Why I cant wait to retire......

[LowRyter]

Bulldog, that was the "public option" for Medicare buy-in.  It failed by one vote.

[Bulldog9]

Bulldog, that was the "public option" for Medicare buy-in.  It failed by one vote.

Yes, the problem was the way it was engineered, it was cobbled by the complexity of the ACA exchanges, with too many controls and few benefits.  They wanted the public option to be "self-sufficient" which was impossible, and of course a thousand other reasons to include neither 'side' wanting the other to win.

[Bulldog9]

ya know, if either of you had "real jobs" to begin with.......   

Just seeing this.... Bahahaaa! 

[LowRyter]

Yes, the problem was the way it was engineered, it was cobbled by the complexity of the ACA exchanges, with too many controls and few benefits.  They wanted the public option to be "self-sufficient" which was impossible, and of course a thousand other reasons to include neither 'side' wanting the other to win.

The public option would've been available for subsidy just like the private plans in the ACA.  However, it would never be allowed to have lower premiums than the actual costs, since it would be unfair competition to the private insurance companies. 

Regardless, it failed by one vote.

[Two Checks]

Health care IS available for everyone. Just go to the doctor.
People confuse health care with insurance.
Doctors provide health care. Insurance pays for it. Or you pay out of pocket.
The big thing about the ACA is its illegal. Health care is not a CotUS mandated function of govt.
This is not meant as a political statement. It is a fact based statement on the subject.

[Wayne Orwig]

Many docs won't see you if you are paying out of pocket. I'm sure you can find them, just saying, it is an issue.
The other annoying issue is that they have negotiated a rate with the insurance companies. As soon as it is outside of insurance coverage, the rate triples, or even higher. Insurance companies probably have them do that just to keep customers on the 'addicted' to insurance companies..

[Kev m]

Many docs won't see you if you are paying out of pocket. I'm sure you can find them, just saying, it is an issue.
The other annoying issue is that they have negotiated a rate with the insurance companies. As soon as it is outside of insurance coverage, the rate triples, or even higher. Insurance companies probably have them do that just to keep customers on the 'addicted' to insurance companies..

I personally know doctors that only allowed people to pay out of pocket (accepted no insurance, you could apply to your own insurance for reimbursement). They did so to prevent any interference with medical decisions by insurance companies.

That said negotiated rates with wholesale customers (instead cos in this case) is commonplace in all industries.

[Lannis]

Many docs won't see you if you are paying out of pocket. I'm sure you can find them, just saying, it is an issue.
The other annoying issue is that they have negotiated a rate with the insurance companies. As soon as it is outside of insurance coverage, the rate triples, or even higher. Insurance companies probably have them do that just to keep customers on the 'addicted' to insurance companies..

Just goes to show how different people's experiences can be.   The first time, for example, that I went to get a colonoscopy after I dropped my O-care policies, I went to my regular doctor and let the lady at the desk know that I was now "self-pay".   

The price was less than half of what it had been the last time I got one, three short years ago.   I found most of my expenses during those years to be discounted the same way.   Any money they can get just by you dropping it on their desk on the spot is better for them than running it through that huge insurance mill .....

Lannis

[Gliderjohn]

Does anyone know what there insurance company payout time to a Dr. or hospital is? I imagine could be quite awhile which doesn't help them pay their bills.
I had a work-study student placed at a small business that sold some of their stuff to Wally World and the Wally payment could be as long as a 180 days. I was invited to be a guest lecturer at KU. They gave me a speaking fee plus mileage, meals and motel but it took five months to get paid.
GliderJohn

[Two Checks]

I have friends who never bought insurance and always paid cash.
They bo the went in the hospital and once out when they got the bill they talked to the hospital and said they were paying out of pocket.
The bills were cut in half. And they set up a payment plan.

