Sicko

[mykidslovedogs]

That is because you are too close to it -- it is your business. I spent thirty years successfully maneuvering in the Federal bureaucracy yet the hassles I encountered with Blue Cross tried my capabilities. I didn't have to read and follow instructions, I had to de-construct medical documents to prove that BC was misreading the claims.

I don't understand why people try to do it on their own when there are a lot of good brokers out there willing to help. It costs you the same premium regardless of whether or not you hire a broker. If you don't hire a broker the insurance company keeps the extra money as profit. You might have been able to save yourself a lot of time by hiring a good broker to help you out.

 

[cute fuzzy bunny]

Is it too much to ask that our general population learn how to read and follow instructions?

I don't understand why people try to do it on their own when there are a lot of good brokers out there willing to help.

I'm a little confused...is everyone supposed to learn how to read and do it themselves, or get you to do it and cause everyone to pay increased premiums because we needed an 'expert' to undo the mess made by the insurance company, who then charges us both for the incompetent bureaucracy AND the expert hired to fix it?

It costs you the same premium regardless of whether or not you hire a broker. If you don't hire a broker the insurance company keeps the extra money as profit. You might have been able to save yourself a lot of time by hiring a good broker to help you out.

Again I'm confused...are the insurance companies extracting excess money from its customers that they would otherwise pocket indiscriminately, or are they charging their customers extra in order to offset the brokers fees?

 

[mykidslovedogs]

Again I'm confused...are the insurance companies extracting excess money from its customers that they would otherwise pocket indiscriminately, or are they charging their customers extra in order to offset the brokers fees?

Insurance companies charge the same premiums regardless of whether someone uses a broker or not. If people don't use a broker, then the insurance companies need to hire more service people, so I guess they figure it's a wash.

Insurance companies have tried separating premiums in the past and offering "the price if you use a broker" vs. "the price if you go direct". Insurance companies found that it was less expensive for them to pay broker commissions than to hire service people to do the extra work, so now they just all charge the same price whether or not you use a broker. They prefer if you use a broker, because ultimately, it costs them less money (particularly in training costs) if you go through a broker than try to go direct to them for their services. This is a high employee turnover industry and there are a lot of laws and regulations that employees need to be aware of. Training on these things alone is a huge expense. Insurance companies don't have to pay to train brokers. Brokers pay for their own licensing and training. Additionally, being commissioned sales people, brokers tend to be much more efficient, motivated to do a good job, and know how to get answers to customers faster and with better results than hourly employees.

 

[cute fuzzy bunny]

And you think all these requisites for 3rd party "helpers" and extra premiums charged to pay for them whether they're internal or external is the sign of a healthy system?

 

[dumpster56]

Insurance companies charge the same premiums regardless of whether someone uses a broker or not. If people don't use a brokers, then the insurance companies need to hire more service people, so I guess they figure it's a wash.

Insurance companies have tried separating premiums in the past and offering "the price if you use a broker" vs. "the price if you go direct". Insurance companies found that it was less expensive for them to pay broker commissions than to hire service people to do the extra work, so now they just all charge the same price whether or not you use a broker. They prefer if you use a broker, because ultimately, it costs them less money (particularly in training costs) if you go through a broker than try to go direct to them for their services. This is a high employee turnover industry and there are a lot of laws and regulations that employees need to be aware of. Training on these things alone is a huge expense. Insurance companies don't have to pay to train brokers. Brokers pay for their own licensing and training. Additionally, being commissioned sales people, brokers tend to be much more efficient, motivated to do a good job, and know how to get answers to customers faster and with better results than hourly employees.

Bottom line when my doctor ordered a few tests he should not need to call an insurance company mine to make sure I could get the test. That is plain BS!But it happens all the time. When did the person on the insurance end of the phone line get their medical degree?? They didn't!

