Health insurance in the US

[Mary Stetler]

We used to look at Canada and maybe be jealous that all their medical needs were met via government. Then we heard they were coming to the US because their wait time was soooooooo long.
In 2015 I needed a hip replacement and was told my mri would cost $2300. I went to a private lab and got one on disc for $600. When I proposed I already had an mri to bring to my appointment, I was told the hospital equipment would not be able to read it.
So I found an exceptional doctor in a different hospital whose equipment could read it just fine...
Hospitals should no longer be industries.
I just saw THIS. It makes my blood boil.

 

[Jacob Petersheim]

It's not just Canada. Europe is packed with stories of the woes of highly-socialized medicine, its high costs, wasteful bureaucracy, waiting lists, and general inadequacies.

I suspect high costs in the US in medical research, practice, and pharma are all about the way Americans have been subsidizing the rest of the world since WW II. They have taken the handouts and squandered them through central planning by a power elite and a bloated civil service class within their societies.

I can't hang all of our woes on Obama, he was just a player in the game that tried to impose the same philosophy upon the US. What they didn't figure on was that there wasn't anyone left to parasitize as Europeans and Canadians have enjoyed for so long. I think it trees up to G. H. W. Bush and Bill Clinton, two turds of a feather, Deep State operatives tied to the WEF.

 

[Don Alaska]

We used to look at Canada and maybe be jealous that all their medical needs were met via government. Then we heard they were coming to the US because their wait time was soooooooo long.
In 2015 I needed a hip replacement and was told my mri would cost $2300. I went to a private lab and got one on disc for $600. When I proposed I already had an mri to bring to my appointment, I was told the hospital equipment would not be able to read it.
So I found an exceptional doctor in a different hospital whose equipment could read it just fine...
Hospitals should no longer be industries.
I just saw THIS. It makes my blood boil.

You may have seen my rant on the way things have gotten out of control. The higher bills are in part a consequence of Medicare and Medicaid (to a lesser extent). Because Medicare reimbursement is so bad, providers have to bill exorbitant amounts to get sufficient payment, but since Federal law prohibits them from charging anyone less than they bill Medicare, all "non-guaranteed" payment systems , i.e., insurance companies, have to be billed the same inflated prices that are billed to Medicare. They are not allowed by law to bill less. "Guaranteed" payment systems, such as self-pay, doctor's offices, and other hospitals or clinics fall under the secondary payment schedule which bills only what the provider needs for that service. It is not really a discount, it is just a different payment schedule.

I, myself, was a victim of something that I don't yet understand and I am pretty savvy when it comes to billing. When I had my back surgery, the only surgeon who could do the operation was out of network for my insurance. I had Medicare Part A, but I didn't get Part B since I had to carry private BC/BS because my wife was not yet old enough to be eligible for Medicare. Since the providers was out of network, Medicare paid a small part of the bill and I expected BC/BS to pay most of the rest, which they did...temporarily. They sent me a check for the surgery, and I promptly sent it to the surgeon. Two weeks later, I got a notice from insurance that they had "overpaid" because they assumed I had Part B and didn't check. They sent me a bill for $8000 that they said they had overpaid since I didn't have Part B and I was responsible for sending the money back and I was supposed to get the money back from the surgeon. Well, you can guess how that went. I still don't understand why one insurance would pay less because another I didn't have additional insurance. Nobody could explain it to me either, and I asked many people.

 

[Mary Stetler]

I suggested a law requiring publication of actual costs of hospitals and clinics for products and procedures. A great surgeon should get paid the most, IMHO. But they should have standardized charges. I believe they do if you go to the right room in the basement. Book keeping? If the charges are standardized, the insurance companies should not be able to do the creative stuff they do.
But corruption will continue to pop up if no one keeps up with it.

 

[Don Alaska]

Hospitals usually do calculate how much things cost. That is what the base amount is that people who self-pay are billed (cost + margin). Just like private companies, they have to know what the overhead is in order to calculate charges. Like I said before, that doesn't matter when the government sticks its nose under the tent flap. Well-intentioned laws have a lot of unintended consequences.

 

[Don Alaska]

I should add that calculating how much something costs is a complicated thing. Each process usually has an assigned number of minutes or hours to perform, similar to what mechanics use to perform repairs. THEN the level of employee or provider required is determined, e.g., surgeon, nurse, technician, etc. After that the facilities and equipment to do it is measured and the utilities, maintenance staff, service contracts, lease or purchase costs are factored in by square footage, as are the housekeeping requirements. For utilities and housekeeping, the square footage (or cubic footage) of space of the entire facility is determined and the costs are allocated by the square footage used. The employee type required then uses the total cost for that employee, i.e., any benefits costs such as PTO and vacation, insurances, average 401K contributions, etc. per hour are then matched against the average of those costs are then allocated against the time specified for that process. Any waiting rooms or recovery spaces are also factored in. It requires a lot of spreadsheet work and database entry if it is done properly. How well this is all done depends on how well the facility as a whole is managed.

