canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I'm also curious if you have any idea of the level of fraud or abuse from doctors? Fraud might be too strong. But take an auto shop for example. You get into a small fender bender, the first thing they ask when you take your car in is "are you paying out of pocket or through insurance?" They ask because if you say "out of pocket" they will at least give you some choices and a reasonable price, with a cheap option of popping out the dent and straightening the fender and doing some touch-up paint. But if you say "Going through insurance" then all of the sudden half your car needs to be replaced and painted because they just send the bill to insurance. Is there an increase in more expensive medial procedures if they just send the bill off to a third party (government) to pay the bill instead of billing you instead?
Doctors overbill and do unnecessary procedures all the time.
Who monitors that?
The bank that doctors deposit their checks into?
Touche.
I meant who from the payer side monitors that to reduce/eliminate that?
Sorry. The world doesn't work the way you tell it to.
canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I challenge your hypothesis of broken limb, etc. I experienced it in Italy with one of our youth soccer players. We ended up deciding to wait until we flew home then next day to NY to have it taken care of after waiting 5 hours and seeing sick babies, mothers, bleeding people and all sorts of coughing, hacking that were going to make him sicker that had been sitting around for 18+hours.
Not sure why you care so much about our healthcare system. You like Canada's and that's where you live. The Republicans have taken over everything in response to Obamacare. Since Obama's first election, the Dems have lost on all levels slowly but surely until this ultimate loss and it's mostly directly related to that. House, Senate, Governors, and finally President. It's loud and clear. Now the only people crying are those that are getting a free ride b/c of it.
I hear people crying that are worried about losing their insurance. The majority of the country wants a single payer system.
The people who are subsidized or unsubsidized?
Sorry. The world doesn't work the way you tell it to.
canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I challenge your hypothesis of broken limb, etc. I experienced it in Italy with one of our youth soccer players. We ended up deciding to wait until we flew home then next day to NY to have it taken care of after waiting 5 hours and seeing sick babies, mothers, bleeding people and all sorts of coughing, hacking that were going to make him sicker that had been sitting around for 18+hours.
Not sure why you care so much about our healthcare system. You like Canada's and that's where you live. The Republicans have taken over everything in response to Obamacare. Since Obama's first election, the Dems have lost on all levels slowly but surely until this ultimate loss and it's mostly directly related to that. House, Senate, Governors, and finally President. It's loud and clear. Now the only people crying are those that are getting a free ride b/c of it.
I hear people crying that are worried about losing their insurance. The majority of the country wants a single payer system.
The people who are subsidized or unsubsidized?
They didn't break it down. Buy I believe you think that would drive the response to the question, no? If so, in what way?
canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I'm also curious if you have any idea of the level of fraud or abuse from doctors? Fraud might be too strong. But take an auto shop for example. You get into a small fender bender, the first thing they ask when you take your car in is "are you paying out of pocket or through insurance?" They ask because if you say "out of pocket" they will at least give you some choices and a reasonable price, with a cheap option of popping out the dent and straightening the fender and doing some touch-up paint. But if you say "Going through insurance" then all of the sudden half your car needs to be replaced and painted because they just send the bill to insurance. Is there an increase in more expensive medial procedures if they just send the bill off to a third party (government) to pay the bill instead of billing you instead?
Doctors overbill and do unnecessary procedures all the time.
Who monitors that?
The bank that doctors deposit their checks into?
Touche.
I meant who from the payer side monitors that to reduce/eliminate that?
That is a good question. You have an answer to it already.
canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I challenge your hypothesis of broken limb, etc. I experienced it in Italy with one of our youth soccer players. We ended up deciding to wait until we flew home then next day to NY to have it taken care of after waiting 5 hours and seeing sick babies, mothers, bleeding people and all sorts of coughing, hacking that were going to make him sicker that had been sitting around for 18+hours.
Not sure why you care so much about our healthcare system. You like Canada's and that's where you live. The Republicans have taken over everything in response to Obamacare. Since Obama's first election, the Dems have lost on all levels slowly but surely until this ultimate loss and it's mostly directly related to that. House, Senate, Governors, and finally President. It's loud and clear. Now the only people crying are those that are getting a free ride b/c of it.
I hear people crying that are worried about losing their insurance. The majority of the country wants a single payer system.
The people who are subsidized or unsubsidized?
They didn't break it down. Buy I believe you think that would drive the response to the question, no? If so, in what way?
I know it would b/c it does. Though, technically you are right. Those facing 25%+ increases in their Exchange rates are crying. But, not for keeping that coverage. I know, I know. Big bad wolf..errr I mean insurance companies.
