Free Birth Control; Children Up to 26; Pre-Existing Conditions; Free Mammograms, etc. If these matter to you...

[creekland]

Along the lines of not knowing the future... I had to edit my post to change "no type of cancer does" to "no type of cancer did" run in my family.  If you've happened to read a couple of other threads I've posted on, you might know my mom is now dealing with esophageal cancer - adenocarcinoma - and it's spread to her liver (all news we found out in varying stages from Nov - Jan).

 

Who gets this?  It's only 1% of cancer diagnoses, so not many people.  MEN get it 3-4 time more than women. Smokers and heavy drinkers get it as do heartburn sufferers.

 

http://www.cancer.org/cancer/esophaguscancer/detailedguide/esophagus-cancer-key-statistics

 

https://www.cancer.gov/types/esophageal

 

My mom ticks NONE of those boxes.  She's female.  She's never smoked (nor did my dad or her parents or workplace atmosphere - no major secondhand smoke exposure).  She has a glass of wine occasionally, but I've never seen her tipsy much less drunk.  She didn't have any symptoms of heartburn - nothing more than the occasional "after Thanksgiving dinner" version anyway.  No one in her family had cancer (not that we know of anyway - in history - who knows)?  She had NO symptoms of this (it was discovered due to a heart issue she had).

 

So you tell me how she drew her "lucky" straw... we're baffled.

 

Fortunately, she has decent medical insurance - but only if Medicare sticks around. (or something equally as good with no gaps)

 

One might be able to predict they won't have a baby (hubby sure isn't likely!), but I don't mind paying for those out of our monthly shares... one can't know their future - nor can one just "live right" and know they'll "miss" the bad stuff.  I wish it worked that way, but it doesn't - not guaranteed anyway. (sigh)  And I'd give a ton to have her "paying in getting nothing for her money."  She's 73 - not bad, right?  Well, her mom lived to 94 and her dad to 88.  None of her 5 siblings have passed away or are likely to (unless something sudden).  We're kinda feeling cheated out of 15-20 years and that will include things like seeing my youngest graduate from college and any great grandkids, etc.  All for a cancer she isn't supposed to be a candidate for.

 

What would be worse?  Having to pay the bills on top of the rest of it... or knowing some things couldn't happen because we couldn't afford it.

 

No one facing health issues should have to worry about the financial end of it - not in a first world country.

Edited January 13, 2017 by creekland

[MEmama]

Can I ask you all (all political views)? Do you think the system you have over there works for the majority (at least 90%). Can you say you have never worried yourself sick about premiums, cover, costs etc? If you were designing a system from scratch who would you model it on?

No. It definitely doesn't work. To tie insurance to one's job--never mind the whims of our politicians-- is a recipe for disaster and this country is living proof.

 

Yes, I lose so so much sleep over it. We've been incredibly fortunate, but it's not all about us, you know? And fortune is tenuous at best, as we are witnessing.

 

Not sure. We had universal coverage in Canada, but it was far from ideal. We paid about the same for insurance but the care was pretty poor compared to what we are accustomed to in the US. However, everyone gets basic care and that's a fundamental human right, IMO. They are on the right track, but the cracks in the system looked very familiar through our lens.

 

I think there must be a combination public-private system that would work here, ensuring complete coverage for all. I don't think it's as difficult as we've made it out to be, but that's our American exceptionalism as work. Sure it might work in all other first world countries, but not here..bah.

Edited January 13, 2017 by MEmama

[PeterPan]

Isn't it a good idea to catch things before they become catastrophic?  If one has to pay out of pocket for the less serious things, isn't one more likely to ignore the minor that turns out to be a symptom of something major, allowing it to worsen?

 

Ok, but did you read the rest, that my catastrophic plan *includes* an annual doctor visit for each person, $250 in testing per person, AND ALL ROUTINE CARE like mammograms, vaccines, etc.? And that was with an affordable, catastrophic plan, pre-law change. What you're saying people should have, WE ALREADY HAD. But we had it because we had a small business and could have an HSA. One of the things they're debating is letting EVERYONE have access to HSAs and lifting the caps on what you can put into your HSA. 

 

I know that doesn't deal with questions about people who can't afford to put into an HSA, etc. My only point is there are other types of approaches besides universal, complete medical coverage that could get you there. 

[creekland]

However we're leaping from wanting everyone to have access to catastrophic coverage to saying everyone ought to have premium coverage of everyday issues. 

 

I fail to see what's wrong with this TBH.  Everyone ought to be able to take their kid to the doctor on a suspicion that something is wrong or for the flu and not have to worry about the cost.  Anyone who wants a mammogram or vaccines or feels they need to check in with the ER about chest pains ought to be able to do so without worrying about the cost or networks.

 

Those of us who can afford these costs think nothing of it.  We can pay.  Many can't.  I care about them and don't mind paying to help them out, but as much as I want to, we can't afford to help everyone.  A national program could.  I want a national program that does.

 

It's not what we have now.  It's not health share even though that works for us (there are gaps with health share - it doesn't work for everyone).  But eliminating what we have now without having a new equally as good or better replacement plan that will take effect immediately has massive potential for hurting so many... 'cause we all know how sympathetic insurance companies are.

