Dr. David Belk - True Cost of Health Care

[Yipper]

I just became aware of this site: https://truecostofhealthcare.org/ by David Belk - a practicing physician who has been focused on uncovering the real reason we in the USA pay so much for healthcare.

The sections on Medicare and the value (or lack thereof) for supplemental or Advantage plans was enlightening. The case studies for the patient with a liver transplant and Part D was also very interesting.

His take is that Advantage, Supplemental and Part D policies are mostly not needed and a waste of money - usually benefiting the insurance company at the expense of everyone else, particularly the policy holder.

Thoughts? Has anyone seen his writing and recommendations?

BTW - I heard about this site via what I've found is an interesting monthly blog post that Chris Mamula shares called "Best of the Web" covering early retirement topics he's found over that month. Chris is part of the "Can I Retire Yet?" site. Here's a link: https://www.caniretireyet.com/august-2022-best-retirement-resources/

 

[RetMD21]

I listened to his YouTubes a couple of years ago. He's right that for part B expenses you get a medicare "discount" off list price then medicare pays 80% but the remaining 20% can be quite expensive if you develop some chronic condition.

I comes down to whether you are feeling lucky

 

[Yipper]

Is the 20% the billed or Medicare price? I think that was one of his points.

 

[RetMD21]

Is the 20% the billed or Medicare price? I think that was one of his points.

IDK what this means

 

[Gumby]

IDK what this means

I think he means to ask whether you pay 20% of the Chargemaster rates or 20% of what CMS actually pays.

 

[teej1985]

I think he means to ask whether you pay 20% of the Chargemaster rates or 20% of what CMS actually pays.

Its supposed to be the latter.

 

[cloudeleven]

I'm surprised we've all put up with this nightmare system for as long as we have. Some people have $10,000+ of out-of-pocket bills even with "excellent" low-deductible health insurance. This woman had $60,000+ of out of pocket bills even with health insurance, due to denied claims for necessary cancer treatment her doctors recommended:

https://www.huffpost.com/entry/your...-as-painful-as-the-treatment-itself_b_8926910

The cost of health care really is scary here in America, EVEN IF you have health insurance (denied claims, uncovered stuff, denied claim due to lack of "prior approval," out-of-network stuff, providers sending bills to you or straight to collections instead of billing insurance, incorrect bills - 90% of hospital bills have errors). It's the #1 cause of bankruptcy here, and many (most?) folks who declare medical bankruptcy have health insurance!

Hopefully the No Surprise Act will help with the out-of-network bills, but I'm doubtful. The greed is too strong and doctors and facilities will find a way around it, most likely. Anesthesiologists in particular are really bad about this.

I almost wish I had worked in the military for a while to get free VA health care for life. But then again, my dad died in a VA hospital at age 57. Maybe he would've died anywhere though. I've heard others say VA healthcare is quite good, maybe it varies a lot by hospital/facility.

 

[CRLLS]

It IS the latter. However, if the procedure is not covered by Medicare, then you pay 100% of the total bill. I Medicare doesn't cover it, neither does the Medicare supplement.

 

[RetMD21]

List price is reduced to Medicare approved amount
Medicare pays 80% (after deductible)
You or the supplement pays 20%

Belk makes out that maybe you are paying 5% of the initial charge but the initial charge is fictitious.

He does have some good stories about people having massive surgeries and paying very little but that is on the part A side.

Part B has no maximum. Maybe you will never be one of those folks going to the outpatient cancer center several times a week for months or years but that is all part B and it can't be cheap.

Sure aggregate costs for the insured individuals are less than aggregate premiums but the same is true for homeowners insurance.

 

[teej1985]

List price is reduced to Medicare approved amount
Medicare pays 80% (after deductible)
You or the supplement pays 20%

Belk makes out that maybe you are paying 5% of the initial charge but the initial charge is fictitious.

He does have some good stories about people having massive surgeries and paying very little but that is on the part A side.

Part B has no maximum. Maybe you will never be one of those folks going to the outpatient cancer center several times a week for months or years but that is all part B and it can't be cheap.

Sure aggregate costs for the insured individuals are less than aggregate premiums but the same is true for homeowners insurance.

This is why I think the HD plan (from United American, typically) is probably the best value. You save the premiums but still effectively give yourself an OOP Max

 

[Bamaman]

My wife had AFIB a year ago, and they "shocked" her back into rhythm. Her cardiologist wanted her to eventually have an ablation so they could get her off some of her medications.