 

[mykidslovedogs]

Bottom line when my doctor ordered a few tests he should not need to call an insurance company mine to make sure I could get the test. That is plain BS!But it happens all the time. When did the person on the insurance end of the phone line get their medical degree?? They didn't!

The doctor doesn't call to see if you CAN get the test...they call to see if the test is going to be PAID for by the insurance company as per your contract with the insurance company. There are many different kinds of insurance policies out there, so doctors want to find out who is going to pay the bill before they do the service. That's just smart business.

One of the nice things about our system is that you are allowed to get the test whenever you want to. If you want to pay your own money for an experimental test, you can....or you can contract with an insurance company and agree to take the test that they are willing to pay for.

In a single payor system like Canada, the gov't, as the single payor, might say, "We don't have enough in our budget for you to get that test right now, so you'll have to wait until we do." Then, they FORBID doctors to allow patients to jump the queue, even if the patient is willing to pay to do so.

The question is, who is going to pay for it? If the test is experimental and the insurance company knows that there is another, less expensive test that would work just as well, they might require that you get the less expensive test. After all, they are paying the bill and they have to make good business decisions.

I understand that this can be frustrating, but which is worse...calling to get approval from an insurance company, or being told that you have to wait 4 months for your MRI?

 

[mykidslovedogs]

And you think all these requisites for 3rd party "helpers" and extra premiums charged to pay for them whether they're internal or external is the sign of a healthy system?

I think our system needs improvement, but, yes, I still think it's better than single payor.

Cute, once America goes single-payor, as I am sure that we will, you can say "I told you so" if, 20 years down the road, there is no such thing as a waiting queue. You can say "I told you so" if you can get all of your service issues resolved in a day or two from Medicare, and you can say "I told you so" if I'm not paying 40%-50% of my income in taxes.

Until then, we'll just have to agree to disagree.....

 

[Beststash]

The doctor doesn't call to see if you CAN get the test...they call to see if the test is going to be PAID for by the insurance company as per your contract with the insurance company.

I think you are missing the point. When we get an insurance policy to cover our illness (if it happens) we expect the Doctor to decide what tests need to be run. This is a reasonable expectation.

Your issue is simply if a procedure is paid for (read dollars) which nothing to do with treatment as prescribed by the Physician. This is another example of the "profit" factor being a negative factor in US Healthcare.

Peace

 

[dumpster56]

I think you are missing the point. When we get an insurance policy to cover our illness (if it happens) we expect the Doctor to decide what tests need to be run. This is a reasonable expectation.

Your issue is simply if a procedure is paid for (read dollars) which nothing to do with treatment as prescribed by the Physician. This is another example of the "profit" factor being a negative factor in US Healthcare.

Peace

Yep!

 

[mykidslovedogs]

I think you are missing the point. When we get an insurance policy to cover our illness (if it happens) we expect the Doctor to decide what tests need to be run. This is a reasonable expectation.

Your issue is simply if a procedure is paid for (read dollars) which nothing to do with treatment as prescribed by the Physician. This is another example of the "profit" factor being a negative factor in US Healthcare.

Peace

No - I don't think I'm missing the point. When it comes right down to it, healthcare is about money. No matter how much you want to think it is, healthcare is NOT an entitlement. Someone else has to work their tail off in order to service your healthcare needs. We can't force people to go to medical school and take care of our nation's health problems. We can't force scientists to invent blockbuster medications and sell them to the public. It has to be their choice, and the amount of money they make is going to play a part in what kind of care we end up with. Not all doctors and providers are in it purely for the charitable and rewarding nature of the business. In either a private or public system, the amount of money fed into the system is going to ultimately dictate the kind of care we get.

The kind of healthcare we get is ultimately all about who pays for it. Personally, I like the freedom of being able to purchase healthcare out of my own pocket if I want to do that. I don't want someody else telling me what kind of services I can or cannot have and when I can have them. In our system, we CAN still choose to buy a service even if our insurance company does not pay for that service per contract. In other single - payor systems, you get what you get. If the gov't doesn't pay for that service, you CAN'T just go out and buy it with your own money even if you have the means to and you want to UNLESS it is a two-tiered system...which many on this forum are advocating against.

