Myths of Universal Health Care

[OldAgePensioner]

nm

[eridanus]

I don't know what to think. My BCBS allowables are multiples (10x in some cases) of the medicare allowable. With what BCBS is saving me, I'd have gotten a better deal if I told the hospital I was indigent and paid out of pocket entirely.

[OldAgePensioner]

nm

[Zipper]

Our whole extended family in ON has NEVER had a healthcare problem.

That includes Mrs. Zipper's mother and father (deceased) at 86 and 84.

My father deceased at 65 and my mother still kicking at 87.

Mrs. Zipper and I are healthy but grandson born in JA had some issues that were treated immediately.

The Myths Of Universal Health Care are exactly that and I would not trade our system for yours in a nanosecond.

[cute fuzzy bunny]

My favorite is still the time the doctor billed BCBS $25 for something and they only paid $24.72 or something like that.

But then again theres horsepuckey on both sides. Like when Gabe was born and his pediatrician and the doctor who was going to circumcize him both performed "examinations" on him and charged BCBS for both. Thing is, both of them were in the room at the same time (I was there), with the pediatrician doing her 'exam' while the other doctor waited. Couldnt both of them have looked him over at the same time? BCBS rejected the second doctors claim entirely. They also asked us if we would agree to a full investigation into the costs, some random check they do...or so they said. About six months later they reported back that they had found about a thousand dollars of overcharges, mistakes and unnecessary or stuff that wasnt actually done. This didnt benefit me at all, it was just money that BCBS got back from the hospital.

The hospital my wife works at ... ... put stuff on her bill that they didnt do or didnt need to do...:P

[region2]

Here is how this works. Nowadays, most physicians and hospitals are contracted providers for insurers, like BC/BS.

The physician and hospital agrees to take payments in full from the insurers and cannot bill the patient except for co-payments, deductibles, or co-insurance. The remainder is a contractual discount to the physician or hospital.

Of course, if your physician or hospital is not a contractual provider for your insurer, you will be in deep doo-doo.

It is a silly system. I am a physician in a market where I must be a contractual provider for many insurers if I want to see patients at all. I can increase my charges any amount that I want to annually, but it matters not, for I only get paid based on my contracts.

[Rich_in_Tampa]

Originally Posted by OldAgePensioner

For the life of me I can't understand the game. I got billed last 12 months for at least $150,000 in hospital, doctor, etc bills.

Not one line item on any of the bills got paid as is, BCBS always gave them about 30% and magically the bill went to zero that I owed.

Here's an example:
37204- Transcath OCC/EMBO $5,300
3624-IR Cath 3rd order ABD/PELV/LE ARTERY BRANCH $1,872
75898/26 ANGIO EXIST CATH-F/U $1,218

BCBS paid $2198

Why go thru all the mumbo jumbo?

One "reason" IIRC is that they follow the medicare "relative value units" which determine how much "weight" every service "deserves" (e.g. an hour spent with a complex patient with diabetes, heart failure, depression and kidney failure is worth about 20% of the same amount of time taking out someone's cataract). MC profiles doctors, and your fees for next year are related to your fees for this year. While you rarely get paid at 100%, if you bill lower, it hurts you the next year. If you feel you deserve $100 for a service, you have to bill $300 to collect $80. Maybe.

It is axiomatic in the field that if you try to understand reimbursement by applying what is commonly known as logic, it won't work. There are enough ex-soldiers and sailors here to understand what I am describing. Crazy.

[OldAgePensioner]

nm

[AltaRed]

FWIW, the Canadian healthcare system provides only basic health care, e.g. doctor visits, outpatient and hospital bills including any drugs, etc prescribed while in hospital.

Canadians not on OAS (Social Security) are on their own for upgrades (e.g. private hospital rooms and prescription drugs) unless they buy an upgrade health policy with private insurers. However, I pay only C$50 per month for that upgraded health insurance.

[OldAgePensioner]

I lived in England for 8 years and while I saw pieces of the system that looked better than the US system, the newspapers, news on TV and locals all decried the system as horrible. Long waits, not enough doctors, poor doctor quality, especially dental care, dirty (acutally filthy) hospitals. Sure it was free, but wow, is free all that matters.

A lot of articles about people just going to India, France, etc and having their surgery rather than waiting years.


Geesh, I hope what we do here in the US in the next few years is well thought out.

[poboy]

Not there yet, but Medicare Part D is probably a good preview of the total cluster that will result if socialized medicine is forced on us.

