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Old 12-13-2009, 04:42 PM   #21
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If I got a job with a large institution, would pre-conditions get grandfathered in, or are you in the same position as if buying private insurance?
In all 5 companies that I personally know about through my family there have been no pre-conditions thank goodness. When my son graduated from college I tried getting private insurance for several weeks but the insurance wouldn't touch him at all as he had been treated for clinical depression in his final year. I was shocked that they wouldn't insure him at all. Fortunately he got a job at a bank within a couple of months and there were no pre-conditions. As it happens he was already off his medication by the time he started and has been perfectly well since then (apart from taking a tumble from his bicycle breaking both wrists and requiring surgery with pins in one of them that would have bankrupted him if he was still uninsured).
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Old 12-13-2009, 05:23 PM   #22
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If I got a job with a large institution, would pre-conditions get grandfathered in, or are you in the same position as if buying private insurance?
I think our policy through blue cross blue shield (from a small private employer) did not cover pre-existing conditions for the first 12 months IIRC if you did not previously have "creditable" insurance coverage. Whether Canadian public care would be considered creditable insurance, I dunno. Bigger companies may have better insurance since you probably have a lower risk of adverse selection vs very small company policies.
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Old 12-13-2009, 07:45 PM   #23
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In my experience as a physician there isn't enough healthcare in the world, or healthcare providers, or physicians, or equipment, or time, to provide all the healthcare that everybody wants. There is, however, sufficient to provide all the healthcare that everybody needs. Ergo, healthcare is rationed everywhere in the world. Healthcare systems differ in the rationing methodology.
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Old 12-13-2009, 08:05 PM   #24
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Food, houses, cars, swimming pools--everything is rationed I guess.
well, rationing by markets and price is different than rationing by government fiat

rationing of a publicly provided base service is one thing, forcing everyone into the one soviet system and making it illegal for me to pay a doctor to provide a service is something else

it only works because we can cross the border or go to the Mayo, which I may end up doing
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Old 12-13-2009, 08:22 PM   #25
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well, rationing by markets and price is different than rationing by government fiat

rationing of a publicly provided base service is one thing, forcing everyone into the one soviet system and making it illegal for me to pay a doctor to provide a service is something else
I agree with you 100%

I don't think it's technically accurate to say health care in the US is "rationed" any more than it is correct to say that we ration food or houses. There's a market. It's a dysfunctional, inefficient market, but it does exist.
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Old 12-17-2009, 07:26 AM   #26
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In network provider, not a ton of options otherwise, and from a medical standpoint I think the doc is highly qualified and has a good patient rapport. The waiting, phone tag, etc is a common occurrence at many local providers apparently.

You see, the doc makes nothing from my phone calls but gets paid a little bit when I have to go in and see him for a couple of minutes. Probably a symptom of my health insurance coverage and the payment structure more than poorly run administration at the docs office. From a doc's standpoint of practice management - focusing on revenue producing activities (patient visits) to the detriment of phone based medicine that is uncompensated is probably a smart thing to do in what is I'm sure a fairly small margin business.
We haven't had near the troubles you have detailed. When we did get involved with doctors who were more interested in only the money making side of their business we took our insurance money and went to another doctor. The DWs first neurologist was more concerned with her research than providing patient care, so when the DW would call to be seen about an issue, it would take 2-3 months to get in. We would go, the doc would tell us that we should have come in sooner because she couldn't do anything now, DW would explain that she called when she was having the issue and asked for the first appointment and this was it. After several months of this the DW changed neurologists. The new one started great then started sliding. The DW complained that the phones weren't being answered and calls weren't being returned. Apparently several patients were complaining about the same thing, because the counter help was fired and service went back to normal.

With those two exceptions I have seen doctors in four states using private insurance in areas ranging from large cities to small very rural towns. If I need anything refilled or assistance in any way, I have been able to pick up the phone and get it.
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Old 12-17-2009, 08:12 AM   #27
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We haven't had near the troubles you have detailed. When we did get involved with doctors who were more interested in only the money making side of their business we took our insurance money and went to another doctor. The DWs first neurologist was more concerned with her research than providing patient care, so when the DW would call to be seen about an issue, it would take 2-3 months to get in. We would go, the doc would tell us that we should have come in sooner because she couldn't do anything now, DW would explain that she called when she was having the issue and asked for the first appointment and this was it. After several months of this the DW changed neurologists. The new one started great then started sliding. The DW complained that the phones weren't being answered and calls weren't being returned. Apparently several patients were complaining about the same thing, because the counter help was fired and service went back to normal.