When I buy an insurance policy, I understand my contract and I'm willing to accept what payment I can get out of it. For anything above and beyond that, I am thankful that I have the freedom to purchase any kind of healthcare I want out of my own pocket if that's what I choose to do.

 

[donheff]

I don't understand why people try to do it on their own when there are a lot of good brokers out there willing to help. It costs you the same premium regardless of whether or not you hire a broker.

Not sure I understand. I have health insurance through the Federal Government. Are there brokers out there who are going to help me for free? I am not buying insurance through them. What about the average Joe who's health insurance is provided by his corp?

 

[mykidslovedogs]

Not sure I understand. I have health insurance through the Federal Government. Are there brokers out there who are going to help me for free? I am not buying insurance through them. What about the average Joe who's health insurance is provided by his corp?

Don - unfortunately, very large groups rarely contract with brokers. (my earlier comments refer more to individual and small group business). They can, but they usually go direct. And in fact, very large groups do get separate rates to choose from ...rates with or without a broker. When they choose to go without a broker, they are supposed to make HR employees available to assist employees with issues, but unfortunately, they don't always do that.

You are right, in this case, unfortunately, unless HR makes themselves available to you for help, which they should do, then you must deal directly with the insurance carrier.

 

[cute fuzzy bunny]

No matter how much you want to think it is, healthcare is NOT an entitlement.

In your generally (and often wildly) incorrect opinion.

People felt the same way about education at one point. Heck, at one time it was even considered pretty reasonable to own other people, beat your kids until you broke their bones, and drive down the street after drinking 14 beers.

Things change. People like you will have to adapt.

Which in this case probably means finding another topic to troll an internet message board about.

 

[mykidslovedogs]

People felt the same way about education at one point.

You're right Cute. I think we should just strap people down randomly
and force them to go to medical school..even if they feel like the pay isn't worth it...then we should punish them severely if they don't get good grades....and then, when they are all done, we should force them, like slaves, to work for mediocre salaries and disallow them from making a profit....and if they do make a profit, they should be punished...that'll teach them....after all, NO ONE should profit off someone else's sickness...healthcare is an ENTITLEMENT. Doctors and hospitals should be happy to service our whole country without making any kind of profit. ....and they better figure out how to get us the best possible technology too....and we better not have to wait, darnit. I don't care how little they get paid..they better figure out how to get their services to us in a timely manner. Healthcare is an ENTITLEMENT! Those providers of healthcare have a DUTY to work long hours for whatever our government feels like paying them and service our nation without making any kind of profit.....It's not fair for them to make a profit....They are OBLIGATED to give us their services for FREE because we are ENTITLED to it.

 

[Bigritchie]

I don't understand why people try to do it on their own when there are a lot of good brokers out there willing to help. It costs you the same premium regardless of whether or not you hire a broker. If you don't hire a broker the insurance company keeps the extra money as profit. You might have been able to save yourself a lot of time by hiring a good broker to help you out.

I think that is the Problem with the American medical system. It should not be so complicated that you need a broker to figure stuff out for you, or to keep someone from screwing you.

 

[eridanus]

They are OBLIGATED to give us their services for FREE because we are ENTITLED to it.

Is your dichotomy (communism v. current system) a persuasive device, or can you truly not imagine there might be other solutions?

This thread has jumped the shark.

