I'm freaking out over health insurance

[Fedup]

Lots of private insurance companies and clinics/hospitals in the U.K. plus the government side of things is managed by trusts who receive funding from central government.

https://en.m.wikipedia.org/wiki/Single-payer_healthcare

I'm not sure Wikipedia is correct.
But from the Forbes articles, very few countries are single payer but the U.K. is one. But that doesn't mean it can't have the private sector. Note the last paragraph. UK NHS is a National and single payer system.

https://www.forbes.com/sites/timwor...ve-national-single-payer-health-care-systems/

 

[Alan]

I'm not sure Wikipedia is correct.
But from the Forbes articles, very few countries are single payer but the U.K. is one. But that doesn't mean it can't have the private sector. Note the last paragraph. UK NHS is a National and single payer system.

https://www.forbes.com/sites/timwor...ve-national-single-payer-health-care-systems/

The NHS is single payer but the country is not single payer, unlike Canada where there is only one single payer, you can't buy private health insurance.

Like the NHS, Medicare is single payer but you can buy private insurance to supplement it in the same way that you can buy private insurance to supplement NHS treatment.

Like Medicare the NHS is a government funded organization that operates alongside private organizations. In fact some NHS trusts have private hospitals owned and operated by them with their profits going into the trust to supplement the government money they receive.

 

[ShokWaveRider]

The NHS is single payer but the country is not single payer, unlike Canada where there is only one single payer, you can't buy private health insurance.

Like the NHS, Medicare is single payer but you can buy private insurance to supplement it in the same way that you can buy private insurance to supplement NHS treatment.

Like Medicare the NHS is a government funded organization that operates alongside private organizations. In fact some NHS trusts have private hospitals owned and operated by them with their profits going into the trust to supplement the government money they receive.

One thing about Canada you CAN buy private health coverage, and insurance for a better hospital room. There are also private doctors where you can "ByPass" the wait.... if there is one. Cataract surgery is an example. If there is a waiting list, which there usually is for that, then you can simply pay and get it done pretty much when you like.

 

[Meadbh]

I'm not sure Wikipedia is correct.
But from the Forbes articles, very few countries are single payer but the U.K. is one. But that doesn't mean it can't have the private sector. Note the last paragraph. UK NHS is a National and single payer system.

https://www.forbes.com/sites/timwor...ve-national-single-payer-health-care-systems/

I think I would rank Alan's input on this higher than the article, given that he was born in the U.K. and lives there now.

 

[Alan]

One thing about Canada you CAN buy private health coverage, and insurance for a better hospital room. There are also private doctors where you can "ByPass" the wait.... if there is one. Cataract surgery is an example. If there is a waiting list, which there usually is for that, then you can simply pay and get it done pretty much when you like.

Cool, I stand corrected.

 

[Alan]

I think I would rank Alan's input on this higher than the article, given that he was born in the U.K. and lives there now.

Thanks, even the Forbes article only mentions the NHS as a system, I just want to point out that it is a system within a country with very vibrant private systems with a large number of providers and insurers. (As I discovered when I signed up for health insurance recently. I had private health insurance in the 70's and 80's through my employer so this not something new over here)

There are indeed national and single payer systems out there, most notably the National Health Service in Britain.

 

[Fedup]

The NHS is single payer but the country is not single payer, unlike Canada where there is only one single payer, you can't buy private health insurance.

Like the NHS, Medicare is single payer but you can buy private insurance to supplement it in the same way that you can buy private insurance to supplement NHS treatment.

Like Medicare the NHS is a government funded organization that operates alongside private organizations. In fact some NHS trusts have private hospitals owned and operated by them with their profits going into the trust to supplement the government money they receive.

I think people mention single payer for everybody and not just Medicare age. And that was what I was referring to. Everywhere you read on the internet, especially on some forums, people keep mention we need single payer. We already have Medicare which is a single payer for 65 and over. If that's what they refer to, I'm sure there is no need to say we need single payer. We already have single payer like VA and Medicare.

 

[Alan]

I think people mention single payer for everybody and not just Medicare age. And that was what I was referring to. Everywhere you read on the internet, especially on some forums, people keep mention we need single payer. We already have Medicare which is a single payer for 65 and over. If that's what they refer to, I'm sure there is no need to say we need single payer. We already have single payer like VA and Medicare.

I agree.

