No Politics, HC big issue for FIRE

[explanade]

I have always wondered about people going bankrupt because of medical bills. I understand the 'old' days where insurance only covered up to $1M and you had to buy over that.

Assuming you have coverage, and you use a in-network facility, you have a max OOP. AKAIK, youy can never be asked to pay more in that calendar year. If you are prepared for the OOP expense, you should be fine. If you are not prepared, you were probably destined to go bankrupt anyway.

I have a friend that uses a out-of-network facility (Mayo) because he thinks it's better. He is worried about going broke. I do not know if there are any studies that say life expectancy is better getting care at the Mayo or not. Either way, going broke would be his choice, no different than if I buy a larger home than I can afford.

I know there is an issue with in-network facilities using out-of-network doctors working there, but I think that is not all that common. And I think a refusal to pay would be in order.

How and why do people go bankrupt with the ACA and OOPs in place?

First of all you're assuming that people on ACA plans have gone bankrupt.

I'd like to hear even anecdotes about that because that shouldn't happen.

ACA got rid of lifetime caps for one thing. I hit my OOP and have been doing a lot of things which are not urgent, such as cataract surgery, in the last two months.

One of my doctors say December is a busy time for them because there are many patients who try to take advantage of hitting their deductibles or OOP to take care of many things.

Before the ACA, you could easily hit lifetime caps for things like cancer or treatment which included months of hospital stay. Those were the kinds of cases driving bankruptcies from health care.

 

[explanade]

That kind of experience makes me think the Government couldn’t do much worse than the Private sector when it comes to managing the healthcare system...

The dirty little secret is that between Medicare, Medicaid and the VA, govt. paid well over 50% of total health care costs.

That was even before the ACA with all the subsidies and the Medicaid expansion.

Govt is already involved in health care.

 

[Chuckanut]

IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans. Cut the cost of medical care and the cost of insurance will fall. This ain't rocket science.

I am surpirsed that some insurance company has not told its patients who need things like replacement knees, etc "Ms Jones, get that done in this modern hospital in Mexico for 1/3 the cost and we will pay everything - no deductible and we will toss in a few thousand for transportation costs. If there is a problem when you get back home we will pay for that also. Here is the name of a Dr in your plan who will provide pre and post operative care."

NOte: I know people who have had surgery in Mexico and they swear that the hospitals and staff are as good if not better than in the USA.

 

[ShokWaveRider]

IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans. Cut the cost of medical care and the cost of insurance will fall. This ain't rocket science.

I am surpirsed that some insurance company has not told its patients who need things like replacement knees, etc "Ms Jones, get that done in this modern hospital in Mexico for 1/3 the cost and we will pay everything - no deductible and we will toss in a few thousand for transportation costs. If there is a problem when you get back home we will pay for that also. Here is the name of a Dr in your plan who will provide pre and post operative care."

NOte: I know people who have had surgery in Mexico and they swear that the hospitals and staff are as good if not better than in the USA.

Not a practical solution for the masses. Healthcare Funding should be Not for profit. Reducing costs with reference to Insurance companies just results in High Profits. Remember the TV Series American Greed.

 

[Winemaker]

IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans. Cut the cost of medical care and the cost of insurance will fall. This ain't rocket science.

I am surpirsed that some insurance company has not told its patients who need things like replacement knees, etc "Ms Jones, get that done in this modern hospital in Mexico for 1/3 the cost and we will pay everything - no deductible and we will toss in a few thousand for transportation costs. If there is a problem when you get back home we will pay for that also. Here is the name of a Dr in your plan who will provide pre and post operative care."

NOte: I know people who have had surgery in Mexico and they swear that the hospitals and staff are as good if not better than in the USA.

Megacorp offered this provision to our health care the year before I retired.

 

[Senator]

IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans. Cut the cost of medical care and the cost of insurance will fall. This ain't rocket science.

I am surpirsed that some insurance company has not told its patients who need things like replacement knees, etc "Ms Jones, get that done in this modern hospital in Mexico for 1/3 the cost and we will pay everything - no deductible and we will toss in a few thousand for transportation costs. If there is a problem when you get back home we will pay for that also. Here is the name of a Dr in your plan who will provide pre and post operative care."

NOte: I know people who have had surgery in Mexico and they swear that the hospitals and staff are as good if not better than in the USA.

That is exactly it. Insurance, private pay, not-for-profit, one-payer, etc. it will all be expensive unless the medical cost is reduced. Insurance has to pay out 85%+, so there is not much of a percentage that does not go to health care. Reducing medical costs goes right to salaries paid to Doctors and nurses, among other things.

