Sad Story

[FIRE'd@51]

(I still can't wrap my head around the fact that people without insurance paid more. I had gall bladder surgery a couple of years ago and what the insurer paid was a small fraction of the billed cost).

I struggled with this for many years, as well, and finally was able to justify it in my own mind as simply a benefit of paying into the system by purchasing the insurance (even a high deductible policy). Even if the policy never pays a dime, one still benefits from the negotiated rates.

 

[Nords]

I'm sure that if she had realized that her pains were heart attack symptoms she would have done that.
I have no doubt that if she thought she was having a heart attack she would have gone to the ER.

I'm sorry, Katsmeow.

From my limited understanding of the subject, women's heart attack symptoms can be very confusing to diagnose.

Speaking of closed threads, I see RonBoyd's is now closed. I don't understand why. I would have been unhappy if I had been away from my computer for a day and didn't even get a chance to say something to him before the conversation was ended.

Happened pretty fast, hunh? I was surprised to see it close so soon too, until I started reading it.

The whole point of throwing a temper tantrum and huffing off is to not have to listen to the other posters...

 

[Silver]

I struggled with this for many years, as well, and finally was able to justify it in my own mind as simply a benefit of paying into the system by purchasing the insurance (even a high deductible policy). Even if the policy never pays a dime, one still benefits from the negotiated rates.

I'm sorry.....but the last statement is just not true. Whatever amount that is paid to a healthcare provider before the deductable is met is paid at the total billed rate. There is no negotiated rate or discount for any healthcare services when paid by the consumer, unless the healthcare provider has agreed to a "cash-pay discount" prior to the provision of services.

Unless you have some special arrangement (which if you do that's great....but very uncommon) American's pay into the healthcare insurance system, but still pay 100% charged rates prior to meeting any deductable, which may be several thousand dollars a year.

So....perhaps we pay only $1,000/month for a catasrophic policy, with a deductable of $7,000/year. The consumer pays $19,000 a year before dime number one is paid by the insurer.

I'm not seeing the benefit of negotiated rates here.

 

[FIRE'd@51]

I'm sorry.....but the last statement is just not true. Whatever amount that is paid to a healthcare provider before the deductable is met is paid at the total billed rate. There is no negotiated rate or discount for any healthcare services when paid by the consumer, unless the healthcare provider has agreed to a "cash-pay discount" prior to the provision of services.

Unless you have some special arrangement (which if you do that's great....but very uncommon) American's pay into the healthcare insurance system, but still pay 100% charged rates prior to meeting any deductable, which may be several thousand dollars a year.

So....perhaps we pay only $1,000/month for a catasrophic policy, with a deductable of $7,000/year. The consumer pays $19,000 a year before dime number one is paid by the insurer.

I'm not seeing the benefit of negotiated rates here.

Well. perhaps it has something to do with the PPO nature of our insurance policies, but both DW and I have benefited (with different insurance companies) within our network from the negotiated rate even though we hadn't satisfied the deductible. Of course, only the negotiated rate was applied to our deductible (not the billed rate). However, it even works out better than that because our hospital gives us a 25% "prompt pay" discount for paying our copay (after the hospital has filed the claim with the insurance company) within 15 days. So in actuality, we still end up with more $ credited to our deductible than we actually paid.

 

[ERD50]

... Even if the policy never pays a dime, one still benefits from the negotiated rates.

I'm sorry.....but the last statement is just not true. Whatever amount that is paid to a healthcare provider before the deductable is met is paid at the total billed rate. There is no negotiated rate or discount for any healthcare services when paid by the consumer, unless the healthcare provider has agreed to a "cash-pay discount" prior to the provision of services.

Unless you have some special arrangement (which if you do that's great....but very uncommon) ...

Well. perhaps it has something to do with the PPO nature of our insurance policies, but both DW and I have benefited (with different insurance companies) within our network from the negotiated rate even though we hadn't satisfied the deductible. ...

Well, you made me look. I have ins from a mega-Corp, so I assume it is similar to others and I absolutely got the negotiated rates for the amounts that I paid out-of-pocket before I hit the deductible. Specifically, on one bill, I paid $122 out-of-pocket for $315 "charged", all of which was applied to the deductible which was not met at that time. The $122 was the "allowable charges" out of the $315.

