Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Old 04-06-2012, 05:04 AM   #41
Recycles dryer sheets
justplainbll's Avatar
 
Join Date: Sep 2011
Location: Easten Long Island
Posts: 414
Quote:
Originally Posted by JOHNNIE36 View Post
I used to be against universal health care but recent dealings with the system make me wonder what we are doing as a country. To site the case of DW's bout with the norovirus recantly. Taken to the emergency room at our local hospital on 3-12 because whe was dehydrated. Discharged 3-6.
Total hospital bill $29215. This does not include doctors charges. I'll break it down for you (large amounts only).
$5247 the room in 2 East
$1409 pharmacy
$932 intervenous therapy
$10075 CT scan (can you believe that?)
$592 radiology
$7579 laboratory
$3086 emergency room
$300 some misc charges

$29215 Total. My part was $912 but discounted $228 for paying on the spot. Doctors and specialists billed separately but covered by insurance plan. All bills not in yet. We have a Medicare Advantage plan where we pay only our Medicare premium. We have copays but I don't think $684 is bad for all the treatment she got. This is the part I don't understand and take exception with our system. Of the billed amount by the hospital of
$29215, the insurance company only allowed $3947 and paid $3092. The balance was my copay which was discounted.

Now, does any of that make sense? The billed amount? The allowed amount? What happens to the difference? This is what I have against our system. The individual just can't relate to the charges. One of DW's regular medications, which we buy for $6 for a 90 day supply, was charged on the bill at $67 every day. This whole system is bulls**t!!!
+ 1
__________________

__________________
justplainbll is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 04-06-2012, 07:21 AM   #42
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Gone4Good's Avatar
 
Join Date: Sep 2005
Posts: 5,381
Quote:
Originally Posted by youbet View Post
You're changing subjects from my original comments to Midpack.
That's probably true, but you also said we should ask people with high deductible policies about getting health care for cash. Even with a high deductible policy, where I know I'm paying 100% out of pocket, I still don't pay cash. Mostly because they charge people without insurance multiple times the insured rate, but also because nobody can tell me what anything costs. So while it is probably technically true that you can get care in the normal health care system by paying cash, I'm not really sure how that works in practice.
__________________

__________________
Retired early, traveling perpetually.
Gone4Good is offline   Reply With Quote
Old 04-06-2012, 07:37 AM   #43
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,424
Quote:
Originally Posted by Gone4Good View Post
That's probably true, but you also said we should ask people with high deductible policies about getting health care for cash. Even with a high deductible policy, where I know I'm paying 100% out of pocket, I still don't pay cash. Mostly because they charge people without insurance multiple times the insured rate.
You can't pay cash with a high deductible policy. You must let the service provider charge your insurance company, let them determine the negotiated price and the amount you are responsible to pay. They will advise the service provider who will then bill you and also "credit" toward your annual deductible the amount you owe. If you pay cash upfront the insurance company never hears about the charge and your deductible remains completely unmet.
__________________
MichaelB is offline   Reply With Quote
Old 04-06-2012, 07:51 AM   #44
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Gone4Good's Avatar
 
Join Date: Sep 2005
Posts: 5,381
Quote:
Originally Posted by MichaelB View Post
If you pay cash upfront the insurance company never hears about the charge and your deductible remains completely unmet.
I understand that the cost of the proceedure wouldn't be applied to my deductible, but I might be willing to do that for cash savings up front. I don't expect to hit my deductible anyway, most folks with HSAs don't.

It seems like I should be able to get a considerable discount off the insured price so the doctor's office doesn't have to do all the paperwork, but they usually can't even tell me what the insured price is.
__________________
Retired early, traveling perpetually.
Gone4Good is offline   Reply With Quote
Old 04-06-2012, 07:53 AM   #45
Recycles dryer sheets
 
Join Date: Dec 2011
Posts: 388
The stark difference between the US and other rich countries that have effective health care systems is that the vested interests have got control of legislative process here. When you hear German legislators, for example, explain that unemployed people have to be assured of continued access to health care because their health is at greater risk, you realize that no one here, even a Democrat Congressman, would dare being heard to say such a thing. I think it comes down to this: when the health care industry has managed to sequester 17% of the GDP, as they have in the US, they are adequately financed to defend their stake from fundamental reform.
__________________
Khufu is offline   Reply With Quote
Old 04-06-2012, 07:58 AM   #46
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
travelover's Avatar
 
Join Date: Mar 2007
Posts: 9,877
Quote:
Originally Posted by obgyn65 View Post
No - and I don't even care who does their paps. How about this for a thread highjack ?
Sorry, obgyn, I shouldn't have pulled you into my private joke.