 

Powers that be (non-partisan - all of them) need to talk out their options first and iron out what will happen - then change things - not "drop it all" and then talk about it.  Many of us fear nothing will happen if things happen in that order - and many will literally suffer while others happily rake in the money.

[PeterPan]

Part of the problem to me is the lack of transparency of the part of providers about cost. I tried calling to get info on what a big evaluation would cost and couldn't get a direct answer from any providers office. As a consumer, I feel this information should be more available so I can choose for myself the balance of cost vs provider.

 

I did it for my granite counters (got many estimates. Prices ranged from $3,500-5,000.) So why shouldn't I be able to find it out before doing a medical appointment, evaluation, lab test or x-ray.

 

The second problem is with crazy billing practices and disallows. My sister in law had a line item the other day that was $1200 for a blood test. It was disallowed down to $90.Over 90% discount. It is such a broken system.

 

Bingo. And the reason we can't get quotes is because they aren't worried (neither consumers nor providers) about the cost. As long as it just mysteriously gets paid, there's no competition, no motivation to shop around or get prices down. Take for instance the cost of vaccines at my ped. Do I know what they cost? Nope. Did I shop around? Nope. Now maybe the insurance holds it down by specifying what they'll pay. But I see this over and over, that I ask for costs and the provider has to scurry to figure something out. 

[Guest]

Creekland I am sorry you feel cheated. I too have a disease that no one ever in my family had, but thats because they didnt have folic acid added to their food supply.Neither of my parents made it past 53, despite their parents living into their late 80s. One of my grandmothers never saw a doctor...she couldnt afford it as she was living in a rural area, self subsistence farming on her homestead. Cost of health care wasn't an issue for my parents since they were military - the real problem was lack of expertise. The research simply hadn't been done...both medically and technically. The brain tumor that was inoperable 25 Years ago is operable today. The epilepsy hasn't been solved. We need more than symptom care, but that calls for schools that will allow the top 25% to access AP level,.affordable college with enough seats in med school and stem, and research funding.And we all need affordable nutritious food.

Edited January 13, 2017 by Heigh Ho

[umsami]

Totally agree with transparency.  I've actually seen a website that lets you see a basic cost range for a procedure.  I also found some website that would let me kind of bid out self pay procedures.  It was cool!  I will look for it.  Also, regarding quotes, if you ever need to negotiate a self pay rate, you can ask for the medicaid/medicare rate.  Providers who accept Medicare and Medicaid are not allowed to charge less, but I know that's what DH offers when he has cash pay patients.

 

I think that Medicare/Medicaid should be able to negotiate with big pharma over drug costs.  It kills me that legally they cannot do that.    I realize that we subsidize drug research for the world that way, but something needs to change.  It's simply not fair.

 

We also need to do something about patents/profitability.  Not enough are working on antibiotic resistance or orphan diseases because they don't pay.  Perhaps all drug companies need to contribute a percentage of revenue into some global fund which funds that sort of research...or even allocate headcount towards it.  Maybe they get longer patents on profitable drugs for helping in this arena or doing the work.  No idea really.

 

I think basic healthcare is a right... especially in a first world country.  I think some sort of universal care is the only thing that makes sense, however costs need to be regulated (including malpractice and medical school costs.)  One interesting thing is that in Egypt, if you are poor, you go to a teaching hospital.  The cost is minimal because residents are learning on you.  I realize it would be two tiered, but still perhaps that's a solution.   If you allow residents/fellows to learn on you (supervised, of course), your care is free or substantially reduced.... however, you can't sue them either.  

 

 

ETA: Oh ArticMama, if a health share is working for you and your family, I would let them know.  Because there are no guarantees that they would be legal/allowed in anything that comes next.  

 

 

Edited January 13, 2017 by umsami

[Laura Corin]

Ok, but did you read the rest, that my catastrophic plan *includes* an annual doctor visit for each person, $250 in testing per person, AND ALL ROUTINE CARE like mammograms, vaccines, etc.? And that was with an affordable, catastrophic plan, pre-law change. What you're saying people should have, WE ALREADY HAD. But we had it because we had a small business and could have an HSA. One of the things they're debating is letting EVERYONE have access to HSAs and lifting the caps on what you can put into your HSA. 

 

I know that doesn't deal with questions about people who can't afford to put into an HSA, etc. My only point is there are other types of approaches besides universal, complete medical coverage that could get you there. 

 

Sorry - I was assuming that by 'routine care' you meant regularly-scheduled visits such as the mammograms and annual visits you mentioned.  I was talking about that visit to the doctor because of irritating numbness in the toes that turns out to be diabetes.

 

[lovinmyboys]

I would model it on a system that is already in place.

 

I have been blessed to have had Tricare (or equiv) for 40 years now. Our premium is low. Our co-pay is low. No, it's not on par with getting care at Cedar-Sinai, but I can take my kid to the emergency room when I need to. I can get an appointment for any of us, when I need to, with doctors who care, but just like any other doctor are rushed for time. Our doctors are paid for on a salary - they aren't in it for the big bucks. There aren't kickbacks. Yeah, sometimes the care is a little......wonky....but it's there. And I can pay to see a doctor "out of network".

