Health care - just venting

WOW Im glad to hear your wife was mis-diagnosed AND shes going to be fine:TU:

 

Marc,

Thanks for your input.

Your description of your recent episode would never happen here.. regardless of your ability to pay, certainly not if you were employed and had health insurance, as 90% of all Americans do. This was before the ACA.. in 2010

3% more have it as of 2014.

Your issue would have been handled quickly, the severity would have classified it as urgent, they figure out the paperwork later. If you live in any kind of a medium size or larger city, the local hospital would have had an MRI Unit, and qualified personel often on hand to do the surgury immediately. The wait would have been hours, not days weeks or months.

No one dies in the USA because of a denial of emergency healthcare, in fact, that is one of the largest arguments for the ACA, you have heard Flynbuick over an over talking about the poor, who simply go to the emergency room for care, which they are provided, and we pick up the tab. It is true that drives the cost of everything up, but the question is what costs more.. an huge new Federal bureaucracy, or paying for 10% of our populations healthcare needs.

I don't know the answer to that question, it needs more study on my part to form an opinion as to the validity of that claim. I suspect, the claim of increased costs is a weapon used by both sides:

The insurance companies use it to raise rates and increase profits.

The socialized medicine crowd uses it to push a social agenda, more so than a fiscal one.

I totally agree, as most all Americans do, that our current system needs fixing, and all Americans should have access to all forms of healthcare.

Where we differ in this country is how to get there.

I find it amazing how the media has generated the notion that people die because of our healthcare system.. but you saw it here..

Wonderful input Marc, and very enlightening to hear from an actual person in the Canadian system, who had to interact with it recently.

I personally have a story of of a situation here that is happening in our system, and shows it's faults.

A friend of mine has an adult child that has a degenerative disc issue with his spine, the pain it has caused him renders him unable to work. But he was working and did have his employers provided health insurance.

The issue is simple.. the Insurance company is trying to avoid paying for disc replacement surgery, which is the recommended treatment by his doctor, and several specialists he has seen. At 30 years of age, they feel this is the best option to insure quality of life in the future.

The insurance company only wants to pay for disc fusion surgery, which will limit his back mobility by 60%.. he has already had this done for the first vertebra to the tailbone but now the discs have degenerated above that, in the critical area of your lower back where you do most of your bending.

Because they are not a wealthy family, they cannot afford to put an attorney on retainer to sue the insurance company. Because winning such a lawsuit will not result in a high probability of a large settlement, no attorney will take the case for a percentage of the settlement.

They are pursuing it legally, with the only means available to them, thru legal aid and the state attorney general. But that process is painfully slow, and he has been nearly bed-ridden now for over a year.

So our system in not perfect, the thing that needs to be fixed is really this issue.. and of course we need to develop a system to provide cost effective healthcare to those who do not have insurance.

But the question is, in a single payer system, would the guy in the above situation be better or worse off.. or the same?

Now it's just a government body denying doctor preferred treatment, vs an insurance company.- That's one view.. but I wonder if there could not be a system put together similar to the dual payer systems they have in Europe, where you have the government insurance as your base, so they pay say 70%, and then you have private insurance that picks up the rest.

This exactly how Medicare works now. But they cannot control costs, nor have anywhere near the funding required to pay the "going rate" So they have established a fee schedule as to what they will pay, and most individuals then have supplemental private insurance to pick up the slack. I know my Mom does, she just turned 70, and is financially sound.

Medicare has succeeded in reducing administrative costs, but like any government program, it is rife with corruption and fraud. It is a fundamental principal of human nature that you will be much less concerned about taxpayers money, than you will be about your own, this attitude allows this fraud to happen, I don't see that changing anytime soon.

Truth be told, we are no where near single payer or socialized medicine here, right now, we have the beginnings of what you could rightly term as "socialized health insurance", but you have seen Flynbuick's fervent argument that all would be rosy if we had single payer healthcare.

I, as well as many Americans who don't strongly Identify with any political party, are more skeptical of such a system.

I don't trust government, there are simply too many instances of politicians out for their own gain, with no concern for those they supposedly represent.

JW

 

This is one of the many problems of Obamacare. Many of us are left paying astronomical increase in premium, stuck with ultra-high deductibles, and are basically left with an over-priced catastrophic policy as we essentially pay for healthcare out of pocket.

My doctor quit his network and started a private practice to mitigate (my new favorite word) the problems Obamacare was going to cause for him. If millions more are now insured, where is the doctor shortage?

I don't agree with Lore - we don't all share the same goal after rolling back "extraneous factors". I don't want someone else to be responsible for paying for my healthcare. I can take care of myself and my family and my employees without govt interference. I'm not the part of society that votes for a living.

 

To be very frank, no, you likely cannot go it alone. Very few could. To keep healthcare costs in check relative to income, it will take a fundamental restructuring of how we insure ourselves such that everyone in the U.S. contributes premium into the pool used to pay claims. You must have skin in the game from both young and old and all ages in between. The states cannot effectuate such a restructure. It has to be handled through the federal government. Like it or not, sooner or later, you will see this happen. It is not a question of if. It is a question of when.

