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05/15/2012 07:41:27 PM · #1351 |
Originally posted by Kelli:
Originally posted by DrAchoo:
Of course, Kelli. That's like polling with the question, "Are you against AIDS?" and then taking that result to claim a government mandate of publically funding medicines for all HIV patients.
We're all for affordable healthcare. Democrats. Republicans. Everybody. Nobody is even arguing that the current system seems to be broken. But the big argument is HOW to fix it... |
Well, duh. Did you even read the article? |
Nope. I assumed you hit the highlights and they weren't very impressive. Cowboy was saying people are bitter over "Obamacare" (ie. a specific plan to get to the affordable healthcare we all want). You said lots of people aren't but then try to use this as evidence to support your position. I'm just pointing out this info doesn't do anything of the sort. It just tells us people are unhappy with the current system and want it fixed. It doesn't say they feel the current plan on the table is the way to do it.
Frankly, when the SCOTUS strikes this down we are completely screwed until we have a real crisis. There will be no fixing the system after that ruling in any systematic way until the crap REALLY hits the fan. Then we'll have the political will to do something about it, but not a moment before. Gotta love how things work in our country. |
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05/15/2012 07:43:59 PM · #1352 |
| It will never be "fixed" as long as those who can afford it can still buy it. Those who can afford health care really don't give a rat's ass about those who can't. |
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05/15/2012 08:03:17 PM · #1353 |
Originally posted by DrAchoo:
Originally posted by Kelli:
Originally posted by DrAchoo:
Of course, Kelli. That's like polling with the question, "Are you against AIDS?" and then taking that result to claim a government mandate of publically funding medicines for all HIV patients.
We're all for affordable healthcare. Democrats. Republicans. Everybody. Nobody is even arguing that the current system seems to be broken. But the big argument is HOW to fix it... |
Well, duh. Did you even read the article? |
Nope. I assumed you hit the highlights and they weren't very impressive. Cowboy was saying people are bitter over "Obamacare" (ie. a specific plan to get to the affordable healthcare we all want). You said lots of people aren't but then try to use this as evidence to support your position. I'm just pointing out this info doesn't do anything of the sort. It just tells us people are unhappy with the current system and want it fixed. It doesn't say they feel the current plan on the table is the way to do it.
Frankly, when the SCOTUS strikes this down we are completely screwed until we have a real crisis. There will be no fixing the system after that ruling in any systematic way until the crap REALLY hits the fan. Then we'll have the political will to do something about it, but not a moment before. Gotta love how things work in our country. |
I figured you didn't by your response. At least I have the decency to read what other people post before I dismiss it. |
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05/15/2012 08:23:16 PM · #1354 |
Ok, I went back and read it. It still doesn't support you. In fact, they say " 60% oppose the legal requirement that everyone buy health insurance" as one fairly easy to understand portion of the medical care act. Unfortunately THAT'S THE CRUX OF THE BILL. That's how it works. We pay for the cool things like people not being able to be excluded for pre-existing conditions or being able to be on your parent's plan longer by making everybody buy it. The healthy young people pay into the system and support the sick (and usually older) people. 60% of Americans have some sort of problem with that (and apparently so does the SCOTUS). Without that portion you have no fix you only have a mandate to spend more money but no way to pay for it.
So, again, you and I think it's a good idea, but "a lot more people" actually disagree with us. I don't know how big the circles are that you run in, but I'm trying to open your eyes to a portion of America you don't seem to have a lot of exposure to. |
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05/15/2012 08:38:48 PM · #1355 |
Originally posted by DrAchoo:
Ok, I went back and read it. It still doesn't support you. In fact, they say " 60% oppose the legal requirement that everyone buy health insurance" as one fairly easy to understand portion of the medical care act. Unfortunately THAT'S THE CRUX OF THE BILL. That's how it works. We pay for the cool things like people not being able to be excluded for pre-existing conditions or being able to be on your parent's plan longer by making everybody buy it. The healthy young people pay into the system and support the sick (and usually older) people. 60% of Americans have some sort of problem with that (and apparently so does the SCOTUS). Without that portion you have no fix you only have a mandate to spend more money but no way to pay for it.