 

I have had my kids in both a civilian and a military hospital. The only difference was less amenities. I shared a room in the military hospital and didn't have access to internet. I had good care in both.

 

We already have a civilian counterpart to this - Medicaid/Medicare. If we expanded it for all and did away with health insurance (which is really more like a health tax), and just gave people what they needed, we could eliminate ballooning costs.

My Dh is just a reservist so we have had Tricare on and off for about 15 years. I was under the impression that military doctors had their schooling paid for and that is at least one reason they work for less money. When we moved to our current city it took me a long time to find a pediatrician who was accepting new tricare patients. I asked the pediatrician we finally found about it, and he said that most of the time they don't even break even with tricare patients. According to him, every practice around here did take tricare patients, but they capped it at a certain number. Patients whose insurance paid more helped make up the difference. I don't have any reason not to trust him, but I can't independently verify that. I know civilian doctors make a good income, but they usually have a lot of school debt. The family doctors/pediatricians I know definitely aren't "rich."

 

I have only used military doctors twice and both times I was thoroughly unimpressed. It is a very small sample size, so I try not to generalize.

 

One thing I was surprised about was how busy the military emergency room was. I thought if everyone had health insurance he ER would be less busy. My guess is that they couldn't get into their primary doctor as quickly as they needed to, so they went to the ER.

 

I will say that my Dh has always worked for large employers so our civilian insurance has been preferable to tricare. My main point is that if we had a national program like that it would have to pay health care providers more which means it would cost more to run. The reason Medicare and tricare can pay so little is because other insurances pay more to make up the difference.

[umsami]

Yes, some military physicians did have free medical school...either directly (Uniformed Services University of the Health Sciences) or scholarship....or even loan forgiveness, but some also just enter the military as a way to serve their country, later in their career.  

[lovinmyboys]

My opinion is that preventative care costs more money then it saves and most of it is unnecessary. My kids are healthy and over the age of 3. They do not need a well check every year. I even asked my pediatrician if they ever catch anything at well visits and he said rarely (once a child is older). Usually a child is having symptoms so the parents bring him in. Most young adults don't need yearly checks. I have to go see my dr every year to get my birth control pills. That is a waste of health dollars.

 

Another way to save money is to have nurse practitioners do well checks and routine office visits. I think some other countries do this. Doctors are for things more complicated than routine strep throat.

[Guest]

You can have tricare standard and never see a military doctor, as a dependent (wah-wah for the member) in almost all oconus locations FYI. And yes, it's wonderful.

 

If pricing would get under control these conversations would be 99% less contentious.

 

When I went to the ER by ambulance last year, I/insurance was charged for the stupid rough grey blanket they put over my feet in the ambulance.

 

One Hundred and Thirty Dollars.

 

Repeat 130$

 

This was obviously an emergent situation and even if they had asked--they did not--if I had insurance, and if not, if it's worth 130$ for my precious toesies to be slightly warmer, I would not have been able to give an answer. Much MUCH less the actual tests performed at the ER.

 

The blanket example stuck out in my mind BECAUSE the woman who did the CAT scan for me was chatting while she covered me back up with that 4X4 too-small, rough blanket about how she always comes around and gathers them to take home to use as "essentially disposable dog blankets. I have three Great Danes..." So when I saw it on the bill I was like day-um.

 

Anyway. Let's not fight with each other. Instead let's figure out WHO IN THE FRACK has the power to charge a sick and injured person 130$ for a radiologist's dog blanket, and revolt.

Edited January 13, 2017 by OKBud

[umsami]

Preventative care has been shown to save money.  Much easier and cheaper to treat many diseases early on that later. 

 

I agree with using more mid level practioners... plus I've often had as good of or better care with NPs and CNMs than with the MD/DO.  I think that pretty much all non highrisk births should use a CNM period.  No reason for an OB, to be frank.  

[maize]

Can I ask you all (all political views)? Do you think the system you have over there works for the majority (at least 90%). Can you say you have never worried yourself sick about premiums, cover, costs etc? If you were designing a system from scratch who would you model it on?

If I were designing a program from scratch it would begin with government health coverage for everyone, combined with private secondary options.

 

I would take what works well in our own Medicare system and also consider the experience of the various countries that have such a system.

 

Unfortunately no-one has asked me to design our next healthcare system.

Edited January 13, 2017 by maize

[HomeAgain]

You can have tricare standard and never see a military doctor, as a dependent (wah-wah for the member) in almost all oconus locations FYI. And yes, it's wonderful.

 

If pricing would get under control these conversations would be 99% less contentious.

 

When I went to the ER by ambulance last year, I/insurance was charged for the stupid rough grey blanket they put over my feet in the ambulance.

 

One Hundred and Thirty Dollars.

 

Repeat 130$

 

This was obviously an emergent situation and even if they had asked--they did not--if I had insurance, and if not, if it's worth 130$ for my precious toesies to be slightly warmer, I would not have been able to give an answer. Much MUCH less the actual tests performed at the ER.