 

[Mary Stetler]

I should add that calculating how much something costs is a complicated thing. Each process usually has an assigned number of minutes or hours to perform, similar to what mechanics use to perform repairs. THEN the level of employee or provider required is determined, e.g., surgeon, nurse, technician, etc. After that the facilities and equipment to do it is measured and the utilities, maintenance staff, service contracts, lease or purchase costs are factored in by square footage, as are the housekeeping requirements. For utilities and housekeeping, the square footage (or cubic footage) of space of the entire facility is determined and the costs are allocated by the square footage used. The employee type required then uses the total cost for that employee, i.e., any benefits costs such as PTO and vacation, insurances, average 401K contributions, etc. per hour are then matched against the average of those costs are then allocated against the time specified for that process. Any waiting rooms or recovery spaces are also factored in. It requires a lot of spreadsheet work and database entry if it is done properly. How well this is all done depends on how well the facility as a whole is managed.

True but I find differences in cost (W/wo insurance, cash payments...)leaves a lot of room for skullduggery.

 

[Marie Mallory]

We used to look at Canada and maybe be jealous that all their medical needs were met via government. Then we heard they were coming to the US because their wait time was soooooooo long.
In 2015 I needed a hip replacement and was told my mri would cost $2300. I went to a private lab and got one on disc for $600. When I proposed I already had an mri to bring to my appointment, I was told the hospital equipment would not be able to read it.
So I found an exceptional doctor in a different hospital whose equipment could read it just fine...
Hospitals should no longer be industries.
I just saw THIS. It makes my blood boil.

Mary I skipped thru the video but got an idea of what they are saying, seems everything is crazy now.
They don't charge the insurance company's what the charge us if we don't have insurance. Our insurance is over $500 a month.

 

[Don Alaska]

True but I find differences in cost (W/wo insurance, cash payments...)leaves a lot of room for skullduggery.

That is true, but the payments without insurance should be thee same as the cash payments. The reference in the video to a "discount" shouldn't be that. The amount billed to insurance out-of-network should be the same as that billed to Medicare. the In-network or PPO billing or amount accepted is negotiated separately and is allowed under the system. If a provider does not accept Medicare patients, they are free to bill as high or as low as they wish. That is why quite a number of providers do not accept new Medicare patients. They usually feel obligated to continue to treat the patients they have seen for years. Our family doctor, who had treated our entire family since we moved to this area of Alaska "retired" when Obamacare was passed. He was a single doctor practice and those were generally eliminated when the ACA was passed due to regulations designed to do just that. I moved to the VA system after that, and my wife moved to one of the internists suggest by the retiring doctor. When my wife turned 65, she could no longer see the doctor she had seen for several years and was moved to a PA in the same practice. Recently, that PA moved from the state and my wife could no longer be seen at that office. It was suggested that she contact a hospital who has a referral service that finds providers who will still accept new Medicare patients. She did find a PA at a clinic who would see new Medicare patients, so she will be going there for her medical care. I don't know what will happen if she should need anything done that goes beyond what a PA can legally do.

I had a friend whose father was a doctor in Illinois who had practiced for decades in a small town who retired but wanted to continue to see his old patients, especially the ones with very low fixed income. He intended to charge them $5 or $10 per visit and prescription refill. He was informed by Medicare that he could not do that, and if he saw even one patient who had Medicare insurance and didn't charge them the Medicare price, the Federal government would sanction him and have his license to practice pulled for "malpractice". When I first started in an ER, people could visit the ER and pay out of pocket. The charges were not really low by those times as they were often $75 or more if they had something done by a doctor. Of course, the standards of treatments were lower then and the likelihood of a physician being sued was much lower.

 

[Mary Stetler]

The part B is pulled from Social Security off the top. Additional insurance can be had.
My youngest daughter found it is cheaper to pay the penalty and out of pocket as she can't afford the premium and the deduction of Obamacare on what she makes. A friend who recently died at 80 always said not to have insurance as it is a racket and to just put the premiums 'in a jar or someplace'. That way it is like gambling, if you need to use it, you do and if you don't need to use it ,you don't. He was very health conscious and never got hit by a bus. But these days cancer causes seem to be everywhere and people are just addicted to processed food.
I grew up in a family who only went to a doctor for broken bones or concerning illness. No symptomless check ups except for babies. This medical industrial complex is nuts.