With those two exceptions I have seen doctors in four states using private insurance in areas ranging from large cities to small very rural towns. If I need anything refilled or assistance in any way, I have been able to pick up the phone and get it.
I'm strongly considering switching doctors. The last straw may have been yesterday. They have H1N1 shots available now. All 4 of us are existing patients (having been seen previously at this office). So I get myself and the two kids signed up for h1n1 shots - simple nurse visit, in out done, they are going to get paid by the insurance company $10 per shot to administer each shot (versus $21.50 per shot to administer a regular flu shot!!??). I pay nothing out of pocket because the ins co picks up the tab for immunizations like this. Nota bene - the h1n1 shot is provided to health care providers free from the govt, but they can request payment just to administer it to patients.

Here's the zinger - they refuse to allow a nurse to administer the h1n1 for my wife because she was last seen 2 years ago. They want her to schedule a regular doctor's visit to get the shot. Not only will this consist of 15-45 minutes of waiting in the main waiting room then another 15-45 minutes in the little exam room, but since we have the high deductible ins plan, it will cost us $60-110 out of pocket for a regular visit. I'm not aware that a healthy 32 year old female who has not needed to go to the doctor for 2 years (other than the annual lady dr visit) would need to see an md just to get an h1n1 shot. Methinks this is an attempt at strictly "revenue enhancement". No way is she going to waste an extra hour+ waiting to see a dr and then pay $60-110 out of pocket for the h1n1 shot. Any medical opinions from dr's, nurses, etc?
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Old 12-17-2009, 09:26 AM   #28
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sometimes what seems like a pain in the butt is the universe doing you a favour

Personally, I would be too superticious to not do the check up.
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Old 12-17-2009, 09:45 AM   #29
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sometimes what seems like a pain in the butt is the universe doing you a favour

Personally, I would be too superticious to not do the check up.
This will be one of those "anything changed since your last confession?" type visits. Then the doc says, great, keep up the good work, exercise, eat right, you're doing good. 2 minutes max, then an h1n1 shot, then out the door. I'm pretty sure this is 100% a revenue enhancing office visit required to get a minimum profit level from the DW. What they don't realize is that they have 3 other profit sources from myself and our 2 children who all come in at least annually currently. But they are about to lose all that business unless they can provide good answers or reverse their stance tomorrow.

DW has been going to her lady dr visit annually so she's doing the regular screenings.

One thing I find interesting is that if this were a matter of paying the $10-25 copay with "regular" insurance, we might just pay it. But with the high deductible "consumer focused" plan, we are intentionally cutting costs here since it is our money and barring an emergency in the next 14 days, we will come no where near the $2400 deductible to cost share w/ the ins co.
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Old 12-17-2009, 10:12 AM   #30
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What they don't realize is that they have 3 other profit sources from myself and our 2 children who all come in at least annually currently. But they are about to lose all that business unless they can provide good answers or reverse their stance tomorrow.
Maybe it's because I lived in Florida which is full of old sick people, but in my experience a doctors office couldn't care less if you moved on. Plenty of other suckers to take your place that will just do as their told and not rock the boat.
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Old 12-17-2009, 10:19 AM   #31
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Maybe it's because I lived in Florida which is full of old sick people, but in my experience a doctors office couldn't care less if you moved on. Plenty of other suckers to take your place that will just do as their told and not rock the boat.
You're probably right. Since we are all young and (relatively) healthy, I imagine we are low margin customers. This is definitely a commodity business as best I can tell. And most of the customers I see waiting in the waiting room are older people who probably are in the doc's office 10-100x what anyone in our family is.
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Old 12-17-2009, 12:37 PM   #32
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This will be one of those "anything changed since your last confession?" type visits. Then the doc says, great, keep up the good work, exercise, eat right, you're doing good. 2 minutes max, then an h1n1 shot, then out the door. I'm pretty sure this is 100% a revenue enhancing office visit required to get a minimum profit level from the DW. What they don't realize is that they have 3 other profit sources from myself and our 2 children who all come in at least annually currently. But they are about to lose all that business unless they can provide good answers or reverse their stance tomorrow.

DW has been going to her lady dr visit annually so she's doing the regular screenings.