-ERD50

 

[NW-Bound]

Sorry to hear about your friend, Katsmeow.

If Melissa were penniless, she would have received care and been alright. My state has an indigent health care system, and I am sure most (all?) states have something similar.

My mother told me the following story, back when she was spending a lot of time at a convalescent home with my late father who was recuperating there.

Another patient in the same ward was a homeless woman who was recovering from a heart attack after getting discharged from a hospital. Her homeless husband, who wandered the streets with her and who managed to get a 911 call that saved her life, hanged around during the day when he was not out looking for some day laborer's work to make a bit of money. He most often came back empty handed, not finding any work, and my mother once gave him a bit of money, like $20. At night, he found a place to sleep somewhere. After the woman recovered, they were turned back out into the streets. But the medical care she received was the same as any other patients, such as my late father who was on Medicare.

I just don't know what to make out of that, or to draw any conclusion. I don't know what the solution is, but people at the two ends of the wealth spectrum get covered, while people with few means are left out.

 

[Purron]

have ins from a mega-Corp, so I assume it is similar to others and I absolutely got the negotiated rates for the amounts that I paid out-of-pocket before I hit the deductible.
-ERD50

A great number of Americans who currently have decent health care coverage have it because they work/worked for a Mega Corp or a Federal/Local government agency and got bennies like negotiated rates and limited out-of-pocket expenses.

Questions: Is this really the American way? Why is access to good, affordable health insurance coverage tied to where you work? How many people are trapped in an unproductive job with a big corporation or the government because they can’t risk the loss of health insurance? How many brilliant people who may be thinking about starting the next big successful company in our country won't try it because they need guaranteed insurance coverage?

Many people right here on ER.org stuck with a job they hated with the government or a big company just long enough to get the retiree health benefits. Imagine if some of these brilliant people were free to move on to a job they loved instead of hanging on to a job they hated just because they needed the insurance coverage.

Seems to me this is not promoting productivity, small start up companies and the entrepreneurial spirit in America. If Bill Gates was working for the Department of *Whatever* and had a kid with a health problem, would he have risked chucking it all to start Microsoft?

 

[ERD50]

A great number of Americans who currently have decent health care coverage have it because they work/worked for a Mega Corp or a Federal/Local government agency and got bennies like negotiated rates and limited out-of-pocket expenses.

Questions: Is this really the American way? Why is access to health insurance tied to where you work? How many people are trapped in an unproductive job with a big corporation or the government because they can’t risk the loss of health insurance? How many brilliant people who may be thinking about starting the next big successful company in our country won't try it because they need guaranteed insurance coverage?

Seems to me this is not promoting small start up companies and the entrepreneurial spirit in America. If Bill Gates was working for the Department of *Whatever* and had a kid with a health problem, would he have risked chucking it all to start Microsoft?

Excellent questions. I agree 100% that Health Insurance should not be tied to employment. Imagine if our car or homeowners insurance was tied to our employer. If we lost our job, wanted to change jobs, or start our own company, we would need to worry about how we would keep our car or our home insured. Crazy, right?

Why should Health Insurance be any different? I shouldn't. But the govt created this situation when they gave preferential tax treatment to Employee provided Health Insurance. Then companies used this to attract talent, as it was 'cheaper' than salary. So companies competed with 'better' policies, which means low/no deductibles, low/no co-pay, and all of that just moves the whole idea of what insurance is supposed to be about and raised prices for everyone.

One of the reasons I'm so skeptical of the govt providing the 'answers' to our HC problems, is that they are the cause of most of the problems we have today. Fool me once...

-ERD50

 

[Letj]

I'll start at the end -

It appears that this person chose to do what she loved, and that didn't come with coverage. Some of us chose to do things we really didn't 'love', in order to get/maintain that coverage.
-ERD50

It detect quite a bit of derision in this comment. Why shouldn't she do what she loved while at the same time having healthcare? Why should working for a large corporation with cushy coverage be more valuable than her chosen vocation? This is essentially why universal healthcare is a must in every society so you don't have to choose a profession that you hate just for medical coverage. I would hate to live in a society where everyone chose the "right" and most "lucrative" career just to get health coverage. I like having artists, philosophers, accountants, scientists and yes even thinkers in society. God forbid if we all worked for big corporations and governments just to have great benefits.

