Obamacare is a mess

EdsonNascimento said:

Gern Blansten said:

EdsonNascimento said:

Gern Blansten said:

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.

EdsonNascimento said:

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?

Yup. It's your for profit health care system that's a scam and a travesty.

oftenreading said:

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.

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.

Go Beavers said:

oftenreading said:

mace1229 said:

oftenreading said:

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.

Now I want a PJ backpack.

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.

rssesq said:

Halifax2TheMax said:

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?

single & per month, I could lease a friggin E-Class

How much is a lesser plan?

EdsonNascimento said:

mace1229 said:

EdsonNascimento said:

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.