 

[Beststash]

You're right Cute. I think we should just strap people down randomly
and force them to go to medical school..even if they feel like the pay isn't worth it...then we should punish them severely if they don't get good grades....and then, when they are all done, we should force them, like slaves, to work for mediocre salaries and disallow them from making a profit....and if they do make a profit, they should be punished...that'll teach them....after all, NO ONE should profit off someone else's sickness...healthcare is an ENTITLEMENT. Doctors and hospitals should be happy to service our whole country without making any kind of profit. ....and they better figure out how to get us the best possible technology too....and we better not have to wait, darnit. I don't care how little they get paid..they better figure out how to get their services to us in a timely manner. Healthcare is an ENTITLEMENT! Those providers of healthcare have a DUTY to work long hours for whatever our government feels like paying them and service our nation without making any kind of profit.....It's not fair for them to make a profit....They are OBLIGATED to give us their services for FREE because we are ENTITLED to it.

I think I figured out your philosophy...you are worried about hospitals getting their money, you are worried about Doctors getting their money, you are worried about insurance companies getting their money, and you are worried about Pharma getting their money.

The only people that you are not concerned about is the consumer - take what you can get and like it!!

Peace

 

[mykidslovedogs]

I think I figured out your philosophy...you are worried about hospitals getting their money, you are worried about Doctors getting their money, you are worried about insurance companies getting their money, and you are worried about Pharma getting their money.

The only people that you are not concerned about is the consumer - take what you can get and like it!!

Peace

I am using sarcasm to make an example of what people out there sound like. Of course I think there are possibilities in the middle....and I've mentioned them many times. A two-tiered system could have the potential of working wonderfully...but the minute I mention a two-tiered system with subsidies for those who slip through the cracks...oh no...that would be unfair to anyone who wouldn't be able to afford something better than they might get through the public system! "Healthcare is an entitlement", and whatever kind of care the richest people are willing and able to pay for is the same kind of care that everybody should get - therefore, the rich people need to make sure that whatever they are willing to pay for, they also need to subsidize the same kind of care for the poor people.

I think I've figured out your philosophy. The consumer should never have to pay for their healthcare at the time of service, because healthcare is an entitlement, and if the consumer has no money, well, the doctor is obligated to give charity! We should have no concern or fear that shortages could develop in a single-payor system, because the comapssionate gov't will always make sure that there is plenty of money to go around, and even if the economy does not allow for enough money to go around, we all know that doctors are all compassionate and charitable human beings who would continue to work, even if their pay doesn't justify the training and hours they have to put in....moreover, we all know that those young and talented potential doctors will surely not even think about potential salaries vs workload when considering the careers they choose. They are only going to be in it for the charity, and they will WANT to become doctors if only to be assured that noone has to wait for service in our country.

C'mon - I am simply a realist. I have a heart AND a brain. I want the most amount of people to get care, especially when it comes to critical illness.

This is a stupid example, but I think it will get my point across. Let's say I wanted to sell sandwitches to raise money for a charitable event (a health fair). I could charge $5 for each sandwitch, or I could charge $100 for each sandwitch. The liberal would say..."obviously, I could raise the most amount of money if I just charged $100 for each sandwich; people will buy them anyway, because they are compassionate, and after all, this is a charity." The conservative would say "Noone would buy my sandwitches for $100....I could sell a lot more of them for $5 each, and raise a lot more money for my charity."

Liberals think if we run out of money for healthcare, we can just keep taxing the evil rich until they have no more money than the average poor person. They have no concept that rich people might not be willing to be taxed that much, and that rich people might voluntarily reduce their salaries to avoid taxes. At some point, money could run short and shortages could develop....especially in a country where everyone expects the best. Thinking about negative side affects in a single-payor system is realism and should be taken into consideration.

 

[cute fuzzy bunny]

I have a brain.

There you go making those spurious claims again.

 

[Beststash]

Liberals think if we run out of money for healthcare, we can just keep taxing the evil rich until they have no more money than the average poor person.

I would be considered rich by most people's standards - I'm not evil.

They have no concept that rich people might not be willing to be taxed that much, and that rich people might voluntarily reduce their salaries to avoid taxes.

Newsflash - Everyone wishes that they didn't pay any taxes - but most realize that it is necessary.