 

[Meadbh]

One thing about Canada you CAN buy private health coverage, and insurance for a better hospital room. There are also private doctors where you can "ByPass" the wait.... if there is one. Cataract surgery is an example. If there is a waiting list, which there usually is for that, then you can simply pay and get it done pretty much when you like.

Canadian doctors must elect to be paid by Medicare OR go it alone. If they go it alone, they will receive nothing from public finances, and must charge their patients directly. This effectively limits private care to elective surgical procedures, such as plastic surgery, hernia repair, cataract removal, etc. For management of chronic diseases, such as diabetes, and for emergencies, Canadians use public healthcare, which is paid for by taxes. Health care is administered by Provinces and Territories. Some Provinces pay for healthcare through general income taxes, and some, like mine, charge a premium to cover part of the cost. My premium this year is $75 per month, or $900 for the year. When I visit my doctor, use the ER, am admitted to hospital, etc, there is no copay and no financial discussion. I just show my Provincial Health Insurance Card. If I get sick while visiting another Province, that Province will provide care and bill my own afterwards. No freaking out required.

 

[Donzo]

It will be interesting to see what we end up with in 2018. I am already paying plenty for DW and I, no subsidy. I am not worried. If the prices go way up there will be "catastrophic/catastrophic" policies available. You may have to pay out of pocket for the first many, say $15,000 and have coverage after that to have a manageable monthly premium. This would be bad for those that have medical issues requiring frequent care - but be tolerable for healthier individuals. I think we may be pleasantly surprised. It's tough to take away benefits the populace has enjoyed - lower and strip a bit yes. I've been wrong before

The thought of going back to work now is almost funny....going on 11 years of freedom and there is NO WAY for me to go back....I would live in a van down by the river first

 

[scrabbler1]

That didn't mean policies were effectively available. Yes, NY required community rating pre-ACA However, my understanding was that premiums were very high and very few insurers participated.

This discusses the history:

https://www.healthinsurance.org/new_york-state-health-insurance-exchange/

This says:


City & State - After Obamacare: What are New York’s options if the Affordable Care Act is repealed?

I recall on another forum I participated in back then someone from New York telling me how much the premiums were for individual coverage and it was insanely high, far beyond the means of most people.

You described my situation back in 2009-2011 just after I ERed and bought my first individual policy. At first, the premium was reasonable ($470 per month)and fit within my budget well. But in 2010 the rates rose 20% and in 2011 they rose another ~25%. Compounded, they rose ~50% overall. If they kept rising at 20% per year, in 10 years I'd be paying over $4,000 per month!

I dropped that policy, by far the cheapest I found on ehealthinsurance.com (except for one), and switched to a hospital-only policy to hold me over until the end of 2013 when I could enroll in an ACA policy which cost me under $400 a month (w/o a small premium subsidy). The hospital-only plan left me badly underinsured.

New York is a model state for a stable ACA exchange with many insurers. The individual mandate is largely responsible for keeping rates down. The absence of age-rating differentials helps, too.

 

[Steve40th]

Two things. Hospitals are generally for profit.
And, we dont necessarily have 300 million doctors and nurses for all peoples ailments.
If ya have a cold, go to Wal Mart, by some chicken noodle soup. Dont go to ER..

 

[Texas Proud]

One of the things that I find interesting is the talk about age related rates... but if you are buying insurance from where you work then there is no age related rates... the young pay the same rate as the old...

Also, family plans cover all children, from 1 to how ever many you have... while individual policies charge for each and every child...

 

[nun]

Isn't classic Medicare and the VA single payer?

 

[Fedup]

Isn't classic Medicare and the VA single payer?

Yes they are. But for a subset of the population, not for everybody.

 

[NYEXPAT]

I'm not sure Wikipedia is correct.
But from the Forbes articles, very few countries are single payer but the U.K. is one. But that doesn't mean it can't have the private sector. Note the last paragraph. UK NHS is a National and single payer system.

https://www.forbes.com/sites/timwor...ve-national-single-payer-health-care-systems/

Here in Peru it is a NHS that anybody can buy into for some ridiculously low amount of money, but you must use gov't hospitals like the VA in the states. In addition there are private hospitals all around the city that you can get private insurance for although most people pay cash in the more exclusive ones.

My Wife had a client today who is a big spender and insisted on getting more band width on his tablet so he could watch netflix. Initially, he bribed somebody to get into the doctors private network but then got caught when he tried casting to the TV.

