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Old 10-26-2016, 05:35 PM   #121
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It may be a lot harder to save money to ER in other countries. And then, I keep reading stories about long waiting lists to get healthcare that scare the bejesus out of me.

Here's a recent story. I am not going to post a link as it may bring Porky, but it was published recently in a country's local newspaper.

Use your favorite Web browser to look for the terms "diabetic pliers DYI self surgery toes". A surgeon even commended the courageous patient, an ex-soldier veteran, for doing a good job on himself. The patient did not want to wait that long for fear of losing his foot. His surgery was cancelled at the last minute, because it was not life-threatening.

PS. I have long suspected that the better health and lower care cost of other countries are due to their citizens taking better care of themselves, compared to US citizens who come crying to their doctors all the time, expecting a magic pill to melt away their ailment. This DIY surgery story is an example.
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Old 10-26-2016, 05:39 PM   #122
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Are "Doctor's and Facilities" set up for other folks? I have not been able to find any doctors in my area that are in network. I hope it just isn't set up yet.
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Old 10-26-2016, 05:43 PM   #123
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I do not remember what the SLCSP (Second Lowest Cost Silver Plan) was for 2016, but there's only one Silver Plan now at both of my homes, and it's $2,700/month.

The Bronze Plan full-fare will be $1,892 against $879 in 2016. That's more than double!

I wonder what it is that makes Arizonans so much sicker than the rest of the nation. Or is it that drugs and hospitals cost a lot more here? What is going on?

Maricopa County, which encompasses the greater Phoenix area, has a population of more than 4 million, and there are more than 250,000 ACA subscribers. You would think it would attract more than just one insurer, and at that horrendous premium to boot.

PS. I am so disheartened that I have not bothered to check to see what hospitals or doctors are included in the new insurer's plan. What difference does it make to rush to find out, if there's only a single insurer, and with only one plan that I can buy? What other choice do I have?

My current primary care doctor does not show up in the roster. I am hoping that the data is not up-to-date. Else, I have to look around for a new one.

And it can be worse.... finding a new PCP might not be easy.... heck, BCBSTX still shows the one I had almost 2 years ago on their website but she moved to NY even before I ever went to see her...


As you say, there is not much choice in the matter if you have only one provider.... however, maybe the silver plan has a better network.... you might have to check it out and suck it up and pay the extra money...
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Old 10-26-2016, 05:59 PM   #124
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As promised, here's the situation at my locale.

In 2016, I chose a Bronze plan because I expected to use little healthcare and wanted a low-cost plan. The premium is $879/month, and that's for 2 of us, both at 60 years of age. I forgot what the deductible is, because we would not come anywhere near it (and if we exceed it, I would have more things to worry about than money).

Anyway, with only 1 insurer left, I have been waiting to see what the number is going to be. Here it is.

The lowest plan is one of the two Bronze plans, with a premium of $1,892/month and a family deductible of $13,600, again for two 60-year olds.

Out of curiosity, I looked up the info at my 2nd home, in the more rural high-country part of the state. Still only one insurer, but a different one. A Bronze plan will cost $1,911/month, with a family deductible of $13,100. Again, this is for a couple.

With the premium so high, undoubtedly more people will qualify for a subsidy. So, I entered in the median family income for the two areas. It is $55,000 for the metropolitan area, and $48,000 for the rural area.

After subsidy, the monthly premium is down to $192 for the metro area, and $0 for the rural area.

One heck of a good deal! I hope this does not bankrupt the gummint, so that it can last.

PS. A Silver plan runs about $2,700/month for two. That's $32,400/year. Add to that the deductible of $13,100 we are up to $45,500 out of the $48,000 median family income. Nice! I believe the $48K income is before taxes and FICA too.
The premium rate doesn't have anything to do with whether you get a subsidy, does it? A subsidy is based soley on your MAGI and household size, with adjustments for Alaska and Hawaii. The amount of the subsidy will certainly increase, but if you are over the cliff you would have to pay the rack rate. Unless there's something I'm missing.
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Old 10-26-2016, 06:09 PM   #125
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The premium rate doesn't have anything to do with whether you get a subsidy, does it? A subsidy is based soley on your MAGI and household size, with adjustments for Alaska and Hawaii. The amount of the subsidy will certainly increase, but if you are over the cliff you would have to pay the rack rate. Unless there's something I'm missing.
I stand corrected. Yes, if you have not fallen off the cliff, you will get more subsidy. I need to get meself some, as this large premium can degrade my lifestyle. Need to climb up the cliff.

