This is Why Healthcare for Profit is Wrong

[ChocolateReignRemix]

24 minutes ago, Murphy101 said:

 

I don't think it's an either or option.  We absolutely need to look at reducing the costs and frankly I think we can do that without affecting those served bc a lot of them are third party bloat or simple greed.

 

One of the major costs people like to point out (medical liability) can be significantly reduced via a socialized healthcare model.  Suffering an injury due to medical negligence under our current model can be absolutely catastrophic for a family due to the possibility of future costs.  Absorbing those costs into a socialized model removes the need for a large % of current medical liability costs and would also reduce the need for CYA tests requested by doctors.

[Terabith]

The best health care we ever had as a family was Tricare, which basically operated as single payer.  

[Frances]

2 hours ago, Selkie said:

I deal with insurance companies and government agencies every day as part of my job, and sadly enough, insurance companies are much better. Which is not to say they are great or even good, but they are not as awful to deal with as anything that is government-run.

I can’t remember the last time I had anything but great customer service dealing with a government agency. But my private cell phone and internet providers just about send me over the edge with horrendous customer service.

[Frances]

1 hour ago, SereneHome said:

Anytime I ever want to say anything about healthcare, whether on here or another message board I frequent, I never seem to be able to make it coherent enough, but what the heck...

I wasn't born in US.  We had socialism and govt healthcare, which was 100% free to everyone.  Of course, it wasn't really free, but it was free on paper.  It was horrible.  So, anytime I hear "affordable" healthcare, I just shudder.

I am very much against single payer, but that's not even the biggest problem.  The problem is that regardless of the number of "payers", NO ONE addressing actual medical costs.  With anything else we deal in life, costs are always addressed.  But not with health care.  Except for the drugs.  But what about all other costs?  Doctor's appts, procedures, hospital stays, ER visits, blood work, ultra-sounds and X-rays.  All those costs are never discussed. 

I also wanted to comment on someone's post about how "unique" we are.  I don't know if I would say "unique", but there is certainly a number of factors that play into a more complex system.   First of all, we have large divervese areas in terms of access and income and distance to services.  Second, I think mentality in this country is different in terms of expectations and rights.  And third, I think there is a large discrepancy between people who are actually paying for services and people using them.

anywhooo, I am an accountant, so I always think that the first thing to do is to actually decrease expenses, instead of trying to figure out who is paying for what and how ?

I completely agree that we have a different mentality in this country in terms of expectations and rights. Several years ago, the Wall Street Journal had an in depth article discussing the differences in attitudes about healthcare in the US versus countries with some type of universal healthcare. The latter had much more of a “we are all in this together” view of healthcare, while more Americans lean towards the “every person for themselves” perspective. 

And personally, I view access to quality, affordable healthcare very similarly to education. We never used the public schools and never will, but I have no problem paying taxes to support them. Similarly, my family is very fortunate to have excellent employer provided health, dental, and vision insurance (and dual coverage for most of us) for which we pay virtually nothing. But I’d have no problem with paying more taxes so everyone could have that, even if it meant a reduction in services for my family.

[Frances]

14 hours ago, sweet2ndchance said:

I have no idea what the answer to everything is, all I know is dh is physically disabled, on disability so we don't have much money to begin with and he has Medicaid because of his disability so we can't afford to buy better health care (oh how I wish we could). Medicaid will not pay for the $300/month medication he needs and his doctor has tried and tried to get them to approve but it is not on their preferred list. The medication they suggest she prescribe instead costs $1200/month and we have trouble finding a pharmacy willing to order it for him without at least $600 upfront which will be returned to us when Medicaid pays them... because yeah we have $600 lying around every month that we can just give to the pharmacy and wait to be paid back!

So we make due with a slightly less effective medication that Medicaid will only pay for 75 pills per month and we pay out of pocket for the 15 additional pills since dh needs to take it 3 times a day. On 31 day months, we have to pay for 18 pills. Oh and they will only pay for 3 prescriptions per month which we can get upped to 6 for dh but we have to do it, every 3 - 6 months and we don't know when they need reupped until we go to get his meds and find out they were denied. Then it takes a day or two to get them re-upped. Meanwhile dh is without meds because they will not let us refill until the day he refilled the previous month so we never know until he is out whether or not his meds are covered We've tried asking how we can know in advance so we can get his meds on time each month and they (Medicaid) claims there is no way to know until the day of the refill. If dh needs more than 6 meds in a month or a medication that can be obtained over the counter (like the stool softeners he needs because his meds cause constipation) we are out of luck and have to pay OOP. All together, we pay between $100 - $150 per month for medications just for dh between copays, OOP and OTC. Oh and every time we've looked into drug company programs for those who can't afford their medications, they are not open to Medicaid recipients, sigh. 

I wish we could have Tricare again. They only seemed like a pain to deal with but I never worried about whether or not we could afford medications or specialists. I would deal with Tricare again any day before dealing with Medicaid. If we could afford it, I would get us an Aetna plan. That's what we had when my ex-husband got out of the military. They were hands down the best and easiest insurance company I've ever dealt with.

I wish there was an easy answer to the health care problem world wide but there just isn't. Every system has it's own dark side. Ex husband's family lives in England and his grandmother was deemed "too old" for an organ transplant that would have saved her life. I don't remember how old she was, sixties or seventies maybe? Not terribly old at all, just past her prime in the government's eyes. Every system has room for improvement but I have no real ideas on how to go about it.

 

Medicaid is likely not a good comparison for what true universal healthcare would look like because only lower income people are covered by Medicaid, so of course there is always the attempt by many to make the budget as absolutely lean as possible. Many people don’t want to pay to help others get anything they are not getting themselves. And because reimbursements rates are kept low due to the budget allotted, many providers will not accept Medicaid patients. If everyone, rich and poor, had the same basic coverage, things would likely look quite a bit different.

[SereneHome]

11 minutes ago, Frances said:

I completely agree that we have a different mentality in this country in terms of expectations and rights. Several years ago, the Wall Street Journal had an in depth article discussing the differences in attitudes about healthcare in the US versus countries with some type of universal healthcare. The latter had much more of a “we are all in this together” view of healthcare, while more Americans lean towards the “every person for themselves” perspective. 