 

[Don Alaska]

Hopefully, Obamacare will go away. It may be a year or more in the future though. If the Democrats retake Congress next year, you can be sure it will not go away and the subsidies will grow along with the restrictions and requirements. If you remember, original Obamacare required single men to buy maternity care and abortion benefits even though they could never use it. It was to subsidize those benefits for others and fatten the insurance company coffers. There was also a "benefit board" in the original bill that would allow care to be withheld for seriously ill patients who were not contributors to society. That was pointed out by Sarah Palin when she ran for VP, but the media quickly shut that news down. "We have to vote for this bill so we can find out what is in it."

 

[Mary Stetler]

I went to talk to a medicare agent Saturday. She showed us zero monthly payment plans that payed back the part B taken out of our social security checks. How can that be? To get us to vote Democrat next time? or to get us to vote for Trump? It won't take down our national debt.

 

[Don Alaska]

I think it is a subsidy for those on Medicare and Medicaid, but it only applies to some zip codes. I have no idea how it is determined.

 

[Yvonne Smith]

I think it is a subsidy for those on Medicare and Medicaid, but it only applies to some zip codes. I have no idea how it is determined.

They always talk about the zip code in the ads , but pretty much you should be able to get a Medicare advantage plan anywhere you live. The extra benefits and free coverage depend on your income, notyour zip code. I think that part is just for the insurance company to decide which agent to have contact a person.
Just about every insurance company has special needs programs, which help people with long term illnesses, and also help low income programs. When you go to an insurance website, they ask you information questions to see which plan can work for you.

 

[Mary Stetler]

I was just watching a youtube about the lie that was the ACA, with receipts, which just increased the wealth of insurance companies while not helping the American citizens at all--maybe just a few lower income people as usual. The members of Congress were discussing positive measures that could be done to actually make a decent approach to healthcare, increasing hospital/clinic competativeness (?) while not enriching the insurance companies unfairly, health savings accounts...
It was pointed out that no Democrats came to the meeting although they were aware of it.
It seems the Democrats want to earn votes by slamming the Republicans and making promises that they will not keep after next elections not accomplishing anything for Americans.
Why? Kickbacks and other corruption?

 

[Don Alaska]

I was just watching a youtube about the lie that was the ACA, with receipts, which just increased the wealth of insurance companies while not helping the American citizens at all--maybe just a few lower income people as usual. The members of Congress were discussing positive measures that could be done to actually make a decent approach to healthcare, increasing hospital/clinic competativeness (?) while not enriching the insurance companies unfairly, health savings accounts...
It was pointed out that no Democrats came to the meeting although they were aware of it.
It seems the Democrats want to earn votes by slamming the Republicans and making promises that they will not keep after next elections not accomplishing anything for Americans.
Why? Kickbacks and other corruption?

That is the game they play. I think the ACA was designed , not to make health care more affordable as advertised, but to make it so expensive as to be unaffordable for most people and for a change to government paid--and run--health care. The American government cannot run a business. That has been shown over and over with the Post Office, Amtrak, Conrail, etc. Look at what has happened to the welfare system ! government-run enterprises here get so bogged down in corruption, inefficiency, and bureaucracy. The same would happen to health care. Some aspects of government health care, such as the VA and military systems, the Indian Health Service and the Public Health Service can be run fairly well, but those systems are small compared to the U.S. healthcare system as a whole. I have advocated for opening Medicare and Medicaid clinics run by private organizations and supported by HHS, not to be the sole means for those populations to be served, but as an alternative to which they can turn with no copays or coinsurance, and perhaps higher payment schedules for the organizations that run the clinics. I think it would be a good thing for patients to see the same provider all the time and to have records located at one place. I would also advocate for a small or moderate co-pay for anyone visiting the Emergency Department for other than emergency reasons to make ERs run more efficiently and not be bogged down by non-emergent cases. All that a trauma victim or heart attack victim needs is to pick up influenza or another virus in the ER when being treated for their critical situation.

The idea of sending healthcare subsidies to the patients rather than the insurance companies is perhaps a good starting point, but, as we have seen in Minnesota, corruption lurks there in a big way as well. The VA and IHS system of the primary care people referring to specialists and consultants and paying the bill keeps that to a minimum.

 

[Nancy Hart]

The heavy involvement of private insurance companies in Obamacare (ACA) was the result of a compromise with the Republicans, because they want to privatize everything.

The ACA is very much like Medicare Part C (Medicare Advantage), for which the insurance companies are making a fortune. The Democrats' contribution was setting certain minimum standards that the insurance companies have to abide by, like pre-existing conditions.

In a democracy there has to be compromise. An alternative is to shut down the House of Representative for 54 days and do nothing.