[Joliet Jim]

7/21 urgent care visit in Hawaii with $125 charge to cover any uncovered expense. 8/12 BCBS pays full agreed upon amount. 10/21 I finally get my refund from the urgent care. After 3 calls and finally threatening reporting them for insurance fraud for double dipping. on the other side my daughter (therapist) just got paid by one insurance company and it took almost a year to get the first visit approved and paid for one of her patients

[trippah]

Our healthcare system is unbelievably expensive, not particularly good and fragmented with so many more "employees" than necessary; only the very lucky can cheer. (Previous posters include a very lucky and an unlucky example)
 Who are all the employees - doctors, doctor extenders (np, pa's), nurses, office staff, billing coders both at the provider and the payers ends of the transactions, a significant number of lawyers, court personnel (malpractice) bankruptcy courts, health insurance companies, pharmaceutical co's and research scientists, and the list goes on and on.
(1)Diagnostic test can be horrendously expensive.
(2) Developing medicines a longterm investment that doesn't always pay off.
(3) In 1950 a local g.p. had a  doctor and a nurse; now 2-3 staffers for phone, scheduling, billing.
(4)As we live longer, a greater percentage of people need medical intervention on any given year - both older and vey young patients with catastrophic events and expensive interventions.
(5)Unhealthy lifestyles, either by choice or financial situations, lead so many to long term care situations (High blood pressure, diabetes etc((and yes these can get you even without an unhealthly lifestyle)).       
(6) Cost of training physician is enormous, and years of productivity shortened (not up NFL standards yet).
and last but not least, the people who are making the most in this 'System" fund and work hard to keep electing people who like the status quo.

[Wayne Orwig]

(3) In 1950 a local g.p. had a  doctor and a nurse; now 2-3 staffers for phone, scheduling, billing.

A few years back the North Georgia health care system took over an old Sams club building. Filled it with offices, just to handle the billing.

https://www.google.com/maps/@34.2286447,-83.8641619,201m/data=!3m1!1e3

[Mr Pootle]

  I'm 72 and never have been fat, drink about 3 beers a month at most. I'm active and years ago started eating what's considered a healty diet and got rid of tobacco...Doctors always said I'm in great shape...Then several months ago I get a rare lethal cancer, I'm not a risk factor for it, just bad luck I guess..I have Medicare managed by a private insurance co..My out of pocket is about 1000 bucks on a bill pushing 50 grand and I'm only about 1/3 of way through treatments...These slap you in the face diseases can happen at 50 years old or 60 or whatever....For the record, the hospital info says if a patient has no heath insure, they will usually settle for 1/2 the billing amount with a monthy payment plan..As you say, it's your money and your risk..
 I have heard people on this site say there was far less cancer years ago, it's all new....Rubbish, many people 100 years ago died early from diseases easily treated today. Lethal diseases were often not treated because they wern't any treatments.Many people never saw doctors and no records were kept..A simple infection eaged on due to lack of antibiotics..How many here owe their lives to heart bypass surgury that didn't exist then...How many here would have been dead 100 years ago?
   It's all fun and games until the shit hits than fan...My advise is always been the same,always  live within your means, retire as early as possible, make sure you have the means to deal with your health,and have a good time while the times are good...

I'm also 72, and have also just been diagnosed with cancer. I went for an ECG on Tuesday, and have been told I need a heart bypass before they'll operate on the cancer. It's all free and would have been whatever age I was.
Yes, I've paid taxes to have the protection of the NHS, and my taxes go to provide cover for those less fortunate in life than me. I'm happy with this. Not everyone is able to get and hold onto a well paying job.
And for most of my working life I was an employer. I didn't need to bother about providing health cover for my employees.
The NHS is playing a major role in the electioneering here at present. Personally, I'd go to the barricades to defend it.

[Lannis]

The NHS is playing a major role in the electioneering here at present. Personally, I'd go to the barricades to defend it.

It's one of the reasons we have different countries! 

I've heard enough UK and Canadian horror stories about waiting for treatment, incompetent doctors, etc that I (like most here, it's not just the "very lucky") would be at the barricades to prevent losing what I've always had ....

Lannis

[Tusayan]

Trippah's list is a good one, and it highlights that the current cost level is in general created by consumer demand for ever better health care and more research, and the US market's willingness to pay for it.  People may complain but in the US people are well informed and take personal action, including paying large bills, to get what the health care they want.  I find that Americans are well informed about health care and make choices in their own interest.

My tally of relatives who have so far died due to routine but not inexpensive diagnostic tests not being run under the UK National Health System is two (2).   I am very happy to be treated in the US, for that and other personal reasons.  My interest is absolutely in maintaining my freedom and choice in health care, and you bet I am willing to pay for it.

By the way, be careful what you may ask for in terms of limiting "unhealthy lifestyles" through health care administration, you may just find motorcycling is one of them.  The world is moving in the direction of removing basic freedom, under the guise of efficiency and/or to benefit the apparent masses of people who prefer a plain vanilla life.  I'll never be one of them, if you're on this website I doubt you will either.