Let's say I wanted to sell sandwitches to raise money for a charitable event (a health fair). I could charge $5 for each sandwitch, or I could charge $100 for each sandwitch. The liberal would say..."obviously, I could raise the most amount of money if I just charged $100 for each sandwich; people will buy them anyway, because they are compassionate, and after all, this is a charity." The conservative would say "Noone would buy my sandwitches for $100....I could sell a lot more of them for $5 each, and raise a lot more money for my charity."

You just made the case for "Single Payer" universal healthcare

The present system is just not sustainable - no one wants "something for nothing" but the insurance industry has created a system that is discriminatory, is not cost-effective, and is not affordable for many Americans. The result is millions uninsured, mediocre healthcare, and huge profits by the healthcare businesses. As the discussion progresses millions of dollars are being spent by these industries to maintain the status quo.

For me there are only 3 solutions - total reform that includes removing the insurance companies from the system, "single payer" which spreads the cost to everyone, or regulation that puts price controls on the healthcare industry. I suggest you read the book - Who Moved My Cheese - change is coming and you should embrace it. There are many ways to "Skin a Bunny" but it is always hard to accept change.

We cannot maintain our present system - it is not working.

Peace

 

[mykidslovedogs]

For me there are only 3 solutions - total reform that includes removing the insurance companies from the system, "single payer" which spreads the cost to everyone, or regulation that puts price controls on the healthcare industry. I suggest you read the book - Who Moved My Cheese - change is coming and you should embrace it. There are many ways to "Skin a Bunny" but it is always hard to accept change.
Peace

Best - I will read the book. Your solutions scare me. Let's think about price controls.

Let's say that you are an oncologist. What do you think is a reasonable salary for an oncologist? Let's assume the gov't decides that your services are worth no more than $250,000/yr so that's going to be your salary from now on. Currently, you own a multi-million dollar home, you have a nanny who takes care of your kids, and you send your children to a local, private school for their education. You have a staff of fifteen employees, and you are used to an income of say, $500,000/year. As the doctor providing the services, are you going downsize to a smaller home, smaller office, sell off your expensive high-tech equipment and fire several employees so you can continue working for the public, or are you going to open a private practice, so you can keep your income where it's at? After all, people who get cancer aren't going to want the 2nd rate care...they'll pay more to have the best doctor with the best equipment.

Now, let's say that we go to single-payor and outlaw private practice like Canada, to prevent doctors from leaving the public system. How many doctors, particularly specialists, are going to be willing to stay in business making 1/2 what they do now and servicing 30% more people? How many young people are going to choose careers as oncologists?

One last question. Do you really believe that doctors, hospitals and insurance companies would continue to raise costs to a point where absolutely no-one could realistically buy their services? Bear in mind...if they did that, they would put themselves out of business. It would be like charging $100 for each sandwitch instead of $5 for each sandwitch. Do you think that they truly want to put themselves out of business? Most business owners and CFOs know about the law of diminishing returns. That know that at a certain X price, they will start to lose business and make less money. Business have motivation not to price their services above that figure. Since healthcare is an inelastic demand, healthcare service providers are going to charge as much as they can without going over that hump. In America, we have reached the HUMP. I foresee that inflation will begin to flatten very soon because of this. That's not to say that we can't make improvements to our system - WE CAN! But why risk the very negative possibilities of care shortages in a single-payor system?

 

[FinanceDude]

Best - I will read the book. Your solutions scare me. Let's think about price controls.

Let's say that you are an oncologist. What do you think is a reasonable salary for an oncologist? Let's assume the gov't decides that your services are worth no more than $250,000/yr so that's going to be your salary from now on. Currently, you own a multi-million dollar home, you have a nanny who takes care of your kids, and you send your children to a local, private school for their education. You have a staff of fifteen employees, and you are used to an income of say, $500,000/year. As the doctor providing the services, are you going downsize to a smaller home, smaller office, sell off your expensive high-tech equipment and fire several employees so you can continue working for the public, or are you going to open a private practice, so you can keep your income where it's at? After all, people who get cancer aren't going to want the 2nd rate care...they'll pay more to have the best doctor with the best equipment.