If you need a prescription in Mexico, the pharmacists can just look at you and sell you what you need. Many items are over-the-counter, and do not even need a prescription.

 

[Meadbh]

This is quite an old paper, but it provides data on the costs of healthcare administration in the US and Canada.

MMS: Error

For many years I worked for a big Health Authority in Canada and the press and the Minister for Health was constantly harassing them because their administrative costs were higher than average. They were ~3.5% of total expenditures.

 

[GTFan]

IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans. Cut the cost of medical care and the cost of insurance will fall. This ain't rocket science.

And then you hit the reality of the doctor, hospital and pharma lobbies and it all comes to a screeching halt.

Which brings us to the main topic to fix almost everything and that's campaign finance reform, otherwise known as public financing along with strict limits on advertising. Another non-starter.

I know, I know, totally OT. Sorry. But since we're already tilting at windmills...

 

[travelover]

And then you hit the reality of the doctor, hospital and pharma lobbies and it all comes to a screeching halt..............

Bingo. Follow the money is still pretty good advice when trying to figure out why things stay screwed up.

 

[Teacher Terry]

I know someone with ACA insurance that needs a dangerous surgery that no one in their state can perform. It is a situation of life/death to not have the surgery. The ACA will not pay a dime for this out of network. That's how people go bankrupt.

 

[explanade]

And then you hit the reality of the doctor, hospital and pharma lobbies and it all comes to a screeching halt.

Bingo. Follow the money is still pretty good advice when trying to figure out why things stay screwed up.

Thing is, they lined up all against the ACA repeal efforts but the Senators and Congressmen mostly ignored them.

Health insurers especially seem to have little standing in Washington right now, with the CSR payments characterized as a bailout of insurers.

Makes you wonder if they decide to severely limit reimbursement rates what would happen.

Sure some older doctors may retire rather than only accept Medicare reimbursement rates for all patients.

Will a lot of doctors refuse to enter the profession?

What I see is there are a lot of doctors in my insurer's network who got degrees in India or China or some other country. So there's some trickle of doctors coming from other countries to practice in the US.

 

[explanade]

I know someone with ACA insurance that needs a dangerous surgery that no one in their state can perform. It is a situation of life/death to not have the surgery. The ACA will not pay a dime for this out of network. That's how people go bankrupt.

Well insurers before and after ACA will not cover certain "experimental" procedures.

One example is Lasik surgery, which millions of people have gotten for decades.

But I've heard of people with employer-provided insurance not being able to get certain types of procedures either.


Now if one is claiming that ACA policies exclude coverage for more procedures than policies offered in the individual market before ACA, that would be surprising.

 

[audreyh1]

What I see is there are a lot of doctors in my insurer's network who got degrees in India or China or some other country. So there's some trickle of doctors coming from other countries to practice in the US.

This is due to the AMA limiting US medical school entrants. They control accreditation.

However, US residencies are more open. So quite a few doctors from foreign medical schools enter US residency programs. And then they practice in the US.

There are many doctors from various Latin American countries in our area that went to medical school overseas and did their residency at a US hospital. We have a large Spanish speaking population.

 

[Senator]

This is due to the AMA limiting US medical school entrants. They control accreditation.

And that is one of the main reason healthcare is so expensive. A Doctors pay is artificially high.

They should allow 100K+ visas for Doctors, every year, like they did with tech workers on H1Bs. That would reduce the cost of doctors in a hurry.

 

[travelover]

And then you hit the reality of the doctor, hospital and pharma lobbies and it all comes to a screeching halt.
.............

Bingo. Follow the money is still pretty good advice when trying to figure out why things stay screwed up.

Thing is, they lined up all against the ACA repeal efforts but the Senators and Congressmen mostly ignored them.
........

All I can say is that there was bigger money on the other side.

 

[Teacher Terry]

Explanade: this is not an experimental procedure. She has a big brain tumor on her brain stem that must come out. It is not cancerous but it is critical that it gets removed in the next few weeks.

 

[ivinsfan]

I know someone with ACA insurance that needs a dangerous surgery that no one in their state can perform. It is a situation of life/death to not have the surgery. The ACA will not pay a dime for this out of network. That's how people go bankrupt.

It's the insurance plan they have through ACA that won't pay, not ACA itself. There are plans on the market with broader networks and PPOs , but they cost more money.

Your friend might be in an area where only a HMO or limited plan is available and this might be the wave of the future. Not a good situation, but it's something that has been around before ACA even started, HMO's or limited networks.

 

[ivinsfan]

And that is one of the main reason healthcare is so expensive. A Doctors pay is artificially high.

They should allow 100K+ visas for Doctors, every year, like they did with tech workers on H1Bs. That would reduce the cost of doctors in a hurry.