[Lannis]

Tripah's list is a good one, and it highlights that the current cost level is in general created by consumer demand for ever better health care and more research, and the US market's willingness to pay for it. 

Along those lines, I have a couple of friends from India who work in this country but who still call India "home", and go back regularly for holidays, visit relatives, etc.   They are very much aware and appreciative of the differences between the USA and India, and are sort of choosing "the best of both worlds", and more power to them.

One fascinating thing (touching on cost) is that they wait to go to the doctor for checkups, physicals, and such when they're at home in India.  I asked about that, knowing that they are not superstitious and that they are well aware of the relative capabilities of doctors Here and doctors There.

According to them, a typical Indian doctor's office consists of one or two doctors, and one or two nurses, and that's IT.   They have the right Xray equipment, blood lab test equipment, etc as a typical internal medicine family doctor would have here.   Appointments are made a week or less in advance, or often walk-in.   (This is for professional Indian folks who make the kind of money most of us do; what the 'untouchables' do, I don't know.)

There are no "malpractice" suits allowed there.   There is not an army of billers, clerks, accountants, and technicians at the front of the office.    A doctor expects to make about as much as a senior engineer does here; they do NOT typically buy NFL football teams and such.
A typical bill for a 45-minute physical (blood samples, "turn your head and cough", stethoscopes, blood pressure and oxygen, "bend over the table", etc) that costs $850 dollars here costs $90 there, and you just pay at the door.

If you figure the cost of maintaining that army of "support", the 3 laptops-on-a-cart-per-nurse, and 300 large each year for malpractice coverage, it's no wonder it costs a fortune here.   I'd be happy if we could just fix that.

Lannis

[LowRyter]

It's one of the reasons we have different countries! 

I've heard enough UK and Canadian horror stories about waiting for treatment, incompetent doctors, etc that I (like most here, it's not just the "very lucky") would be at the barricades to prevent losing what I've always had ....

Lannis

Unlike the stories we've read here on this topic regarding folks in the USA that can't afford healthcare? 

I suppose it's only a horror when health care access only affects you or someone in the UK & Canada but not for your fellow Americans?

[Joliet Jim]

Ironic, through work I met many from Canada and England. Never heard a complaint about their healthcare systems from them only from second hand Americans who want to keep the status quo.

[Wayne Orwig]

Ironic, through work I met many from Canada and England. Never heard a complaint about their healthcare systems from them only from second hand Americans who want to keep the status quo.

 

[Lannis]

Ironic, through work I met many from Canada and England. Never heard a complaint about their healthcare systems from them only from second hand Americans who want to keep the status quo.

Well, maybe they knew you really didn't want to hear about it .... ?   Different people hear different things, have different experiences, amazingly enough, and they all get shared here.

Lannis

[Tusayan]

Ironic, through work I met many from Canada and England. Never heard a complaint about their healthcare systems from them only from second hand Americans who want to keep the status quo.

You have now.   And in fact somebody with experience with both systems.

[kirby1923]

I have spent a lot of my adult life living outside the States and there are SIGNIFICATE difference in culture (much too much to discuss here), between the States and other places I have been in.

Not a subject that has entered any communication w/ "other" cultures casually and not many well versed but those that have had serious problems w/ their health or some sort of trauma.

We need to reduce the cost in the States but not many of we that understand (maturity and experience) want the Gov (read bureaucrats) taking charge of such an important need.

There has to be other ways to do it...

My time is short, hope it gets sorted.

[Tusayan]

Re cultural differences, absolutely.  How would the average American react to the following?

You would like to establish a PSA check as part of your regular physical exams and the associated lab panel.  It won’t be funded by the system because the government has determined that because most men won’t in their estimation get regular checks like you, the PSA test is “not effective” in detecting prostate cancer.   You know your uncle died of undetected prostate cancer (never had a PSA check...  it was never suggested by his doctor because it isn’t sanctioned) but your father in the US had prostate cancer detected by PSA in his 70s, it was successfully treated and he is now in his 90s.  You go to a different doctor who operates outside of the system and pay cash.

Or...

You are finding your commute to work too long and want to move a bit closer to work.  This proves challenging because your family likes their doctors but they will not be able to see you in the future if you move the short distance intended, their allowed service area is too small and the government uses geographic restrictions to control the numbers of patients assigned to each doctor.  It’s a very similar system to school districts.  You don’t move.