The bill arrived this week, and the ablation cost just over $100K.

She recently hasn't been able to sleep with debilitating back and leg pain, and 4 discs were removed and replaced with cages. Fusions followed 2 days later. Then she got a blood clot in her leg, and had to be hospitalized again and go to rehab for 2 weeks. She was home 5 hours when she fell and broke a leg--and here we go for another surgery, a week in the hospital and 2 more weeks in a nursing home/rehab. She comes home tomorrow, but it's going to be the middle of October before she can walk on 2 legs.

If an ablation cost $100K. What's the total cost of 6.5 weeks in the hospital and rehabs and 3 major surgeries going to be? I am so thankful that we have Medicare AND Plan F which covers just about everything. We'd be fiscal dead ducks if we weren't covered.

 

[gauss]

The 20% unbounded liability always made me think that I would want a supplemental plan.

As I have dug into this deeper, I have started to question this as Part A (ie so called "hospital insurance") would not be subject to this (just the Part B) -- I would think that Part A is where the big expenses often are.

Thanks for the article.

-gauss

p.s. It looks the 10 minute video talk at this link gets into this issue.

p.p.s Given that premiums for Medicare Supplemental policies have never been reimbursable by Healthcare Savings Accounts (HSAs), the tactic of foregoing a supplemental policy may have even more benefit. Hmmm...

 

[RetMD21]

This is why I think the HD plan (from United American, typically) is probably the best value. You save the premiums but still effectively give yourself an OOP Max

I think the HD makes a lot of sense. I went for simplicity with plan G. Everything covered after the deductible.

As more formerly inpatient treatments and procedures transition to outpatient the risk increases. If one has the foresight to have just office visits on part B and the major expenses in the hospital you would save money by skipping the supplement

 

[Yipper]

I think he means to ask whether you pay 20% of the Chargemaster rates or 20% of what CMS actually pays.

Yes, that's what I meant - sorry for not being clear. It's my understanding that Medicare would pay their price for the procedure(s) and my 20% responsibility would be based on that. Not the higher "rack" rate.

 

[ncbill]

I just became aware of this site: https://truecostofhealthcare.org/ by David Belk - a practicing physician who has been focused on uncovering the real reason we in the USA pay so much for healthcare.

The sections on Medicare and the value (or lack thereof) for supplemental or Advantage plans was enlightening. The case studies for the patient with a liver transplant and Part D was also very interesting.

His take is that Advantage, Supplemental and Part D policies are mostly not needed and a waste of money - usually benefiting the insurance company at the expense of everyone else, particularly the policy holder.

Thoughts? Has anyone seen his writing and recommendations?

BTW - I heard about this site via what I've found is an interesting monthly blog post that Chris Mamula shares called "Best of the Web" covering early retirement topics he's found over that month. Chris is part of the "Can I Retire Yet?" site. Here's a link: https://www.caniretireyet.com/august-2022-best-retirement-resources/

IIRC, Medicare parts A & B alone with no supplement plan offer limited in-hospital coverage (number of days)

Last I checked his website did not address the above, given recent experience with COVID where people were in-hospital for weeks or months on end.

 

[REWahoo]

His take is that Advantage, Supplemental and Part D policies are mostly not needed and a waste of money - usually benefiting the insurance company at the expense of everyone else, particularly the policy holder.

Isn't this true of ALL insurance? Otherwise an insurance company would not exist.

It's that "mostly" qualifier that's the sticking point.

 

[Yipper]

Isn't this true of ALL insurance? Otherwise an insurance company would not exist.



It's that "mostly" qualifier that's the sticking point.

Actually no… mutual insurance companies aren’t really for profit since there aren’t shareholders. Insurance is a shared risk situation so I understand why insurance and insurance companies exist. What I don’t understand is why we allow for-profit insurance companies to exist.

Mutual insurance companies have cost of operations but don’t have to answer to shareholders who demand a profit.

Maybe you’re only used to for-profit companies.

Unfortunately, I am not personally aware of any mutual health insurance companies.

 

[teej1985]

Actually no… mutual insurance companies aren’t really for profit since there aren’t shareholders. Insurance is a shared risk situation so I understand why insurance and insurance companies exist. What I don’t understand is why we allow for-profit insurance companies to exist.