[haha]

Originally Posted by poboy

Not there yet, but Medicare Part D is probably a good preview of the total cluster that will result if socialized medicine is forced on us.*

Medicare Part D is not socialism. It is the Repubs not wanting to offend the insurers. If it were run like parts A and B ( actually closer to what you are erroneously referring to as "socialism", it would be a whole lot smoother.

Ha

[farmerEd]

Originally Posted by OldAgePensioner

I lived in England for 8 years and while I saw pieces of the system that looked better than the US system, the newspapers, news on TV and locals all decried the system as horrible.* Long waits, not enough doctors, poor doctor quality, especially dental care, dirty (acutally filthy) hospitals.* Sure it was free, but wow, is free all that matters.

A lot of articles about people just going to India, France, etc and having their surgery rather than waiting years.


Geesh, I hope what we do here in the US in the next few years is well thought out.*

There are plenty of articles right here in this country decrying the sorry state of health care in the US...and there are also lots of stories about people going to far-off places (India, for example) to get equivalent care at a much better price...even when factoring in the travel.

The simple fact of the matter is the most countries that have universal health care for their citizens, are paying less for it than we are, and on average their citizens live longer than ours are with our "great" system....if their is a better metric of which system is better (cost and the longevity of its patients) I'm all ears....

[OldAgePensioner]

OldMcDonald,
England, I lived there, did you? [MODERATOR EDIT]

[Peter]

Originally Posted by OldAgePensioner

I lived in England for 8 years and while I saw pieces of the system that looked better than the US system, the newspapers, news on TV and locals all decried the system as horrible.

Don't forget that the Brits are the world's best (worst?) whingers. They will always find something to complain about. That's one of the main reasons why I left the UK in 1977.

The reality of the NHS is that health care is rationed according to the perceived urgency of the case. Have a stroke while shopping in the local supermarket, like my Dad did recently, and you'll be off to intensive care in no time flat. Something less serious, well, yes, you might have to wait a while. (Just like you do here in many cases.)

Also, don't lose sight of the fact that the Brits spend a tiny fraction of the amount we spend on healthcare in the US, measured on a per person basis. And life expectancy and infant mortality figures are still better in the UK, and most other developed countries, than they are here.

A decently run universal system, costing what we're spending now, could provide a good standard of care for everyone.

Peter

[OldAgePensioner]

Peter,
I agree, the NHS was a "decent" level of care.

If you were not on death's bed, an appointment in 4-6 months was the norm.

A great system for minor illness and my NHS was on Leeds, Rd. Harrogate would see you in 3-4 weeks. Check that place out, every physician is from India or Pakistan. Do the check out. Not that they are not great physicians but why are no British grads wanting to be doctors. Bad pay, bad facilities, bad system.

I do believe that we could implement a "decent" level of health care in the US for less money than our current system.

A "fair" system, even less. And a "poor" system would cost even less.

[OldAgePensioner]

MODERATOR: EDIT THIS: See ya.

[Rich_in_Tampa]

Originally Posted by poboy

Not there yet, but Medicare Part D is probably a good preview of the total cluster that will result if socialized medicine is forced on us.

Wherever one stands on this, it's important to realize that socialized medicine is a very different thing from universal coverage. It is one way to achieve the latter, but probably the most drastic and with the least widespread support.

[d]

Sure it was free, but wow, is free all that matters

there's alot more to what you pay than just the $ price!

[AltaRed]

I would suggest being careful about making assumptions about the British system. It has changed a lot in last 10 years, including both public and private care. I do not know details, only bits of info here and there based on my frequent business trips to the UK before ER, but my basic understanding is that access to health care has improved, even if doctors and appointments still are hard to find. Would be helpful if a couple of Brits with a lot more knowledge would chip in here.

I think what the USA needs, having seen the US health care system for 5 years during my time stateside is some standardization of care, standardization amongst all the health care providers and some framework for unit costs. Just as posters here have noted, I found all the 'posted' rates for things somewhat bizarre because they bore no reality to the PPO contracted rates I always received as part of my care.

As I understand it, Medicare and Medicaid rates paid by gov'ts are not competitive (don't cover costs) and because so many people are not insured, the health system 'attempts' to hose the deep pockets to cover the difference. Just imagine now if all procedures had standardized rates at a cost competive level that keep sufficient medical staff employed and infrastructure in place, etc. It could still be 'privately' financed (except Medicare and Medicaid).