 

The blanket example stuck out in my mind BECAUSE the woman who did the CAT scan for me was chatting while she covered me back up with that 4X4 too-small, rough blanket about how she always comes around and gathers them to take home to use as "essentially disposable dog blankets. I have three Great Danes..." So when I saw it on the bill I was like day-um.

 

Anyway. Let's not fight with each other. Instead let's figure out WHO IN THE FRACK has the power to charge a sick and injured person 130$ for a radiologist's dog blanket, and revolt.

 

Did you see the story of the man who was charged for holding his baby after the birth?  Because they needed an extra body in the room for liability reasons, he was charged for holding his newborn.  http://ktla.com/2016/10/04/dad-i-had-to-pay-39-35-to-hold-my-baby-after-he-was-born/

 

Something is sick.  It's not the patients. 

[lovinmyboys]

Some preventative care saves money and other preventative care does not. I think as we figure out which is which, costs will come down.

 

For instance, from what we know now, widespread mammogram use for women with no symptoms does not save money. Instead, lots of women end up being over treated for a cancer that likely would have never killed them. Not to mention all the extra biopsies that are done. Now, I know the science hasn't advanced to where we know for sure which cancers will kill and which won't. I'm all for saving lives, so I am not necessarily advocating that we get rid of widespread mammogram use yet. I am just pointing out that mammograms as preventative care most certainly cost more money than they save.

[Lady Florida.]

Can I ask you all (all political views)? Do you think the system you have over there works for the majority (at least 90%). Can you say you have never worried yourself sick about premiums, cover, costs etc? If you were designing a system from scratch who would you model it on?

 

1. No I don't think it works for the majority. 

 

2. We're fortunate in that both dh and I were employed in industries where we got decent, affordable insurance coverage. When I became a sahm I was easily added to his policy. So while we've complained about the rising costs and shrinking coverage, and we've appealed (sometimes successfully, sometimes not) coverage denials, we haven't had to lose sleep over our coverage or costs. We know too many people who aren't as fortunate as us. 

 

3. I would personally prefer single payer universal health care covered by our taxes but you can buy private insurance too, similar to how it's done in some other countries. That's never going to happen here, at least not in my lifetime. The next best option that isn't far-fetched is something like Medicare for all.

 

ETA: Dh would like to retire in a few years. He can't because he has to wait for me to catch up to him in age and be eligible for Medicare. He'll continue working just for the health insurance

Edited January 13, 2017 by Lady Florida.

[Carrie12345]

Preventative care has been shown to save money.  Much easier and cheaper to treat many diseases early on that later. 

 

I agree with using more mid level practioners... plus I've often had as good of or better care with NPs and CNMs than with the MD/DO.  I think that pretty much all non highrisk births should use a CNM period.  No reason for an OB, to be frank.  

 

And, really, it's in ALL our best interests to have healthy babies and mothers beyond our own households.  The idea that a low-income mother shouldn't get medical care that she can't personally cut a check for is just... well, it's unimaginable to me.  Digging her deeper pushes that baby deeper and doesn't just perpetuate that cycle, but worsens it.  (And doesn't even ONLY apply to low-income families.)

 

Having conceived on a birth control method that doesn't really have a "human error" component, making coverage an *option seems crazy.

[lovinmyboys]

And, really, it's in ALL our best interests to have healthy babies and mothers beyond our own households. The idea that a low-income mother shouldn't get medical care that she can't personally cut a check for is just... well, it's unimaginable to me. Digging her deeper pushes that baby deeper and doesn't just perpetuate that cycle, but worsens it. (And doesn't even ONLY apply to low-income families.)

 

Having conceived on a birth control method that doesn't really have a "human error" component, making coverage an *option seems crazy.

Preventative maternity care saves money.

Preventative mammograms for everyone does not.

 

Earlier I said preventative care doesn't save money. Some of it does and some doesn't. I am in favor of maternity care for everyone, which was the original point of this thread. But, not all preventative care saves money (or even lives). Getting rid of unnecessary preventative care would save money and bring medical costs down, which would be good for everyone.

Edited January 13, 2017 by lovinmyboys

[Laura Corin]

My opinion is that preventative care costs more money then it saves and most of it is unnecessary. My kids are healthy and over the age of 3. They do not need a well check every year. I even asked my pediatrician if they ever catch anything at well visits and he said rarely (once a child is older). Usually a child is having symptoms so the parents bring him in. Most young adults don't need yearly checks. I have to go see my dr every year to get my birth control pills. That is a waste of health dollars.

 

Another way to save money is to have nurse practitioners do well checks and routine office visits. I think some other countries do this. Doctors are for things more complicated than routine strep throat.

 

I like evidence-based medicine.  If a particular screening regime saves lives/reduces costs, then it's very worthwhile.  I'm not sure that a tick-box annual visit would do that, but I don't know the figures.  If, on the other hand, bowel cancer screening, mammograms, pap smears, have a decent body of evidence for their efficacy, then do them.

 

And I agree about better use of nurse practitioners.

 

Edited January 13, 2017 by Laura Corin

[Guest]

Preventative maternity care saves money.

