crisis, if not personally, then a family member. And people shouldn't go bankrupt as a result. I'm not arguing that we all shouldn't be doing our best to help save some money and pay for a portion of the costs, I'm just saying that the playing field should be leveled. It's unfathomable to me that other families have experienced emotionally everything we have and then have also faced bankruptcy on top of that. Experiencing a health crisis is difficult enough without suffering a monetary crisis at the same time!

[Guest]

Maybe it's fair to compare high deductible plans to catastrophic plans pre-ACA. Even high deductible plans cover certain things 100% and they are there in case of an accident or heart attack or cancer.

Uh,no. High deductible plans do not cover much of anything 100%. Compared to the preACA PPO plans, they cost much more as they are the 80s major medical plans regurgitated. Coinsurance, rx not countng toward family deductible have raised oop in comparison to the preACA PPOs with low copays and no coinsurance. We have eliminated wellness options for many due to high deductible plans.

 

 

I agree playing field should be leveled..I want the same options and costs the govt union employees have, especially since my taxes pay for them.

 

I have to agree it is good for chronic conditions to be covered but it isn't driving the competition necessary to get prices down.

 

I have asked my senator and representative to do meanimgful reform by starting with free cancer coverage. Pre ACA,.my friends with cancer were finding first line treatment for breast cancer reasonable...$5-50 copays for OV, no oop for treatment. Now its pay the family deductible, about $10k annually then 20% before oop max is reached. Considering the fraction of women who find breast cancer before medicare age, that's retirement down the drain and guaranteed poverty in old age (what's new for women).

Edited October 14, 2017 by Heigh Ho

[Homebody2]

Maybe it's fair to compare high deductible plans to catastrophic plans pre-ACA. Even high deductible plans cover certain things 100% and they are there in case of an accident or heart attack or cancer.

But the truth behind these catastrophic plans is that they usually only covered the treatment associated with the initial diagnosis. They didn't cover the long term care for the condition, which is the costliest part of the care. That could've been as simple as covering the ER expenses, but not the expenses once one was admitted to the hospital. At least now, because of the ACA, people are covered for the long term care.

[Spryte]

Those old catastrophic plans were not cheap, either. Not if one had pre-existing conditions. I have a multitude of pre-existing conditions, and I could never afford health insurance, back then. Even under DH's employer policy - my coverage was sky high. I was denied coverage many times, then later they just made it completely unaffordable. And, of course, there were caps and exclusions.

[TechWife]

 

Stunned? Maybe the young people there are. In the '90s, the NHS almost tanked financially, and was in horrible shape.

That was nearly 30 years ago. The fact is, the NHS made it through what you are calling a crisis (I have no info on it, I don't personally know if it was a crisis) and is still operating today and providing access to healthcare. Changing to meet needs is a good thing, so I fail to see how a "crisis" this old is relevant for anything other than a historical learning opportunity for those considering implementing this model.

[ChocolateReignRemix]

That was nearly 30 years ago. The fact is, the NHS made it through what you are calling a crisis (I have no info on it, I don't personally know if it was a crisis) and is still operating today and providing access to healthcare. Changing to meet needs is a good thing, so I fail to see how a "crisis" this old is relevant for anything other than a historical learning opportunity for those considering implementing this model.

 

It's amazing how many Americans insist that other nations have worse healthcare when those countries consistently have better outcomes and spend less than we do per capita.

[Bootsie]

I see your point now that I follow your line of thinking. Profits are like French fries--a little addicting and you keep grabbing at them long after you've had enough. Why then do we need continual rate increases as profits continue to chug along? Which brings me to my original assertion. Health care has no business being a for-profit or investor-supported industry and this conversation really reinforces that.

This raises a question regarding why hospitals, that were formerly not-for-profit organizations, have converted to for-profit organizations.  Also, many health insurance companies were at one time mutual, not-for-profit organizations.  The not-for-profits have chosen to leave the industry.  I do not understand the economics of why this has happened.  One of the disadvantages is that these organizations have to pay taxes once they are for-profit which is an increased expense for the organization.  

[Bluegoat]

Your example proves that single payer in most places is a two tier system, with the top tier only for those who can afford it. Why is that great physical therapist working for private insurance in the UK rather than helping the masses on the NHS?

 

Some places allow for private care along side of the public care, and other places, like Canada, don't.

 

Depending on what you want, as a people, and how you set it up, you can do it either way.  There are pros and cons to both approaches.

 

That being said, some of the most successful systems, in terms of costs and outcomes, have a private element.  

[Frances]

Your example proves that single payer in most places is a two tier system, with the top tier only for those who can afford it. Why is that great physical therapist working for private insurance in the UK rather than helping the masses on the NHS?

But at least everyone has access to healthcare and no one is going bankrupt paying for it. And the costs are lower for everyone. He's in central London, one of the most expensive places in the world, and his private physical therapy costs less than it did here in the US. As for NHS cost, he had to make a onetime payment of £150 to the NHS with his student visa application.

 

My son will likely use the NHS for anything acute, as he knows he will be seen quickly. But a chronic knee problem that doesn't stop him from normal daily activities isn't going to be a priority for physical therapy. He's a young adult who wants to be able to ski and do karate. And maybe the NHS physical therapists would be just as good, we don't know because he hasn't seen one.

 

And why shouldn't the private physical therapist be able to choose where she works? Isn't that one of the fears some people in the US have of any sort of universal healthcare? The government will control everything and people and providers will have no choices.

 

But to make anything like it work the US we would actually have to start producing enough of all types of healthcare providers to meet the needs of our population. We have way more than enough qualified young people who want to pursue healthcare careers, but not nearly enough training spots. And with the baby boomers aging, it's only going to get worse.

[Bluegoat]

But at least everyone has access to healthcare and no one is going bankrupt paying for it. And the costs are lower for everyone. He's in central London, one of the most expensive places in the world, and his private physical therapy costs less than it did here in the US. As for NHS cost, he had to make a onetime payment of £150 to the NHS with his student visa application.