And personally, I view access to quality, affordable healthcare very similarly to education. We never used the public schools and never will, but I have no problem paying taxes to support them. Similarly, my family is very fortunate to have excellent employer provided health, dental, and vision insurance (and dual coverage for most of us) for which we pay virtually nothing. But I’d have no problem with paying more taxes so everyone could have that, even if it meant a reduction in services for my family.

 

I disagree.  I think it's more of "we would like everyone to have some skin in a game" thing.  I find Americans quite generous and fairly community oriented (although not very family oriented, but that's a whole other story ? ). 

To your second paragraph, I've known many people who feel the way you do with one major caveat - as long as their money spend wisely.  But most think there is no point due to all the waste.

[Murphy101]

42 minutes ago, SereneHome said:

 

I disagree.  I think it's more of "we would like everyone to have some skin in a game" thing.  I find Americans quite generous and fairly community oriented (although not very family oriented, but that's a whole other story ? ). 

To your second paragraph, I've known many people who feel the way you do with one major caveat - as long as their money spend wisely.  But most think there is no point due to all the waste.

 

I’m so sick of this “thing”.  What more skin can they have in this craptastic game than their very lives? While one side stamps their foot about raised taxes and talk about games, the other side works just as hard as anyone else and wonders if they’ll die before they can afford to refill their medications or afford surgeries.

Skin in the game my ample right butt check.  We all have skin in this game of life and, again, to suggest otherwise comes across as condescending and heartless to say the least. So yeah, that’s just mental gymnastics to avoid seeing that it really is everyone for themselves. 

Edited September 15, 2018 by Murphy101

[Frances]

1 hour ago, SereneHome said:

 

I disagree.  I think it's more of "we would like everyone to have some skin in a game" thing.  I find Americans quite generous and fairly community oriented (although not very family oriented, but that's a whole other story ? ). 

To your second paragraph, I've known many people who feel the way you do with one major caveat - as long as their money spend wisely.  But most think there is no point due to all the waste.

While I didn’t do the polling or write the article, so it’s not my opinion. It was an actual news article, not an editorial or opinion piece.

I agree there is lots of waste, especially when it comes to all the resources going to insurance companies. I also think people need to be lots more realistic about end of life and life extending treatments, regardless of quality of life. Research has shown that when people have the time and knowledge to make decisions in advance of facing life or death decisions, they almost always choose less intervention and quality over quantity. The problem is that too many people don’t plan in advance. Fortunately, Medicare now pays for those types of consultations, so hopefully it will become more and more common.

 

Edited September 15, 2018 by Frances

[SereneHome]

22 minutes ago, Frances said:

While I didn’t do the polling or write the article, so it’s not my opinion. It was an actual news article, not an editorial or opinion piece.

I agree there is lots of waste, especially when it comes to all the resources going to insurance companies. I also think people need to be lots more realistic about end of life and life extending treatments, regardless of quality of life. Research has shown that when people have the time and knowledge to make decisions in advance of facing life or death decisions, they almost always choose less intervention and quality over quantity. The problem is that too many people don’t plan in advance. Fortunately, Medicare now pays for those types of consultations, so hopefully it will become more and more common.

 

 

Oh OK, I didn't realize that, I was just stating my observations and opinion.

And I agree with your second point.  I will add that I think that there is additional push from doctors to keep going - may be bc they truly trying to help, may be bc they are too afraid of law suits.  I don't know. 

[ktgrok]

9 hours ago, SereneHome said:

 

I disagree.  I think it's more of "we would like everyone to have some skin in a game" thing.  I find Americans quite generous and fairly community oriented (although not very family oriented, but that's a whole other story ? ). 

To your second paragraph, I've known many people who feel the way you do with one major caveat - as long as their money spend wisely.  But most think there is no point due to all the waste.

First, do those worried about "waste" think that insurance companies are being super efficient with their money? Really? I'd say paying huge CEO salaries while people can't afford medication is a waste, myself. 

Second, the idea that people dying for lack of healthcare is more tolerable than the government possibly wasting some money is mind boggling. Is any system going to be perfectly efficient? Nope. But I can accept some waste if it means people can afford their insulin.

[GoodGrief]

12 hours ago, Terabith said:

The best health care we ever had as a family was Tricare, which basically operated as single payer.  

 I've been under military health care and/or the Indian Health Service for healthcare my entire life, the two major examples of socialized medicine in the US. I've been reading this thread and holding back on my stories of incompetency within those frameworks. I nearly lost my oldest daughter due to limitations within the systems, and I am not given to hyperbole. We pay out of pocket for care for her issues now, and occasionally for other things too. The systems work great as long as you are relatively healthy.

[goldberry]

21 hours ago, SKL said:

Until recent legislation, yes, it was temporarily costly for SOME people with pre-existing conditions to pay for gap insurance until their new company's insurance kicked in.  But that problem has been legislated away.

I have always advocated for a fix for that particular gap problem (and a few others).  It has nothing to do with whether or not we have a single-payer system.

 

It wasn't just a "gap" for people who were self-employed or unemployed.  For DH and I who are relatively healthy people, taking anti-depression meds and migraine medication maybe once a year disqualified us from several plans altogether.  Then the plan that would accept us was crazy expensive PLUS would not cover anything pre-existing, not for awhile, but EVER.

My sister with numerous medical conditions became unemployed.  Her husband worked enough for them not to qualify for Medicaid, but not enough to cover any of her medications or doctor visits.  It was horrible. 

Single payer is one of the few ways there will be enough bargaining power to get costs down.  A company I do accounting for, run by a very good guy who really wants to keep offering health insurance, is suffering because of how much the costs keep going up.  This is a small to midsize company.  It is not going to be very much longer before midsize companies can no longer offer health care and there will be more and more people uninsured.  There are already so many companies not offering it.  The idea that if you need insurance you should just go get a good job is ridiculously naive.  And as has been mentioned, even folks with insurance can't always afford everything.  But let's change legislation to make MORE plans that don't really cover anything, that'll solve it! ?