Preventative mammograms for everyone does not.

 

Earlier I said preventative care doesn't save money. Some of it does and some doesn't. I am in favor of maternity care for everyone, which was the original point of this thread. But, not all preventative care saves money (or even lives). Getting rid of unnecessary preventative care would save money and bring medical costs down, which would be good for everyone.

But, damn, it can't just be about money! I'm sure women are alive today because of getting a routine mammogram. This is America, we can do better than just saving the most money.

[scrapbookbuzz]

Good morning, all!

 

The first thing I want to say is how proud I am of all of you for keeping this a relatively civil discussion!

A discussion on the right way to provide affordable healthcare CAN be contentious but you've all managed

to keep it to a dull roar. That deserves a  :hurray:

 

Second, let's get rid of the word "free" , shall we? NOTHING, and I mean NOTHING is free. Someone pays for it 

somewhere. Call it what it is here, something like "tax-subsidized healthcare." Or "block cheese healthcare" (analogy

in that whatever healthcare you have, it cuts a chunk off your salary).

 

Third, having spent time in the military, I can tell you that I personally do not want any government in charge of my healthcare.

That's not to say I don't use the VA from time to time BUT we all know how they've been doing!  

 

All that to say, SOMETHING needs to be done, something positive, about the healthcare system in the U.S. 

[Crimson Wife]

 

I have only used military doctors twice and both times I was thoroughly unimpressed. It is a very small sample size, so I try not to generalize.

 

I was stuck using Army healthcare for 4 years and it was dreadful. No choice in provider- I would call up to make an appointment and would get assigned to someone. At best that person was inexperienced and at worst totally incompetent. There was no ability to go "out of network" for a higher cost-share like there is with private health insurance (even Kaiser HMO had a way to see a non-Kaiser doctor, though it was a hassle). Wait times were long and procedures routine in the civilian world like a 2nd trimester ultrasound were simply not done. Trying to get a referral to a specialist was a nightmare. The prescription formulary was extremely limited (again far worse than Kaiser HMO's). I wound up paying 100% out-of-pocket for a 2nd opinion at UCLA because a quack Army doctor couldn't read a breast ultrasound and wanted to biopsy me (I was 24 and have no family history of breast cancer). Fortunately, the civilian breast oncologist felt sorry for me and charged me the absolute bare minimum for an office visit & not for redoing the ultrasound.

 

I don't like all the costs associated with our PPO but the quality of care is a zillion times better than the Army's, and also better than Kaiser HMO's.

 

My disabled child has Medicaid as secondary to our PPO and it's hard to find providers who will accept it. Several times I've been told that they'll bill Medicaid for the co-pays because it is secondary coverage but if she had it as primary they wouldn't accept her as patient at all.

[lovinmyboys]

But, damn, it can't just be about money! I'm sure women are alive today because of getting a routine mammogram. This is America, we can do better than just saving the most money.

The evidence that routine mammograms save lives is mixed at best (hope I am not totally derailing the thread).

[Guest]

Did you see the story of the man who was charged for holding his baby after the birth?  Because they needed an extra body in the room for liability reasons, he was charged for holding his newborn.  http://ktla.com/2016/10/04/dad-i-had-to-pay-39-35-to-hold-my-baby-after-he-was-born/

 

Something is sick.  It's not the patients. 

 

 

Yes I did, and it's bunk because there is ALWAYS a ped nurse in the room in a c section. The nurse didn't come in special so he could kangaroo care the kid. What do people think the surgical staff does with the baby when they pull it out? Just set it aside til they are done?

[Carol in Cal.]

Can I ask you all (all political views)? Do you think the system you have over there works for the majority (at least 90%). Can you say you have never worried yourself sick about premiums, cover, costs etc? If you were designing a system from scratch who would you model it on?

--I have been extremely fortunate to have had good insurance my entire adult life.  

--I still worried myself sick over it at one point--DH had lost his job, and we were on (extremely expensive) COBRA, which can only last for 18 months.  Toward the end of month 17 he finally got another job with health benefits.  Whew, that was close.

 

But even then, I had stepped in and gotten a job myself, which did have a catastrophic plan that wasn't very good but was better than nothing.  If COBRA had run out I could have added him to it I believe.

--This system absolutely doesn't work for a lot of people because it is tied to employment for a company or organization that gives good health insurance.  If you didn't have that, you would be either insurable at a high and annually changing rate or uninsurable.  There was a big gap in insurability for people whose health had deteriorated over the years, which hit those in their late 50s to early 60s particularly hard.  They had to hold out somehow until Medicare kicked in at age 65.

--It is unacceptable to me to have so many people without a reasonable way to get medical care. 

--If I were designing a system from the ground up, it would be modelled on patients making medical decisions based on their values and their doctors' advice, and insurance companies not being able to second guess this.  It would be regulated by state insurance commissions rather than federal ones.  It would be subsidized and there would be a state high risk pool similar to that for auto insurance.  When a policy said 'out of pocket limit' that would mean 'This is the maximum you will have to pay this year', no exceptions.  High deductible plans would be available and encouraged.