 

My son will likely use the NHS for anything acute, as he knows he will be seen quickly. But a chronic knee problem that doesn't stop him from normal daily activities isn't going to be a priority for physical therapy. He's a young adult who wants to be able to ski and do karate. And maybe the NHS physical therapists would be just as good, we don't know because he hasn't seen one.

 

And why shouldn't the private physical therapist be able to choose where she works? Isn't that one of the fears some people in the US have of any sort of universal healthcare? The government will control everything and people and providers will have no choices.

 

But to make anything like it work the US we would actually have to start producing enough of all types of healthcare providers to meet the needs of our population. We have way more than enough qualified young people who want to pursue healthcare careers, but not nearly enough training spots. And with the baby boomers aging, it's only going to get worse.

 

Yeah, there are all kinds of problems in healthcare that really aren't related to being for-profit or not, or single-payer or not.

 

We keep increasing our ability, for example, through technology and science, to do things for certain conditions, or lengthen life.  But they are also extremely expensive.  Most western countries have ageing populations.  Many countries have a hard time producing enough doctors.  Many countries have a hard time getting health care workers in more rural or remote areas.

 

These are problems that all systems face, and no one is saying changing to a different model in terms of single payer or universal insurance will fix all of them.  And it's pretty strange to think it would or should.

[Sandwalker]

But at least everyone has access to healthcare and no one is going bankrupt paying for it. And the costs are lower for everyone. He's in central London, one of the most expensive places in the world, and his private physical therapy costs less than it did here in the US. As for NHS cost, he had to make a onetime payment of £150 to the NHS with his student visa application.

 

My son will likely use the NHS for anything acute, as he knows he will be seen quickly. But a chronic knee problem that doesn't stop him from normal daily activities isn't going to be a priority for physical therapy. He's a young adult who wants to be able to ski and do karate. And maybe the NHS physical therapists would be just as good, we don't know because he hasn't seen one.

 

And why shouldn't the private physical therapist be able to choose where she works? Isn't that one of the fears some people in the US have of any sort of universal healthcare? The government will control everything and people and providers will have no choices.

 

But to make anything like it work the US we would actually have to start producing enough of all types of healthcare providers to meet the needs of our population. We have way more than enough qualified young people who want to pursue healthcare careers, but not nearly enough training spots. And with the baby boomers aging, it's only going to get worse.

We have many graduates from medical schools who cannot find a residency, so they waste the years of education and triple digit cost. https://www.statnews.com/2016/03/17/medical-students-match-day/

 

And many established doctors have retired way early in the past few years because of the new changes. Older, more experienced nurses are being fired and replaced by new grads who will work for 1/2 the salary.

[Frances]

We have many graduates from medical schools who cannot find a residency, so they waste the years of education and triple digit cost. https://www.statnews.com/2016/03/17/medical-students-match-day/

 

And many established doctors have retired way early in the past few years because of the new changes. Older, more experienced nurses are being fired and replaced by new grads who will work for 1/2 the salary.

Yes, I'm aware of the shortage of residency training spots. I didn't say it, but I was including it in the problem of not training enough doctors. It's my understanding that about 1/4 of the current doctors in the US attended foreign medical schools and then did residencies in the US.

 

I've not heard of the problem of older nurses being fired and replaced by younger, cheaper ones. But that is very unfortunate and seems very short sighted. I live in a pretty desirable part of the US with a fairly reasonable COL, and there is a definitely a shortage here.

[Lady Florida.]

It's amazing how many Americans insist that other nations have worse healthcare when those countries consistently have better outcomes and spend less than we do per capita.

 

And they continue to insist healthcare in those countries doesn't work even when people who actually live there and use the system say there's no way they want American style insurance.

[ChocolateReignRemix]

And they continue to insist healthcare in those countries doesn't work even when people who actually live there and use the system say there's no way they want American style insurance.

 

Well in fairness, you can't really trust the word of a bunch of commies, amirite?

[Lanny]

We have many graduates from medical schools who cannot find a residency, so they waste the years of education and triple digit cost. https://www.statnews.com/2016/03/17/medical-students-match-day/

 

And many established doctors have retired way early in the past few years because of the new changes. Older, more experienced nurses are being fired and replaced by new grads who will work for 1/2 the salary.

 

Experienced physicians were retiring early, before ACA/ObamaCare came into law.  I remember talking with a guy, I think this was about 2005, who was an Orthopedic Surgeon in the St. Louis area. On the IL side.  He had never had a Malpractice complaint filed against him. His Malpractice insurance company informed him that they were going to double his yearly premium, from USD $100K to USD $200K.  He (and others he knew) threw in the towel and retired.

 

One of the many problems with the health care system in the USA is the Malpractice Attorneys, but there is no way their protectors (Politicians who get large contributions and gifts from them) will seek to limit what they do.

 

That's just one of many things that increases the cost of medical care.

[TechWife]

Yes, I'm aware of the shortage of residency training spots. I didn't say it, but I was including it in the problem of not training enough doctors. It's my understanding that about 1/4 of the current doctors in the US attended foreign medical schools and then did residencies in the US.

 

I've not heard of the problem of older nurses being fired and replaced by younger, cheaper ones. But that is very unfortunate and seems very short sighted. I live in a pretty desirable part of the US with a fairly reasonable COL, and there is a definitely a shortage here.

Slightly off topic here, but I wonder if any of the MD's who don't get residency training slots later apply for PA or NP training slots? It would seem that if someone can pass medical school much of their coursework and internship could be transferred to one of these other programs. Advanced practitioners are filling the gap that exists because there aren't enough doctors in some areas. They often specialize as well, so they can select an area of interest to train and work in. No, they don't have the income potential that a physician does, but they also don't have the same responsibility and liability levels, either. Does anybody need know if there are any MD to PA or MD to NP programs out there?

