Obamacare is a mess

mace1229 said:

HughFreakingDillon said:

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.

mace1229 said:

HughFreakingDillon said:

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?

it's not like that, because a doctor doesn't ask if you're privately insured. he has no reason to, as there is no private insurance for procedures, only precriptions and other services that are not considered primary care (like physiotherapy, some mental health services, massages, etc), but those aren't administered by a doctor anyway. he can't "upsell" anything, like giving a better quality tensor bandage or anything like that depending on your coverage. we all have the same. and the pharmacists are the same. there are some differences when it comes to generic brands of drugs or a name brand, but that's up to you if you want to contribute to driving up the costs of your private insurance and have to pay for it on the back end later on down the line.

there is no out of pocket expenses for the patient for primary care. I go to the ER, they see my medical card, and there is no exchange of money or insurance forms or anything. All they care to know is if you are a permanent resident of that province. if you aren't. you may have to pay up front and then get reimbursed by your provincial government. or they may direct bill, I don't know that part.

The problem is assigning people things they deserve. Sure, everyone "deserves" healthcare. And the guy with a 500k job probably doesn't deserve that any more than the guy who makes only 50k and in most cases only received those opportunities because he was born into a class that allowed him a good education and better opportunities.
The problem with the current system is they are forcing healthy people to pay for more than they need, and forcing wealthier people to pay more than their share. If we level the playing field completely then that destroys the American system. Who's going to start the next billion dollar business by working 80 hours a week that eventually employs thousands, if only to have your success taken and given away?
The biggest benefactors of the new healthcare system are the insurance companies themselves. This system is a total scam. Only very few actually benefit from it, and those would be anyone who has month or even year long treatments for serious illnesses. Even small doctors offices have to hire a full time employee just to manage healthcare stuff, and that cost is passed on to me. Except my wife's doctor, who just got tired of dealing with it and send us the bill and make us spend weeks or months fighting with insurance to get anything covered.
If you find a doctor who accepts cash payments, its a third of what they bill insurance. Instead of paying insurance $1500/month to cover a family of 4, that money can be put towards a cash visit at just a fraction of the cost. And even a major medical incident would only cost $3-5000 without insurance (that insurance would send a bill for 20k for, making you think you got a great deal) that would be covered in just 2 or 3 months of not paying these ridiculous premiums.
So why does AHA get the blame for this? Because the costs have skyrocketed in the last 5 or 6 years since it has become a requirement. 6 years ago I had good health insurance I paid out of pocket myself for less than $150. I had $10 copays to see a doctor, which also covered x-rays if I needed it, lab work, etc. Now my single coworkers pay 3-4 times that. Families pay a combined total (employer contribution + employee cost) of $1500 a month, and if you actually use any of your insurance you get another bill for $200 just to see a doctor that sent in some blood work to get examined. In many cases our pharmacy co-pay is HIGHER than the out-of-pocket cost. My copay may be $60, when the medicine is actually only $40! When I complained to our company about this the only response I got was "It's always a good idea to ask for the out of pocket price."
This NEVER happened before Obamacare.
Its a total mess and a scam and the insurance is the biggest benefactor of the system.

I wasn't arguing the merits of obamacare. I was arguing the merits of health care for all.

I got a little side-tracked with my frustration.
The problem with healthcare for all is many end up over paying, or paying for things they don't need or want. AHA even advertises that they need more healthy people to sign up to cover the cost of the unhealthy.
How is it fair to make some healthy kid just out of school and probably will see the doctor once every few years pay the same cost as someone who's 70 and smoked their whole life? But without massive tax increases, that is the only plan so far to make it for all.
You wouldn't make good drivers pay more to subsidize the cost of bad drivers, why should healthcare be different?

I agree that it's not perfect. I too have my own issues with your example, but that's the sacrfiice you have to make in order for everyone to be covered. does it suck that some tax the system because of their own personal life choices? but if I am forced to make the choice between having to endure folks who tax the system or someone not being able to access care for a condition they got through no fault of their own, I choose the former, every single time.

I would be much happier with a system that helped people with those conditions you were referring to. A sort of "major health issue" with a sort of "no fault of their own" clause.
But that isn't the case. The bottom line is we (or I) are forced to pay significantly more than my share. It also affects our healthcare decisions when the costs is still so high even after paying ridiculous premiums that we have to debate weather to wait to take our sick child to the doctor now or try to wait it out.

It might be misguided to blame the high costs on the consumer. Countries where everyone is insured have lower costs.

Terrible, very simpleton argument made all the time.

Let's go with your single payer model. What's the payment rate? The CMS Medicare fee schedule (or worse, States' Medicaid fee Schedule). Do you know how providers feel about said fee schedule? So, let's go there and see what happens. So, yes, you can get to your lower costs on the back of the providers. Problem is, you still haven't solved the (for example) obesity and diabetes epidemic. And the government (as Bloomberg proved) are helpless when it comes to that. So, let's lower the provider fee schedule again.

You have 2 lever points - cost per service and utilization. Government can do nothing about utilization unless you limit benefits or enforce some sort of management scheme (good luck with the gov't doing that). So, have at the cost per service. I'd love to hear gimmesometruth's thoughts about that.

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.

EdsonNascimento said:

Go Beavers said:

mace1229 said:

HughFreakingDillon said:

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?

EdsonNascimento said:

HughFreakingDillon said:

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.

the discussion is about socialized healthcare, which is what I have where I live. and even if I didn't have it, what is it with americans that, as soon as they are pressed with real facts that go against their narrative, the fall back is always "you are in (not america)! what do you care! it's not your business!". it's so predictable.

is it perfect? of course not. A friend of mine had a heart issue, and while he got seen right away, he spent a night in a fucking hallway instead of in a room before his operation.

challenge my hypothesis all you want. I have lived it, I know hudreds of people who have had broken limbs and haven't had to wait to get treated.

"sick babies, bleeding people....sitting around for 18+ hours". that is LAUGHABLE. how more dramatic are you going to get to prove your point? the problem is, yes, there can be sick people that go to the ER when they shouldn't, and they end up waiting. Why? because there are people with life-threatening issues that need help first. that's called a system that works.

EdsonNascimento said:

Go Beavers said:

EdsonNascimento said:

Go Beavers said:

mace1229 said:

HughFreakingDillon said:

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.

EdsonNascimento said:

Go Beavers said:

EdsonNascimento said:

Go Beavers said:

EdsonNascimento said:

HughFreakingDillon said:

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.

rssesq said:

rssesq said:

have a "cadillac" plan with anthem bc/bs, before ACA $395, now $690
Appreciate it bro.

Per month? Single or family plan?