So, again, you and I think it's a good idea, but "a lot more people" actually disagree with us. I don't know how big the circles are that you run in, but I'm trying to open your eyes to a portion of America you don't seem to have a lot of exposure to. |
You're right. I don't have a lot of access to rich people. The crux of that article is that people don't understand the bill. They don't have a freaking clue that it will help them. They just listen to the sound bites. Death panels. Eeek! Forced to buy insurance. Eeek! Guess what. I'm on permanent disability. I have to buy medicare. I can't turn it down (I'd be a fool to want to), but that's not something new. When I was working my daughter was kicked off my private plan when she turned 18 because she wasn't in school. Poor kid, shouldn't have graduated early. Her mistake. When I was working and had very good private insurance, I had claims denied for pre-existing conditions. Silly me for having health problems. I'm sorry, but you've got to be a complete and utter moron to not want health insurance. No matter how healthy you are.
eta: You seemed to have cherry picked one thing out of that article. What about this... When asked about what should be the goals of health care reform, about 90% of all Americans indicated that it was important to find a way to get health insurance for those who are uninsured, to prevent insurance companies from refusing to ensure people with pre-existing conditions, and to prevent insurance companies from dropping persons due to illness. About six out of every 10 said these goals were “critically important”. Only one of every 10 said they were not important. These goals remain at the core of Mr. Obama’s health care reforms. Other goals were less popular but still had the support of a majority of Americans.
Message edited by author 2012-05-15 20:51:00. |
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05/15/2012 08:49:59 PM · #1356 |
Originally posted by Melethia:
It will never be "fixed" as long as those who can afford it can still buy it. Those who can afford health care really don't give a rat's ass about those who can't. |
I agree completely with your assessment. I also think that a very common misperception is that people believe they will be forced to give up the health care provided by their employer if Obamacare goes into effect.
Message edited by author 2012-05-15 21:00:58. |
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05/15/2012 09:07:44 PM · #1357 |
Originally posted by Kelli:
You're right. I don't have a lot of access to rich people. The crux of that article is that people don't understand the bill. They don't have a freaking clue that it will help them. They just listen to the sound bites. Death panels. Eeek! Forced to buy insurance. Eeek! Guess what. I'm on permanent disability. I have to buy medicare. I can't turn it down (I'd be a fool to want to), but that's not something new. When I was working my daughter was kicked off my private plan when she turned 18 because she wasn't in school. Poor kid, shouldn't have graduated early. Her mistake. When I was working and had very good private insurance, I had claims denied for pre-existing conditions. Silly me for having health problems. I'm sorry, but you've got to be a complete and utter moron to not want health insurance. No matter how healthy you are. |
For years I went with no insurance....and I am sure you will say...but you were in the military....I got out of the military in 2000 (before 9/11) then I ended up joining the army reserves after being out for about 2 years.(absolutely no insurance) My insurance only covered me on drill weekends...or deployments. Now that I have given my background it is time to come into the real world.
In my time of no insurance or virtually none..(I joined the reserves in 2002 and stayed til 2010 with 2 deployments under my belt and no-one offered insurance at the jobs I was working) there was always help when I needed it. Free clinics for the poor. I went several times.
I do have a job now that offers health insurance...It is a perk to keep good people. They have had this perk since before I was born.....and it is a very old company. I have watched my premiums go up 3 times in 6 months. The reason behind this...Obama is attacking the citizen not the problem. Just like all his policies.
Ya know the robin hood complex. Give from the rich take from the poor. A socialistic lifestyle is not for me.
Anyway to sum things up. When I was unemployed and had no insurance. I did not blame the rich guy. There was no reason to be upset that someone could afford something that I couldnt....
Attack the prob with the costs...not forcing people to contribute
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05/15/2012 10:00:59 PM · #1358 |
Originally posted by cowboy221977:
I have watched my premiums go up 3 times in 6 months. The reason behind this...Obama is attacking the citizen not the problem. Just like all his policies. |
That's quite an interesting interpretation given that most of the provisions of the healthcare act don't take effect until 2014, the most recent Kaiser Family Foundation study stated that employer contributions to health insurance premiums have not shown “a statistically significant increase over the 2010 values,” and that independent studies have estimated only 1-3% of premium increases could be attributed to Obamacare. If this particular law were actually to blame for rising costs, then you would expect rates to FALL in the past few months if insurers anticipate parts of the act to be struck down.
Message edited by author 2012-05-16 08:51:09. |
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05/16/2012 03:26:20 PM · #1359 |
Originally posted by cowboy221977:
In my time of no insurance or virtually none..(I joined the reserves in 2002 and stayed til 2010 with 2 deployments under my belt and no-one offered insurance at the jobs I was working) there was always help when I needed it. Free clinics for the poor. I went several times. |
There are low-cost (pay on a sliding scale, government-subsidized) clinics here, too, and I've used them. They're great at providing inexpensive care for the simple things, like a sore throat or the flu. But as soon as the diagnosis is a little more involved than those kinds of simple things, they refer you to the pricey doctor or the expensive hospital. And they're certainly not the appropriate venue for receiving ongoing care for cancer or other chronic conditions. And, these kinds of clinics don't exist in many areas anyway. So your solution is that 50 million uninsured people should get all their health care from these clinics? Will this also be your solution when there are 100 million Americans who are uninsured?
