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Old 10-13-2018, 02:13 PM   #161
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.... It is difficult for any individual except those who are very well off to cover the potential costs involved in the healthcare for a catastrophic or chronic illness in themselves or their children. This is especially true in the US which has the most costly and opaque healthcare system of all of these countries. ...
I agree with this part.... that is why it is important that everyone buy health insurance... to protect yourself from the potential costs. I'm also fine with subsidies... providing financial help for low income people ... effectively limiting their health insurance costs to a sliding scale percentage of their income and for the particularly low income helping on deductibles and co-pays.

The current system could work if we could put a good effort towards reducing costs.... and the link referenced earlier this thread by a medical professional hs some good ideas about how to do that.
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Old 10-13-2018, 02:22 PM   #162
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Excellent. We agree. Looking from the outside (and having worked on the inside long ago), it is hard to see how the current system could work without significant reform and intervention. There seem to be just too many middle men and too much money in play to even seriously consider the necessary changes. I sincerely hope that I am completely wrong.
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Old 10-13-2018, 02:42 PM   #163
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The link mentioned from the White Coat Investor forum regarding healthcare reform is interesting and the comments even moreso IMHO. I think Dr Elisabeth Rosenthal's book 'An American Sickness' also has many useful suggestions. Earlier this year she wrote a piece on 'Nine Rights Every Patient Should Demand'. Interestingly, in my experiences with the Canadian, British and French healthcare systems it seems like not one of these issues would be in play.
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Old 10-13-2018, 02:56 PM   #164
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I just want a Robot that do all the housework for free, is that too much to ask for?
This is an excellent point. Maybe Elon Musk can take this on next.
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Old 10-13-2018, 02:57 PM   #165
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I can't believe how much Medicare B, D, and Medigap added together is.
I mentioned earlier in this thread that I'd love to see a high-deductible Medicare plan. If I could be liable for the first $10K of my yearly medical expense but covered 100% beyond that, I'd be a happy man. That would effectively cancel out my need for a $115/mo Medicare supplement.

I imagine that the risk pool would suffer from such an offering, though. Same with Medicare D -- it's a total waste until you really, really need it.
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Old 10-13-2018, 03:13 PM   #166
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Excellent. We agree. Looking from the outside (and having worked on the inside long ago), it is hard to see how the current system could work without significant reform and intervention. There seem to be just too many middle men and too much money in play to even seriously consider the necessary changes. I sincerely hope that I am completely wrong.
I would agree that huge changes are required. A couple examples of my favorites.

There needs to be much more transparancy on pricing.... if you're willing to perform a service for a large group for $x why in the world would you charge $10x to the guy off the street? To start with, how about a law that precludes charging those without health insurance more than 150% of what you charge for the same service for your second highest negotiated contract? The difference between rack rates and negotiated rates is too ridiculous and needs to be addressed.

Another big change would be to prohibit employer provided coverage... individual policies only... everyone should have one. Employer provided coverage might have made sense in "the old days" when people spent long times with an employer and employers were more paternalistic... it makes no sense that when someone gets fired or laid off or quits that their health insurance is disrupted... those life events are stressful enough as it is and the health insurance implications just make it worse... requiring only individual coverage would create a huge block of consumers for insurers to fight over and for medical service providers to woo. Today, employers provide health insurance because they want healthy employees and for competitive advantages in recruiting... they could continue to provide subsidies or just increase pay to attract employees. At the same time equalize the tax implications of health insurance by making it deductible or not for all irrespective of whether one is employed, self-employed or not employed.
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Old 10-13-2018, 03:27 PM   #167
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Excellent. We agree. Looking from the outside (and having worked on the inside long ago), it is hard to see how the current system could work without significant reform and intervention. There seem to be just too many middle men and too much money in play to even seriously consider the necessary changes. I sincerely hope that I am completely wrong.
I hope you wrong too. I'm not optimistic.

I w*rked for a middleman in health insurance and financial services. There's a currently a need for health insurance companies to spend billions yearly to determine pharmacy benefits.

The only reason Megacorp existed, in that marketplace, was to tell customers how much the drug cost in their insurance plan. The insurance companies paid many millions every year for someone else to tell their customers how much that prescription costs.

How about the drug has a price, and that's what it costs? Save lot of money.
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Old 10-13-2018, 03:48 PM   #168
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Still ignoring the taxpayer funded part.... eh?
You appear to be so wrapped up in your argument about health care that you are missing the forest for the trees. Where in your statement "The only rights that you have are those set forth in the U.S. Constitution" do the words "taxpayer funded" appear? They don't. Rather, it was an unqualified statement of general application -- "The only rights that you have are those set forth in the U.S. Constitution."