 

[Westernskies]

One of the reasons I'm so skeptical of the govt providing the 'answers' to our HC problems, is that they are the cause of most of the problems we have today. Fool me once...-ERD50

Oh, come on ERD50, how can you say that? Look at Freddie, Fannie, SS, Medicare, Cash for Clunkers, PBGC, USPS, and all the other successful federal programs. You really need to temper your "skepticism" with a bit of "federalism" and get onboard with with this HC issue, it'll be great. Really.

 

[ERD50]

Hi ERD50 - The last time I debated with you on this topic, the thread was closed as deemed "too political". This time I will stay away from this thread.

But I also think it is over-reaching to say that 50 million (or whatever number) are uninsured through no fault of their own.

Well, there have been many threads and many posts on the subject, so I don't really recall which you are referring to. But I'm having trouble seeing how you would have problems with my comment that you quoted, as President Obama said almost exactly the same things as I:

How many uninsured? Number widely debated - Health - Health care - msnbc.com

Some people don't want health insurance or just don't bother to get it, but most people who don't have it can't afford it, Obama said.

If Melissa were penniless, she would have received care and been alright. ...

My mother told me the following story ... Another patient in the same ward was a homeless woman .... the medical care she received was the same as any other patients, such as my late father who was on Medicare.

Wait a minute. The article said "Melissa died because she couldn't afford to see a doctor." But you are saying that once you are poor, you qualify for Medicaid, and then you do get to see the Doctor. So, it's not really the case that she couldn't get care, she chose not to, since the expenses could drive her into poverty. Now, I'd much rather see that everyone has insurance, so we spread the risk, and no one is faced with that - but that is not the situation that the article seems to present.

Again, it is still very sad and it's bad, we need reforms. I just don't like the disingenuous implications that author makes.

-ERD50

 

[NW-Bound]

I am not one who wants "free" healthcare. Perhaps it is because I have saved enough money and can afford it. Or at least I think I can.

The darn problem is whatever else you buy, be it goods or services, I know the cost of it. Health care? No way. They can charge you whatever they like. You cannot do comparison shopping, or even know the costs in advance to prepare. Can you get a quote? Nope. Just make the darn thing fair. I know that there may be complications in many cases, but that is also true with home or car repairs, and people do negotiate for things that are unforeseen.

A friend of mine had a knee replacement. The main surgeon was on the "covered network", while his assistant surgeon was not. The bill he received later showed that the assistant billed 2 or 3 times higher charges than the main surgeon. My friend went ballistic. Me too, even though I was not the patient. My friend's insurance won't pay the higher charge, and my friend wouldn't either. All parties settled out somehow, I forgot.

What a bunch of crap! There's no free market at work here either. I don't want the gummint to get involved either, but with health care providers and insurance companies like we have now, what to do?

 

[ERD50]

Originally Posted by ERD50
It appears that this person chose to do what she loved, and that didn't come with coverage. Some of us chose to do things we really didn't 'love', in order to get/maintain that coverage.
-ERD50

I detect quite a bit of derision in this comment. Why shouldn't she do what she loved while at the same time having healthcare? Why should working for a large corporation with cushy coverage be more valuable than her chosen vocation? This is essentially why universal healthcare is a must in every society so you don't have to choose a profession that you hate just for medical coverage. I would hate to live in a society where everyone chose the "right" and most "lucrative" career just to get health coverage. I like having artists, philosophers, accountants, scientists and yes even thinkers in society. God forbid if we all worked for big corporations and governments just to have great benefits.

My comment wasn't directed at the way things should be, but the way they are/were (remember, I say in just about every post that I'm in favor of reform?).

And as youbet pointed out, some of us made some hard choices to ensure we had coverage for ourselves and our family. So all I'm saying is if someone chooses a different path, and it doesn't provide coverage, then they shouldn't be surprised when they aren't covered. But they got to live the life they wanted. It's a trade off with the system we lived under. That seems pretty basic, it's not judgmental, it just is.