 

To clear up any potential confusion, in the US, when a student (called an intern) graduates from medical school, they receive the degree of MD. They have not yet received any specialty training (residency) that then enables them to become licensed, and later, board certified. Licensure is required to practice medicine as a physician, board certification is not, but it is a valuable credential in some areas.

[extendedforecast]

I am not convinced that the NHS does work better than our system, even in ours' current state of crisis.

 

I'd like to address the lawyer point mentioned above. The real cost of lawyers is the adaptations that hospitals, physicians, and the entire health care system must make in order to stave off huge lawsuits that would threaten their practice/institution. Patient care is #2.

 

The charting on patients done by nurses like me has ballooned to ridiculous mountains of unnecessary, time-wasting, cover-your-butt information input into slow and repetitive programs. The real reason is to make it difficult for lawyers to go through and find pertinent information in the hundreds of pages of garbage spewed out as 'medical records' these days. As a hospital RN, I am required by law to do continuing ed every year; the large teaching hospital I work for requires yearly training on what things not to write in the chart. There is also a special computer program on reporting "incidents" (mistakes or accidents) directly to our hospital lawyers before charting anything about it. The lawyers also draft all of the consents that patients are required to sign for care, procedures, surgeries, privacy documents, etc.

 

I'll be 60 years old this year, and have seen patient care in the hospital worsen unbelievably since the ACA doled out hundreds of millions to the health care community to get them on board with electronic medical records. So now when you are hospitalized, your nurse is likely looking at the computer more than she is at you, the patient--even when she is in your hospital room. And at the physician's office--are they looking at you more than in a cursory fashion? Or are they filling in boxes on the (likely non user friendly) medical record while you tell them your symptoms?

 

In addition, most hospitals and doctor's offices I am aware of are still using Windows 7 for their operating systems. Yes, insecure 7. And Win10 is not considered secure for electronic medical records--so what happens when Windows support for 7 ends next year? Our large urban public hospital had to switch from XP(!) a year or two ago when Microsoft stopped supporting it.

 

Recently I had a short hospitalization, my first since my childbirths. Although I was there for cardiac issues, not one nurse touched a stethoscope to my body the entire time. The nurse would come in the room, shielded by her huge wheeled computer on wheels, and each one spoke to me from behind the computer, so I was not even assessed by the eyes of a nurse, her most important tool. Not one nurse touched me in any way, although I know they were all charting full head to toe pretend assessments every four hours. The PCT did vital signs, and the EKG tech did EKGs every four hours. The RNs? Came in and asked questions while typing and then left.

 

Before the forced switch to the EMR, nurses had time to assess patients properly, even fluff a pillow or two, sit with a scared pediatric patient for a few minutes, reassure a worried spouse. Nurses are the front line; if we don't see changes in condition, the doctor will not know, as he only sees the patient once a day for a couple minutes. These days? Nearly all the time for both RNs and physicians is used on charting. And most charting is for the lawyers.

I understand the point you're trying to make, and I'm sorry you had that experience. My daughter was in the hospital for three nights last winter, and that was not our experience at all. She had a team of two nurses, one who attended to her as needed and another who came in every two to four hours to input data as dictated by the other nurse. All of her needs were either met or exceeded.

[Laura Corin]

Spending more, as though money is some endless pool and taking it from one part of the economy (spending by the public on goods and housing) and moving it increasingly to services, has no ramifications or unintended consequences? You can’t just endlessly shift more and more tax dollars to cover funding issues. And *some* consumers pay more commensurate with the quality or quantity of the healthcare they want to receive, but this is not monolithic across the population and many many people were paying far less before the ACA precisely because their costs were lower. Taking more from them to cover a higher risk population and decreasing the costs for that risk pool isn’t just benign and fair and helps everyone. It really doesn’t. It’s the least efficient and one of the more economically damaging ways to deal with the problem of sick people and associated expenses.

 

Pooling costs between the sick and the well is indeed the most benign and fair system.

 

The US already spends more tax on public healthcare than the UK does (per capita) to cover only those who have Medicare and Medicaid (if I understand this 2013 chart correctly https://www.statista.com/statistics/283221/per-capita-health-expenditure-by-country/). When I suggest that the UK could do with raising taxes a bit, I don't think that is unreasonable. I'm a UK basic rate tax payer who earns about the average for the country (including rental property income), so I'm not some super-rich person suggesting higher taxes for all. Taxes for good things. More doctors and nurses (who then use their salaries in the economy). ETA: more purchase of equipment from the private sector. Sounds good to me.

 

Your example proves that single payer in most places is a two tier system, with the top tier only for those who can afford it. Why is that great physical therapist working for private insurance in the UK rather than helping the masses on the NHS?

That's not how employment of specialists in the NHS works. That physio will either a) have been an NHS physio or b) still will be on a part-time contract.

 

a) the private physio in our town spent many years in the NHS. It's the standard that is expected by his private patients: many years of dealing with everything that the NHS threw at him. Alongside the letters after his name, he details his NHS experience in his advertising. Ten years ago, he was offering services free-at-the-point-of-delivery - the same physio, the same services - but now he works privately. He and his wife have their own business and he takes Fridays off to go surfing. Good for him! It's a town with a lot of visitors taking part in sports, so I'm sure he gets great custom.

 

b) when I had a benign lump removed from my breast, I had the choice of going on the waiting list (it had already been biopsied and was non-cancerous but a bit sore) for NHS care or having it done privately within weeks. I had private top-up insurance through my work at the time, so I went with the quicker option. It was the same surgeon. The same man. Just in a prettier hospital. Many consultants/specialists choose to work part time for the NHS, as that is where stability and prestige lies, and part-time privately.

And they continue to insist healthcare in those countries doesn't work even when people who actually live there and use the system say there's no way they want American style insurance.

Yup.