Mutual insurance companies have cost of operations but don’t have to answer to shareholders who demand a profit.

Maybe you’re only used to for-profit companies.

Unfortunately, I am not personally aware of any mutual health insurance companies.

....Mutual of Omaha has Medigap. As does State Farm Mutual.

Stock insurers can have lower rates than Mutual insurers though.

 

[arcyallen]

I'd always be weary of anyone that "has been focused on uncovering the real reason for ___". Their ideas may have merit, but likely is missing or intentionally misconstruing certain things. I used to gobble these up and think "I finally figured it out!" only to hear a similarly compelling but totally different explanation. But I'll check it out regardless. One more possible piece to the puzzle!

 

[gauss]

At Thanksgiving dinner, an Uncle mentioned that he had cancelled his supplemental policy and was going with the basics (ie Part A/B/D).

I mentioned that I saw Dr. David Belk articles/videos referenced above and that I would send it to him for reference.

Unfortunately (or maybe fortunately depending on your point of view), all of Belk's content on his website has been purged as well as the youtube videos.

I was able to find older versions of the text from his web site on archive.org, but not the videos.

I would be curious if anyone knows what happened with this.

(cynical thought) Maybe it will show up again after the Medicare Annual Enrollment Period has closed for the year.

-gauss

 

[audreyh1]

At Thanksgiving dinner, an Uncle mentioned that he had cancelled his supplemental policy and was going with the basics (ie Part A/B/D).

I mentioned that I saw Dr. David Belk articles/videos referenced above and that I would send it to him for reference.

Unfortunately (or maybe fortunately depending on your point of view), all of Belk's content on his website has been purged as well as the youtube videos.

I was able to find older versions of the text from his web site on archive.org, but not the videos.

I would be curious if anyone knows what happened with this.

(cynical thought) Maybe it will show up again after the Medicare Annual Enrollment Period has closed for the year.

-gauss

This brings back sad memories. I remember my in-laws making such an announcement one time. Unfortunately a couple of years later MIL was diagnosed with late stage colon cancer and it was very expensive.

I really don’t see how anyone can blithely recommend this approach. There is no annual max out of pocket on the 20% copay. You are taking some serious chances.

I listened to his YouTubes a couple of years ago. He's right that for part B expenses you get a medicare "discount" off list price then medicare pays 80% but the remaining 20% can be quite expensive if you develop some chronic condition.

I comes down to whether you are feeling lucky

Exactly!

And taking such chances when you are elderly and much more prone to serious disease and chronic conditions.

 

[RetMD21]

Well he lost his medical license so maybe that had something to do with it https://www2.mbc.ca.gov/BreezePDL/d...10729\DMRAAAHL5\&did=AAAHL210729230921162.DID

 

[foxfirev5]

To me, Medicare is a once in a lifetime opportunity to buy good medical insurance. While I never spent a day in the hospital, my life turned around at the end of my first year of Medicare. Hundreds of thousands of dollars in treatment later I'm grateful for my supplemental plan G. Top notch Dr's that I picked and excellent results. Out of pocket expense - $250 or so in deductible costs.

 

[youbet]

To me, Medicare is a once in a lifetime opportunity to buy good medical insurance. While I never spent a day in the hospital, my life turned around at the end of my first year of Medicare. Hundreds of thousands of dollars in treatment later I'm grateful for my supplemental plan G. Top notch Dr's that I picked and excellent results. Out of pocket expense - $250 or so in deductible costs.

For over a decade now, I've carried A, B, D and a type F-Select supplement from BCBS and am pleased. OTOH, I wouldn't be worried if, for whatever reason, the supplement went away. Thanks to our friends at Medicare only allowing a small percentage of the rack-rate for medical expenses covered by Part B and to the fact that most end-of-life hospital costs are paid by Part A, my OOP would be manageable even with a million bux plus aggregate final bill.

Even without your type G supplemental policy, you would have received the same medical care from the same top-notch docs. The difference is that it might have cost you, say, $20k OOP.

I carry my F supplement for the convenience. I like never getting a bill. One less thing to worry about checking out and paying. But without the supplement, my medical care would be the same because. like most middle class folks, I could afford to pay a few kilobux after a critical and expensive medical ordeal. The majority of us will pay more in supplemental plan premiums over our post-65 lives than they collect in benefits. It's insurance.