[Guest]

--If I were designing a system from the ground up, it would be modelled on patients making medical decisions based on their values and their doctors' advice, and insurance companies not being able to second guess this.

 

+1

[LifeLovePassion]

Routine screening coverage isn't always what it is cracked up to be either. I have had crohn's disease since I was a child. As time goes on, colon cancer risk goes up for me more than the average person. Colonoscopys  are the way to check for that. I was happy one year when I saw they would be covered for people under 50. Imagine my surprise to see a bill for the whole procedure. The second they took biopsy's, it was no longer considered a screening (even though they need to biopsy the colon to look for potential activity/pre cancer cells, etc.) it was considered diagonistic and they covered nothing. So yeah. More stuff that needs fixing. Even though the procedure did what was needed to try to be preventive, it still wasn't covered. 

[AmandaVT]

Can I ask you all (all political views)? Do you think the system you have over there works for the majority (at least 90%). Can you say you have never worried yourself sick about premiums, cover, costs etc? If you were designing a system from scratch who would you model it on?

 

1. No, not as is. In VT, we do a little better than a lot of states because of Dr. Dynasaur. That's a plan that was implemented (across party lines) that guarantees coverage to all children and pregnant women. It's a sliding scale premium and works very well. 

 

2. No - I worry constantly. DH left his job with employer health insurance to work for himself, which is great. I also work at the company. We have to buy our insurance and are currently paying almost $2000/month. It's really hard to manage our bills right now and we have no breathing room in the budget. 

 

3. I like the Medicare system as well. Covers 80% and people buy plans to cover the extras. 

[ktgrok]

My main point is that if we had a national program like that it would have to pay health care providers more which means it would cost more to run. The reason Medicare and tricare can pay so little is because other insurances pay more to make up the difference.

 

Not absolutely....becaue the doctor's overhead would go WAY down if they weren't dealing with a dozen different insurance companies and having to pay people to handle that paperwork. And then yes, the money I spend now that lines the pockets of an insurance CEO and their stockholders could be going to pay actual doctors. 

[ktgrok]

Preventative maternity care saves money.

Preventative mammograms for everyone does not.

 

Earlier I said preventative care doesn't save money. Some of it does and some doesn't. I am in favor of maternity care for everyone, which was the original point of this thread. But, not all preventative care saves money (or even lives). Getting rid of unnecessary preventative care would save money and bring medical costs down, which would be good for everyone.

 

I wold like to see more info on this. 

 

One idea I've seen used is group visits for things like maternity, diabetes, etc. You have a short period of time one on one, but most of the time is in the group to discuss what is normal, what isn't, how to check blood sugar, warning signs, etc. So instead of repeating that spiel 20 times a day, they do it twice, to two group of 10. 

 

Actually, some of my bariatric appointments were done that way, now that I think about it. 

[maize]

 

 

Third, having spent time in the military, I can tell you that I personally do not want any government in charge of my healthcare.

 

 

Tricare is not the only model out there.

 

And...you prefer that getting your healthcare needs met be dependent on a profit-driven corporation?

[bettyandbob]

Not absolutely....becaue the doctor's overhead would go WAY down if they weren't dealing with a dozen different insurance companies and having to pay people to handle that paperwork. And then yes, the money I spend now that lines the pockets of an insurance CEO and their stockholders could be going to pay actual doctors.

Absolutely.

 

There would no longer need to be a staff devoted to insurance. Having a full time employee trying review multiple insurance plans that accept billing in differ ways is expensive.

[Crimson Wife]

If I were designing a system from the ground up, I would scrap the 4 years of college + 4 years of med school and have a 6 year combined program that admits students either right out of high school (if they've done well on enough AP or IB exams) or from community college. No general ed requirements, only the classes needed to become a physician. It would be free in exchange for a service obligation as a primary care doctor for a certain number of years in a location with shortages. If the individual wanted to become a specialist, there would be an option for getting specialist training after the initial service obligation was up, but that would incur additional years' service obligation.

 

I would also reform the malpractice system to make it more like workers' comp, where there is a standardized award system but still some flexibility for unusual circumstances.

 

I would ban direct-to-consumer advertising of pharmaceuticals and strictly regulate marketing to physicians.

 

I would eliminate restrictions on telemedicine and increase the use of electronic monitoring of symptoms & side effects. For a while, I was having to bring my child in for a blood pressure and weight check at the pediatrician's office every 3 months in order to get her ADHD medication refill. What a waste of money. I should be able to stop by a pharmacy, have her step on a scale & use the automatic BP monitoring station there, then have the results automatically analyzed to make sure everything is fine.

[Serenade]

If you were designing a system from scratch who would you model it on?

I would have a system where the cost of every procedure would be itemized so that people would know in advance what they are paying. I understand that there are emergencies and sometimes things cost more than planned, but costs would be determined in advance unless there is an emergency.

 

The cost on the menu would be the set price, no negotiated discounts. If a person had insurance, the insurance would pay that published amount, not less. One of the worse things in our system is that often the poorest people without insurance pay the most for their care since they don't have an insurance company to whittle it down for them. That is wrong IMO. The "insurance" price should be available to all. Either something costs a certain amount or it doesn't.