Edited October 15, 2017 by Laura Corin

[creekland]

It's amazing how many Americans insist that other nations have worse healthcare when those countries consistently have better outcomes and spend less than we do per capita.

 

Seems this happens often when people buy into the sound bites they hear rather than learning from real people or stats.

 

It's a bit like how so many are concerned about college debt because they see the story in the news about one young lad/lass who took out 6 figures and can't find a job afterward.  They ignore the thousands who took out lower 5 figures and are happily employed at decent jobs.  Statistics favors the latter, not the former.

 

There can be news stories about how universal care lets someone down, but look at the health/longevity statistics or ask the other thousands instead of focusing on the one...

 

Meanwhile, those who are making the bucks off insurance (or pharmaceuticals or similar) keep raking it in and release another sound bite.

[FaithManor]

Seems this happens often when people buy into the sound bites they hear rather than learning from real people or stats.

 

It's a bit like how so many are concerned about college debt because they see the story in the news about one young lad/lass who took out 6 figures and can't find a job afterward.  They ignore the thousands who took out lower 5 figures and are happily employed at decent jobs.  Statistics favors the latter, not the former.

 

There can be news stories about how universal care lets someone down, but look at the health/longevity statistics or ask the other thousands instead of focusing on the one...

 

Meanwhile, those who are making the bucks off insurance (or pharmaceuticals or similar) keep raking it in and release another sound bite.

Exactly.

 

People prefer to believe odd, once in a while, anomaly stories instead of sound research. Time and time again countries with universal healthcare come out better in every aspect of health than Americans with maybe, just maybe the only exception being trauma care outcomes. We do have top of the line paramedic/rescue services in many areas of this country, and seriously good trauma centers. So in that respect, we may be doing better. But the bulk of what is going to kill people, make the miserable, shorten their lives, and cause their bankruptcies is not trauma care, but other healthcare concerns, and America ranks down there with undeveloped nations! That's crazy!

[creekland]

I lived in Devon and we saw NHS first hand. It was a factor in our moving back to the states instead of staying and seeking permanent residency. Do I therefore get to have an opinion on the subject now and not be insulted?

 

Of course you are welcome to have and share your opinion! 

 

But it's also ok for many of us with other contacts who have seen different programs first hand and been able to compare to let folks know your opinion is pretty rare - rare enough that I haven't heard of it from anyone else who can compare.  Everyone can speak of the pros and cons with each type, of course, as those are there and known, but no one I know IRL who has experienced two first world systems (even one who has come to the US for quicker service on a surgery) thinks the US system is better, almost exclusively due to the high cost at the point of service - and often no service or less service if one can't come up with the cost. They are amazed that we put up with it. Wondering if one should go to the ER or not due to cost?  Unfathomable.  Jars put out next to cashiers to assist with cancer (or other) treatments?  Unheard of.  Declaring bankruptcy due to too many medical bills from an illness or disease?  Why do we put up with it as a nation - esp when our "results" statistically are NO better (often worse)?  People still complain about waits.  They still complain about doctors.  Then they have massive bills to pay either from the service or for insurance policies (or both).  Those I know shake their heads and feel sorry for us.  Exchange students are mystified.

 

You are welcome to have a different opinion with your experiences.

[kroe1]

Preventative care is covered, birth control is covered, preexisting conditions are covered, lifetime and yearly caps are abolished, high school and college graduates who used to fall between the cracks between dependency and full time work are covered, and uninsured rates have fallen to record lows

https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf

The problem is that much of what was gained by ACA are expected costs and should not be insured anyway. What we lost is the number of doctors willing to take the insurance, more claims being denied for whatever reason, and such higher costs for coverage for many that being “insuredâ€is merely a label. In actuality, the premiums preclude the ability to pay co-pays and deductibles for even simple, but, necessary doctor visits.

 

What has transpired is that ER visits have skyrocketed which increases overall healthcare costs for all.

 

For me personally, since ACA, my monthly premiums have gone from $400 a month to $1600 a month. I just got the notice that I will be paying $2400 a month as of January. Whether that is entirely because of ACA, I doubt it. Nonetheless, healthcare is quickly becoming a higher expense than housing for many, even for those perfectly healthy. DH and I will most likely drop all insurance as of January. We figure pocketing $30,000 a year, Crossing our fingers, shutting our eyes and saving like crazy is the best way to handle healthcare at this time for us.

[TechWife]

The problem is that much of what was gained by ACA are expected costs and should not be insured anyway. What we lost is the number of doctors willing to take the insurance, more claims being denied for whatever reason, and such higher costs for coverage for many that being “insuredâ€is merely a label. In actuality, the premiums preclude the ability to pay co-pays and deductibles for even simple, but, necessary doctor visits.

 

What has transpired is that ER visits have skyrocketed which increases overall healthcare costs for all.

 

For me personally, since ACA, my monthly premiums have gone from $400 a month to $1600 a month. I just got the notice that I will be paying $2400 a month as of January. Whether that is entirely because of ACA, I doubt it. Nonetheless, healthcare is quickly becoming a higher expense than housing for many, even for those perfectly healthy. DH and I will most likely drop all insurance as of January. We figure pocketing $30,000 a year, Crossing our fingers, shutting our eyes and saving like crazy is the best way to handle healthcare at this time for us.

Who says those costs shouldn't be insured?

 

My previously healthy son had an emergency GI hemorrhage with no warning whatsoever. Seven days of treatment that included ventilator support, PICU and surgery were covered by insurance. The bill topped $95K before the insurance paid. We only paid $5K in addition to our monthly premiums. Three years later he contracted a rare childhood illness that caused kidney damage. All treatments, biopsies and follow up care are covered. The insurance paid out several thousand dollars and student health provided a lot of care free of charge. The big thing is that, as of now, if he needs a transplant in the future it will be covered. If the requirement to cover pre-existing conditions is eliminated, then it won't be.

 

I truly do hope that not having insurance works out for your family. Please shore up your savings account, though, because you might need to pay for extensive, critical medical care with no warning whatsoever.