 

My biggest problem with a single payer is the lack of competition. The government does nothing as well as the private sector when there is competition. National security and securing our borders should be top priorities and the rest is a distraction of unconstitutional expenditures. You think the insurance companies are corrupt fat cats now, just wait until the government can get its greedy, incompetent hands on the roughly $3 trillion that it currently covets.

If government really wanted to help the people out on insurance costs, they'd allow any accredited insurance company to sell their legally minimum policies nation wide. They could under the interstate commerce clause. REAL competition will sort the market out rather quickly.

Second, standardizing on a fee schedule (or at least making them publicly available so we can pick and chose) and cutting down on extraneous paperwork would reduce the overhead considerably.

I hear of several doctors either quitting, selling their practices or going into concierge type service where the patient pays a monthly fee for access to the practice/group and gets a reduced rate due to the doctor not having to have a full blown paperwork filing staff to support and deal with all the insurance.

 

I've broken so many bones and torn ligaments and cartlidge , (five surgeries) and I'm on I first name basis with my Orthopedic doctor.
I just call him and make an appointment with out referral.
Once, I got a check from him, I had over paid the co-pay.

Also, I have chronic bronchitis. Over the years My primary care doctor has arranged for me to participate in three different bronchitis drug (antibiotics) trials .
Not only did they get me better at no cost, I got $200 check in the mail .

Edit , my orthopedic has treated me many more times WITHOUT surgery than with a knife.
He would rather not cut on me

 

There in lies the problem with single payer Jim..

"everyone contributes"

How will that happen, when 45% of American citizens pay no income tax at all? A good percentage of those folks don't work at all.

To say nothing of the burden on the system cause by illegal immigrants.

The tax burden on the other 55% would be enormous to actually cover the costs and create the "pool of money" to pay actual costs.

It won't happen, as proof of that I offer up the Medicare and Social Security entitlements.

Everyone who works, with few exceptions, pays into social security and medicare. There simply just aren't enough workers.

This problem only gets compounded when all the baby boomers retire.

Personally, I have been paying into Social Security for 33 years.. and I don't plan on ever seeing a dime.. if it happens that a check comes to my mailbox after I turn 66, then wonderful, I will buy some race car parts.

But I sure as hell am not basing my retirement income on it, as I am sure you have not.

The Social Security system is relavant to this discussion, you have brought it up as an example of a government program no one wanted, but is working now.

I will say that it did work for about the first 50 years, when there were 16-18 workers per retiree.

That number these days is about 3, soon to be 2.

Here is what the Social Security Administration says about the future. This is not some nutbag right wing website, ,this is straight from the horse's mouth in DC..

And when you read this, think of benefits as health care, and not a paycheck.. That's scary..

https://www.ssa.gov/policy/docs/ssb/v66n4/v66n4p37.html


JW

 

Ooh, pick me, pick me!! It won't, and it doesn't. Math is a real bitch for some folks. Obama tried getting all those young, healthy kids to sign up to infuse monies into the Ponzi scheme. Why would all of those young, healthy adults want to willingly pony-up health care costs when the majority of them are struggling financially right out the hole (Buick-related) and the males especially feel like they are invincible like we did? They can stay on their parents policies until they're 26.

I would be happy to have the old major-medical back at the rates they were and pay for everything else out of pocket.

Why have such a low HSA contribution ceiling?? Why have a ceiling at all?? Why pay tax on healthcare at all??

 

Agreed! Ponzi scheme indeed! I pray I don't need it and hope that I get anything out of it. I've paid into it for the last 38 years and been saving for my own retirement for the last 30.

My daughter, with her own job in another state making more than my wife, stayed on my policy because it is only an extra $40 a month to add her vs over $100 for her to join her employer's group plan. However, this is her last year. At least I made sure she's starting her 401k sooner than I did.

I contribute the max to my FSA and $2,500 is a pittance in this day and age. My wife will burn that up before the end of May with a dental procedure. The rules around it are ridiculous!

I'm doing my taxes now and it sucks what they keep of what I made.

 

Having experienced the CA and EU healthcare systems first hand we have a lot to fear with the ACA or worse a single payer system. The ACA was rammed down the American public's throat plain and simple. Using SSI or medicare as comparable examples that were resisted when they were enacted is a pretty feeble defense and sadly about the only one it has. It's all about buying votes for the left, little or nothing to do with actually improving the healthcare system. Those who engineered the system knew or hoped it would collapse into a single payer system. Moreover the largest health insurers were allowed to help craft the law to their benefit, blocking our ability to shop for insurance like we would for anything else, across any market or state. How or why did that happen? :eek2:

The ACA was crafted by lobbyists and politicians, not your local MD. They put our healthcare system in the control of those who manage the VA and IRS, I'm sure it will be fine.

Let's hope it will soon collapse under it's own weight and we can start over.

Talk to any private practice MD or business owner, like me.... The days of going to your private practice MD are numbered under the ACA. While it's benefited some, it's hurt many, many more. End of my ACA rant, I feel better, maybe it's added back a couple mins to my life venting about it...