I didn’t make these situations up, or get them from the ‘net 

[LowRyter]

I have spent a lot of my adult life living outside the States and there are SIGNIFICATE difference in culture (much too much to discuss here), between the States and other places I have been in.

Not a subject that has entered any communication w/ "other" cultures casually and not many well versed but those that have had serious problems w/ their health or some sort of trauma.

We need to reduce the cost in the States but not many of we that understand (maturity and experience) want the Gov (read bureaucrats) taking charge of such an important need.

There has to be other ways to do it...

My time is short, hope it gets sorted.

And private healthcare bureaucrats do should a great job?  You think For-Profit companies are very compassionate ?

Having made half a dozen calls to Mercy to straighten up my bill, two to Cigna health insurance and one to Medicare, guess which one was helpful and knew what they were doing?  It wasn't the first one that actually did the billing.  I can't give you a great opinion about the Doctor they "assigned" to me either.

[pebra]

I’m more than a little surprised that we haven’t heard from moderators already. Intending to keep the tone apolitical, I will note this:

The grass is often greener on the other side of the fence. I tend to think I would have a better health service in certain other European countries, and I’m fairly confident there are some Europeans (and Americans) who would prefer our Norwegian healthcare. Naturally there are Americans who look favourably on European healthcare, and for various reasons.

There is no perfect system. A system comprising a considerable part of the population per se has to be based on compromises, otherwise costs will explode. Thus there has to be a political aspect to the design of the system.

US medical expertise is probably superior, but it can’t be available even to all Americans. Rich Europeans will look to the US when they need the utmost expertise in many fields of medicine.
Healthcare systems all over the western world have a quality superior to what we had a generation ago. Big Pharma has contributed, as well as medical science. And certainly national health policies have contributed, too. Think about tobacco. Is this a political aspect? Probably.

But how do you measure the quality of a «national healthcare system?» A frequent definition of quality is value for money. Costs are difficult enough to measure across nations and systems, but what about value? How do you measure the population’s «health?» Why indeed would you look at the whole population, and not only on certain segments?

Like many others I have friends and relatives working in some area of the health service. They confirm that most of the time the system works and keeps improving. What we hear about are the outliers, those many but few cases compared to all cases, that go wrong. And we tend to believe they’re doing things better in another system.

What has moved me most during my many years on this board are stories about those individuals and families that go broke because they couldn’t pay for adequate medical insurance or pay their medical bills. To Europeans this sounds strange and unnecessary. Well, there I suppose I made a political statement. Should I be sorry?

[Lannis]

Healthcare systems all over the western world have a quality superior to what we had a generation ago. Big Pharma has contributed, as well as medical science.

There's a statement right there that I'll bet everyone reading this will agree with.   Open heart surgery, cancer treatments, heart valve replacements, knee replacements, hip replacements ... none of that stuff was available when I were a lad.

My dad had a heart attack when he was 35, got over it, then just went grayer and slower and dropped dead at age 39.   Today, they'd whip in a stent and a couple of spare veins and he'd probably still be around today ...

So, maybe appreciating what we DO have would be a good way to go?

Lannis

[travelingbyguzzi]

Today, I am at St. Joseph-Franciscan Hostital with Cookie. She is having her first session of a new infusion drug. This is the fourth series over the last 2.5 years.
When she was first diagnosed with stage 4 ovarian, she had Kaiser Permanente thru her employer. We knew that wouldn’t last as she’s as no longer working, but for 6 months they were excellent.
We got her on United thru my employer and they have also provided excellent benefits
Last year my employer switched to Cigna and so far, they also have been good.
My employer pays for all of my insurance and heavily subsidized Cookies. I pay $500/month dollars n pretax dollars.
THIS is why I can’t retire, but I wouldn’t have it any other way. I have had terrible experiences with single-payer. By single payer, I mean our state L&I insurance. We are required by law to pay in. Paying out after an accident, I mmediately went to my doctor, who was not in their network.
All in all, I think that our system, while very expensive, has provided us with the best care possible. Many Americans are not as fortunate as Gail and I, but we have worked hard and lived clean and frugally to be where we are.

Bill Lovelady          IS
Eskimo Spy

[Joliet Jim]

Don't confuse not appreciating with seeking improvement. I would be dead by now with the technology of 20 years ago.

[Wayne Orwig]

I’m more than a little surprised that we haven’t heard from moderators already.

I hope it stays friendly. It has been very interesting to read everyone's thoughts and what they have encountered.