The idea of regulating costs by setting limits on profitability is something I would support, but I don't see that ever happening.  Something has to get costs under control.  The current situation is unsustainable.

[goldberry]

13 hours ago, SereneHome said:

anywhooo, I am an accountant, so I always think that the first thing to do is to actually decrease expenses, instead of trying to figure out who is paying for what and how ?

 

So how do we decrease expenses?  The negotiating power of single payer is one option, but if you oppose that, what are the other options that actually might have a chance?

[Frances]

27 minutes ago, GoodGrief1 said:

 I've been under military health care and/or the Indian Health Service for healthcare my entire life, the two major examples of socialized medicine in the US. I've been reading this thread and holding back on my stories of incompetency within those frameworks. I nearly lost my oldest daughter due to limitations within the systems, and I am not given to hyperbole. We pay out of pocket for care for her issues now, and occasionally for other things too. The systems work great as long as you are relatively healthy.

I’m very sorry to hear about the issues with your daughter. I do think Medicare is probably the largest proxy for universal healthcare in the US, although still not completely analogous because it only covers a portion of the population, therefore you are going to have providers opting out of accepting it or limiting how many patients in it they will take. It’s my understanding that Indian Health Servicss is severely underfunded, which I think is almost always a problem for any program that benefits only some of the population. I also think that programs like the military or Indian Health Services or Veterans Affairs that hire at least some of their own providers and have some of their own clinics/facilities are quite a bit different than what something like Medicare for all would look like. If everyone in the US was in the same program, virtually all providers would be incentivized to participate.

Edited September 15, 2018 by Frances

[frogger]

Just now, goldberry said:

 

So how do we decrease expenses?  The negotiating power of single payer is one option, but if you oppose that, what are the other options that actually might have a chance?

 

Currently my state seems to do everything in its power to increase costs. A) It limits doctors. B) Doctor groups in many areas have monopolies. C) Hospitals have to prove to the state that there is a need before they are allowed to build on. The year before last, both hospitals were spending big money on lobbying and t.v. and radio commercials to try to get permission to add rooms or add a small hospital to my local town. It is called requiring a Certificate of Need. It puts the government in control of the supply. D) States manage Medicade and Medicare grants differently. Some do so better than others.

 

Most people discuss Federal gov't when they discuss health care. Of course, there are Federal mandates that will increase costs also. 

States are technically supposed to be in charge of a lot of this. IF you are going to attempt to fix it at the Federal level then you need to first say state laws are obsolete. Every mandate and law affects every state differently. What we must first understand about the US is that we are a federation of different states. Each state has it's own government and that needs to be dealt with first if you want to fix things at the Federal level. 

[frogger]

Disclaimer: I think we have the worst possible system. The government and insurance companies choose and negotiate deals with doctors and drug companies. The individuals aren't allowed to price shop or choose much of anything, they just pay. They have no incentives to choose a best alternative as that is controlled by gov't and insurance. The one choice they have is to simply not get care or drugs which isn't much of an option. I believe that both a free market with catastrophic insurance and subsidies for low income AND a single payer system would be better than our current system. Compromise has led us to accept the worst parts of both systems into a maze of ridiculousness.  

ETA :  Public pay and control with private profit of insurance and pharmaceutical companies means those companies will lobby and really know how bills will affect them and hire lawyers to do so. The average consumer cannot have that same amount of knowledge for every state and federal bill.

Edited September 15, 2018 by frogger

[SereneHome]

2 hours ago, Ktgrok said:

First, do those worried about "waste" think that insurance companies are being super efficient with their money? Really? I'd say paying huge CEO salaries while people can't afford medication is a waste, myself. 

Second, the idea that people dying for lack of healthcare is more tolerable than the government possibly wasting some money is mind boggling. Is any system going to be perfectly efficient? Nope. But I can accept some waste if it means people can afford their insulin.

I can't speak for anyone, but I can tell you from what I know - for-profit business are very much more efficient than govt and non-for profit.  I am not going to comment on CEO salaries bc that's always start an entire different discussion. 

To your second comments - I can't intelligently say much bc I don't know anything about people dying due to lack of healthcare.  I know that ER will take anyone, I know that medical debts are discharged in BK.  I know people keep bringing up insulin as an example, but I think coverage of drugs is a separate topic than getting health care services. 

 

 

[SereneHome]

28 minutes ago, goldberry said:

 

So how do we decrease expenses?  The negotiating power of single payer is one option, but if you oppose that, what are the other options that actually might have a chance?

I don't know.....I think it's hard bc it's not like we are talking about making widgets.  We are talking about people's lives.  So, anytime there could be any proposal, there will be an huge emotional side to it.

So, those are just my opinions only:

End of life  is one area that needs to be looked at.

Malpractice lawsuits and insurance.  I don't think malpractice insurance should  be paid by individual doctors and I think there shouldn't  be any punitive damages awarded in law suits, only $$ needed for future care.

I think certain procedures could be more streamlined.

I think businesses should allow more sick days

I think health insurance (or whatever alternative) should be completely separated from employment and I think it should be completely tax free.

there are other things but those would be a nice start, I think.

 

[Frances]

34 minutes ago, SereneHome said:

I can't speak for anyone, but I can tell you from what I know - for-profit business are very much more efficient than govt and non-for profit.  I am not going to comment on CEO salaries bc that's always start an entire different discussion. 

To your second comments - I can't intelligently say much bc I don't know anything about people dying due to lack of healthcare.  I know that ER will take anyone, I know that medical debts are discharged in BK.  I know people keep bringing up insulin as an example, but I think coverage of drugs is a separate topic than getting health care services. 

 

 

But having people go to the emergency room for care or waiting until they are so sick it’s an emergency, rather than having basic preventive care their whole lives is one of the reasons we spend more on healthcare in the US, but get worse outcomes. It’s inefficient and wasteful for people to not have affordable access to basic preventive care and instead treat them later for the resulting acute needs. It’s inefficient and wasteful for providers to deal with numerous different health plans and have a significant portion of healthcare dollars go to insurance administration.