Sorry. The world doesn't work the way you tell it to.
canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I challenge your hypothesis of broken limb, etc. I experienced it in Italy with one of our youth soccer players. We ended up deciding to wait until we flew home then next day to NY to have it taken care of after waiting 5 hours and seeing sick babies, mothers, bleeding people and all sorts of coughing, hacking that were going to make him sicker that had been sitting around for 18+hours.
Not sure why you care so much about our healthcare system. You like Canada's and that's where you live. The Republicans have taken over everything in response to Obamacare. Since Obama's first election, the Dems have lost on all levels slowly but surely until this ultimate loss and it's mostly directly related to that. House, Senate, Governors, and finally President. It's loud and clear. Now the only people crying are those that are getting a free ride b/c of it.
I hear people crying that are worried about losing their insurance. The majority of the country wants a single payer system.
The people who are subsidized or unsubsidized?
They didn't break it down. Buy I believe you think that would drive the response to the question, no? If so, in what way?
I know it would b/c it does. Though, technically you are right. Those facing 25%+ increases in their Exchange rates are crying. But, not for keeping that coverage. I know, I know. Big bad wolf..errr I mean insurance companies.
But you're saying that drives the answer based on opinion and assumption, rather than fact.
The problem is the health insurers. They are making a fortune off this. I tried to search for average healthcare costs the first 2 sources gave me an average of $16,000 per family and the second was $22,000. Seems accurate because my cost is exactly in the middle at $19,000. Not to mention co-pays and deductibles families end up paying even more, with that price everything should be free. What family comes even close to spending that in actual medical expenses? Very few. Get ride of insurance and the hospitals/doctors will actually only charge you a 1/3 of what they bill insurance. If you're worried about a major medical expense of $100,000 due to some accident, well just a few years of not paying this ridiculous rate will have that covered. I don't understand arguments of how the skyrocketing increases and just on track with normal inflation? They've doubled or tripled in 6 or 7 years, and the coverage has gone down. That is not normal cost increase. Obamacare forces us to buy into this scam at ridiculous rates and allows the health insurers to continue to hike price beyond what is affordable. 99% of families don't need this. 99% of families will have medical expenses 1/10 of what they are paying in premiums alone. For now I'd prefer to opt out of insurance, get my extra 19k a year that's going to premiums, and pay a reasonable cash price for doctor visits that is way less that what insurance will bill for. And with an extra 19k a year I could actually afford to take my kid to the doctor.
You're claiming only 1% of the US population is unhealthy or uses more than $16,000 to $22,000 of health care costs. Cancer patients, diabetes, accident/shooting victims? Seriously? Where do you get the 99% have medical expenses of 1/10 of premium costs? Do you have a link to that stat? My health insurer sends me itemized listing of the costs and there is no way I would take the chance of being financially ruined because of unforeseen medical expenses. Its like life insurance, you hope you don't need it but better to pay in and have peace of mind.
In the above bolded example you provided, it would take 6.25 years to pay that off, without interest and late fees, which you know corporate healthcare is turning you over to collection agencies. They don't do finance.
Somehow the quotes got jacked up..... my 99% estimate was completely made up, I should have made that clear I guess. But that seems common sense to me. How many people do you know who regularly have $100,000 in medical bills? I know a handful. A coworker has stacked tens of thousands from an accident, but auto insurance is paying for that. And I wont guess a percent, but I would say a significant portion of major injuries are car accidents, so scratch that off your list because that is irrelevant to health insurance. I have a few member of my family with diabetes, and none rack up those kind of bills. Sure, there's some exceptions, and my cousin's husband had a leg amputated as a result 15 years ago. My brother had back surgery, that wasn't covered and had to pay 60k out of pocket anyway. Well 3 years of not paying premiums would have paid for that. My brother in law had open heart surgery 5 years ago that would cost about 40k, and 2 years of premiums would have covered that and he hasn't had a major medical expense since. So yes, my 99% was a made up number, judging on the amount of people who have regular major medical expenses. Most of the time its just once. I'm paying 20k a year and my biggest expense would have been about $2000-$3000 if we were on a cash payment. That means I could have easily afforded some big 100k expense by now if something were to come up. And before turning you over to collections, nearly all would attempt some payment plan option, most likely much less than 20k/year. I know of maybe one family who would benefit from this system, a friend of a friend who had cancer treatment for a year. so sure, of all the hundreds of people I am acquainted with I'm sure 2 or 3 would benefit from this system. But far, far more do not. Really, when it comes to things other insurances or work does not cover, there are very few people who rack up $100,000 medical bills on a regular basis. And unless you do ever few years, you'd be better off keeping that 20k a year and paying out the couple hundred bucks that a typical doctor visit actually costs. I don't think a stat exist, but I still firmly believe 99% is only slightly exagerated, most of the country would be financially better off if they kept 20k a year and paid cash for medical treatments. And that once in a lifetime treatment of 100k would have been paid off in 5 years, because most years you wouldn't even exceed a couple thousand. How many people out of the hundreds you know have required months of cancer treatment or other major illness that would have totaled 100k or more? Between coworkers, friends, family, friends of friends, of the hundrends of people I know I could think of maybe 4 or 5 that fit into that in the last 5 years. Of those 4 or 5, half were work related or car accidents, so health insurance does not come into play. So with the exception of those 2 or 3, everyone else would be better off. You must have some very unlucky friends and family if the majority falls into the other category.
