Both of the pedi's I have used have fever/antibiotic flyers on bulletin boards their patient rooms. They don't call attention to them, but they are there. However, both of these pediatricians have been intrinsically linked with a hospital system and are not more or less "free standing". The nature of the relationships between doctors and hospitals has also been drastically changing and is another significant factor in where this mess is heading; and I'm not sure, may also be another factor drastically different from the universal systems as well. Stefanie

I think it would generally lead to more interest in actually evaluating treatment options and increased education, not just the public, but by the docs as well. And many people absolutely get more than they need and are never educated otherwise. Here is an example: Basic oxygen monitoring is a pulse oximeter. When DD was an infant she was on oxygen. It would have cost $500 to rent a pulse ox. The hospital wanted to force us to get an apnea monitor, didn't even mention the pulse ox, which would have cost at least $1,000. We managed to negotiate a pulse ox because DH is a nurse. The difference....one would alarm after she'd 'stopped breathing' long enough to drop her oxygen saturation and one would show how oxygenated her blood was at a glance at any time AND alarm at less than 92%. If we hadn't worked in health care and hadn't known better, we wouldn't have even been given the option to evaluate what was best for us and what risks we were comfortable to take. It didn't matter what the cost actually was to us as insurance was paying 100% by then, but we felt the apnea monitor was more risk than the pulse ox. It also shows the basic lack of regard for the costs of things when third party payers are involved, who cares how much it costs....its what the doc wants even if there is a better, least costly alternative. Stefanie

You absolutely can shop around for an open heart surgeon, its just a very limited shop due to insurance. Most open heart surgeries are not emergent and are in fact "preventative" in nature. There is also very differing ideologies in preventative cardiology that affect the necessity of needing open heart surgery later. Open heart surgery would also be catastrophic. I am not talking about paying catastrophic or chronic costs OOP. I'm talking about *routine* care. Basic check ups, medical and dental, basic vaccinations, basic, short term use medications, lab work, diagnostic xrays. Those most certainly could be shopped around but most times aren't because of insurance. And I can't for the life of me see why any of those services should be so cost prohibitive as to essentially require a 3rd party payer in order to be able to afford to utilize them. I also can't for the life of me see why I should have to shell out thousands of dollars a year, either in ins. premiums or taxes, for those services either. The only reason I can see why they do cost so much today is the horrid mass of regulations, write offs, gov't subsidies, etc. that have evolved around health care (and a few OT social problems too) in the decades since health insurance was dreamed up. Stefanie

Haha....I will admit, my big boy is the most trained of my 3, although the girls are pretty good too. He had to be. He was the only one that could literally drag me down the road or knock me over.

Agreed, it was a bad, example and one I was hesitant initially to use. I just couldn't think of a better one at the time. Lovinmyboys post about the tonsils is really more what I was trying to get at. If someone was paying OOP in a similar situation, would they have been a bit more diligent in examining their options before agreeing to a medical procedure?

That is because costs are insanely out of control at this time. If costs were reasonable a much greater segment of the population could afford most routine/preventative care. Go back and look at the kind of bills that people had back in the 50s. For those interested......here are some breakdowns from some of our itemized hospital bills from this year. The vet charges are from a bill from 2012. 1000mL of normal saline - charge $113 per bag. Cost to obtain....about $2.50. plastic urinal - charge $31 12 hours oxygen - charge $480 plastic bulb syringe 2 oz- charge $33 Complete blood count - hospital charge $132, my vet's charge $37 Basic metabolic panel - hospital charge $591, my vet's charge $65 Why is there *such* a discrepancy? Why can I pay $2,500 total for an OOP Lasix procedure and three follow up eye exams; and yet a simple blood test from a hospital costs 1/5th of that? Why are the same tests, using the same machines that much cheaper at a vet than a doc? Is it because I would have to pay for it myself?

Agreed, fevers have a biological purpose, so unless it is getting dangerously high I usually let them run its course without intervention. And in my example, presumably the people are going to the ER because they DO want treatment, they just don't want to be personally responsible for it. Otherwise, why bother sitting through the ER wait at all, wouldn't it just be easier to ignore the fever? Stefanie

Well, then they would fall into the "some, no" category wouldn't they and you could still argue that behavior is a symptom of "something for nothing". But there are many points along the way in health care where people don't question or examine their options when they don't have to pay out-of-pocket for it. Stefanie

They can get pretty big (and eat a ton), hunting lines may trend a bit larger generally. My purebred Lab has been 115 lbs his entire adult life. He was 95 lbs before he was a year old. His paw is the size of my palm. And he's so smart and sweet. Stefanie

My major complaint #2. You are not your insurance company's customer, your employer is.....so you have no real say in the decisions being made there. Stefanie