Originally posted by cowboy221977:
I have watched my premiums go up 3 times in 6 months. The reason behind this...Obama is attacking the citizen not the problem. Just like all his policies. |
What Shannon said. Also, I'm curious who or what you think is to blame for the skyrocketing cost of health care before the Affordable Care Act was passed. And who will you blame for the continuing increase in medical costs after the Act is struck down (if it is) by the Supreme Court?
Originally posted by cowboy221977:
Ya know the robin hood complex. Give from the rich take from the poor. A socialistic lifestyle is not for me. |
Still trying to decipher this comment. One thing I will say is that the long-term solution will involve basically everybody being in the insurance pool, because that's the only way that the system will be affordable, whether it's private sector or public sector.
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05/16/2012 04:32:30 PM · #1360 |
| Here's a reality check on why the system is so broken. I recently had cataract surgery in both eyes. I have an HMO through medicare. Each eye cost me 3 visits @ $35 for before & afters, plus $75 day of surgery for a total of $360. A bargain! But, because it's medicare I get copies of the bills & what was paid (something someone on a regular HMO plan wouldn't see). Each eye was billed @ $3000. What was paid was $695.03. Anesthesia billed @ $455. Paid $66. Evaluation & Mgt @ $125. Paid $15. Same day surgery charge @ $2464. Paid $923. EENT services @ $315. Paid $140.35. Total billed to medicare HMO $12088. Total paid by medicare $3678.76. Difference between billed & paid a whopping $8409.24. If I had to pay for this surgery on my own what would I have been billed? $12088. So, I'd still be blind. You're probably wondering what my point is right now, right? My point is, if the surgery is really only worth what the insurance companies pay then they should be billed that way. Regardless if they were billing an individual or an insurance company what should have been billed is $3678.76. If they agreed to this amount from the insurance company, that's really all it's worth isn't it? This is why the system is broken. The worst part about all this? Medicare only covers lenses for distance. Once they removed my natural lens, I'm still practically blind for close up stuff. If I had wanted a lens that would let me see both near & far, it would have cost me an extra $1000 per eye out of pocket. I bet the difference in cost was less than $10. |
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05/16/2012 04:58:20 PM · #1361 |
I agree that is a sign of a broken system Kelli. There are a few factors that force doctors to bill that way.
1) All contracts with insurance companies stipulate that you need to bill everybody the same amount. You can't choose to bill Patient A $200 and then Patient B $400.
2) Every insurance contract is likely to be different meaning each company agrees to pay a different amount for a particular procedure.
Naturally this means the smart thing for the doctor's office to do is to make sure their charge is at least as much or more than the highest paying insurance company (of which Medicare is not, it is the lowest paying insurance company). The difference is then written off and never collected EXCEPT when you have someone with no insurance, but you are at least not leaving money on the table that could otherwise be collected.
Because you have agreed that you can't charge different amounts to different people you are forced to charge the non-insured patient the full amount. If you don't you are in breech of your contracts. There are some ways around this (cash discounts, etc), but it is clearly a problem. Nobody intends to stiff the uninsured patient, but the system forces it. |
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05/16/2012 05:42:13 PM · #1362 |
Originally posted by DrAchoo:
Because you have agreed that you can't charge different amounts to different people you are forced to charge the non-insured patient the full amount. If you don't you are in breech of your contracts. There are some ways around this (cash discounts, etc), but it is clearly a problem. Nobody intends to stiff the uninsured patient, but the system forces it. |
Why? Why should any insurer, or private patient, ever have to pay more than the least amount you're willing to bill?
R.
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05/16/2012 06:15:59 PM · #1363 |
Originally posted by Bear_Music:
Originally posted by DrAchoo:
Because you have agreed that you can't charge different amounts to different people you are forced to charge the non-insured patient the full amount. If you don't you are in breech of your contracts. There are some ways around this (cash discounts, etc), but it is clearly a problem. Nobody intends to stiff the uninsured patient, but the system forces it. |
Why? Why should any insurer, or private patient, ever have to pay more than the least amount you're willing to bill?