 

I would also allow people to buy drugs across any border. The US indirectly subsides the drug prices in other countries by allowing drug companies to charge us way more than they charge for the same drugs in other countries because they know they have a captive audience. That is just plain wrong. If our drugs could be bought on a free and open market, the price would come down. I realize that the US now looks the other way if people buy a small amount of drugs from other countries, but they should not have to look the other way. This should be standard practice.

[maize]

I wold like to see more info on this.

 

One idea I've seen used is group visits for things like maternity, diabetes, etc. You have a short period of time one on one, but most of the time is in the group to discuss what is normal, what isn't, how to check blood sugar, warning signs, etc. So instead of repeating that spiel 20 times a day, they do it twice, to two group of 10.

 

Actually, some of my bariatric appointments were done that way, now that I think about it.

Yep, no reason standard prenatal care could not be accomplished in a group format.

 

There could be an opportunity afterwards for whoever had personal questions or more complicated needs to see a provider privately. At least 50% of women could probably leave after the group appointment.

 

(also, those appointments that are just "urine sample, blood pressure, listen to the heartbeat" could totally be done at home with mom forwarding her information to the provider; travelling to the office, sitting in the waiting room, then getting a total of 90 seconds with a provider for those monthly appointments is nonsense and a wase of everyone's time and resources)

Edited January 13, 2017 by maize

[Guest]

Tricare is not the only model out there.

 

And...you prefer that getting your healthcare needs met be dependent on a profit-driven corporation?

 

I'd rather see a witch in the woods in the 1850s than go to the VA.

 

Only verrrrrrrry very slightly exaggerating.

[Serenade]

I would ban direct-to-consumer advertising of pharmaceuticals and strictly regulate marketing to physicians.

Yes, this.

 

I remember when direct marketing to consumers happened. Ugh.

 

This practice has significantly impacted the price of drugs in our country.

[Crimson Wife]

 And...you prefer that getting your healthcare needs met be dependent on a profit-driven corporation?

 

Most hospitals and many clinics are non-profit. The insurance company may be a publicly held corporation, but the organizations who are actually giving my family medical treatment for the most part aren't.

 

[ChocolateReignRemix]

Some preventative care saves money and other preventative care does not. I think as we figure out which is which, costs will come down.

 

For instance, from what we know now, widespread mammogram use for women with no symptoms does not save money. Instead, lots of women end up being over treated for a cancer that likely would have never killed them. Not to mention all the extra biopsies that are done. Now, I know the science hasn't advanced to where we know for sure which cancers will kill and which won't. I'm all for saving lives, so I am not necessarily advocating that we get rid of widespread mammogram use yet. I am just pointing out that mammograms as preventative care most certainly cost more money than they save.

Show your work.

[SparklyUnicorn]

Nothing is free.  Free mammograms and birth control are just added in to the cost of the insurance itself.  Then you pay higher premiums or the taxpayers pay higher premiums for you.  And yes, urging people to call to save the ACA is political.  Nothing else you can call that.

 

Ok so going at it from that angle, what happens when people don't get the care they need and don't have the money, they go to the emergency room and/or get care or treatment that costs a lot more at that point.  Might have cost less had they got what they needed sooner.  I don't know that that approach is any better from the standpoint of what this is costing everyone else (AKA taxpayers).  The only way around that is to flat out say if someone doesn't have the money they don't get any care and can be refused for medical care.  It's certainly an option, but I dunno, do most people think that's ok?

[Carrie12345]

I was stuck using Army healthcare for 4 years and it was dreadful. No choice in provider- I would call up to make an appointment and would get assigned to someone. At best that person was inexperienced and at worst totally incompetent. There was no ability to go "out of network" for a higher cost-share like there is with private health insurance (even Kaiser HMO had a way to see a non-Kaiser doctor, though it was a hassle). Wait times were long and procedures routine in the civilian world like a 2nd trimester ultrasound were simply not done. Trying to get a referral to a specialist was a nightmare. The prescription formulary was extremely limited (again far worse than Kaiser HMO's). I wound up paying 100% out-of-pocket for a 2nd opinion at UCLA because a quack Army doctor couldn't read a breast ultrasound and wanted to biopsy me (I was 24 and have no family history of breast cancer). Fortunately, the civilian breast oncologist felt sorry for me and charged me the absolute bare minimum for an office visit & not for redoing the ultrasound.

 

I don't like all the costs associated with our PPO but the quality of care is a zillion times better than the Army's, and also better than Kaiser HMO's.

 

My disabled child has Medicaid as secondary to our PPO and it's hard to find providers who will accept it. Several times I've been told that they'll bill Medicaid for the co-pays because it is secondary coverage but if she had it as primary they wouldn't accept her as patient at all.

 

To be fair, the care in our location, with coverage from a major insurance company, sucks.  Their new "tier" system currently has us going outside of coverage with a doctor who is trying to coordinate with our covered providers to do the simpler tests and procedures so only the more complicated things are full-bill.

 

My conversations with people who've used military coverage range the same way my conversations with civilians do.  Some are very happy, some are very desperate.