My state recently did an audit of its Medicaid program, and just about the only waste they found was not removing no longer eligible people from the rolls quickly enough. They use CCOs (coordinated care organizations) which pay a flat fee per patient and therefore greatly incentivize preventive and outpatient care. They also require providers and clinics wanting to have the more lucrative state employee insurance patients to accept a certain percentage of Medicaid patients, thus dealing fairly effectively with the problem of providers not accepting Medicaid patients. Many hospitals here have also implemented social work programs to cut down on emergency room visits by frequent fliers.

Edited September 15, 2018 by Frances

[SereneHome]

8 minutes ago, HeighHo said:

 

Insulin costs seem to depend very much on what the plan includes.  I know people who have it completely covered after premiums and others who are paying the full deductible, about 10% of their pre-tax income. What seems hard for some is getting ahead enough to pay for the deductible, especially in cases where the deductible is re-imbursed by the employer. The younger people with cancer are depending on the community for that, as they aren't far enough ahead in life for a loan. And some of the older people still working didn't set aside for it. I'd like to see some actual stats, maybe ProPublica can take that on.

That's one of the reasons I think drugs should be completely separate from services.  I think there are SO SO SO many issues with how drugs are covered, how they are prescribed and all the unnecessary hoops people need to jump through to get them.

I am usually  not in favor of increasing govt regulations, but I actually think there should be some type of schedule set for how companies charge for their drugs. Sort of like amortization schedule.

[goldberry]

50 minutes ago, SereneHome said:

I don't know.....I think it's hard bc it's not like we are talking about making widgets.  We are talking about people's lives.  So, anytime there could be any proposal, there will be an huge emotional side to it.

So, those are just my opinions only:

End of life  is one area that needs to be looked at.

Malpractice lawsuits and insurance.  I don't think malpractice insurance should  be paid by individual doctors and I think there shouldn't  be any punitive damages awarded in law suits, only $$ needed for future care.

I think certain procedures could be more streamlined.

I think businesses should allow more sick days

I think health insurance (or whatever alternative) should be completely separated from employment and I think it should be completely tax free.

there are other things but those would be a nice start, I think.

 

 

It's been shown repeatedly that malpractice issues only account for a small percentage of costs.  End of life I totally agree, but that's one of the main scare tactics against single payer, so I don't know how that gets addressed in any productive way when so many want to use it to scare people.  Your other items are valid, but again are not going to affect costs significantly.

Here's a question: When has a for-profit business every voluntarily reduced charges?  Isn't it only when people can or will no longer pay those charges?  Doesn't that inherently exclude healthcare, when people will pay whatever they are able to or have to because lives and health are involved? Do for-profit businesses ever voluntarily reduce charges just because their own costs went down?   

And here's that catch with even not-for-profit - the zero payers.  Hospitals, ambulance services, etc, MUST include the zero payers into their pricing.  How is that ever eliminated without going to a universal plan?  Right now, our local ambulance service is trying to increase revenue.  Their number one issue/liability is zero payers.  I don't think that's isolated.  I can't imagine running a business when you never know when a person comes in the door if they are going to pay you nothing, pay you a little, or pay you a fair amount.  How does anyone price services when that factor is totally random?

[goldberry]

1 hour ago, HeighHo said:

 

Reducing usage by improving wellness, rather than waiting for acute needs.  In my state the first push was for reducing type 2 diabetes and its complications by reducing morbid obesity....the patient is no longer referred to help such as nutritionists, but walked over after seeing the doctor - wellness is now part of the appointment.  The gov't is expanding the network of accessible rail trails and walking trails...if they can get dog owners to use leashes or take pets to dog parks, the seniors will actually be able to walk or use their assistive devices and get out for nature therapy. The next push is depression and the costs and loss of wellness in medicare recipients - my primary's practice has brought in psychs as part of the appointment and they are seeing a good reduction in 70+ senior costs as they steer the patients to well ness , rather than complications.  Among almost everyone we are seeing dna testing help quite a bit to avoid younger folks going in to chronic illness. Some of our friends' business offer a premium cost reduction to those who move/maintain their weight in the normal rather than obese or overweight zone, and provide coverage of the supports necessary to get there.

What's being talked about is how to educate patients to realize when they need to be seen and where.  What's been done is moving patients who come to the  ER to the doctor's office...the ER nurses will call the office, make the appt and call the taxi. They have a voucher system.  Tere is also a bit of online appointments available

What's being experimented with is the traveling doctor, so seniors without transportation after being discharged home from surgery can be seen, rather than moving them to a nursing home. 

 

 

What you are describing has nothing to do with actual cost of services provided. You're talking about how people avoid *spending* more and stay healthier, not how to get providers to *charge* less.

[goldberry]

51 minutes ago, HeighHo said:

 

I've already written my Congressperson...I believe genetic issues should be covered in full.  I challenged him to expand the kidney program coverage to include Type 1 diabetes and genetic cancer (most people under 50 at diagnosis).  No response. 

I really don't think the cost of chronic genetic diseases should go to people in a particular plan, it should be spread over the whole population as well as the alcohol and recreational drug manufacturers.  

I do not beleive that people who ignored good incontrovertible medical advice should have the rest of the world picking up the consequences.  I know too many with good insurance who are happy to pass the buck along with the sugar, as they continue with the YOLO philosophy.  Free can stop with the free metformin and blood pressue meds. 

 

13 hours ago, SereneHome said:

 

I disagree.  I think it's more of "we would like everyone to have some skin in a game" thing.  I find Americans quite generous and fairly community oriented 

 

Let's be real here...it's not a matter of "everyone having skin in the game" (which I think Murphy addressed pretty well with her reply.)  It's a matter of Americans wanting to decide who we think is deserving. HeighHo is basically describing a universal system for what she terms "genetic issues".  So she would be okay with a universal system *for that*.   As long as people who are sick by their own fault (according to who I wonder?) are not having to be paid for by "the rest of the world".  

Are there people out there sick "by their own choices"?  Sure.  But I'm not willing to deny coverage to people because I think I'm in a position to judge how they got there.  How in the world am I in that position to judge people whose lives I have no idea about?  What, everyone with high blood pressure just needs to lay off the salt?  