Edited October 17, 2017 by TechWife

[kbutton]

Slightly off topic here, but I wonder if any of the MD's who don't get residency training slots later apply for PA or NP training slots? It would seem that if someone can pass medical school much of their coursework and internship could be transferred to one of these other programs. Advanced practitioners are filling the gap that exists because there aren't enough doctors in some areas. They often specialize as well, so they can select an area of interest to train and work in. No, they don't have the income potential that a physician does, but they also don't have the same responsibility and liability levels, either. Does anybody need know if there are any MD to PA or MD to NP programs out there?

 

To clear up any potential confusion, in the US, when a student (called an intern) graduates from medical school, they receive the degree of MD. They have not yet received any specialty training (residency) that then enables them to become licensed, and later, board certified. Licensure is required to practice medicine as a physician, board certification is not, but it is a valuable credential in some areas.

 

The system is not remotely this flexible. Before commenting on midlevels, it's really inflexible if you have more than one role in healthcare. For instance, if you are a PA, for instance, that also volunteers or works for local EMS, you might be able to intubate for the EMS runs but not in an emergency department. When you get into military training for those sorts of jobs (corpsman, etc.), I believe it gets weird like that too. Some privileges vary by state too. I had a labor doula when I gave birth, and she is a nurse that happens to be a doula and childbirth instructor. She said she can't work as a nurse on a maternity floor for liability reasons! It's really messy.

 

PA programs have only recently (last 10-15 years) begun to standardize--at one point, you basically had to choose ONE program to try to get into, and then you had to hope you made it in (it might have been easier in PA-friendly states that had lots of programs to choose from like PA or CA, but not in OH). Pre-reqs are much more standardized, but in the interim, the programs have become super, super competitive. 

 

An MD would already have "more" schooling than a PA, but not as much direct patient/clinical experience from what I understand; however, PAs are trained like docs (vs. NPs who are trained like nurses with additional degrees after the initial nursing degree). Usually experience is sprinkled throughout the PA experience, and I imagine there are certain things that MDs are expected to pick up during their additional training that PAs (and maybe NPs) would be taught directly during their training since PAs do not have residencies and things like that unless they seek them out. Not sure about MD programs and patient contact experiences (clinical or pre-reqs). I think an MD to PA path could unintentionally cause people to think less of midlevels (like they are the leftovers). In actuality, people usually choose one role over the other pretty consciously. 

 

NPs are nurses first--the training is totally different than that of a PA or MD/DO. It would be harder to make an MD to NP path than an MD to PA path because it's just not analogous training.

 

Overall, PAs and NPs are utilized differently in different specialties and areas of the country. Some offices barely use their PA's or NP's capabilities, and other places couldn't deliver adequate care without them taking a major role. The midlevel role is changing and adapting rapidly. I am not sure how an MD to PA/NP path would work into that unless the changes settle quite a bit. It does make sense that we should not have a bottleneck--we should be finding ways for qualified people to become practitioners.

 

On a side note, since the responsibility thing was mentioned...it's scary for an experienced midlevel to answer to an MD or DO who is wet behind the ears. All of that "less responsibility" stuff goes right out the window when the doc signing your charts is asking you what to do! I kind of want to comment on what's been said about litigation in this thread as well since the responsibility thing plays right into this--some of the comments on litigation have been really out there. There are crazy, negligent patients (for starters, patients who LIE--unethical people consume healthcare too) and crazy, negligent docs. And midlevels get sued. And lawyers do, indeed, encourage frivolous lawsuits or lawsuits that they KNOW will be more winnable because they are sob stories (you can do everything right and still have a patient die very, very suddenly--those cases draw lawyers). And sometimes the wrong practitioner is left holding the bag for another one's mistake. It's really not easy to generalize. We need tort reform in many areas, not just medicine. It is possible for a practitioner to be criminally prosecuted; it's just rare.

[EMS83]

Who says those costs shouldn't be insured?

 

My previously healthy son had an emergency GI hemorrhage with no warning whatsoever. Seven days of treatment that included ventilator support, PICU and surgery were covered by insurance. The bill topped $95K before the insurance paid. We only paid $5K in addition to our monthly premiums. Three years later he contracted a rare childhood illness that caused kidney damage. All treatments, biopsies and follow up care are covered. The insurance paid out several thousand dollars and student health provided a lot of care free of charge. The big thing is that, as of now, if he needs a transplant in the future it will be covered. If the requirement to cover pre-existing conditions is eliminated, then it won't be.

 

I truly do hope that not having insurance works out for your family. Please shore up your savings account, though, because you might need to pay for extensive, critical medical care with no warning whatsoever.

First, I am sorry that happened, it sounds scary.

 

 

Regarding the cost, though...a $95k bill that a hospital will (hopefully) knock 40% - 60% off for self-pay, is still less than 2 years of $2400/month premiums.  I know laws vary, but I think most hospitals can't and/or won't do anything if you're paying something.  $2000/month (saving the rest for routine care--assuming the crisis doesn't result in on-going extra care) seems like the hospital wouldn't get their knickers too much in a wad.  Also, did you see an itemized bill?  They overcharge like crazy for some things.  IV fluids, Motrin.  I get off-setting all the people who don't pay, but my point is what they charge is not the true cost of services rendered.

 

Well a $95k bill that a hospital will (hopefully) knock 40% - 60% off for self-pay, is still less than 2 years of $2400/month premiums.  I know laws vary, but I think most hospitals can't and/or won't do anything if you're paying something.  $2000/month (saving the rest for routine care) seems like they wouldn't get their knickers too much in a wad.  

 

ETA: my other point is that if someone can afford to pay $2400/month in premiums, plus out of pocket costs before reaching their deductible, they might as well bank it and shop doctors and other healthcare services as long as they have a choice (I know one does have that luxury in an emergency).