One thing I find interesting is that if this were a matter of paying the $10-25 copay with "regular" insurance, we might just pay it. But with the high deductible "consumer focused" plan, we are intentionally cutting costs here since it is our money and barring an emergency in the next 14 days, we will come no where near the $2400 deductible to cost share w/ the ins co.
yeah...I see what you mean. Our Veteranarian is doing that on us with prescription refills

why not call back and tell them to give you a nurse shot without the shakedown or you are taking the family elsewhere?
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Old 12-17-2009, 01:39 PM   #33
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yeah...I see what you mean. Our Veteranarian is doing that on us with prescription refills

why not call back and tell them to give you a nurse shot without the shakedown or you are taking the family elsewhere?
We're all going in tomorrow morning. DW is coming with me to help restrain comfort the children while they receive their shots. We will see if they relent on DW getting a shot from the nurse. I'm definitely going to confront them as to whether the issue is medical in nature or financial. I may even offer them a crisp $20 in exchange for immediate service for the DW.
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Old 12-17-2009, 01:42 PM   #34
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Trek,
If what they say is right, 'Medicare does not cover the doctor's cost and cost are made up by other patients', then my guess your doctor may care, unless you are on Medicare.
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Old 12-17-2009, 01:52 PM   #35
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Trek,
If what they say is right, 'Medicare does not cover the doctor's cost and cost are made up by other patients', then my guess your doctor may care, unless you are on Medicare.
It seems like a billing-savvy doctor could make up the losses on revenue. Ie - the 2 minute dr's visit to refill an rx that nets him $40. Or a whole ton of unnecessary lab tests?? Not sure where the profit is in medicare/medicaid reimbursements, but if there are some things that pay more than others, I'd bet a savvy/unscrupulous dr could figure out how to work the system to get a little "juice" out of it.
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Old 12-20-2009, 11:52 AM   #36
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People can get flu shots at Walgreens just walking in off the street. Why is your doc so concerned about not seeing your wife for 2 years? The folks administering the shots at Walgreens know nothing about your health history and they are not concerned. Of course, they have no revenue enhancement opportunities related to an office call.
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Old 12-20-2009, 12:12 PM   #37
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I agree with you 100%

I don't think it's technically accurate to say health care in the US is "rationed" any more than it is correct to say that we ration food or houses. There's a market. It's a dysfunctional, inefficient market, but it does exist.
But it is rationed. That's what markets do. They set a price that buyers and sellers agree is fair, but if you can't afford that price, tough luck. So if you can't afford medicine and go with out (as many people do), medicine is being rationed. Sure, no government agency is saying "you can't have that". But the seller sure is.

The only difference between administrative rationing and market based rationing is that in market based rationing the well-to-do can pretend it doesn't exist while in administrative rationing they have to wait in line with everyone else.
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Old 12-20-2009, 12:47 PM   #38
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Exactly. Why is Mrs Fuego not getting her H1N1 shot? Because it's rationed.

"Rationing is the controlled distribution of scarce resources, goods, or services." (Wikipedia)
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Old 12-21-2009, 11:26 AM   #39
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But it is rationed. That's what markets do.
I guess we'll just have to disagree on the definition of "rationing." You've certainly chosen to use the word in a way outside of normal experience. No one says "I didn't buy the sirloin at the market because it was being rationed." They say "the price was too high." And we know what that means. Here are some other ways rationing is different from the market.
- When prices go up, we can expect that higher supplies wil soon follow (as suppliers respond to the higher prices). This tremendously beneficial mechanism does not exist with administrative rationing-what is in short supply (doctors, medicines, etc) tends to remain in short supply.
- People can optimize their consumption and make judgments on worth. If I want the sirloin I can have it by choosing to economize somewhere else. If a 42 YO woman with a family history of breast cancer wants a mammogram she can get one and choose not to buy a new dress. Under administrative rationing, if the guidelines say a 42 YO woman doesn't need a mammogram, then she's SOL.
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Old 12-21-2009, 01:33 PM   #40
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- People can optimize their consumption and make judgments on worth. If I want the sirloin I can have it by choosing to economize somewhere else. If a 42 YO woman with a family history of breast cancer wants a mammogram she can get one and choose not to buy a new dress. Under administrative rationing, if the guidelines say a 42 YO woman doesn't need a mammogram, then she's SOL.
And if she does have cancer, she can forego another dress and get her cancer treated.
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