That is not only wrong, but dangerously so. Look, this is not even about health care policy (about which you and I appear to mostly agree), but about the fundamental nature of our government.

Ours is a government of limited powers, deriving its powers from the consent of the people. I cannot emphasize enough the point that the government is not the source of your rights. You have rights because you are a human being. The Declaration of Independence says you are "endowed by [your]Creator" with them. The Bill of Rights enumerates certain of your human rights that the founders were particularly concerned about the new government violating. The Bill of Rights acknowledges those rights, but it does not grant them to you. Those rights, and many others not enumerated, existed prior to the Constitution and continue to exist to this day.

When people start to believe that we have only the rights the government expressly "gives" us, we are well on our way to losing our democracy. It may only be a matter of words, but they are important ones.
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Old 10-13-2018, 03:57 PM   #169
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....You have rights because you are a human being. ...
Where does it say that? I would like to read about it. And what specifically are these alleged rights that every human being on the planet are entitled to? And if someone infringes on one of these rights, what recourse does one have?

Additionally, if every human being has these rights then they transend international boundaries... a human being in China or Mexico or Russia or the US would have the same "human" rights.... would they not?
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Old 10-13-2018, 04:17 PM   #170
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You may enjoy reading the Universal Declaration of Human Rights, which touches on some of questions you raise about the rights commonly understood to accrue to you by virtue of your status as a human being.

Universal Declaration of Human Rights | United Nations

In the United States, we typically enforce and protect our human rights either through the legislature passing appropriate laws or through the court system.
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Old 10-13-2018, 04:33 PM   #171
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I mentioned earlier in this thread that I'd love to see a high-deductible Medicare plan. If I could be liable for the first $10K of my yearly medical expense but covered 100% beyond that, I'd be a happy man. That would effectively cancel out my need for a $115/mo Medicare supplement.

I imagine that the risk pool would suffer from such an offering, though. Same with Medicare D -- it's a total waste until you really, really need it.
That's an interesting idea. My guess is such a large deductible would bring the Part B premium to 0 and even cover some of the IRMAA (in addition to the MediGap), and the risk pool probably doesn't suffer.

Part D would be a problem. Both the insurers and the pharma co's need everyone to have coverage. There is so much money in drugs, drug management and insurance.
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Old 10-13-2018, 04:39 PM   #172
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I would agree that huge changes are required. A couple examples of my favorites.

<snip>

Another big change would be to prohibit employer provided coverage... individual policies only... everyone should have one.
A lot of people who benefit from the current system would beg to differ, like me. I'm on Medicare now but DW isn't, and we're covered by the same group health insurance policy I've had since 1973. (Although the insurer has changed, the policy has not.)

In the last four years I've run up medical expenses that I'm sure without insurance would have been a couple or three hundred thousand or more. In one emergency room visit before Medicare I once paid a $50 copay. If I'm admitted, there was no copay. That's the only expense I remember paying for all of that medical care, which included about seven ER visits for afib, several hospital admissions, surgeries for a blocked cardiac artery, cardiac ablation, ERCP and a four-day hospital admission from complications, two surgeries for melanoma and follow up care, multiple office visits and probably some other stuff I don't remember at the moment. Prescriptions cost $5, rarely $10. Before Medicare office visits were $10, still are for DW.

My former employer pays 70% of the BCBS PPO plan premium and I pay the rest, which for me is now secondary to Medicare.

I LIKE this plan. Between Medicare and HI premiums I pay a bit over $800/month, which covers DW too. All that treatment and I paid $50 OOP? That's a deal! Anyone who wants to take that away from me and DW is going to have a fight on their hands. I cringe and thank my lucky stars when I see the premiums and OOP payments that others post here.

And yes, I'm part of the problem and I know it. When I'm told I need to have an MRI for example, I don't shop around. I have no incentive to because I'm not going to see a bill. It will be 100% covered, whatever it is.

While that level of coverage is probably unusual lots of other people have that or similar types of coverage (some even better!) and they're going to want to keep it too.
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Old 10-13-2018, 04:42 PM   #173
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I tend to largely agree with pbski up to that point. Why have a big change that affects a very large percentage of people without knowing how the new system is going to work here in USA. I really don’t care if it works elsewhere, it may not work here.
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Old 10-13-2018, 04:47 PM   #174
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And yes, I'm part of the problem and I know it. When I'm told I need to have an MRI for example, I don't shop around. I have no incentive to because I'm not going to see a bill. It will be 100% covered, whatever it is.
Walt, you should cut yourself some slack. Providers and insurers deliberately make it almost impossible to shop around.