Edited October 17, 2017 by CES2005

[FaithManor]

Around here no one knocks more than 10% off a bill for self pay.

 

They need their money the end. The hospital goes after you for as much as they can get. No mercy.

[TechWife]

First, I am sorry that happened, it sounds scary.

 

 

Regarding the cost, though...a $95k bill that a hospital will (hopefully) knock 40% - 60% off for self-pay, is still less than 2 years of $2400/month premiums.  I know laws vary, but I think most hospitals can't and/or won't do anything if you're paying something.  $2000/month (saving the rest for routine care--assuming the crisis doesn't result in on-going extra care) seems like the hospital wouldn't get their knickers too much in a wad.  Also, did you see an itemized bill?  They overcharge like crazy for some things.  IV fluids, Motrin.  I get off-setting all the people who don't pay, but my point is what they charge is not the true cost of services rendered.

 

Well a $95k bill that a hospital will (hopefully) knock 40% - 60% off for self-pay, is still less than 2 years of $2400/month premiums.  I know laws vary, but I think most hospitals can't and/or won't do anything if you're paying something.  $2000/month (saving the rest for routine care) seems like they wouldn't get their knickers too much in a wad.  

 

ETA: my other point is that if someone can afford to pay $2400/month in premiums, plus out of pocket costs before reaching their deductible, they might as well bank it and shop doctors and other healthcare services as long as they have a choice (I know one does have that luxury in an emergency).

 

Thank you, it was scary. Thankfully he is down to lab work and check in with the nephrologist every three months at this point. That will likely continue for the next year or two, then decrease in frequency as long as his condition remains stable. 

 

Hospitals aren't going to knock that much off of a bill. By law, they cannot charge any patient lower than the Medicaid rate. Yes, I did see an itemized bill. I can't comment on charges for simple things such as Motrin and fluids because my son received none of that - all of his IV's (nine running simultaneously at one point) were either delivering medications or blood & blood products. Of course the hospital doesn't charge the true cost of service rendered. In our system, we cannot expect it to be so.  

 

We have, as a culture, determined that affordable insurance is not a priority. The premise of insurance is that the insurance company is accepting the financial risk. When people choose not to enter the insurance pool or they are unable to enter the insurance pool, the financial risk is shifted to the hospital. We can pay more for insurance and less for care at the point of service or we can pay less for insurance and more for care at the point of service, but we really can't expect to have both a low cost insurance and see a reduction in cost at the point of service in our current system. Because the financial risk for the uninsured is borne by the hospital, they have to spread the cost of providing care to all patients, both paying and non paying, among the patients that do pay. In some cases, Medicaid payments don't meet cost, so the difference between the cost of the service and the Medicaid rate has to be spread out among the other paying patients as well. 

 

Personally, I think that having everyone in the pool is critical to the success of any national health insurance program. In the many years we did not need a high level of critical care, we were paying for those people on our insurance plan that did need it through our premiums. I don't think we saw the ACA implemented in full long enough to determine it's overall effectiveness. There were a great many people added to insurance rolls that needed a higher level of care because they had neglected their health due to not having the ability to pay for it. That is going to drive the expenses of the insurance companies up, but don't forget their revenues were going up through receiving increased premiums as well. As the general health of the population improves due to access to preventative care, the cost to the insurance company will go down. Ideally, we should then see premiums decrease, but that would be the decision of an insurance company that could decide to increase dividends to share holders instead and not decrease premiums. Without regulation, the insurance companies could continue to charge large amounts to premiums that may not be related to the cost they are incurring by paying claims. Insurance companies don't want everyone on their insurance rolls because they are then assuming the financial risk for everyone instead of having the hospital take on the financial risk of non-insured, non-paying patients. However, if everyone were in the insurance risk pool, we would see hospitals getting reimbursed for all of the care rendered. If the hospital knows it will get paid for every patient that steps through their doors, they can then charge prices that are closer to the true cost of care as the need for the paying patients to cover the cost of the non-paying patients has been eliminated. Most hospitals in this country do still operate as non-profit entities (even the corporations that own hospitals put the hospitals in a non-profit corporation), so they are not beholden to paying shareholder dividends like insurance companies are. As long as hospital executive salaries are kept in check, we would see the cost at the point of care stabilize and then go down as the hospital reduces the amount of bad debt that they are carrying over time. 

 

Now, regarding the "over-charges" that people see, or think they see, on their hospital bills.  That ibuprofen that many think is ridiculously expensive is actually the ibuprofen cost, time for the pharmacy tech to stock the pharmacy, storage costs, the computer system, the nurse that put the order into the computer, the pharmacy tech that filled it, the pharmacist that checked the order, the delivery system to the nursing unit (whether it be through med carts or pneumatic tubes), the time for the nurse to administer it and do the corresponding notations in the computer.  Then, added in there somewhere are the insurance costs to the hospital as well as administrative costs to ensure that all regulations are followed, non-bilable items (such as the food patients eat, the toilet paper, the housekeeping staff, the kitchen staff, the transport team, the power bill and on and on and on). When we consider all of that, it really isn't just the pill that is getting paid for - it's the entire package. Then, that price doesn't seem so unreasonable. 

Edited October 17, 2017 by TechWife

[TechWife]

The system is not remotely this flexible. 

 

 

Thank you for your very thorough explanation. I appreciate it! 

[Homebody2]

Thank you, it was scary. Thankfully he is down to lab work and check in with the nephrologist every three months at this point. That will likely continue for the next year or two, then decrease in frequency as long as his condition remains stable.

 

Hospitals aren't going to knock that much off of a bill. By law, they cannot charge any patient lower than the Medicaid rate. Yes, I did see an itemized bill. I can't comment on charges for simple things such as Motrin and fluids because my son received none of that - all of his IV's (nine running simultaneously at one point) were either delivering medications or blood & blood products. Of course the hospital doesn't charge the true cost of service rendered. In our system, we cannot expect it to be so.