This is the problem with the idea of community generosity actually working in real life.  Community generosity works for best for those who are pretty, those who are young, those whose stories pull at people's hearts.  Unfortunately there are sick people who don't fit those molds.  And that's where "American generosity" breaks down.  Then you bet it's skin-in-the-game and everyone-for-themselves and not-my-problem.

Sometimes I think that's really at the core of opposition to a universal system.  People want to be able to judge who is deserving (by their standards) rather than just everyone getting healthcare.

[Cindy in FL.]

15 hours ago, EKS said:

Have you ever had to obtain and pay for individual health insurance?  I did (before ACA, so I don't know if things are better), and it was totally frightening.  30% increase each year and that was with me dropping as many benefits as I could.

We have. For 25 years, and we managed to afford decent coverage. Then came the AFFORDABLE Care Act, and we can’t afford regular insurance at all. We basically have something that would cover something severe or catastrophic. 

[goldberry]

9 minutes ago, Ordinary Shoes said:

What a provider charges is largely irrelevant. Medicare and Medicaid pay according to their fee schedule, regardless of what the provider charges. Commercial insurance almost always has a contract with the provider that determines payment. If a patient is out of network, the patient's benefits determine payment. It's rarely paid according to charges. Healthcare costs are about utilization, not charges. 

 

 

But it totally includes the zero payer factor.  With the cost of insurance to employers going up like it is, it is not going to be much longer before more of the country is uninsured than insured.  More uninsured, more zero-payers, higher costs.

 

[goldberry]

4 minutes ago, Cindy in FL. said:

We have. For 25 years, and we managed to afford decent coverage. 

 

Wow, did you have any medical conditions or take any medications?  Your experience does not match mine or anyone I've known in the private insurance market.

[Cindy in FL.]

1 minute ago, goldberry said:

 

Wow, did you have any medical conditions or take any medications?  Your experience does not match mine or anyone I've known in the private insurance market.

I have Hashimoto’s/Hypothyroid and take a low dose of Synthroid. That’s it for our family.

[frogger]

51 minutes ago, Ordinary Shoes said:

Certificate of Need requirements were actually intended to reduce costs. I think it's debatable whether it actually does reduce costs. If a certificate of need is not required then there is an element of "build it and they will come" at work. But on the other hand, requiring certificates of need promotes monopolies which drives up costs as well. I used to do consulting work for providers applying for certificates of need (CON) and it was really shameful how political it is these days when you compare to what it was intended to do. 

 

 

 

 

It goes against the most basic and agreed upon economic theory. Sigh. I don't find it debatable when the the more they use it the higher the costs is and people are sitting in hallways because there aren't enough beds and a town in the most earthquake prone state in the entire nation is separated from all hospitals by bridges due to politics. Certificates of Need are centralized control. I believe most of modern society realizes that though socialism can work,  centralized control and decision making of goods and services is a disaster. What people who are using it say it's for is beside the point. The important thing is what it actually does. 

[SereneHome]

27 minutes ago, goldberry said:

 

It's been shown repeatedly that malpractice issues only account for a small percentage of costs.  End of life I totally agree, but that's one of the main scare tactics against single payer, so I don't know how that gets addressed in any productive way when so many want to use it to scare people.  Your other items are valid, but again are not going to affect costs significantly.

Here's a question: When has a for-profit business every voluntarily reduced charges?  Isn't it only when people can or will no longer pay those charges?  Doesn't that inherently exclude healthcare, when people will pay whatever they are able to or have to because lives and health are involved? Do for-profit businesses ever voluntarily reduce charges just because their own costs went down?   

And here's that catch with even not-for-profit - the zero payers.  Hospitals, ambulance services, etc, MUST include the zero payers into their pricing.  How is that ever eliminated without going to a universal plan?  Right now, our local ambulance service is trying to increase revenue.  Their number one issue/liability is zero payers.  I don't think that's isolated.  I can't imagine running a business when you never know when a person comes in the door if they are going to pay you nothing, pay you a little, or pay you a fair amount.  How does anyone price services when that factor is totally random?

The cost of malpractice is  not just $$.  Some dr push unnecessary treatments and procedures so not to get sued.  Some stop doing certain procedures bc their insurance rates have gone up.  That's why I think malpractice insurance has to be completely separated from practitioner

I am not sure what you mean by "reducing charges" . I am going to respond assuming you mean costs.  Businesses reduce costs in a variety of ways.  But the only one that can be compared health care is reducing price of services.  That's really it.   And yes, I've seen businesses reduce charges. 

I am not terrible familiar with Single Payer or Universal insurance, but isn't it the whole idea behind it that everyone is covered?  And if govt is paying for everyone, who are not payers?  Or are you referring to people who don't pay into the tax system?

[SereneHome]

38 minutes ago, goldberry said:

 

 

Let's be real here...it's not a matter of "everyone having skin in the game" (which I think Murphy addressed pretty well with her reply.)  It's a matter of Americans wanting to decide who we think is deserving. HeighHo is basically describing a universal system for what she terms "genetic issues".  So she would be okay with a universal system *for that*.   As long as people who are sick by their own fault (according to who I wonder?) are not having to be paid for by "the rest of the world".  

Are there people out there sick "by their own choices"?  Sure.  But I'm not willing to deny coverage to people because I think I'm in a position to judge how they got there.  How in the world am I in that position to judge people whose lives I have no idea about?  What, everyone with high blood pressure just needs to lay off the salt?  

This is the problem with the idea of community generosity actually working in real life.  Community generosity works for best for those who are pretty, those who are young, those whose stories pull at people's hearts.  Unfortunately there are sick people who don't fit those molds.  And that's where "American generosity" breaks down.  Then you bet it's skin-in-the-game and everyone-for-themselves and not-my-problem.

Sometimes I think that's really at the core of opposition to a universal system.  People want to be able to judge who is deserving (by their standards) rather than just everyone getting healthcare.

I'll be honest and blunt- I don't really want to express my own opinion on it bc last time I tried here I was not treated very nicely.  I know there are lot of old-times here and I know that certain views are popular more than others,and it seems some people are allowed more "free speech"  but I was called names, including a liar, and was told a few other "nice" things.