Your statistics are way off. While even I tried to make an argument based on dread disease, to think that's the only thing eating up the healthcare dollar is silly. 1 hospital stay is $10K. A pregnancy is $15K for the mom assuming no complications. It's easy to rack up half of the base price you're talking about without even considering maintenance situations like Diabetes, etc.
But, forget all that. If your fuzzy math were right on the total cost of healthcare, there would be no debate. It would all be easily coverable.
Sorry. The world doesn't work the way you tell it to.
It's absolutely the insurers that are the problem. It makes no sense to have that layer of administrative costs between patient and doctor.
We need to follow the lead of every other industrialized nation in the world and drop this bullshit. We already have a single payer system in place for everyone over 65....just start dropping the required age to participate annually and get it over with.
So, you think if the Gov't ran it there'd be no administrative costs?
We already have an agency that handles it. WOuld more people be required? Yes....would they be paid millions of dollars in CEO bonuses each year? No.
Who's paying the claims? (BTW, who pays the claims today?)
Who's putting in programs to "bend the cost curve?"
If all you want to do is cut provider fees, then your solution is a great one. I'm not for that, but you seem to be. You should let your doctor and anesthesiologist know that view next time you need a procedure.
No you should let your doctor know...then your doctor can see if your insurance company will pay for the treatment that you need. You are ok with insurance companies controlling your life. I'm not.
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canadian doctors bill the govenment directly. it's pretty fucking simple. no insurance companies to deal with. if I want reimbursement on something I'm privately insured for, I have to do the adminstrative work.
I really don't get what's so fucking scary and difficult about it.
wait times can suck, but americans seem to think they will die waiting, or they won't get immediate treatment for a broken leg. which is patently false. everything is done in priority, so yes, if you go to emergency with a finger nail falling off, you're going to have to wait. HOURS. But if you have chest pain or a broken limb, you get access IMMEDIATELY.
the single solitary reason american politicians won't get this done is because they are in the back pocket of the insurance companies. that's it. that's all.
I'm also curious if you have any idea of the level of fraud or abuse from doctors? Fraud might be too strong. But take an auto shop for example. You get into a small fender bender, the first thing they ask when you take your car in is "are you paying out of pocket or through insurance?" They ask because if you say "out of pocket" they will at least give you some choices and a reasonable price, with a cheap option of popping out the dent and straightening the fender and doing some touch-up paint. But if you say "Going through insurance" then all of the sudden half your car needs to be replaced and painted because they just send the bill to insurance. Is there an increase in more expensive medial procedures if they just send the bill off to a third party (government) to pay the bill instead of billing you instead?
Doctors overbill and do unnecessary procedures all the time.
Who monitors that?
The bank that doctors deposit their checks into?
Touche.
I meant who from the payer side monitors that to reduce/eliminate that?
Your statistics are way off. While even I tried to make an argument based on dread disease, to think that's the only thing eating up the healthcare dollar is silly. 1 hospital stay is $10K. A pregnancy is $15K for the mom assuming no complications. It's easy to rack up half of the base price you're talking about without even considering maintenance situations like Diabetes, etc.
But, forget all that. If your fuzzy math were right on the total cost of healthcare, there would be no debate. It would all be easily coverable.