As Sue has pointed out earlier, for her location

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... At $60,000 the subsidy is $618/mo, at $64,079 it's $585/mo, at $64,080 it's $0. There's that cliff!
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Old 10-26-2016, 07:23 PM   #126
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adverse selection - healthy people pay the penalty and unhealthy people use the insurance

If premium gets too much that a healthy person such as I will not pay the premium, the government can pound sand collecting my penalty. The law is set up for people to exploit premium subsidy by controlling reported income. Well I can exploit the law concerning penalty. No refund...No govt collection of penalty. They set the law up that way. If I get priced out of insurance market, I sure as hell ain't paying the penalty that they are allowing me not to pay.
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Old 10-26-2016, 07:33 PM   #127
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But without health insurance, will you do self-administered health care like the tough guy I mentioned in a post earlier, who self-amputated several toes?
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Old 10-26-2016, 07:45 PM   #128
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Im not at the point, yet. But eventually a point comes for some people where the breaking point is reached...The bottom line is 5% of people consume 50% of healthcare costs and 20% consume 80%... Insurance companies knew that. That is why my insurance from 2010 to Dec. 2014 went from $73 to $85 with a $5500 deductible... And thanks to Obamacare booting me off my underwritten plan, I went to $325 with $6500 deductible and an in-network plan that consists basically of the local veterinary clinics. My $85 was subsidizing other healthy people. Now I am subsidizing the 20% thus my premiums have sky rocketed and medicare facilities options compromised. Not everybody gets sick. In fact most dont. John Adams drank like a fish, spent 7% of his presidential salary on personal alcohol consumption, had whiskey and leeches as medical options and lived to be 91, without insurance. I have decided I will be like him!
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Old 10-26-2016, 07:58 PM   #129
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...I went to $325 with $6500 deductible and an in-network plan that consists basically of the local veterinary clinics...
But they do have anesthetic at the local vet clinics, compared to your having to chop off fingers and toes with just a few shots of whiskey. No?

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... Not everybody gets sick. In fact most dont...
Eventually, most do. It happens with old age. The difference is that some die cheaply, while some linger on for a very looong time, costing a lot of money.

My pre-ACA policy had a lifetime limit of $1M, and that did not bother me any. I thought, and still think, that if I got so sick that $1M could not cure me, I would not want to live anyway with that quality of life. But one cannot get a policy like that anymore. It's illegal. So, the premium has to go up (though there's something else that causes it to go up that much!).

Insurers have to pay out 85% (the so-called MLR or Medical Loss Ratio). Their profit is contained in the remaining 15%, which includes the operating cost. Now, even the government Medicaid program has a 10% operating cost or overhead, as I recently saw elsewhere. And people still call insurance companies names.

PS. The $1M limit was more than 10 years ago. If adjusted for inflation, I would like it even more now.
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Old 10-26-2016, 08:19 PM   #130
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Mine had a $7 million limit. Im not worth 7 million. If I had hit that limit, throw me in the trash can. Old age to me is 65. Once you hit that point, its Medicare and that is cheap compared to this crap plan I am getting. The costs go down. I will just write a list of things to repair when I am 65 and take care of it then!
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Old 10-26-2016, 08:35 PM   #131
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I am not sure if I would want to go through $1M worth of pain and suffering, let alone $7M. Put me down, please.
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Old 10-26-2016, 08:42 PM   #132
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Mine had a $7 million limit. Im not worth 7 million. If I had hit that limit, throw me in the trash can. Old age to me is 65. Once you hit that point, its Medicare and that is cheap compared to this crap plan I am getting. The costs go down. I will just write a list of things to repair when I am 65 and take care of it then!

Thanks Mulligan for telling it like it is. It is about time someone got in the fighting mode.
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Old 10-26-2016, 08:44 PM   #133
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Well remember NW, we are talking about medical billing dollars not real world dollars. A million dollars in healthcare costs equates to buying a Toyota Corolla in real world bucks, lol.
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Old 10-26-2016, 09:02 PM   #134
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Thanks Mulligan for telling it like it is. It is about time someone got in the fighting mode.


I cant help myself, Retire, lol. Im actually not opposed to single payer. Just make it a VAT tax on things so the local lazy beggar has to contribute also to his healthcare costs when he goes and buys his cigs and booze. Im tired of all this cross subsidization in 10 different ways and directions so that many people never feel the financial pain of healthcare. We need everybody mad to overhaul the system, just not the 1 million getting hosed with the full rate hikes and everybody else not noticing it. And IMHP it isnt the insurance companies most at fault. They are just the people we write the check to so they bear the brunt.
I cant tell you how dumb some people are....Many friends I have who work get their insurance mostly free. And I cant get it through their thick heads, their paycheck increases are minimized because of the "free insurance" costs employers are paying.
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Old 10-26-2016, 09:22 PM   #135
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Well remember NW, we are talking about medical billing dollars not real world dollars. A million dollars in healthcare costs equates to buying a Toyota Corolla in real world bucks, lol.
Medical billing dollars are highly inflated. Insurance-negotiated costs are less so.

As I have often talked about, I was faced with a life-threatening illness 4 years ago. After 2 major surgeries, 2 minor ones, and extensive 18-month treatment, I cost the insurer around $180K, I think. My wife kept track, and still has the exact number somewhere.