R. |
Exactly! If the least amount you're willing to take for cataract surgery for 2 eyes is $3700, why not have a system where everyone is billed $3700 and insurance companies have to pay 100% at that rate? This would go a long way in fixing a lot of the runaway costs. Doctors write off their bad debt based on prices that are over inflated then claim a loss. It's bizarre. |
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05/16/2012 06:24:17 PM · #1364 |
Originally posted by Bear_Music:
Originally posted by DrAchoo:
Because you have agreed that you can't charge different amounts to different people you are forced to charge the non-insured patient the full amount. If you don't you are in breech of your contracts. There are some ways around this (cash discounts, etc), but it is clearly a problem. Nobody intends to stiff the uninsured patient, but the system forces it. |
Why? Why should any insurer, or private patient, ever have to pay more than the least amount you're willing to bill?
R. |
Because they are willing to pay more. That's capitalism, isn't it? Flip it around, why would the business ever have to take less when that person is happy to pay more?
To confound the matter, there are procedures where the physician loses money on the medicare payment. Some physicians will not see Medicare patients others view it as their "charity". So Kelli's asking why can't we just bill everybody $3700 or whatever might, in some cases, drive the physician out of practice.
Message edited by author 2012-05-16 18:25:58. |
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05/16/2012 06:28:18 PM · #1365 |
Originally posted by Kelli:
Doctors write off their bad debt based on prices that are over inflated then claim a loss. |
i.e. they are reimbursed by the taxpayers (having to make up for the lost taxes) ... but we're not willing to have the government pool everyone's resources and have a single system for billing for/paying for all care ... when it takes more people to bill for services than it takes to provide those services*, well, "the market" has a problem ...
*I heard an interview with a private practitioner who needed three front-office people just to bill the various insurances ... |
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05/16/2012 06:31:58 PM · #1366 |
Originally posted by DrAchoo:
Originally posted by Bear_Music:
Originally posted by DrAchoo:
Because you have agreed that you can't charge different amounts to different people you are forced to charge the non-insured patient the full amount. If you don't you are in breech of your contracts. There are some ways around this (cash discounts, etc), but it is clearly a problem. Nobody intends to stiff the uninsured patient, but the system forces it. |
Why? Why should any insurer, or private patient, ever have to pay more than the least amount you're willing to bill?
R. |
Because they are willing to pay more. That's capitalism, isn't it? Flip it around, why would the business ever have to take less when that person is happy to pay more?
To confound the matter, there are procedures where the physician loses money on the medicare payment. Some physicians will not see Medicare patients others view it as their "charity". So Kelli's asking why can't we just bill everybody $3700 or whatever might, in some cases, drive the physician out of practice. |
There exists a monumental amount of difference between willing to pay more and being compelled to pay more.
The situation you describe here is akin to mergers of small communities in this country, where we were led to believe that bigger was better and would cost less.
Guess what...all the salaries gravitated to the apex of the salary scale, no one lost there jobs, bigger and better offices were required and all the offices and IT equipment had to be upgraded.........yes indeed, we saved a shitload.
The saddest thing about medical costs are the exorbitant prices charged for rather mundane products.
Ray
Message edited by author 2012-05-16 18:50:00. |
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05/16/2012 06:41:32 PM · #1367 |
Originally posted by Kelli:
Originally posted by Bear_Music:
Originally posted by DrAchoo:
Because you have agreed that you can't charge different amounts to different people you are forced to charge the non-insured patient the full amount. If you don't you are in breech of your contracts. There are some ways around this (cash discounts, etc), but it is clearly a problem. Nobody intends to stiff the uninsured patient, but the system forces it. |
Why? Why should any insurer, or private patient, ever have to pay more than the least amount you're willing to bill?
R. |
Exactly! If the least amount you're willing to take for cataract surgery for 2 eyes is $3700, why not have a system where everyone is billed $3700 and insurance companies have to pay 100% at that rate? This would go a long way in fixing a lot of the runaway costs. Doctors write off their bad debt based on prices that are over inflated then claim a loss. It's bizarre. |
Funny thing, that. I had no problem finding doctors when I had straight medicare. Everyone (at least in this area) is more than happy to take it. But now with the HMO, I'm very limited. I choose the one that my cardiologist would take and had to get a new primary doctor. It costs me less out of pocket, but the hoops they make me jump through for everything is insane. They've denied 3 of my prescriptions. Things I've taken for years, and straight medicare D had no problem paying for. 2 were fought for 1 approved, 1 was needed for my eye surgery and just given to me by the eye doctor so the schedule wasn't messed up. The third is still denied, much to the distress of the cardiologist. In truth, I think straight medicare is better, pays the doctors better, and works. These HMO's are a disaster. And I'm sure the CEO's of these insurance companies aren't losing any money. |
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05/16/2012 06:53:12 PM · #1368 |
Originally posted by Kelli:
It costs me less out of pocket, but the hoops they make me jump through for everything is insane. |
Yep, it's pretty crazy. For HMOs, you have to jump through hoops. With PPOs, you don't have to jump through those hoops, but then you receive a bill later and find the Anesthesiologist wasn't covered and you now have to pay $3,000 for his fee.