I'm not sure where those numbers came from. We did just have a baby 6 months ago, and we saw all the bills before they were paid. And there were some minor complications, mom stayed 3 nights and the baby stayed 4. Total paid to the hospital was less than 6k. Now maybe your numbers are the jacked up rates they present insurance, because on our bill it has a "regular fee" and a "negotiated fee" Yeah, the "regular fee" was listed at like 20k or something ridiculous, but when looking at what the hospital was actually paid through our copay and insurance, the "negotiated fee" was less than 6k. And people without insurance don't get billed that ridiculous first amount, that is just what they send insurance hoping the pay it, and what insurance wants you to see so you think you have these great savings through them. That was part of my point as well, going through the insurance jacks the rates way up. My sister in law was not on health insurance when she had 3 of her 4 kids, paid cash for all of them. And it was in the 4-5k range she ended up paying in cash. If you tell a doctor or hospital that you are uninsured and want the cash price, it is a fraction of what they bill insurance. At least that was the case before having insurance became law. I have before, and had family members pay cash for doctor visits, it is a small fraction of what they bill insurance. Take away the middle man and a 10k bill becomes only 2k. Another example with our first kid we didn't really ask many questions, did whatever the doctor suggested. He suggested bloodwork early on to detect any illnesses. We receive a bill a few weeks later for $2500 for this bloodwork. We call the company and say we had no idea what this was when it was being done or that it was being sent out of network to get done and we are not paying it. They told us they just bill insurance $2500 and hope they pay it, but if we forward the letter stating it was not covered by insurance, their cash price is only $150. That happens all the time. they bill insurance 10 times when they would bill you if you pay directly. Part of my point was that without insurance, the cost of medical care will not only drop significantly, but I wont be paying 20k a year into premiums either, that 20k will cover A LOT more. And if you are afraid of something drastic, they used to be catastrophic coverage. I used that twice for short periods when I was relocating and without insurance. It was actually recommended for healthy people. It was $80 a month, I covered all basic medical needs out of pocket, but if I got cancer or sent to the hospital and would up with a bill for 80k, that was covered. And as a healthy person since I saw the doctor like once a year, that was the way to go. That is a better system than forcing healthy people to sign up for over-coverage to make them over-pay so the insurance companies can get rich. If I'm wrong about this, then the insurance wouldn't be the big industry that it is. How do they post billion dollar profits if we aren't grossly overpaying for insurance? If it is such a good deal fos us to fork over that 20k a year, how do they make so much money and employ such a large industry?
Another aspect not mentioned are the co-pays and deductibles. Its not like after paying 20k in premiums I get a free trip to the hospital. I found articles that state the average deductible ranging from $1300 to over $2000, and that $1300 one was dated 7 years ago so I know it isn't very accurate. Max out of pocket expenses are in many cases $7500. So after all the cost of your premiums, a trip to the hospital can still run you several thousand dollars. The current system is a scam. it isn't Obamacare that makes it a scam, but it does make it easier for them to profit even more.
Yup. It's your for profit health care system that's a scam and a travesty.
I asked yesterday if there's a scam problem up north with doctors taking advantage of just billing the government. Hugh said not, but my gut tells me otherwise. Like I mentioned earlier, we had a blood test done that was recommended, but optional. Basically it was a blood test to get info about the baby early since my wife was 35 at the time, but we would have learned the same info weeks later in an ultrasound anyway. We didn't realize it was being sent out of network and received a bill for $2500. When we contacted the company they told us to file an appeal with our insurance and if it is still declined their cash price is only $150. Even at $150 I probably wouldn't of had it done, but was just happy to not pay the $2500. So in Canada where you don't have to worry about the bill, you're telling me there isn't price hiking, or people agree to some tests or procedures who don't really need them, but do it because they don't have to worry about the bill? My instinct tells me otherwise. Person A gets told "hey we can do this test to determine the gender and many potential health problems of the baby weeks before an ultrasound can, want to do it? Wont cost you anything?" they'll do it and a ridiculous bill of $2500 gets paid by the government. That raises the cost for everyone that is in turn paid for by taxes. Person B gets asked the same thing, but is told "its going to cost you $150, many will decline and you end up paying for only what you need, but f you do agree you only pay a reasonable price that doesn't go through all the price hiking of insurance no wasted cost. Cheaper for everyone.
Yup. It's your for profit health care system that's a scam and a travesty.
I asked yesterday if there's a scam problem up north with doctors taking advantage of just billing the government. Hugh said not, but my gut tells me otherwise. Like I mentioned earlier, we had a blood test done that was recommended, but optional. Basically it was a blood test to get info about the baby early since my wife was 35 at the time, but we would have learned the same info weeks later in an ultrasound anyway. We didn't realize it was being sent out of network and received a bill for $2500. When we contacted the company they told us to file an appeal with our insurance and if it is still declined their cash price is only $150. Even at $150 I probably wouldn't of had it done, but was just happy to not pay the $2500. So in Canada where you don't have to worry about the bill, you're telling me there isn't price hiking, or people agree to some tests or procedures who don't really need them, but do it because they don't have to worry about the bill? My instinct tells me otherwise. Person A gets told "hey we can do this test to determine the gender and many potential health problems of the baby weeks before an ultrasound can, want to do it? Wont cost you anything?" they'll do it and a ridiculous bill of $2500 gets paid by the government. That raises the cost for everyone that is in turn paid for by taxes. Person B gets asked the same thing, but is told "its going to cost you $150, many will decline and you end up paying for only what you need, but f you do agree you only pay a reasonable price that doesn't go through all the price hiking of insurance no wasted cost. Cheaper for everyone.