So, I won't address that particular idea

 

[frogger]

1 hour ago, goldberry said:

 

 

Here's a question: When has a for-profit business every voluntarily reduced charges?  Isn't it only when people can or will no longer pay those charges?  Doesn't that inherently exclude healthcare, when people will pay whatever they are able to or have to because lives and health are involved? Do for-profit businesses ever voluntarily reduce charges just because their own costs went down?   

 

 

When they are competing for consumers. So gas stations make minuscule amounts off each gallon of gas but if they try to charge a couple pennies more than the person simple drives to a different station. The prices are out in the open for all to see and the cost of driving across the street is also very small.

Stores have loss leaders so they can draw people into stores but some stores with loss leaders also mark up other prices because it's hard for consumers to know all of the prices of everything they buy. 

This is impossible with health care. Doctors and hospitals don't expect and sometimes won't tell you the price. There is also a high cost because you often don't know what's wrong to begin with and it costs just to talk to a doctor. I had to make three trips to the doctor and was charged hundreds of dollars each time despite the doctor not solving the problem and asking me to bring my child in again for a full body rash that was extremely miserable as in Chicken Pox rash but it wasn't chicken pox. It took going to a specialist to get it figured out.  If it were a mechanic I could have sued. A doctor can even brush off your concern, refuse to give you tests or prescriptions even if that is specifically why you came in and still charge you. I realize often the doctor can't know what is wrong with you the first time you show up but the incentives here are to chat (as quickly as possible to move onto another patient) then just have you come in again. 

Our orthodontist doesn't charge us for consultations. You only pay for procedures which they tell you ahead of time. One major difference is that orthodontist work is more straightforward than the complex human body in it's entirety. Another issue though is that insurance doesn't just pay for all the procedures and so consumers ask. 

 

Consumers have no choices in our current system. There is 0 transparency. At least with a single payer system the government would know prices etc.  

It is impossible to ask such questions when you are hemorrhaging though obviously. Overall if hospitals were transparent and helpful to patients in total the better ones would stay in business longer. 

 

There is a lot more to say but I must get off here.

[Murphy101]

3 hours ago, SereneHome said:

I can't speak for anyone, but I can tell you from what I know - for-profit business are very much more efficient than govt and non-for profit.  I am not going to comment on CEO salaries bc that's always start an entire different discussion. 

To your second comments - I can't intelligently say much bc I don't know anything about people dying due to lack of healthcare.  I know that ER will take anyone, I know that medical debts are discharged in BK.  I know people keep bringing up insulin as an example, but I think coverage of drugs is a separate topic than getting health care services. 

 

You do not know what you think you know.

ERs do NOT take anyone.  They either stabilize an acute situation or admit to the hospital.  Let's say a diabetic comes in unconscious due to high or low blood sugar.  They stabilize them if possible and then they discharge them with orders to take better care of themselves and follow up with a primary care physician.  The ER doesn't "take them".  The ER doesn't make sure they can get their meds or medical equipment.  They do triage and send them home. 

Medical debts are the leading cause of bankruptcy. It's nuts that you think people should have to live in perpetual bankruptcy to stay alive.  But it also doesn't take into account that doctors and clinics don't have to see patients for free.  If you can't afford the appt, then it doesn't much matter if you could eventually file bankruptcy on the balance.  If a diabetic needs a pump today and doesn't have the money, there isn't a debt to file bankruptcy on.  Not to mention, you can only file bankruptcy every 10 years.  

Medications are not separate from healthcare. It's rot nonsense to suggest it is.  Both need heavier government involvement and regulations that favor reasonable good for society over mega profit for the few.  My God, eliminating medications from the healthcare reform leaves nearly everyone with mental illness screwed even more than they are now.  I guess labotomies could make a comeback?

I bring up insulin because it's something many are familiar with but I could list so many more.

Someone else mentioned people going to the dr too often, especially kids going too much.  That often isn't up the parents.  Our family work and education policies are crap.  Kid probably has the common cold, but he can't be out of school long enough to recover without a dr note, or mom can't take off work without it.  And since people often put off going as lob as they can, it can take many more appts to complete care. A lot of expense could be saved by giving MORE access to physicians and medications from the start.

Edited September 15, 2018 by Murphy101

[SereneHome]

1 hour ago, Murphy101 said:

 

You do not know what you think you know.

ERs do NOT take anyone.  They either stabilize an acute situation or admit to the hospital.  Let's say a diabetic comes in unconscious due to high or low blood sugar.  They stabilize them if possible and then they discharge them with orders to take better care of themselves and follow up with a primary care physician.  The ER doesn't "take them".  The ER doesn't make sure they can get their meds or medical equipment.  They do triage and send them home. 

Medical debts are the leading cause of bankruptcy. It's nuts that you think people should have to live in perpetual bankruptcy to stay alive.  But it also doesn't take into account that doctors and clinics don't have to see patients for free.  If you can't afford the appt, then it doesn't much matter if you could eventually file bankruptcy on the balance.  If a diabetic needs a pump today and doesn't have the money, there isn't a debt to file bankruptcy on.  Not to mention, you can only file bankruptcy every 10 years.  

Medications are not separate from healthcare. It's rot nonsense to suggest it is.  Both need heavier government involvement and regulations that favor reasonable good for society over mega profit for the few.  My God, eliminating medications from the healthcare reform leaves nearly everyone with mental illness screwed even more than they are now.  I guess labotomies could make a comeback?

I bring up insulin because it's something many are familiar with but I could list so many more.

Someone else mentioned people going to the dr too often, especially kids going too much.  That often isn't up the parents.  Our family work and education policies are crap.  Kid probably has the common cold, but he can't be out of school long enough to recover without a dr note, or mom can't take off work without it.  And since people often put off going as lob as they can, it can take many more appts to complete care. A lot of expense could be saved by giving MORE access to physicians and medications from the start.

I didn't respond the first time you quoted me.  And I really won't respond this time except to say that while you might be a popular member on here - you come off as insulting and condescending and entirely intolerable to any views other  than your own and I have less than zero interest in having any kind of discussion with you.

Obviously, you can quote whoever you want, but you will be wasting your time if you waiting for any kind of response from me.

[Pawz4me]

13 minutes ago, HeighHo said:

Under the ACA annual checkups are free. 