I've become disillusioned about any meaningful healthcare reform. It is a highly complex, interconnected issue, which I honestly don't think the public has the capacity nor the patience to ever understand. Thus the Kardashian connection.

Forces that stand to benefit from the status quo have unleashed literal armies of lobbyists on congress to derail any meaningful change that might jeopardize profits. Radio pundits have turned the whole issue into a sound bite distortion of grandmothers being euthanized and big government running our lives. Any real in depth discussion quickly causes glazed eyes and lost advertising dollars.

I do however believe in equilibrium, and at some point the golden goose will kill itself.
__________________
Yes, I have achieved work / life balance.
travelover is offline   Reply With Quote
Old 04-06-2012, 08:09 AM   #47
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,424
Quote:
Originally Posted by Gone4Good View Post
I understand that the cost of the proceedure wouldn't be applied to my deductible, but I might be willing to do that for cash savings up front. I don't expect to hit my deductible anyway, most folks with HSAs don't.

It seems like I should be able to get a considerable discount off the insured price so the doctor's office doesn't have to do all the paperwork, but they usually can't even tell me what the insured price is.
I see your logic. The differences between list and negotiated price are so great I can't imagine getting a better deal with cash. The fact that cash upfront is such a better deal for the provider yet they can't even make that deal just shows how dysfunctional this whole thing is.
__________________
MichaelB is offline   Reply With Quote
Old 04-06-2012, 08:35 AM   #48
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Sep 2005
Location: Northern IL
Posts: 18,264
Quote:
Originally Posted by travelover View Post
I've become disillusioned about any meaningful healthcare reform. It is a highly complex, interconnected issue, which I honestly don't think the public has the capacity nor the patience to ever understand. ...

Forces that stand to benefit from the status quo have unleashed literal armies of lobbyists on congress to derail any meaningful change that might jeopardize profits. .... Any real in depth discussion quickly causes glazed eyes and lost advertising dollars.
What you say is true of many issues these days - substitute 'energy policy', 'pollution controls', 'immigration', or 'tax reform' for 'health care' , and it's the same thing. I skipped over the partisan comments you included, as those could be countered with distortions from the other side, but why go there?

While I don't expect it either - I think the proper route would be small, bite-sized bills that attack HC issues, and keep building on that. Yes, some problems like adverse selection require some wide-reach, but there are many things that could come before that.

Quote:
Originally Posted by Khufu View Post
The stark difference between the US and other rich countries that have effective health care systems is that the vested interests have got control of legislative process here. .... I think it comes down to this: when the health care industry has managed to sequester 17% of the GDP, as they have in the US, they are adequately financed to defend their stake from fundamental reform.
Again, true of many issues. One of the reasons that 'health care industry has managed to sequester 17% of the GDP' is because Congress put laws in place favoring them (tax benefits for companies providing HI). But that was probably done to 'help' people, not industry, and it back-fired big time.

-ERD50
__________________
ERD50 is offline   Reply With Quote
Old 04-06-2012, 09:19 AM   #49
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Midpack's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 11,968
Quote:
Originally Posted by youbet View Post
I'm not arguing against the need for a better medical system here in the USA. But your statement is just not accurate. Why not say something like 17% of the population does not have insurance and must either pay for services themselves or, if indigent, find charitable or gov't provided free services (which is going to be tough).
I picked it up the 17% in reading, coincides with the 45 million uninsured that you often hear. But fair point, and here's another POV that indeed calls the 17% into question (from Sen James E. Risch, Idaho). Remains that we can do much better and still cover everyone at lower cost, there are more than 30 active examples for us to benchmark from public to private and every combination in between.

However, is this acceptable/necessary?
Quote:
A Harvard Study estimates 45,000 people a year die because they lack access to affordable health care.