I don't have time to tap out a detailed response to your question on my phone, but one thing you're missing is that our system works very, very differently. Price hike? How could there be a price hike for an investigation? The cost of that particular investigation is fixed by the government. The doctor can't change it, and in any case doesn't get the money for it so why would they?
Where there is a range of reasonable options to investigate something, then the patient and the doctor choose which one. However, we have a lot clearer guidelines/requirements as to when a particular test can be ordered and what criteria must be met for it to be covered. You can't just walk in and say "I want this test".
Edit: Which isn't to say there's no fraud. Obviously, no system involving humans is perfect. Just that it isn't nearly as much as your for-profit system, and not the same types.
Post edited by oftenreading on
my small self... like a book amongst the many on a shelf
PS It's also illegal here to do prenatal genetic testing just to determine sex of the fetus. You can only do it if there is a sex linked genetic condition you need to test for.
my small self... like a book amongst the many on a shelf
Yup. It's your for profit health care system that's a scam and a travesty.
I asked yesterday if there's a scam problem up north with doctors taking advantage of just billing the government. Hugh said not, but my gut tells me otherwise. Like I mentioned earlier, we had a blood test done that was recommended, but optional. Basically it was a blood test to get info about the baby early since my wife was 35 at the time, but we would have learned the same info weeks later in an ultrasound anyway. We didn't realize it was being sent out of network and received a bill for $2500. When we contacted the company they told us to file an appeal with our insurance and if it is still declined their cash price is only $150. Even at $150 I probably wouldn't of had it done, but was just happy to not pay the $2500. So in Canada where you don't have to worry about the bill, you're telling me there isn't price hiking, or people agree to some tests or procedures who don't really need them, but do it because they don't have to worry about the bill? My instinct tells me otherwise. Person A gets told "hey we can do this test to determine the gender and many potential health problems of the baby weeks before an ultrasound can, want to do it? Wont cost you anything?" they'll do it and a ridiculous bill of $2500 gets paid by the government. That raises the cost for everyone that is in turn paid for by taxes. Person B gets asked the same thing, but is told "its going to cost you $150, many will decline and you end up paying for only what you need, but f you do agree you only pay a reasonable price that doesn't go through all the price hiking of insurance no wasted cost. Cheaper for everyone.
I don't have time to tap out a detailed response to your question on my phone, but one thing you're missing is that our system works very, very differently. Price hike? How could there be a price hike for an investigation? The cost of that particular investigation is fixed by the government. The doctor can't change it, and in any case doesn't get the money for it so why would they?
Where there is a range of reasonable options to investigate something, then the patient and the doctor choose which one. However, we have a lot clearer guidelines/requirements as to when a particular test can be ordered and what criteria must be met for it to be covered. You can't just walk in and say "I want this test".
Edit: Which isn't to say there's no fraud. Obviously, no system involving humans is perfect. Just that it isn't nearly as much as your for-profit system, and not the same types.
And in the US, free market rules are being applied to healthcare. So you will try to get as much money as you can for something. Like how the same rules apply when you're selling a PJ20 backpack, but the backpack also contains life saving drugs.
Yup. It's your for profit health care system that's a scam and a travesty.
I asked yesterday if there's a scam problem up north with doctors taking advantage of just billing the government. Hugh said not, but my gut tells me otherwise. Like I mentioned earlier, we had a blood test done that was recommended, but optional. Basically it was a blood test to get info about the baby early since my wife was 35 at the time, but we would have learned the same info weeks later in an ultrasound anyway. We didn't realize it was being sent out of network and received a bill for $2500. When we contacted the company they told us to file an appeal with our insurance and if it is still declined their cash price is only $150. Even at $150 I probably wouldn't of had it done, but was just happy to not pay the $2500. So in Canada where you don't have to worry about the bill, you're telling me there isn't price hiking, or people agree to some tests or procedures who don't really need them, but do it because they don't have to worry about the bill? My instinct tells me otherwise. Person A gets told "hey we can do this test to determine the gender and many potential health problems of the baby weeks before an ultrasound can, want to do it? Wont cost you anything?" they'll do it and a ridiculous bill of $2500 gets paid by the government. That raises the cost for everyone that is in turn paid for by taxes. Person B gets asked the same thing, but is told "its going to cost you $150, many will decline and you end up paying for only what you need, but f you do agree you only pay a reasonable price that doesn't go through all the price hiking of insurance no wasted cost. Cheaper for everyone.
I don't have time to tap out a detailed response to your question on my phone, but one thing you're missing is that our system works very, very differently. Price hike? How could there be a price hike for an investigation? The cost of that particular investigation is fixed by the government. The doctor can't change it, and in any case doesn't get the money for it so why would they?