Everyone pays for their own *routine* care and then if the gov't would get out of the way some, the market can be quite inventive for a wide variety of plans. Really, I can get a check up, the same x-rays, ultrasounds, labs, and meds for my dog from the vet as I can for myself from my doc; and pay a ton less. No, I'm not comparing people to animals; I'm comparing costs for the EXACT same services. There is nothing intrinsically different.....so why is the cost so much greater for us? For the record, my husband has been using our deceased dog's prednisone for years to fight off lingering sinus infections, it cost us $36. But again, this is my ideal, not what I think is necessarily do-able based on how out of control costs currently are. As for how gov't/insurance driving up costs....it's because neither actually pays the full costs. Medicare/Medicaid pay by schedules. The way medicare pays hospitals is by admitting diagnosis. So, if you go in for pneumonia and Medicare has decided that pneumonia is a 4 day stay, they will pay for 4 days, and ONLY 4 days. If you leave after 3, great the hospital made money on you. If for some reason you don't respond well to treatment and you stay 5 or 6 days....well, too bad, hospital lost out on money and they'll have to eat the cost of your extra days stay. Very much a simplified example, but what generally happens. It is generally well understood that businesses "pay taxes"....they pass them on to the customer via price. Same thing. The hospital doesn't just eat it, they try to get it back by increasing the costs of care. Same thing happens with insurance. The contracts the doctors have with the different insurance carriers have agreements to "write off' portions of the bills, once again leaving those costs uncovered and to be made up elsewhere. It really isn't about paying for private insurance or private treatment. Both are a bit unrealistic to your average person right now because of the constraints of the system and realistically has been for decades. I would 100% do both if it were a viable option. But bottom line, your generally 100% elective surgery options (Lasix/boob implants) are so much more affordable in the grand scheme of health care costs because they know they have to appeal directly to the consumer. Stefanie

You are reading in too much. Its just very well known that generally across the board, people don't take as good care of the things don't have financial stakes in. Health care is no exception. When you remove the individual from the costs of their health care....the vast majority get lax. It doesn't have anything to do with being able to look into a crystal ball and seeing what your health is going to look like in 20 year. It is about making better choices on the whole. Some may make better choices about their lifestyles, but I really mean more responsible, non-lifestyle, choices as a whole, across the board. To go fall back on the extreme stereotype (which is actually fairly common), the person on "gov't insurance" who waited 8 hours in the ER because they wanted the "free healthcare" to give their kid the Tylenol so they didn't have to go buy it. You really have to ask yourself, if there had been some cost to the the person for the ER visit, would they have just gone and gotten the Tylenol from the store? Some, no, many more others, yes. Yes, extreme example, but I see this behavior and type of thinking to some extent infiltrating everywhere. I just think it cultivates a "something for nothing" attitude; with the lovely bonus of skyrocketing costs. Stefanie

They can't.....it's too wrapped up in red tape. Stefanie

We don't use a top sheet and each use our own blanket. I'm a light and sensitive sleeper. I don't like how top sheets press on my feet when they are tucked at the bottom and I don't like breezes. I don't like being touched in my sleep either. A top sheet exacerbates all those issues for me and it is much easier to shove DH back over to his side of the bed without one. ETA: When we travel I rip off the top sheets almost universally. Stefanie

Amen. I said it up thread....I really think health insurance should be kind of like car insurance. Can you imagine what car insurance would cost you if they paid on a similar structure for gas, inspection, repairs, etc. Can you imagine what would happen to the costs of gas, inspections, repairs if it worked like health care. Stefanie

Because I don't think insurance/gov't health care does much but drive up costs. I think our routine care could/should be affordable enough to actually pay it all out of pocket leaving people to pay for plans that generally just cover catastrophic or chronic issues. I don't think health insurance should be provided through any 3rd party; employers or government. When you look at how health insurance developed in the states, you can understand a lot of the problems we have today with it. But that is the way I think it should work, not necessarily what I think is possible to achieve after the long years of health care decline. So, in my mind, universal health care is so much more of a step in the wrong direction. But the bolded isn't quite true now is it....you may not be paying directly at point of service, but you ARE paying in the form of much increased taxes. And every year those "costs" go up due to many different factors. And a vicious cycle begins when people are not generally held responsible for their personal choices and are removed from the consequence of their choices. It is generally accepted that it is generally a bad thing when a parent shields their children from consequence, I don't see most of life all that differently. In this case, the choice has been removing the public from their role in making their own insurance choices (employers and gov't make those choices) and the bad thing that has happened is that health care costs have bloomed out of control. Stefanie

I don't particularly care. I don't care for universal systems for the same reason I don't particularly like the current system. Stefanie

No thank you. Stefanie

Oh, yes, the bills can get horrendous. Several years ago, I had an out-of-network emergency c-section and my DD was in a NICU for 3 months over the new year, 2 months of that was out-of-network. When she was transferred to our hospital she *HAD* to be flown in.....at a total cost of $12,000. They wouldn't let her go in an ambulance because they had a 75 mile transfer radius for ambulance. Fortunately our plan has odd dates and everything was covered under 1 year until we were home and the only thing affected was a couple of weeks of home oxygen. Her bill was 150K+. Our OOP max was fairly low then, even for out-of-network and I think we paid 3k. And again this year we had another catastrophic accident and one of my stepsons broke a hip and jaw, his bill was just over 100K, but now our plan isn't as good, and we have bills for over 8k. Not to mention he has 3.5K of additional dental expenses to fix general cavities from the jaw, and another doc wants 3.5K before he'll even consider finishing (and charging more money) the cosmetic work on the actually broken teeth. Thank goodness this year they offered additional accident insurance policies and DH took one out. It went a long way to covering the majority of the main bill. Stefanie

I'm not confusing them. I've personally been told my pedi they won't see my grandchild because he is medicaid, go to the medicaid clinic and I've seen the signs in more than several doc offices saying "not accepting new medicare patients at this time". The ones that are typically still accepting or are at the medicaid office in the area are *NOT* our best docs. Specialist sometimes don't have much choice though. Several have told us payments schedules as some form of the reason why they are not/can not accept that type of patient. And I lumped them together because BOTH are not accepting.