Although people die because they have no health insurance, a hospital cannot turn away anyone with a life threatening condition so in theory nobody should die because they do not have health insurance. However, many people choose not to see a physician because they do not have a way to pay once the treatment has been provided. However, often by the time they get to a hospital, their life threatening condition is too far advanced to be saved. Also, life saving treatment of some prescription drugs or certain medical procedures (such as dialysis or transplant operations) may not be affordable and are thus the patient is denied a life saving drug or operation.
Attached Images
File Type: jpg uninsured_chart.jpg (28.7 KB, 3 views)
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57

Target AA: 60% equity funds / 35% bond funds / 5% cash
Target WR: Approx 2.5% Approx 20% SI (secure income, SS only)
Midpack is offline   Reply With Quote
Old 04-06-2012, 09:31 AM   #50
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Chuckanut's Avatar
 
Join Date: Aug 2011
Location: West of the Mississippi
Posts: 6,323
Quote:
Originally Posted by Khufu View Post
When you hear German legislators, for example, explain that unemployed people have to be assured of continued access to health care because their health is at greater risk, you realize that no one here, even a Democrat Congressman, would dare being heard to say such a thing.
Another reason for the difference, IMHO, is the attitude towards Freedom.

Most Europeans seek "Freedom From", while many Americans seek "Freedom To".
__________________
The worst decisions are usually made in times of anger and impatience.
Chuckanut is offline   Reply With Quote
Old 04-07-2012, 08:16 AM   #51
Full time employment: Posting here.
 
Join Date: Sep 2009
Posts: 739
From the pie chart it appears more than 60% of "uninsureds" are doing so by choice or are illegally in the country. Am I reading that correctly?
__________________
Zero is offline   Reply With Quote
Old 04-07-2012, 08:23 AM   #52
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Midpack's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 11,968
Quote:
Originally Posted by Zero View Post
From the pie chart it appears more than 60% of "uninsureds" are doing so by choice or are illegally in the country. Am I reading that correctly?
According to the Senator who provided the info...
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57

Target AA: 60% equity funds / 35% bond funds / 5% cash
Target WR: Approx 2.5% Approx 20% SI (secure income, SS only)
Midpack is offline   Reply With Quote
Old 04-07-2012, 08:36 AM   #53
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,424
Here is Kaiser Foundation data on the uninsured in the US The Uninsured: A Primer - Kaiser Family Foundation, with lots of data for those interested. While this data has been used extensively, much of it has been interpreted and framed in many different and creative ways.
__________________
MichaelB is offline   Reply With Quote
Old 04-07-2012, 08:38 AM   #54
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Gone4Good's Avatar
 
Join Date: Sep 2005
Posts: 5,381
Quote:
Originally Posted by MichaelB View Post
I see your logic. The differences between list and negotiated price are so great I can't imagine getting a better deal with cash. The fact that cash upfront is such a better deal for the provider yet they can't even make that deal just shows how dysfunctional this whole thing is.
True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."
__________________
Retired early, traveling perpetually.
Gone4Good is offline   Reply With Quote
Old 04-07-2012, 08:45 AM   #55
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,424
Quote:
Originally Posted by Gone4Good View Post
True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."
If you read Kenneth Arrow's paper (not an easy chore) he points out that price discrimination is a key impediment to free market functionality.
__________________
MichaelB is offline   Reply With Quote
Old 04-07-2012, 08:48 AM   #56
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Midpack's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 11,968
Quote:
Originally Posted by MichaelB View Post
Here is Kaiser Foundation data on the uninsured in the US The Uninsured: A Primer - Kaiser Family Foundation, with lots of data for those interested. While this data has been used extensively, much of it has been interpreted and framed in many different and creative ways.
Good read. It doesn't appear one could compare the Kaiser data to the Senators chart directly, which speaks to your "creative ways" point. Bias is always a challenge...
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57

Target AA: 60% equity funds / 35% bond funds / 5% cash
Target WR: Approx 2.5% Approx 20% SI (secure income, SS only)
Midpack is offline   Reply With Quote
Old 04-07-2012, 09:11 AM   #57
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Sep 2005
Location: Northern IL
Posts: 18,264
Quote:
Originally Posted by Gone4Good View Post
True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."
Good point, and subtle enough that it is hard to tell how big an effect it has. I could see how it could be a big deal for many.