Where there is a range of reasonable options to investigate something, then the patient and the doctor choose which one. However, we have a lot clearer guidelines/requirements as to when a particular test can be ordered and what criteria must be met for it to be covered. You can't just walk in and say "I want this test".
Edit: Which isn't to say there's no fraud. Obviously, no system involving humans is perfect. Just that it isn't nearly as much as your for-profit system, and not the same types.
And in the US, free market rules are being applied to healthcare. So you will try to get as much money as you can for something. Like how the same rules apply when you're selling a PJ20 backpack, but the backpack also contains life saving drugs.
I was taking my PJ20 backpack to the beach every day until one day I saw one sell on eBay for $500 and thought "II better take better care of this thing." Still use it regularly though, just no beach trips.
So here's the bigger problem with Healthcare costs. Hospitals continue to buy out smaller outpatient centers to monopolize regions for healthcare. The hospitals continue to employ the doctors to work there. The current trend is for most doctors, especially newer ones, to become employees in current hospital practices that are obviously managed by the hospitals. It is BIG business for the hospitals. The physicians don't have ultimate say in what's charged to their patients. Most physicians want to just worry about treating patients, which is what they studied for in medical school. Hospitals buy out other hospitals and get bigger. Lawyers are in the background waiting for any potential malpractice lawsuits, so they can hit the lottery suing the physicians and hospitals. Thereby the physicians order more tests to cover any loophole for potential misdiagnosis, most of which may not be completely necessary. This is extremely rampant through the ER system where hospitals make more money from insurance companies. But the patients are demanding and want the immediate gratification and response, kind of like drive thru treatment. Patients don't want to drive 15 min to the hospital, they want to have a clinic in their own neighborhood. They can't see their family Doc for 1 week+, so go to the ER where you will get immediate treatment. Meanwhile the insurance companies negotiate contracts with hospitals for coverage and payments. As hospitals get bigger, they negotiate for more reimbursement because they have more patient coverage area. The insurance companies have been trying to merge to get bigger to negotiate for lesser reimbursements to hospitals. Just recently Anthem and Humana and Cigna and Aetna tried to merge with each other, luckily to be stopped by antitrust laws. Further behind the scenes, the hospital and insurance companies lobby corrupt government officials to create bills and laws in their favor. Do you see the problem with all of it??
Doctors used to "rape" the patient wallets and insurance companies the past several decades... but they've given that up to the businessmen who run the hospitals. Everyone is at fault in the current system, even the patients.
My point being that Obamacare does not really address this issue. Hospitals are actually doing better because more people are covered and they don't have to get stuck with the lost profit of uninsured patients.
Your statistics are way off. While even I tried to make an argument based on dread disease, to think that's the only thing eating up the healthcare dollar is silly. 1 hospital stay is $10K. A pregnancy is $15K for the mom assuming no complications. It's easy to rack up half of the base price you're talking about without even considering maintenance situations like Diabetes, etc.
But, forget all that. If your fuzzy math were right on the total cost of healthcare, there would be no debate. It would all be easily coverable.
I'm not sure where those numbers came from. We did just have a baby 6 months ago, and we saw all the bills before they were paid. And there were some minor complications, mom stayed 3 nights and the baby stayed 4. Total paid to the hospital was less than 6k. Now maybe your numbers are the jacked up rates they present insurance, because on our bill it has a "regular fee" and a "negotiated fee" Yeah, the "regular fee" was listed at like 20k or something ridiculous, but when looking at what the hospital was actually paid through our copay and insurance, the "negotiated fee" was less than 6k. And people without insurance don't get billed that ridiculous first amount, that is just what they send insurance hoping the pay it, and what insurance wants you to see so you think you have these great savings through them. That was part of my point as well, going through the insurance jacks the rates way up. My sister in law was not on health insurance when she had 3 of her 4 kids, paid cash for all of them. And it was in the 4-5k range she ended up paying in cash. If you tell a doctor or hospital that you are uninsured and want the cash price, it is a fraction of what they bill insurance. At least that was the case before having insurance became law.
There is more to having a baby than the hospital stay. That's why your fuzzy math is so far off.
Sorry. The world doesn't work the way you tell it to.
Your statistics are way off. While even I tried to make an argument based on dread disease, to think that's the only thing eating up the healthcare dollar is silly. 1 hospital stay is $10K. A pregnancy is $15K for the mom assuming no complications. It's easy to rack up half of the base price you're talking about without even considering maintenance situations like Diabetes, etc.
But, forget all that. If your fuzzy math were right on the total cost of healthcare, there would be no debate. It would all be easily coverable.