 

We have, as a culture, determined that affordable insurance is not a priority. The premise of insurance is that the insurance company is accepting the financial risk. When people choose not to enter the insurance pool or they are unable to enter the insurance pool, the financial risk is shifted to the hospital. We can pay more for insurance and less for care at the point of service or we can pay less for insurance and more for care at the point of service, but we really can't expect to have both a low cost insurance and see a reduction in cost at the point of service in our current system. Because the financial risk for the uninsured is borne by the hospital, they have to spread the cost of providing care to all patients, both paying and non paying, among the patients that do pay. In some cases, Medicaid payments don't meet cost, so the difference between the cost of the service and the Medicaid rate has to be spread out among the other paying patients as well.

 

Personally, I think that having everyone in the pool is critical to the success of any national health insurance program. In the many years we did not need a high level of critical care, we were paying for those people on our insurance plan that did need it through our premiums. I don't think we saw the ACA implemented in full long enough to determine it's overall effectiveness. There were a great many people added to insurance rolls that needed a higher level of care because they had neglected their health due to not having the ability to pay for it. That is going to drive the expenses of the insurance companies up, but don't forget their revenues were going up through receiving increased premiums as well. As the general health of the population improves due to access to preventative care, the cost to the insurance company will go down. Ideally, we should then see premiums decrease, but that would be the decision of an insurance company that could decide to increase dividends to share holders instead and not decrease premiums. Without regulation, the insurance companies could continue to charge large amounts to premiums that may not be related to the cost they are incurring by paying claims. Insurance companies don't want everyone on their insurance rolls because they are then assuming the financial risk for everyone instead of having the hospital take on the financial risk of non-insured, non-paying patients. However, if everyone were in the insurance risk pool, we would see hospitals getting reimbursed for all of the care rendered. If the hospital knows it will get paid for every patient that steps through their doors, they can then charge prices that are closer to the true cost of care as the need for the paying patients to cover the cost of the non-paying patients has been eliminated. Most hospitals in this country do still operate as non-profit entities (even the corporations that own hospitals put the hospitals in a non-profit corporation), so they are not beholden to paying shareholder dividends like insurance companies are. As long as hospital executive salaries are kept in check, we would see the cost at the point of care stabilize and then go down as the hospital reduces the amount of bad debt that they are carrying over time.

 

Now, regarding the "over-charges" that people see, or think they see, on their hospital bills. That ibuprofen that many think is ridiculously expensive is actually the ibuprofen cost, time for the pharmacy tech to stock the pharmacy, storage costs, the computer system, the nurse that put the order into the computer, the pharmacy tech that filled it, the pharmacist that checked the order, the delivery system to the nursing unit (whether it be through med carts or pneumatic tubes), the time for the nurse to administer it and do the corresponding notations in the computer. Then, added in there somewhere are the insurance costs to the hospital as well as administrative costs to ensure that all regulations are followed, non-bilable items (such as the food patients eat, the toilet paper, the housekeeping staff, the kitchen staff, the transport team, the power bill and on and on and on). When we consider all of that, it really isn't just the pill that is getting paid for - it's the entire package. Then, that price doesn't seem so unreasonable.

Thank you for saying all of this.

[Zinnia]

My dh's company just sent out a letter warning of the coming rate hikes. They are also including different rates across salary bands. My dh is well paid for his company, and I am afraid that will hit us hard. His company is not known for great benefits, and most people choose to be on a spouse's insurance if possible. Without me working, that's not an option.

 

But needing a warning letter 3 weeks out doesn't bode well for affordability

[lynn]

DH company said they are able to keep premiums down  this year.  We have not seen the enrollment package yet so I'm curious what rates did not up.

[Guest]

My healthcare, as a woman, has deteriorated since the ACA. The HMO cites the "national studies" (ie, the "death panels") for why screenings and tests have been eliminated.

 

I absolutely don't want single payer. Switzerland and Australia both have hybrid systems wherein gov't pays for baseline care for everyone, and individuals pick up private insurance to pay the rest. I'd be intersted in learning more about that and the pros and cons. That sounds like Medicare.

[Laura Corin]

I absolutely don't want single payer. Switzerland and Australia both have hybrid systems wherein gov't pays for baseline care for everyone, and individuals pick up private insurance to pay the rest. I'd be intersted in learning more about that and the pros and cons. That sounds like Medicare.

 

We have something similar in the UK, although most people don't bother with top-up insurance.  I'm happy to answer questions.

Edited October 17, 2017 by Laura Corin

[goldberry]

DH company said they are able to keep premiums down  this year.  We have not seen the enrollment package yet so I'm curious what rates did not up.

 

The company I bookkeep for, their rates went up but they kept employee contribution the same.  They try really hard not to raise it every year for the employees even when their rates go up.  It's possible the company is just absorbing the cost, or they changed their package to get a better price.

[goldberry]

Well a $95k bill that a hospital will (hopefully) knock 40% - 60% off for self-pay, is still less than 2 years of $2400/month premiums.  I know laws vary, but I think most hospitals can't and/or won't do anything if you're paying something.  $2000/month (saving the rest for routine care) seems like they wouldn't get their knickers too much in a wad.  

 

ETA: my other point is that if someone can afford to pay $2400/month in premiums, plus out of pocket costs before reaching their deductible, they might as well bank it and shop doctors and other healthcare services as long as they have a choice (I know one does have that luxury in an emergency).

 

 

Around here no one knocks more than 10% off a bill for self pay.

 

They need their money the end. The hospital goes after you for as much as they can get. No mercy.

 

What Faith said is correct.  I don't know when it changed, because I still hear that argument all the time, but I don't know of any states where hospitals act any differently than any other entity regarding bill collection.  They will send you to collections faster than some other agencies in our area.  Regarding the percentage, the internet says it's worthwhile to keep arguing to try to get to 30% off.  My experience is that sometimes that works and sometimes it doesn't.  My doctor gives 10% off max.  