I have enough experience with both thank you very much. I know how my previous employer (non profit hospital) gets reimbursed by medicare (and in many cases it isn't adequate), and I was told by my grandchild's pedi that they would no longer see him just because he was a medicaid patient and he now had to go to the only medicaid clinic in town....which I know the docs are not the best quality in town. I also know that my doc isn't taking any new medicare or medicaid patients, my husbands doc isn't taking any either, and numerous docs my husband has talked to via work are not taking new patients. They aren't refusing medicare/medicaid, they are just refusing *new ones* but they all cite medicare/medicaid repayment/regulation isn't worth taking on new patients for. One complaining doc was a nephrologist (and those are limited supply) saying that medicaid wouldn't pay out if a patient's lab values didn't meet certain parameters....like the doc can enforce a patient's compliance/response with the treatment plans. Honestly, I know what I would like health insurance to work....like car insurance; ie catastrophic. If health insurance hadn't acted like pre-paid health care for all these years I think costs would be much more manageable in general. I'm just not sure it can act that way now or how to get it back to where it can act that way. My DH and I are seriously considering dropping insurance and just signing back up if something happens. My state has opted out of the exchanges, as have I believe most states have, which, according to the law make them ineligible for subsidies. But my gripes against the ACA go much farther than just insurance premium costs and lead into the doctor/nurse rationing measures. Stefanie

I don't consider those things discipline....those are guidance/redirection/removal in order to teach self control and proper behavior. Safety related commands are always enforced immediately and at this age I don't wait to see if he'll comply on his own, I do it for him. Discipline is time out/spanking/other consequence such as additional chores, all of which I consider inappropriate at this time. His parents don't. They want us to spank for him pulling away or grabbing things or expressing his autonomy and desires for personal space. They were spanking (hand and diaper though not hard) him for grabbing when he was 6 months without doing any set up in order for him to be successful at *not* grabbing. They want us to discipline him for saying 'no' or turning away from hugs/kisses/tickles or invites to play. Honestly, the kid is pretty freaking well behaved for 19 months and follows commands well, even if sometimes it takes a little cajoling. He isn't the toddler that goes around hitting, biting, and pushing the other kids over.

I wish that was all it was here.....but they have such a global unrealistic expectation of age appropriate behavior and his ability to understand across the board. Several times during their visit I heard them "discipline" for hitting. All I know is, the child doesn't hit, so I can only assume they were interpreting him pushing them away as "hitting". He doesn't bite. He's actually very well behaved in that way for a 19 month old and redirects very easily, but when he is upset, he *really* doesn't want you to touch him. But there is a reason why we are his guardians......

Providers and participants are most certainly NOT happy. Many of the doctors in my area will not accept new medicare/medicaid patients. This forces those patients to have a very limited, and honestly, IMO very substandard choice of doctor (I generally know most of them and their abilities) and *long* wait list times before being seen.....for a general practitioner to do routine management care. Some people even have to leave the doctor they have had relationships with because they will no longer accept medicare/medicaid. The hospitals are NOT happy with their payment schedules that only pay out a certain amount by admitting diagnosis and not based on what goes on with the patient during treatment or what the actual cost of treatment actually is. Stefanie

We did too...and DH works for a hospital so they basically self-insure and we are primarily limited to their system providers. It was wonderful for things like MRI, urgent care clinic visits, lab work. Imaging cost us like $200 co-pay and that was it. Now, it is $500 co-pay and 20%. Urgent care clinics were $25 co-pay and 20%, now it is $150 plus 20%. DH went to urgent care for dehydration recently. All he got was 1 bag of IV fluids. We paid $150 co-pay plus got a bill for over $500. Full ER visits were $125 copays, now $250 and 20%. And we are paying a pretty penny every payday. We paid OOP for a flu vaccine at Wal-greens because it was cheaper to do it that way than to go through insurance. Not to mention, we've been going round and round with our pedi for months over insurance not recognizing flu shots for the kids and they are insisting we pay for those OOP. Also really telling: this year was the first year ever that DH had to certify that a spouse was unable to insure themselves via their employers and that if I was able to get my own insurance and opted to be on his plan we'd have to pay an extra charge per payday. More expense for less coverage all throughout the plan. We went from *great* insurance to pretty poor, and still more expensive insurance this year. But the ACA is only part of the problem, the main problem is that the way health insurance/medicaid work is what propels the continuous health care cost increases. Also, I'm not sure how many of you realize, but insurance companies have insurance policies for those 100+K bills. Stefanie