I'm not sure where those numbers came from. We did just have a baby 6 months ago, and we saw all the bills before they were paid. And there were some minor complications, mom stayed 3 nights and the baby stayed 4. Total paid to the hospital was less than 6k. Now maybe your numbers are the jacked up rates they present insurance, because on our bill it has a "regular fee" and a "negotiated fee" Yeah, the "regular fee" was listed at like 20k or something ridiculous, but when looking at what the hospital was actually paid through our copay and insurance, the "negotiated fee" was less than 6k. And people without insurance don't get billed that ridiculous first amount, that is just what they send insurance hoping the pay it, and what insurance wants you to see so you think you have these great savings through them. That was part of my point as well, going through the insurance jacks the rates way up. My sister in law was not on health insurance when she had 3 of her 4 kids, paid cash for all of them. And it was in the 4-5k range she ended up paying in cash. If you tell a doctor or hospital that you are uninsured and want the cash price, it is a fraction of what they bill insurance. At least that was the case before having insurance became law.
There is more to having a baby than the hospital stay. That's why your fuzzy math is so far off.
I'm guessing he has a good idea what he paid out of pocket.
Your statistics are way off. While even I tried to make an argument based on dread disease, to think that's the only thing eating up the healthcare dollar is silly. 1 hospital stay is $10K. A pregnancy is $15K for the mom assuming no complications. It's easy to rack up half of the base price you're talking about without even considering maintenance situations like Diabetes, etc.
But, forget all that. If your fuzzy math were right on the total cost of healthcare, there would be no debate. It would all be easily coverable.
I'm not sure where those numbers came from. We did just have a baby 6 months ago, and we saw all the bills before they were paid. And there were some minor complications, mom stayed 3 nights and the baby stayed 4. Total paid to the hospital was less than 6k. Now maybe your numbers are the jacked up rates they present insurance, because on our bill it has a "regular fee" and a "negotiated fee" Yeah, the "regular fee" was listed at like 20k or something ridiculous, but when looking at what the hospital was actually paid through our copay and insurance, the "negotiated fee" was less than 6k. And people without insurance don't get billed that ridiculous first amount, that is just what they send insurance hoping the pay it, and what insurance wants you to see so you think you have these great savings through them. That was part of my point as well, going through the insurance jacks the rates way up. My sister in law was not on health insurance when she had 3 of her 4 kids, paid cash for all of them. And it was in the 4-5k range she ended up paying in cash. If you tell a doctor or hospital that you are uninsured and want the cash price, it is a fraction of what they bill insurance. At least that was the case before having insurance became law.
There is more to having a baby than the hospital stay. That's why your fuzzy math is so far off.
I'm guessing he has a good idea what he paid out of pocket.
He only talks about the hospital, so keep guessing.
Sorry. The world doesn't work the way you tell it to.
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I meant who from the payer side monitors that to reduce/eliminate that?
In the above bolded example you provided, it would take 6.25 years to pay that off, without interest and late fees, which you know corporate healthcare is turning you over to collection agencies. They don't do finance.
Somehow the quotes got jacked up.....
my 99% estimate was completely made up, I should have made that clear I guess. But that seems common sense to me. How many people do you know who regularly have $100,000 in medical bills?
I know a handful. A coworker has stacked tens of thousands from an accident, but auto insurance is paying for that. And I wont guess a percent, but I would say a significant portion of major injuries are car accidents, so scratch that off your list because that is irrelevant to health insurance. I have a few member of my family with diabetes, and none rack up those kind of bills. Sure, there's some exceptions, and my cousin's husband had a leg amputated as a result 15 years ago.
My brother had back surgery, that wasn't covered and had to pay 60k out of pocket anyway. Well 3 years of not paying premiums would have paid for that. My brother in law had open heart surgery 5 years ago that would cost about 40k, and 2 years of premiums would have covered that and he hasn't had a major medical expense since.
So yes, my 99% was a made up number, judging on the amount of people who have regular major medical expenses. Most of the time its just once. I'm paying 20k a year and my biggest expense would have been about $2000-$3000 if we were on a cash payment. That means I could have easily afforded some big 100k expense by now if something were to come up.
And before turning you over to collections, nearly all would attempt some payment plan option, most likely much less than 20k/year.
I know of maybe one family who would benefit from this system, a friend of a friend who had cancer treatment for a year. so sure, of all the hundreds of people I am acquainted with I'm sure 2 or 3 would benefit from this system. But far, far more do not.
Really, when it comes to things other insurances or work does not cover, there are very few people who rack up $100,000 medical bills on a regular basis. And unless you do ever few years, you'd be better off keeping that 20k a year and paying out the couple hundred bucks that a typical doctor visit actually costs.
I don't think a stat exist, but I still firmly believe 99% is only slightly exagerated, most of the country would be financially better off if they kept 20k a year and paid cash for medical treatments. And that once in a lifetime treatment of 100k would have been paid off in 5 years, because most years you wouldn't even exceed a couple thousand.