With PPOs, you have to manage the bills and doctors more (different hoops).
I don't know which is better. |
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05/16/2012 06:59:57 PM · #1369 |
Originally posted by RayEthier:
There exists a monumental amount of difference between willing to pay more and being compelled to pay more. |
We're possibly talking about two different things.
First, you have insurance companies negotiating with physicians for reimbursement. Second, you have out of pocket patients. In the first case it would be very anti-American to insist that the physician show his hand by revealing his negotiations with other insurance companies. What other business would we even consider this to be reasonable? If Insurance company A wants to pay $55 for a procedure and B wants to pay $49 and the physician is willing to enter in those contracts, then what of it? If insurance company A was told by B what it paid and used that to force the physician to take $49 we'd call that collusion and it would be illegal.
The second though, is the out of pocket patient. Most doctors (at least in my experience) would be happy to let them pay less than the "billing rate" since they know they rarely actually get that rate anyway. But, like I said, the price for dealing with insurance companies is that you agree to bill the same to everybody. Obviously the system is broken, but I'm just trying to reveal a little of what's behind the curtain.
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05/16/2012 07:06:36 PM · #1370 |
On a totally different note, I recall my missus having a medical appointment at 0900 hrs in the city, and since she doesn't drive I took the morning off work to drive her to her doctor's and back.
We sat there and waited and waited and at 1100 hrs I saw the person I believed to be her doctor and asked him if I should bill him directly or bill the practice. He asked me what for and I explained that I had been sitting in his office for the last two hours and someone owed me for two hours of my time.
He paid me (after some discussion, we remained friends and now have a wonderful understanding... My wife does NOT get double booked and if I can't make a scheduled appointment, not only do I call him, but I pay for the missed appointment.
... and everyone is happy.
Ray |
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05/16/2012 07:10:00 PM · #1371 |
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05/16/2012 07:11:52 PM · #1372 |
Originally posted by DrAchoo:
Originally posted by RayEthier:
There exists a monumental amount of difference between willing to pay more and being compelled to pay more. |
We're possibly talking about two different things.
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We may very well be.
When I need medical services, I know what my coverage is, what the costs are and what my out of pocket expenses will be (if any).
It might come as a surprise to my American friends, but things like ambulance costs, stitches and other things are, (if not totally covered), really affordable by comparison.
Simple things like the removal of stitches if I recall correctly are many times cheaper in this country than the USA... and we won't even talk about the costs of a periodontist.
Ray |
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05/16/2012 07:17:31 PM · #1373 |
| Yes, very true. Although you do have to include the "cost" in taxes since that's the way it's ultimately funded. Personally I think I'd be happy with a system like that, but I don't see it happening anytime soon (even less so after the SCOTUS ruling). |
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05/16/2012 10:12:20 PM · #1374 |
Originally posted by DrAchoo:
The second though, is the out of pocket patient. Most doctors (at least in my experience) would be happy to let them pay less than the "billing rate" since they know they rarely actually get that rate anyway. But, like I said, the price for dealing with insurance companies is that you agree to bill the same to everybody. Obviously the system is broken, but I'm just trying to reveal a little of what's behind the curtain. |
And yet, the "system" tolerates Medicare essentially stiffing the doctors for a substantial portion of the billed procedure? And everyone's OK with that? That the "billing rate" is a convenient fiction? So, based on this, I should feel OK with cutting off say, 40-60% of what I'm billed for procedures, since it's just fictional anyway? And nobody's gonna come after me and garnish my wages and take my house and drive my family into bankruptcy over "fictional billings" we can't possibly afford, after the insurance company, which was supposed to cover all this, comes up with what amounts to a fictional justification for NOT covering it?
Right, I didn't think so...
R.
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05/17/2012 11:24:48 AM · #1375 |
Originally posted by RayEthier:
medical appointment at 0900 hrs
We sat there and waited and waited and at 1100 hrs I saw the person I believed to be her doctor and asked him if I should bill him directly or bill the practice. He asked me what for and I explained that I had been sitting in his office for the last two hours and someone owed me for two hours of my time.
He paid me |
WHAT?!?!
He paid you? I'm going to try that next time. |
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