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I tend to largely agree with pbski up to that point. Why have a big change that affects a very large percentage of people without knowing how the new system is going to work here in USA. I really don’t care if it works elsewhere, it may not work here.
I don't think that's what pb4uski was suggesting.
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Old 10-13-2018, 04:48 PM   #175
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I would agree that huge changes are required. A couple examples of my favorites.

There needs to be much more transparancy on pricing.... if you're willing to perform a service for a large group for $x why in the world would you charge $10x to the guy off the street? To start with, how about a law that precludes charging those without health insurance more than 150% of what you charge for the same service for your second highest negotiated contract? The difference between rack rates and negotiated rates is too ridiculous and needs to be addressed.

It is one of the things that outsiders find amazing. One can go online and find the set price for pretty much any visit type, intervention or procedure that a doctor might do in any Canadian province. Of course, no patient bothers to do this because they don't pay directly anyway. I might expect that the 'average' price paid to the MD might be lower in Canada but the MD probably comes out even because actually collecting the money is so simple with a single payer.


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I hope you wrong too. I'm not optimistic.

I w*rked for a middleman in health insurance and financial services. There's a currently a need for health insurance companies to spend billions yearly to determine pharmacy benefits.

The only reason Megacorp existed, in that marketplace, was to tell customers how much the drug cost in their insurance plan. The insurance companies paid many millions every year for someone else to tell their customers how much that prescription costs.

How about the drug has a price, and that's what it costs? Save lot of money.

The huge irony is that folks in the US continually seem to harp on how inefficient government bureaucracy is and yet are seemingly completely blind to the vast amounts of money that are lost to the for profit and 'non-profit' entities that 'deliver' healthcare in the US. It truly boggles the mind.
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Old 10-13-2018, 04:49 PM   #176
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I’m referring to snipet from post #172, the part about prohibit employer from providing health care plan. Individual health care plan only.
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Old 10-16-2018, 04:11 PM   #177
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This is the curse of untaxed benefits, they become more valuable than salary. And since there are no prices on healthcare, the cost goes to infinity, exceeding the value of the salary itself. I keep asking for what I get at Walmart. Price shopping on goods and services. Will I be dead before capitalism finally becomes part of healthcare? All the economic gains since the 80's have been eaten by benefits inefficiency.
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Old 10-16-2018, 09:42 PM   #178
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I pay $1309 per month for my wife and I for catastrophic only coverage, but I think that's affordable.
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Old 10-17-2018, 04:57 AM   #179
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I pay $1309 per month for my wife and I for catastrophic only coverage, but I think that's affordable.
do you live in a state where catastrophic plans or not rated by age? I looked at them one year and found bronze plans were basically the same cost.
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Old 10-17-2018, 05:06 AM   #180
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I'm in Ohio and our Obamacare stinks, so I'm working simply for the paid healthcare. I have two years until Medicare, so it's not terrible, but I wish I had other options. My supplied healthcare is simply excellent and I can't touch it with a marketplace policy. I wish our government would simply stay out of healthcare insurance so we can plan with some actual hard data from year to year.
We live in SW Ohio (45430 zip code) and Obamacare has worked well for us. My wife and I retired early in 2010 and have been on Obamacare since its inception in 2014. We planned on early retirement for quite a while, and budgeted for expensive private individual healthcare insurance until we were Medicare-eligible. But, even retiring from a major defense contractor where medical premiums for employees were insignificant, for retirees the medical plans were very expensive. So, when the PPACA came out we switched from our retiree medical plan, and through tax-efficient withdrawals from our investments, we've been able to qualify for heavily subsidized Silver HMO plans from the Exchange for a fraction of what we would have had to pay in the open market.

Though the insurers used to offer PPO, POS, and HMO Exchange plans in our region, all plans now are HMOs. The first year we weren't able to "keep our old doctors." But, besides that issue the first year, the network of doctors has been OK. We have three carriers providing on-Exchange plans this year; there will be five carriers in 2019.

The key (as others have stated) is controlling your modified AGI (MAGI). We’ve been able to keep ours below 250% of the FPL, so not only do we get a significantly subsidized Silver plan, we also get the benefit of Cost Sharing Reductions (CSR) of the other out-of-pocket costs. (Note that even if you “guess” wrong on your MAGI and have to return some of the subsidy, you still have the out-of-pocket CSR savings that you won’t need to reimburse.) With the subsidy, our Silver HMO plan this year costs us $108/mo; $1,900 deductible; $3,200 out of pocket maximum. (My knee surgery in June burned through all the out-of pockets.)

We only have one year to go until we’re both Medicare-eligible.
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