Not always, apparently.

I had my annual physical a few weeks ago. I was told because it involved a medicine check I'd have to pay my regular co-pay. That medicine check consists of my thyroid--the check is only as involved as reviewing blood work. It probably takes an extra ten seconds as the provider is reviewing all the other standard annual blood work (CBC, lipid panel, etc.).

[SereneHome]

Just now, Pawz4me said:

Not always, apparently.

I had my annual physical a few weeks ago. I was told because it involved a medicine check I'd have to pay my regular co-pay. That medicine check consists of my thyroid--the check is only as involved as reviewing blood work. It probably takes an extra ten seconds as the provider is reviewing all the other standard annual blood work (CBC, lipid panel, etc.).

We also had to pay for regular blood work that used to come as part of physical. It was around $300.

[frogger]

4 minutes ago, Pawz4me said:

Not always, apparently.

I had my annual physical a few weeks ago. I was told because it involved a medicine check I'd have to pay my regular co-pay. That medicine check consists of my thyroid--the check is only as involved as reviewing blood work. It probably takes an extra ten seconds as the provider is reviewing all the other standard annual blood work (CBC, lipid panel, etc.).

 

 

Yes, if you involve any actual needed things (like dealing with my asthma) it isn't any longer just a check up. It is dealing with an issue.  Even if it takes almost no time from the doc. 

[historically accurate]

44 minutes ago, Pawz4me said:

Not always, apparently.

I had my annual physical a few weeks ago. I was told because it involved a medicine check I'd have to pay my regular co-pay. That medicine check consists of my thyroid--the check is only as involved as reviewing blood work. It probably takes an extra ten seconds as the provider is reviewing all the other standard annual blood work (CBC, lipid panel, etc.).

DH's employer switched insurances in January so our physicals are free this year (Whoo-hoo!). But last year's insurer was apparently grandfathered in or something and we still paid our co-pay ($25) for annual physicals/well child visits. 

[Pawz4me]

32 minutes ago, HeighHo said:

 

Yes, I'm being told same as frogger.  An annual has a specific set of things that is covered; outside of that you pay for a regular office visit.  I've actually waived the vision screening portion of the annual, I don't need it as the optometrist knows how to correctly measure my vision, can't be done in the primary's office with a wall chart.  I've added bloodwork that I feel is important that is not the standard of care or covered as part of an annual -- vitamin D for my dc for example, and I completely pay the negotiated price for that oop if I haven't met deductible.  You could possibly cost cut by scheduling that thyroid bloodwork review with the PA or the nurse. I'm cost cutting by doing all my bloodwork at the same time...everything for the specialist and the primary...at the lab in one draw, rather than at any one provider.  I've found the lab has the least expensive draw price and since I just walk a block down the street, its not a time suck to go there.

My primary care provider is a PA. I'm lucky--the cost isn't a big deal for me. I just wanted to point out that yearly physicals aren't always free now. My guess is that more people than not need some sort of medicine check. 

[Murphy101]

1 hour ago, SereneHome said:

I didn't respond the first time you quoted me.  And I really won't respond this time except to say that while you might be a popular member on here - you come off as insulting and condescending and entirely intolerable to any views other  than your own and I have less than zero interest in having any kind of discussion with you.

Obviously, you can quote whoever you want, but you will be wasting your time if you waiting for any kind of response from me.

 

That’s okay.  I don’t necessarily respond for the sake of getting a response from the one quoted but to rebuttal their view. Such is the nature of serious discussion. 

I’m actually very receptive to most ideas but the truth is some views aren’t worth consideration. 

For example, the idea that a demographic isn’t deserving of basic healthcare and life saving medications is abhorrent and unworthy of genuine consideration beyond pointing out in a clear concise manner why it’s abhorrent.

Other ideas that are simply not factual being presented as though they are truth are unworthy of consideration beyond pointing out in what ways that it is not actually true.

If having that pointed out makes someone uncomfortable, that’s less priority to me than refusing to perpetuate the wrong and the inhumane being discussed.

If that bothers you, you should block me.  Or make my day by proposing ideas that are both reasonable and ethical. 

[SereneHome]

14 minutes ago, Murphy101 said:

 

That’s okay.  I don’t necessarily respond for the sake of getting a response from the one quoted but to rebuttal their view. Such is the nature of serious discussion. 

I’m actually very receptive to most ideas but the truth is some views aren’t worth consideration. 

For example, the idea that a demographic isn’t deserving of basic healthcare and life saving medications is abhorrent and unworthy of genuine consideration beyond pointing out in a clear concise manner why it’s abhorrent.

Other ideas that are simply not factual being presented as though they are truth are unworthy of consideration beyond pointing out in what ways that it is not actually true.

If having that pointed out makes someone uncomfortable, that’s less priority to me than refusing to perpetuate the wrong and the inhumane being discussed.

If that bothers you, you should block me.  Or make my day by proposing ideas that are both reasonable and ethical. 

Wow, can you get any more sanctimonious and pompous??

You don't have to answer it....it's not worthy of your consideration.....

[frogger]

4 hours ago, goldberry said:

 

Wow, did you have any medical conditions or take any medications?  Your experience does not match mine or anyone I've known in the private insurance market.

 

How ACA affected people really varies by state. In our state rates went through the roof. Other states saw improvement. When each state has its own beauracracy you will end up with different results with the same bill. Thus my earlier content about State versus Federal  regulation. 

[Murphy101]

17 minutes ago, SereneHome said:

Wow, can you get any more sanctimonious and pompous??

You don't have to answer it....it's not worthy of your consideration.....

 

If pointing out that it’s abhorent to say some people don’t deserve medical care because they brought the need for it on themselves or pointing out that certain statements are not true makes me sanctimonious and pompous - I’ll wear those badges with no shame at all. 

[Murphy101]

39 minutes ago, StellaM said:

 

Hear hear!

(And no, that's not because Murphy is 'popular' but because she's right).

 

Probably the first time in my whole life I’ve ever had it suggested that I am popular.  I feel like I should do more hair tossing or something to reflect my status.  Maybe work on my flirty girlie giggle...