How many people out of the hundreds you know have required months of cancer treatment or other major illness that would have totaled 100k or more? Between coworkers, friends, family, friends of friends, of the hundrends of people I know I could think of maybe 4 or 5 that fit into that in the last 5 years. Of those 4 or 5, half were work related or car accidents, so health insurance does not come into play. So with the exception of those 2 or 3, everyone else would be better off.
You must have some very unlucky friends and family if the majority falls into the other category.
Your statistics are way off. While even I tried to make an argument based on dread disease, to think that's the only thing eating up the healthcare dollar is silly. 1 hospital stay is $10K. A pregnancy is $15K for the mom assuming no complications. It's easy to rack up half of the base price you're talking about without even considering maintenance situations like Diabetes, etc.
But, forget all that. If your fuzzy math were right on the total cost of healthcare, there would be no debate. It would all be easily coverable.
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I have before, and had family members pay cash for doctor visits, it is a small fraction of what they bill insurance. Take away the middle man and a 10k bill becomes only 2k.
Another example with our first kid we didn't really ask many questions, did whatever the doctor suggested. He suggested bloodwork early on to detect any illnesses. We receive a bill a few weeks later for $2500 for this bloodwork. We call the company and say we had no idea what this was when it was being done or that it was being sent out of network to get done and we are not paying it. They told us they just bill insurance $2500 and hope they pay it, but if we forward the letter stating it was not covered by insurance, their cash price is only $150. That happens all the time. they bill insurance 10 times when they would bill you if you pay directly.
Part of my point was that without insurance, the cost of medical care will not only drop significantly, but I wont be paying 20k a year into premiums either, that 20k will cover A LOT more.
And if you are afraid of something drastic, they used to be catastrophic coverage. I used that twice for short periods when I was relocating and without insurance. It was actually recommended for healthy people. It was $80 a month, I covered all basic medical needs out of pocket, but if I got cancer or sent to the hospital and would up with a bill for 80k, that was covered. And as a healthy person since I saw the doctor like once a year, that was the way to go. That is a better system than forcing healthy people to sign up for over-coverage to make them over-pay so the insurance companies can get rich.
If I'm wrong about this, then the insurance wouldn't be the big industry that it is. How do they post billion dollar profits if we aren't grossly overpaying for insurance? If it is such a good deal fos us to fork over that 20k a year, how do they make so much money and employ such a large industry?
The current system is a scam. it isn't Obamacare that makes it a scam, but it does make it easier for them to profit even more.
Like I mentioned earlier, we had a blood test done that was recommended, but optional. Basically it was a blood test to get info about the baby early since my wife was 35 at the time, but we would have learned the same info weeks later in an ultrasound anyway. We didn't realize it was being sent out of network and received a bill for $2500. When we contacted the company they told us to file an appeal with our insurance and if it is still declined their cash price is only $150. Even at $150 I probably wouldn't of had it done, but was just happy to not pay the $2500.
So in Canada where you don't have to worry about the bill, you're telling me there isn't price hiking, or people agree to some tests or procedures who don't really need them, but do it because they don't have to worry about the bill? My instinct tells me otherwise.
Person A gets told "hey we can do this test to determine the gender and many potential health problems of the baby weeks before an ultrasound can, want to do it? Wont cost you anything?" they'll do it and a ridiculous bill of $2500 gets paid by the government. That raises the cost for everyone that is in turn paid for by taxes. Person B gets asked the same thing, but is told "its going to cost you $150, many will decline and you end up paying for only what you need, but f you do agree you only pay a reasonable price that doesn't go through all the price hiking of insurance no wasted cost. Cheaper for everyone.
Where there is a range of reasonable options to investigate something, then the patient and the doctor choose which one. However, we have a lot clearer guidelines/requirements as to when a particular test can be ordered and what criteria must be met for it to be covered. You can't just walk in and say "I want this test".
Edit: Which isn't to say there's no fraud. Obviously, no system involving humans is perfect. Just that it isn't nearly as much as your for-profit system, and not the same types.
Meanwhile the insurance companies negotiate contracts with hospitals for coverage and payments. As hospitals get bigger, they negotiate for more reimbursement because they have more patient coverage area. The insurance companies have been trying to merge to get bigger to negotiate for lesser reimbursements to hospitals. Just recently Anthem and Humana and Cigna and Aetna tried to merge with each other, luckily to be stopped by antitrust laws. Further behind the scenes, the hospital and insurance companies lobby corrupt government officials to create bills and laws in their favor. Do you see the problem with all of it??
Doctors used to "rape" the patient wallets and insurance companies the past several decades... but they've given that up to the businessmen who run the hospitals. Everyone is at fault in the current system, even the patients.