[ChocolateReignRemix]

Good morning, all!

 

The first thing I want to say is how proud I am of all of you for keeping this a relatively civil discussion!

A discussion on the right way to provide affordable healthcare CAN be contentious but you've all managed

to keep it to a dull roar. That deserves a :hurray:

 

Second, let's get rid of the word "free" , shall we? NOTHING, and I mean NOTHING is free. Someone pays for it

somewhere. Call it what it is here, something like "tax-subsidized healthcare." Or "block cheese healthcare" (analogy

in that whatever healthcare you have, it cuts a chunk off your salary).

 

Third, having spent time in the military, I can tell you that I personally do not want any government in charge of my healthcare.

That's not to say I don't use the VA from time to time BUT we all know how they've been doing!

 

All that to say, SOMETHING needs to be done, something positive, about the healthcare system in the U.S.

It's free (or low cost) at the point of service, and for the life of me I don't know anyone who doesn't know there is a cost that must be paid.

[Laura Corin]

 

 

Second, let's get rid of the word "free" , shall we? NOTHING, and I mean NOTHING is free. Someone pays for it 

somewhere. Call it what it is here, something like "tax-subsidized healthcare." Or "block cheese healthcare" (analogy

in that whatever healthcare you have, it cuts a chunk off your salary).

 

 

The UK term is 'free at the point of delivery'.  Ours isn't tax-subsidised, it's tax-paid-for.  And I'm happy to pay.

 

[ChocolateReignRemix]

Most hospitals and many clinics are non-profit. The insurance company may be a publicly held corporation, but the organizations who are actually giving my family medical treatment for the most part aren't.

 

A for profit entity has still been inserted into the equation with our current insurance model.

[Guest]

Tricare is not the only model out there.

 

And...you prefer that getting your healthcare needs met be dependent on a profit-driven corporation?

The best medical care I have had is via a profit driven corporation, because they were self insured and valued their employees. They had a seperate cancer care policy that didn't include any oop, and they covered pre-existing pregnancies. I would take that again in a heartbeat...its actually what my school taxes pay for for a small pool in the community and I want that coverage for everyone.

[SparklyUnicorn]

Yeah, just on the flip side, it frustrates me to no end that I would have to pay for maternity care I don't want and can't use (because, um, hello, infertility) till I'm in my 50's just because some politician decides everyone MUST have it.

 

There really is room for more opinions. If people want policies with that stuff, let them buy it. Those of us who don't use any of that don't want to.

 

But thanks for the update. I agree, things are being done so quickly, it's hard to keep up, whether you agree with the changes or not! 

 

There are many instances of times we pay for things we wouldn't ever use.  Then again there are times we get a lot out of something and pay very little or nothing.  So are we in it (in it in terms of our existence) alone or should we consider working together for a common good?

 

I get your frustration because you are personally upset, but this thinking is very selfish.  And I hate to be so mean and blunt because I don't want to hurt your feelings, but really since when is it strictly about what you personally will benefit from?  This may benefit someone you care about.  Your neighbor.  Your friend.  Or you never really know.  Why is that a bad thing?  Not everyone uses the roads.  Not everyone uses the park.  Or the library.  Or the schools.  Those things wouldn't exist without pooling resources though. 

 

 

[Laura Corin]

If I were designing a system from the ground up, I would scrap the 4 years of college + 4 years of med school and have a 6 year combined program that admits students either right out of high school (if they've done well on enough AP or IB exams) or from community college. No general ed requirements, only the classes needed to become a physician. It would be free in exchange for a service obligation as a primary care doctor for a certain number of years in a location with shortages. If the individual wanted to become a specialist, there would be an option for getting specialist training after the initial service obligation was up, but that would incur additional years' service obligation.

 

We rarely agree, but I agree with this.  Doctors in the UK start into their training at age 18 from (roughly) high AP level.  The initial degree takes four, five or six years, then they go into the training detailed in this table:

 

https://en.wikipedia.org/wiki/Medical_education_in_the_United_Kingdom#NHS_medical_career_grades

 

[Guest]

Ok so going at it from that angle, what happens when people don't get the care they need and don't have the money, they go to the emergency room and/or get care or treatment that costs a lot more at that point. Might have cost less had they got what they needed sooner. I don't know that that approach is any better from the standpoint of what this is costing everyone else (AKA taxpayers). The only way around that is to flat out say if someone doesn't have the money they don't get any care and can be refused for medical care. It's certainly an option, but I dunno, do most people think that's ok?

Just so everyone knows, in NY you can get your mammo and your followup ultrasound on the taxpayers dime if you do not have insurance and are poor. New state law in effect this year.

[SparklyUnicorn]

Just so everyone knows, in NY you can get your mammo and your followup ultrasound on the taxpayers dime if you do not have insurance and are poor. New state law in effect this year.

 

I thought so.  I think some other stuff mentioned here is also mandated by individual state laws.  So for some states this probably doesn't matter.

 

When I worked for an insurance company years ago I believe it was Mass that mandated coverage of some infertility treatments.  So different states can have their own regulations.