[SereneHome]

6 minutes ago, Murphy101 said:

 

If pointing out that it’s abhorent to say some people don’t deserve medical care because they brought the need for it on themselves or pointing out that certain statements are not true makes me sanctimonious and pompous - I’ll wear those badges with no shame at all. 

It would probably make you look little better, siting on that high horse of yours, if I actually said those things.

And there are various way to point out to people if their statements are inaccurate or if you simply disagree.  You picked  a fairly insulting way.  It seems it severed you well, though, since you now have a cheerleader.  Good for you.

It's clear that you and I are not meant to have any kind of discussion, so I suggest we both happily move on with our lives.

[Paige]

I wish we could reframe the discussion so that we look at healthcare in terms of public health, public good, and as something we need to protect our communities- national defense-instead of as individual needs.

I don't really care if some guy down the street chooses to spend his money on travel instead of paying insurance. I care that he sees the doctor when he's sick. I don't care if someone has 50/11 kids and should have stopped because now she can't afford their meds. I care that the kids get their medicine. I don't care about anyone else's choices or whether they deserve it or what their level of responsibility is. I only care that the guy who travels can pick up a nasty flu that could become a pandemic in our country and that those kids could help spread it all over the neighborhood. Our terrible system is an actual danger to all of us if there's any kind of outbreak going around. Clean water and proper sanitation are good for everyone. Public rest areas on the highway are good for everyone.  The police and military are good for everyone. And access to healthcare is something we should see as a need for general public safety and national security. 

[Murphy101]

10 minutes ago, HeighHo said:

 

Again, you are ducking my question.  Enjoy your blame game. Don't bother responding to me.

 

Maybe she can’t find the question bc I can’t seem to...

Is the question:

Allow all genetic disorders to be fully covered, but not disorders deemed to not be genetic?

My answer is no. 

Because people shouldn’t have to justify or prove their DNA to get medical care for many reasons.

Because that creates second class citizens.  Either the government policy/law applies to everyone equally or it shouldn’t be a government policy/law.

Aside from that, what little we know about genetics makes this such a chicken vs egg first scenario.

 

[Murphy101]

16 minutes ago, Paige said:

I wish we could reframe the discussion so that we look at healthcare in terms of public health, public good, and as something we need to protect our communities- national defense-instead of as individual needs.

I don't really care if some guy down the street chooses to spend his money on travel instead of paying insurance. I care that he sees the doctor when he's sick. I don't care if someone has 50/11 kids and should have stopped because now she can't afford their meds. I care that the kids get their medicine. I don't care about anyone else's choices or whether they deserve it or what their level of responsibility is. I only care that the guy who travels can pick up a nasty flu that could become a pandemic in our country and that those kids could help spread it all over the neighborhood. Our terrible system is an actual danger to all of us if there's any kind of outbreak going around. Clean water and proper sanitation are good for everyone. Public rest areas on the highway are good for everyone.  The police and military are good for everyone. And access to healthcare is something we should see as a need for general public safety and national security. 

 

I whole heartedly agree. 

A healthy and good society needs education, health, infrastructure and economic opportunity. The more of those in a society the better for everyone.

[Murphy101]

18 minutes ago, HeighHo said:

 

No, that isn't the question.  I am sorry I cannot help you with reading comprehension.  

And you already know that surgery and medication for genetic disorders aren't fully covered as it is, especially if it involves dental or eyeballs. If you want to spout off on the ethics, go ahead. You can play the blame game all you want. If you need a new blame topic, go ahead and pontificate on how LASIK for nearseated people who are -10 diopters isn't covered, but coke bottle lenses for life is...despite the coke bottles being more expensive over lifetime. Similar for dental orthodontia.

 

What the hecken? I asked a sincere question. What, exactly, is your question?  I thought maybe it was about who should be covered, in specific to the threads around your comments.  My error that it wasn’t, which I apologize for while still wondering what exactly your question was, please?  It’s not like I’m the first person to make a conversation flow error in a heated thread around here.

It is one thing to say one way of correcting vision is paid vs another that isn’t and a whole other thing to say no vision correction is covered and yet another that only certain people are worthy of vision coverage. 

It’s my opinion that too many people don’t care if anyone has healthcare as long as they do. Everyone else? Oh well.  Too bad. So sad.  Then many many people are saying A comment is unethical and that B comment is simply not true and make sincere pleas of frustration at the lack of righteous reason and compassion - they are met with Scrooge-like insistence that it can’t be all that bad because we have prisons and poor house. (Or ERs and bankruptcy)

It’s only feels like blame to a Scrooge. To everyone else it’s just dumbfounding basic decency and often good economic sense. Or at least more sense than the crazy current mess. 

I don’t want to blame the fat person for their blood pressure and I don’t want to blame the healthy person for their miserliness. I want everyone to quit being petty and DO something, ANYTHING, so that the next generation has a better system than this. I want people to quit acting like healthcare for all, or as close to it as we can get, doesn’t benefit everyone in the long run. 

[goldberry]

7 hours ago, Cindy in FL. said:

I have Hashimoto’s/Hypothyroid and take a low dose of Synthroid. That’s it for our family.

You were lucky where you lived maybe.  I have a friend with Hashimoto's and she could not get private insurance - regardless of cost - in the pre-ACA years.  That's here in Colorado.  Her husband had to be careful of his hours at work so they would stay under the qualifying limit to be on Medicaid.  

[goldberry]

2 hours ago, frogger said:

 

How ACA affected people really varies by state. In our state rates went through the roof. Other states saw improvement. When each state has its own beauracracy you will end up with different results with the same bill. Thus my earlier content about State versus Federal  regulation. 

Oh no, our rates are going through the roof now also.  I was talking more about how expensive it was to get coverage with a pre-existing condition, if you could even get coverage.  There were several companies offering to accept people with pre-existing conditions at a higher price...but they would just exclude the condition.  ???  Um, if you are excluding the condition that will cost you money, which should the price be higher? Shouldn't it be lower?

There are many complicated reasons why rates are going through the roof.  Requiring coverage of pre-existing conditions is only one part of that puzzle.  The shrinking participation pool is huge.  Everyone has to be in the same pool for it to work.