An interesting side-note to this - I've seen some stories about the kinds of procedures generally not covered by insurance: lasik, cosmetic surgery, etc. In these cases, prices are totally transparent, they can't get business if people don't know what it is going to cost them, and the customers can comparison shop. It's a shame that low deductible insurance most have has warped this whole process.

I think if our system had been centered around high-deductible policies, things would be very different.

-ERD50
__________________
ERD50 is offline   Reply With Quote
Old 04-07-2012, 09:50 AM   #58
Full time employment: Posting here.
 
Join Date: Sep 2009
Posts: 739
Quote:
Originally Posted by 2B View Post
Our convoluted health care system goes back to the wage and price controls initiated during WWII. The single payer system used by most of Western Europe and Canada goes back to the end of WWII and was made possible to a large extent by the Marshall Plan. Both approaches effectively ration care. The US does it by employment status and income. The single payer systems have prioritization policies. Of course, the rich from these countries have ways around the rationing aspect.
I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.

I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.
__________________
Zero is offline   Reply With Quote
Old 04-07-2012, 10:03 AM   #59
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Midpack's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 11,968
Quote:
Originally Posted by Zero View Post
I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.

I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.
US health care is already rationed/prioritized. You can't have any and all procedures done, nor can you be charged an unlimited amount for the services provided.

And if wealthy folks can buy better care for themselves, that's as it should be. Wealthy folks in developed countries with universal care already do that, and they're entitled to. Universal care should provide some basic level of care IMO, not the best medicine available. YMMV
Quote:
Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organizations (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.

Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare and Medicaid programs, arguing that a proper rationing mechanism is more equitable and cost-effective. The Congressional Budget Office (CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.
__________________
No one agrees with other people's opinions; they merely agree with their own opinions -- expressed by somebody else. Sydney Tremayne
Retired Jun 2011 at age 57

Target AA: 60% equity funds / 35% bond funds / 5% cash
Target WR: Approx 2.5% Approx 20% SI (secure income, SS only)
Midpack is offline   Reply With Quote
Old 04-07-2012, 10:11 AM   #60
Moderator
Alan's Avatar
 
Join Date: Jul 2005
Location: Eee Bah Gum
Posts: 21,085
Quote:
Originally Posted by 2B View Post
Our convoluted health care system goes back to the wage and price controls initiated during WWII. The single payer system used by most of Western Europe and Canada goes back to the end of WWII and was made possible to a large extent by the Marshall Plan. Both approaches effectively ration care. The US does it by employment status and income. The single payer systems have prioritization policies. Of course, the rich from these countries have ways around the rationing aspect.
Quote:
Originally Posted by Zero View Post
I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.

I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.
I've said this many times here, and I'll say it again, a single payer system does not have to exclude private insurance, through employement or otherwise.

When I lived and worked in the UK I was never rich, just an average income from normal jobs. However, the last 8 years I worked there ('79 - '87) the 2 companies I worked for provided HI as an employee benefit. The first company had it as an option you could pay for, the second had it as part of the benefits package. It was primarily used for elective surgery to avoid waiting lists - I had foot surgery when I was age 29 and used the HI to have it done at a time of my choosing to fit into work projects.

I don't think a single payer system will be accepted in the USA because of the great distrust Americans have of their government. (Note that in the UK the recent documentary on CNN stated that overhead costs of the NHS Trusts running the healthcare is 5%). However, the argument that single payer excludes private insurers is a scare tactic that works very well to ensure it won't happen. (except when you get to Medicare age).
__________________

__________________
Retired in Jan, 2010 at 55, moved to England in May 2016
Now it's adventure before dementia
Alan is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
What won't you give up? REattempt Health and Early Retirement 73 04-09-2012 07:26 AM
How frugal are you in ER? Birchwood Life after FIRE 132 04-08-2012 10:58 AM
What Would You Have Done? TrvlBug Other topics 41 04-05-2012 05:39 PM
Can We Talk Cataract Surgery? Marita40 Health and Early Retirement 28 04-05-2012 05:34 AM
Any suggestions for a good riding lawnmower? hakuna matata Other topics 29 04-04-2012 07:37 PM

 

 
All times are GMT -6. The time now is 09:37 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.