Now, let's say that we go to single-payor and outlaw private practice like Canada, to prevent doctors from leaving the public system. How many doctors, particularly specialists, are going to be willing to stay in business making 1/2 what they do now and servicing 30% more people? How many young people are going to choose careers as oncologists?

One last question. Do you really believe that doctors, hospitals and insurance companies would continue to raise costs to a point where absolutely no-one could realistically buy their services? Bear in mind...if they did that, they would put themselves out of business. It would be like charging $100 for each sandwitch instead of $5 for each sandwitch. Do you think that they truly want to put themselves out of business? Most business owners and CFOs know about the law of diminishing returns. That know that at a certain X price, they will start to lose business and make less money. Business have motivation not to price their services above that figure. Since healthcare is an inelastic demand, healthcare service providers are going to charge as much as they can without going over that hump. In America, we have reached the HUMP. I foresee that inflation will begin to flatten very soon because of this. That's not to say that we can't make improvements to our system - WE CAN! But why risk the very negative possibilities of care shortages in a single-payor system?

IMHO, the health care industry is trying to "push the envelope" to see the upper range of what they can charge.

Once they start to see people balking at it, they'll adjust prices by cutting what they'll cover, etc, push high deductibles, etc. Keep in mind NO insurance company WANTS to pay claims, their business model is to AVOID paying claims, and that mantra isn't going to change soon.........

 

[cute fuzzy bunny]

Alright, you go back on the ignore list.

Its no longer amusing to play "pin the tail on the troll".

 

[mykidslovedogs]

Once they start to see people balking at it, they'll adjust prices by cutting what they'll cover, etc, push high deductibles, etc. Keep in mind NO insurance company WANTS to pay claims, their business model is to AVOID paying claims, and that mantra isn't going to change soon.........

True, but even at that, people aren't going to buy the products if they see no value in them. You can only make deductibles so high, until at some point, people see no value in the product.

 

[Rustic23]

Universal Healthcare (UH)
It seems like folks on this board could have an intelligent discussion on a subject that effects all of us to some extent. Calling Mykidslovedogs a troll because you disagree with his point of view, or telling him to read ‘Who Moved My Cheese’ does not seem to contribute to any insight to the problem.

So maybe we should define the problem first.

1. What percentage of the U.S. population have health care?
2. What percentage of those that do no do so by choice?
3. Are children included in this number?
4. What should be the objectives of a Universal Health Care Program?
5. How will we reward, i.e. pay, those that provide service?
6. How will we encourage research and development?
7. How do you overcome the Insurance lobby?
8. Will supplemental care be allowed? i.e. doctors start their own clinics for additional fee.
9. What about the lawyers? If the salaries and profits of the healthcare industry are controlled, will we allow huge jury awards?
10. How will we pay for it?
11. What will it cost per person?
12. Currently the profit motive brings service into the market. i.e. M.D. Anderson runs one of the only for profit Proton Treatment Centers in the U.S. It cost in excess of $125M not including the building and staffing. I think there are only three or four of these in the U.S. So, How will a UH system promote this type of investment?
13. Is it necessary to replace the current healthcare system or modify it?
14. While writing this Rudy just announced his plan. I don’t have a clue what it is, however, I am sure there will be a Rudy, Mitt, Hillary, Edwards, Obama and other plans. Can they be merged or is winning more important?
15. 45 million uninsured. Does this include the estimated 20 million illegals?



These are some of the questions I think should be addressed before we start name calling, and sarcasms. I am sure others could add to this list. I know we have doctors (Rich), lawyers (Martha), and educated people (see Rich’s ‘where did you go to school’). It would be nice to see a discussion that does not roll down hill into ‘my side is better than yours’. Or, you’re a troll because I don’t agree with you.