 

Also the problem with paying those bills in the long term is how many people develop chronic illness that requires ongoing treatment and may result in disability.  So the bills keep accumulating and then you may not be working enough to pay that same amount every month anymore.  

[Bluegoat]

My healthcare, as a woman, has deteriorated since the ACA. The HMO cites the "national studies" (ie, the "death panels") for why screenings and tests have been eliminated.

 

I absolutely don't want single payer. Switzerland and Australia both have hybrid systems wherein gov't pays for baseline care for everyone, and individuals pick up private insurance to pay the rest. I'd be intersted in learning more about that and the pros and cons. That sounds like Medicare.

 

France's system is also supposed to be very good.

 

There has been a lot of research going on with screenings and things like yearly physicals which seem to indicate that they aren't an effective use of resources.  Many health systems are phasing some of these things out, or reducing their use, or changing the parameters.  For example, a few years ago they raised the age to begin certain procedures related to PAP smears here - they found that doing them in very young women actually increased problems, rather than preventing them.

 

So it may be more a matter of the direction of best practice, at least for some things.

[ktgrok]

Listened to a bit about this on the radio today. An interesting aspect was one of marketing, which surprised me. Basically, you need younger, healthy people to get insurance to keep costs reasonable. But if it is hard to enroll, or they don't know how, they will just risk skipping insurance. Meanwhile the people with cancer or diabetes will do whatever they have to to sign up, even if it means hours on the phone on hold, whatever. So California spends a ton on marketing, and keeps open enrollment open longer, and in response they get more healthy people signed up, which lowers costs and keeps the insurance companies happy....which is one of the reasons they still have 11 plans to offer in that state versus what is happening in other places. If the insurance company knows only the very sick are likely to sign up they will cut their losses and run. 

 

Of course, we just decided to shorten enrollment periods, cut the marketing budget to 1/10 of what it was (and the marketing budget also goes to upgrading the sign up websites), take away payments to the insurance companies, stop enforcing penalties for not signing up, etc. Basically, everything possible to make sure only the very sick sign up. Sigh. 

[Arctic Bunny]

..... if one can't come up with the cost. They are amazed that we put up with it. Wondering if one should go to the ER or not due to cost? Unfathomable. Jars put out next to cashiers to assist with cancer (or other) treatments? Unheard of. Declaring bankruptcy due to too many medical bills from an illness or disease? Why do we put up with it as a nation....

.

Unfathomable, exactly. I had an annual physical, where the dr thought he felt something in my right breast. After my physical, the nurse in the office booked me in at the radiologist (completely different business, not affiliated with the office at all) and gave me a dtap booster. Radiology appointment made for 3 business days later. Full mammogram, with the pics sent to my dr while I waited about 3 minutes. He requested additional views and an ultrasound. I didn’t have an appointment for that, so had to wait about 30 minutes. Doctor will call me with the results either way in 2-3 days. Cost to me (that isn’t my tax dollars at work): $0

 

If we lived in the US, would I have even gone for an annual physical? What kind of choice would I have to make? I don’t know, maybe all that would have been covered?

[Guest]

Why is open enrollment a thing? I can buy life insurance, auto insurance, homeowners insurance, etc., any old time. No snark (well, mostly no snark) why do we have to get health insurance in this tiny window??

[emzhengjiu]

In the "old" days of insurance,pre existing conditions were a great fear of mine. I'm praying we don't return to those days when I was afraid to see a doctor.

[kiana]

In the "old" days of insurance,pre existing conditions were a great fear of mine. I'm praying we don't return to those days when I was afraid to see a doctor.

 

Yes. I've recently started treatment for something that ... frankly, I would have avoided treatment for or getting diagnosed with if the pre-existing condition thing hadn't been nixed. I'm really scared to change jobs now. 

[brehon]

Why is open enrollment a thing? I can buy life insurance, auto insurance, homeowners insurance, etc., any old time. No snark (well, mostly no snark) why do we have to get health insurance in this tiny window??

Open enrollment has been present in the marketplace for decades - long pre-dating the ACA.

 

Although I agree with you in principle that health insurance should be open like auto insurance, I think the fact that most health insurance in this country is still tied to employment is one one major reason why we have open enrollment periods. Employers simply can’t devote the time, money, or effort to constantly negotiate different plans with different insurance companies throughout the year. What a nightmare that would be.

 

I suppose the exchanges followed an already existing model. Most employees choose plans (in employer-based insurance) in the latter part of the fiscal year; so, I imagine the exchanges followed suit.

[ChocolateReignRemix]

Because you can’t pressure people into a bad system without a credible threat like a fine, and you need a drop dead day to apply that sort of thing.

 

Also, since they had to compel people who didn’t want their crap product to buy it, and open enrollment allows for that but theoretically limits the amount of people picking up coverage just a day before using it for major medical, essentially. And since the fine is levied against tax refunds there needs to be clean fiscal timeframes for it.

 

Joy, right?

So in your mind open enrollment periods didn’t exist before the ACA?

[ktgrok]

My understanding is that if you didn't have an enrollment period that was limited, people just wouldn't pay for it/enroll until they have a medical issue. 

[TechWife]

If we lived in the US, would I have even gone for an annual physical? What kind of choice would I have to make? I don’t know, maybe all that would have been covered?

The annual physical and mammogram would both be free at the point of service under the ACA. The more detailed diagnostic mammograms might be covered differently and subject to a deductible, I'm not sure.

[TechWife]

Why is open enrollment a thing? I can buy life insurance, auto insurance, homeowners insurance, etc., any old time. No snark (well, mostly no snark) why do we have to get health insurance in this tiny window??

To prevent people from only enrolling in insurance when they are sick. The risk pool needs both healthy and unhealthy people in order for the insurance to be affordable. That's also why the ACA initially had a requirement for everyone to have insurance. It's also why those who have national plans cover everyone.