 

Single male, no kids, a check-up once a year and not much else for decades, yet my insurance has more than doubled in the last 3 years.


At this rate I won't be able to afford it after a while.

 

Partially correct regarding wait times. Depending on the symptom, treatment can be done very quickly. Several years ago my doctor sent me to a local hospital ER after I told him about a recurring throbbing ache in my right leg. He was very concerned I had a blood clot. The hospital wait was about 4-5 hours, then treatment was administered fairly quickly. I was immediately scheduled for ultrasound the following morning, which found no clot. The clot busting drug given me the previous night apparently took care of the problem, as it has not resurfaced. I was suitably impressed with our health care system after this. :TU:

Last summer, I injured my left foot and went to a well known local clinic, Pan Am Sports. After numerous visits and consultations with them, etc., I still have the injury problem. This clinic used to be privately owned, until a few years ago when the Province of Manitoba bought it. They do have some excellent doctors, but it seems to have morphed into a "let's try this first" system.

My own family doctor has arranged an appointment with a specialist after which I might need to see a surgeon. It took 6 weeks to get the specialist appointment, and who knows how long for the surgeon. That could be 2-4 months more!! In the meantime, I have an orthotic shoe insert which is only partially ameliorating the issue.

As Marc said, 10 provinces and 3 territories. Our federal government simply writes each province/territory a cheque, and they in turn administer their own health care system. Unfortunately bureaucratic expenses and salaries are gobbling up an ever increasing portion of the annual cheque. ou: :af:

Our system has it's good, great and horrible parts. I would love to see lower administration costs, and more :dollar::dollar::dollar: to actual patient care. Most doctors here care about their patients and do their best to help based upon what the patient tells them.

It is very difficult for anyone to "jump the queue" with our socialized system, unless it's an urgent life or death matter. I suspect that age has something to do with it as well in that younger people *might* get preferential treatment. You must wait your turn in most cases. BTW, several years ago I read an article about the British health care system blatantly discriminating against older patients, but there was little proof to back that claim up

Where I live wait times for an MRI can be up to 6 months, depending on where you wish to have it done. I needed one last fall, and waited 2.5 months for it, AND had to drive 80 miles each way to the hospital, since their wait times was shorter than in Winnipeg. Easy for me with having my own transportation. Not so much for those who must rely on public transport, as city buses don't run that far.

I have heard, but not verified, that one can obtain an MRI appt during the night in much less time.

There is also a mobile MRI company who comes up to Pembina, ND periodically. They charge about $450.00 US, IIRC

I will eventually require a new right knee, and dread the possibility of a long wait for that. It will not be a selective option when the time comes.

 

That Canadian premier was Danny Williams, who was a self made millionaire prior to becoming Premier of Newfoundland. The procedure he required was not readily available in Newfoundland, although it was apparently available in other provinces. From what I remember, he paid for it entirely out of his own pocket.

http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/18279

http://www.theglobeandmail.com/news...my-choice-danny-williams-says/article4311853/

http://www.theglobeandmail.com/life...choice-was-based-on-ignorance/article1365308/

http://www.macleans.ca/politics/ottawa/canadian-health-care-survives-danny-williams-surgery/

Incidentally, my now retired long time family physicians two sons are both heart specialists, one in Toronto ON, the other in Vancouver BC

There occasions when it's easier for a Canadian to travel to the USA for treatment if the closest Canadian hospital is much further away. I have a friend who lives in far southwestern Manitoba and some procedures are best obtained in Minot, ND which is closer to her than Brandon, MB is. Canada is not as populous as America, yet we are the larger country.

 

Europe? They pay for healthcare by paying huge taxes called VAT and fuel duty on every litre of gas. Its been a long time ago but when I was there I don't remember it being liked at all..maybe things have changed.

I don't think there plan would work here. Much of the US is very rural and has no public transportation.

 

UPDATE - I went to the doctor for an injury to my arm. I was sent out for X-rays even though I had no broken bones and then given a referral for an orthopedic specialist who was a half hour drive away. I went to the specialist who then ordered a series of MRI's and diagnosed me with having a partially torn bi-cep. The insurance company never approved me for the MRI's and on top of that they sent me a denial letter saying that the orthopedic specialists' services are not covered.
I am about to drop this frigging obamacare like a hot potato and go with the plan that Guy Parquette told me about, Liberty Health Care. The co-pays on the obamacare are more than the monthly insurance premium, how am I supposed to justify this kind of service for what it costs me? Honestly, I can't!

 

That is ridiculous. If you were one of those who milk the system, it would all be free. The price you pay for being an honest responsible working person.

On another note: Hope you get healed fast, Lee. And Joe, How's your wife doing?

 

Far truer than you think. The reimbursment that hospitals get for medicaid patients is so low that it's not worth them billing. So guess who it gets passed on to......

 

Try this...



Mikey

 

Thanks Mikey, This is just another reason I like this forum, you learn something new every day.

 

I copy/pasted that in my documents. Thank You, Mikey.