 

[daylatedollarshort]

My wife and I pay $12,500 in premiums and another $400 or so in copay for tests ordered by the doctor not covered by the ACA preventive care. We don't get any subsidies. My advice is to stay healthy (keep your BMI below 25 and exercise regularly) and see a doctor once a year for your preventive care.

My doctor recommended that I have an ultrasound test recently. The test lasted under an hour and the bill came to almost $5K. The good news that I'm fine. But I'm almost at my out of pocket max for the year for the one test. So maybe even staying healthy isn't enough. I will negotiate the bill with the hospital, but what is to stop them from charging me $10K or $20K or really whatever they feel like next year for the same test? The hospitals make it very hard to price shop. This was an in network hospital.

I looked up the prices online and the web sites that have averages for medical services showed the $5K was way out of line with what these kinds of tests normally cost on average in the U.S. I live in a high cost of living area so I would not feel so ripped off at even the high end of the range but what they charged me was crazy high. We're just shocked that I could almost reach my out of pocket annual max over a 45 minute test.

 

[Meadbh]

My doctor recommended that I have an ultrasound test recently. The test lasted under an hour and the bill came to almost $5K.

That is insane. It bears no relationship to the costs of doing an ultrasound, accounting for labour, depreciation of equipment, and keeping the lights on. In fact, it is more than the total per capita cost of health care in Canada in 2016. This hospital is charging whatever the market will bear. Profit, at your expense.

 

[daylatedollarshort]

In fact, it is more than the total per capita cost of health care in Canada in 2016.

I'll mention that when I call to complain and try to negotiate the bill down. DH brought up moving outside the U.S. again when he saw the bill, though I think he has calmed down now. It is not that we can't afford it, but it is a feeling of getting robbed by medical workers who are supposed to be taking care of our health but are acting more like grifters instead. I'm wondering now if I really even needed the test in the first place.

 

[audreyh1]

My doctor recommended that I have an ultrasound test recently. The test lasted under an hour and the bill came to almost $5K. The good news that I'm fine. But I'm almost at my out of pocket max for the year for the one test. So maybe even staying healthy isn't enough. I will negotiate the bill with the hospital, but what is to stop them from charging me $10K or $20K or really whatever they feel like next year for the same test? The hospitals make it very hard to price shop. This was an in network hospital.

I looked up the prices online and the web sites that have averages for medical services showed the $5K was way out of line with what these kinds of tests normally cost on average in the U.S. I live in a high cost of living area so I would not feel so ripped off at even the high end of the range but what they charged me was crazy high. We're just shocked that I could almost reach my out of pocket annual max over a 45 minute test.

Yeah, that's crazy! A couple of years ago I made the mistake of getting an ultrasound at a hospital and they wanted $500, not $5K! And I thought $500 was outrageous as I pay $115 to $150 at my doctor's office for ultrasounds. I think even with the $500, the insurance company stepped in and knocked a couple of hundred off the bill.

 

[Sarah S]

Day, does your bill not go to your insurance first? Anything that I have done does. The insurance then tells the service provider what they pay for the service and how much is my responsibility if I have not met a deductible. That number is always less. Often a lot less. Then I get a bill. The only way I know the original ridiculous costs is looking at the EOB online

I can't imagine any insurance allowing 5K for an ultrasound! If they are not negotiating with providers of services no wonder premiums in some areas are crazy

 

[Fermion]

This is why we can't go back to a system where some people can't get insurance at all (because of pre-existing conditions). The list prices are so out of wack that you need some sort of insurance just for negotiating and navigating them. Either that or every little item you are going to have to fight the hospital and negotiate down to some unadvertised low ball price. It sounds like buying stuff off craigslist.

 

[LARS]

It sounds like buying stuff off craigslist.

Love it!

 

[ivinsfan]

and it feel like blackmail, have insurance or pay any darn price we put out of our hat...health care Wheel of Fortune style.

 

[daylatedollarshort]

Day, does your bill not go to your insurance first? Anything that I have done does. The insurance then tells the service provider what they pay for the service and how much is my responsibility if I have not met a deductible. That number is always less. Often a lot less. Then I get a bill. The only way I know the original ridiculous costs is looking at the EOB online

I can't imagine any insurance allowing 5K for an ultrasound! If they are not negotiating with providers of services no wonder premiums in some areas are crazy

We found out our portion from our insurance company's online statement. I can't figure out why the insurance company allowed it either since this was an in network test. For everything else this year the insurance company rates (not the initial charges) were fairly reasonable, for the U.S. at least.