I'd like to see some form of universal coverage, and for everyone to have some 'skin in the game'. That's the only way you can avoid people avoiding paying for coverage, then suddenly wanting it at 'affordable' prices when they get sick. And you need 'skin in the game' to control costs.

And it has to be Constitutional.

-ERD50

 

[NW-Bound]

So, it's not really the case that she couldn't get care, she chose not to, since the expenses could drive her into poverty.

Yes, I believe that once you pay all that you have for health care and become penniless, the public assistance will then step in.

I think that is also true for elderly care like nursing home costs. Just become penniless and you would be taken care of.

 

[NW-Bound]

I just remember now that the homeless woman I described suffered from a stroke and not a heart attack.

About Melissa's death, it is not at all uncommon for heart attack victims to not recognize it and to seek help immediately. My close friend's mother-in-law died from it, even though she had Medicare coverage. As she lived with them, my friend said that she just stayed inside her room for a couple of days, and blamed it on some other illness. By the time they took her to the ER for a diagnosis, it was already too late. The doctors said that her heart was too damaged to have any chance of surgery. In layman's terms, it was explained that some of the heart tissues already died, and it would not even hold any suture.

So, my friend's mother-in-law was sent home to die. She lasted a month in agony. She was in her 70s.

 

[FIRE'd@51]

I think that is also true for elderly care like nursing home costs. Just become penniless and you would be taken care of.

Yes, this is basically the way it works. Once a person spends down his/her assets to below a certain level (which differs from state to state), Medicaid will pick up the cost of the nursing home (or the difference between that cost and his/her SS and/or pension). No one (at least in theory) is left without care.

 

[Silver]

Well. perhaps it has something to do with the PPO nature of our insurance policies, but both DW and I have benefited (with different insurance companies) within our network from the negotiated rate even though we hadn't satisfied the deductible. Of course, only the negotiated rate was applied to our deductible (not the billed rate). However, it even works out better than that because our hospital gives us a 25% "prompt pay" discount for paying our copay (after the hospital has filed the claim with the insurance company) within 15 days. So in actuality, we still end up with more $ credited to our deductible than we actually paid.

This helps to clarify your statements so I appreciate the response. And thanks to ERD50 for his response as well. But what you both describe as your advantaged negoiated rates has not been my experience at all having worked for non-profits for most of my career. And as I have been researching future options with my COBRA ending soon, it is clear that finding afforable coverage with this negoiated rate-advantage is not probable. So...congrats to those who have this coverage. That's great.

 

[sheehs1]

[And it has to be Constitutional.

-ERD50[/QUOTE]

Amen to that. Anyone see the interview done with Obamas aunt who is an illegal immigrant (or was) living for free with free health care in our country? Her statements were basically that "to live in America one is lucky" and when asked how she felt about getting things for free, she said "lucky and a gift from God". It is that freeloader attitude that gets me riled up. They come and "sit" in our country and say to us "provide for me please" ( not all but a huge percentage).

For any kind of universal health care to work, it has to be fairly administered and the cost fairly borne across the spectrum. Too many special interests and freeloaders right now as well as holes in it that make some of us pay bigger bucks - like those that have to buy individual personal policies since we don't have access to group.

The government can not administer anything. Their lack of being able to do so is why there was and is fraud in every system they have their hands in.
Sandra

 

[sheehs1]

Here is the link for Obamas Aunt on Utube"

YouTube - Obama's Illegal Aunt: "You Have The Obligation to Make Me a Citizen"
If the link doesn't work you can search "utube video Obamas Aunt" and find it.

 

[sailor]

Unless you have some special arrangement (which if you do that's great....but very uncommon) American's pay into the healthcare insurance system, but still pay 100% charged rates prior to meeting any deductable, which may be several thousand dollars a year.

Are you sure about it?
I live in Georgia and had Cigna, Aetna and Kaiser insurance and for all these providers I only paid deductible on negotiated rates.

 

[Alan]

This has now gone way off the rails....

YouTube - Porky Pig Cartoon Ending "That's All Folks!"