Can you back up that statement, in fact I would bet it's hospital charges, high prices for tests and experimental treatments coupled with drug costs that jack up the price of healthcare. Do you expect someone with 20 plus years of education and training to work for average pay?. i.e. the same as a high shool grad with 12 years..

 

[zedd]

IMHO, we are all fussing over insurance costs, when we should be questioning the cost of medical care itself and why it is so much higher here than in other countries with similar lifespans. Cut the cost of medical care and the cost of insurance will fall. This ain't rocket science.

+1

 

[travelover]

Can you back up that statement, in fact I would bet it's hospital charges, high prices for tests and experimental treatments coupled with drug costs that jack up the price of healthcare. Do you expect someone with 20 plus years of education and training to work for average pay?. i.e. the same as a high school grad with 12 years..

I don't think that doctor's pay is "the" problem, but it appears that US docs don't do too badly. https://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

 

[BeachOrCity]

Plenty of blame to go around, but what seems to be missing from this thread is the fact that we already know how it (lower costs) could be done, but there is not the political will (not just our elected leaders, but patients, providers, insurers, etc) to get it done.

The solution is to do what just about every other developed country does. They all vary a bit in approach, but in general there is:
-- No individual underwriting, but everyone has to have coverage
-- Controls on the amount of care provided (special / experimental procedures)...end of life care.
-- Controls on the amount of pay / reimbursement for providers.
-- Tort controls
-- Less consumer driven procedures / pills (new knees and hips when losing weight, or exercise could help, pills for all kinds of stuff)

In doing all of this, we would cut our countries healthcare expenses by 30-50% (if you assume we can cut to other countries cost structure relative to GDP).

Why hasn't this happened?
Doctors would make less (by alot), and if most Doctors tell patients a proposal is bad, they will almost always win.
Insurers would make less
Some other companies would make less (pharma, hospitals, etc)
People could not get all you want medical care (i.e. 20 separate numbers for blood / urine for a simple annualcheck up). Unlimited end of life care. Unlimited care for procedures wanted (ex: New knees w/o a diet 1st)

So in the end, it is what I said upfront. There is not the political will, and it is not just politicians, it is all of us (and by this I don't mean everyone, but I mean that it is not a solid majority who is ready for all of the changes that would be needed)

Until this changes, we will continue to just nip at the real problems.

 

[MRG]

It's the insurance plan they have through ACA that won't pay, not ACA itself. There are plans on the market with broader networks and PPOs , but they cost more money.

Your friend might be in an area where only a HMO or limited plan is available and this might be the wave of the future. Not a good situation, but it's something that has been around before ACA even started, HMO's or limited networks.

+1

I remember my last mentor at Megacorp. He had a huge tumour in his head, an 18 hour procedure to remove it, with several specialists.

The surgeon who did his soft palate was in zero networks. His bill was extreme(+250K) as it also included(by necessity) his T&E expenses. Eventually the insurance caved, perhaps because Megacorp was self insuring.

 

[Senator]

Can you back up that statement, in fact I would bet it's hospital charges, high prices for tests and experimental treatments coupled with drug costs that jack up the price of healthcare. Do you expect someone with 20 plus years of education and training to work for average pay?. i.e. the same as a high school grad with 12 years..

I think if we had 10x+ the number of doctors we have now, the pay would be less. That's economics. Importing more doctors and nurses, or training more, should be the priority to reduce healthcare costs.

Allowing imported or domestic mail order drugs, without a prescription, would reduce drug costs.

Do you think a Doctor is worth over $200K a year, when they cannot even pass a football? The NFL minimum is $450K to sit on the bench. A Doctor is obviously not worth as much as a NFL player.[/sarc]

 

[ivinsfan]

I think if we had 10x+ the number of doctors we have now, the pay would be less. That's economics. Importing more doctors and nurses, or training more, should be the priority to reduce healthcare costs.

Allowing imported or domestic mail order drugs, without a prescription, would reduce drug costs.

Do you think a Doctor is worth over $200K a year, when they cannot even pass a football? The NFL minimum is $450K to sit on the bench. A Doctor is obviously not worth as much as a NFL player.[/sarc]

10 times the numbers of doctors, even if they make less money isn't going to really drop the total doctor expense. Instead of paying, say a million doctors you now have to pay 10 million doctors.

 

[Senator]

10 times the numbers of doctors, even if they make less money isn't going to really drop the total doctor expense. Instead of paying, say a million doctors you now have to pay 10 million doctors.

Prices will drop, assuming there will be a surplus of doctors. That's just economics.

If there are more doctors than actually needed, hospitals can pay less, insurance will offer less, and the government will pay less.