With what I went through, I did not see how I would want 6x that, let alone 39x. In fact, many older patients would drop out and said they'd rather died. And they did.
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Old 10-26-2016, 09:25 PM   #136
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Just checked ACA, only one insurer (BCBS) to select from in southeast AZ. They do offer a bronze HSA plan very similar to what I currently have but the plan cost is ~75% more. Not sure if there is a miscalculation somewhere but if I use the same income for 2017 that I used for 2016 my subsidy increases from $320/month to $949/month.
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Old 10-26-2016, 09:38 PM   #137
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Medical billing dollars are highly inflated. Insurance-negotiated costs are less so.

As I have often talked about, I was faced with a life-threatening illness 4 years ago. After 2 major surgeries, 2 minor ones, and extensive 18-month treatment, I cost the insurer around $180K, I think. My wife kept track, and still has the exact number somewhere.

With what I went through, I did not see how I would want 6x that, let alone 39x. In fact, many older patients would drop out and said they'd rather died. And they did.

Well, when you hear the cost of many procedures when you go to Thailand or some other place I would say that even insurance costs are highly inflated....

And I am not talking third world care.... but top of the line care...

Our system is broken and moving deck chairs on the Titanic will not help... single payer will not help... it is actually the cost that is the problem, not who pays for it...

I hope I have not crossed the line.... just stating an opinion that is not blaming any political party....


Edit... Decided to put something down to show my point... well, not so good.... here is a link... http://www.medretreat.com/procedures/pricing.html





This chart will provide you with a basic comparison of common procedure pricing between the U.S. and overseas hospitals. As pricing will vary depending on where you originate from, and which country you choose to receive your procedure, we have provided a price range for comparison purposes.


PROCEDURE COST IN U.S. COST ABROAD Orthopedic Hip Replacement $40,000 - $65,000 $7,000 - $13,000 Hip Resurfacing $50,000 - $60,000 $8,000 - $12,000 Knee Replacement $45,000 - $60,000 $7,500 - $12,000 Neurology Spinal Fusion $80,000 - $100,000 $6,000 - $10,000 Total Spinal Disc Replacement $100,000 - $150,000 $8,000 - $12,000 Discectomy $20,000 - $24,000 $5000 - $7,000 Cardiology Angioplasty $50,000 - $65,000 $5,000 - $7,000 Heart Bypass $90,000 - $120,000 $10,000 - $18,000 Heart Valve Replacement $125,000 - $175,000 $13,000 - $18,000 Gynecology Hysterectomy $18,000 - $25,000 $4,000 - $7,000 Cosmetic Face & Neck Lift $8,000 - $15,000 $2,500 – $4,000 Breast Augmentation $6,000 - $12,000 $3,500 - $5,000 Tummy Tuck $6,000 - $12,000 $3,800 - $5,200 Liposuction/Area $2,000 - $3,000 $800 - $1,200 Dental Dental Implants/Tooth $3,000 - $5,000 $800 – $2,000 Dental Crowns $800 – $1,200 $200 – $600
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Old 10-26-2016, 09:41 PM   #138
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Medical billing dollars are highly inflated. Insurance-negotiated costs are less so.

As I have often talked about, I was faced with a life-threatening illness 4 years ago. After 2 major surgeries, 2 minor ones, and extensive 18-month treatment, I cost the insurer around $180K, I think. My wife kept track, and still has the exact number somewhere.

With what I went through, I did not see how I would want 6x that, let alone 39x. In fact, many older patients would drop out and said they'd rather died. And they did.


And we are glad you came through strong and enjoying life! These plans are becoming useless. If I go into a hospital Dec. 30 for a few days, I am out over $20,000 before I get a penny assistance. Great insurance! I think I want to by twice as much as it is such a great deal.
There is another way people game it. A friend on mine told me he knows several people who have large hospital bills, and brag they just pay $20 a month to them to keep them off their backs. Maybe that will be my gaming plan, lol.
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Old 10-26-2016, 09:43 PM   #139
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Well, it's all about ACA plan availability and premium increases we talk about, yes?

It does not bother me that much that the healthcare cost is higher here than in Thailand. Heh, when working I got paid a lot more than a Thai engineer did in his country, so why should I ask an American doctor or nurse to be paid in Thai baht? Everybody gets paid more here than his counterpart in Thailand.

The question should not be whether it should be higher here in the US, but how much higher it should be.
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Old 10-26-2016, 09:54 PM   #140
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Well, it's all about ACA plan availability and premium increases we talk about, yes?

It does not bother me that much that the healthcare cost is higher here than in Thailand. Heh, when working I got paid a lot more than a Thai engineer did in his country, so why should I ask an American doctor or nurse to be paid in Thai baht?

The question should not be whether it should be higher here in the US, but how much higher it should be.


Medical providers salaries are a zit on the face of medical costs. They deserve their bucks. Ok, Im done complaining. I cant solve anything. I will write my check....until I dont. And I aint paying no "penalty" if it ever comes to that!
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