Do yourself a favor...............

[Partial]

I think its very expensive, but I also think that like gasoline, it is something you need to adapt your spending habits around.

Fuck! My cancer is back! God damn property taxes are due! Who do I pay?

How much are you guys paying? Earlier in my education when I F'd up some classes I had to get insruance. It was like 99 a month with a 1k deductible. It seemed like a solid coverage plan.

My mom paid 250 for 3 people before. I am not sure what she pays now.

[Freak Out]

I think its very expensive, but I also think that like gasoline, it is something you need to adapt your spending habits around.

Fuck! My cancer is back! God damn property taxes are due! Who do I pay?

How much are you guys paying? Earlier in my education when I F'd up some classes I had to get insruance. It was like 99 a month with a 1k deductible. It seemed like a solid coverage plan.

My mom paid 250 for 3 people before. I am not sure what she pays now.

It was a joke Partial...as I said earlier I have great coverage because of my wife. I'm self employed and make good money but without her I would be paying out the ass. I could afford it, I've carried just catastrophic before and paid cash for everything. But things could be much better under a single payer system.

[Partial]

I think its very expensive, but I also think that like gasoline, it is something you need to adapt your spending habits around.

Fuck! My cancer is back! God damn property taxes are due! Who do I pay?

How much are you guys paying? Earlier in my education when I F'd up some classes I had to get insruance. It was like 99 a month with a 1k deductible. It seemed like a solid coverage plan.

My mom paid 250 for 3 people before. I am not sure what she pays now.

It was a joke Partial...as I said earlier I have great coverage because of my wife. I'm self employed and make good money but without her I would be paying out the ass. I could afford it, I've carried just catastrophic before and paid cash for everything. But things could be much better under a single payer system.

I'm not disagreeing with that. I am not at all saying the system is good. I am just saying why it is the way it is. I don't think nationalizing health care is the answer either. I have no idea what the answer is.

Fos, what should we as a country do?

[Fosco33]

I think its very expensive, but I also think that like gasoline, it is something you need to adapt your spending habits around.

Fuck! My cancer is back! God damn property taxes are due! Who do I pay?

How much are you guys paying? Earlier in my education when I F'd up some classes I had to get insruance. It was like 99 a month with a 1k deductible. It seemed like a solid coverage plan.

My mom paid 250 for 3 people before. I am not sure what she pays now.

It was a joke Partial...as I said earlier I have great coverage because of my wife. I'm self employed and make good money but without her I would be paying out the ass. I could afford it, I've carried just catastrophic before and paid cash for everything. But things could be much better under a single payer system.

I'm not disagreeing with that. I am not at all saying the system is good. I am just saying why it is the way it is. I don't think nationalizing health care is the answer either. I have no idea what the answer is.

Fos, what should we as a country do?

That's a huge question, Partial. You could look at it a number of ways....

I'll share some things that we've been investigating which fundamentally changes the approach to insurance processing for private payers. That really looks at 1 of the 3 issues (second being gov't assistance and third being hospital requirements).

A few years ago, a former (and possibly future client) client contacted us because a large insurer had contacted them with an idea. See, I work for hospitals - and we make the insurers profits diminish. We analyzed the processing breakdowns for the payer (w/ limited access) and determined that both sides (payer/provider) have an opportunity (in terms of processing time, manual intervention and net financial gains) to collaborate. So - we helped create a coined term called payer-provider collaboration. If payers give very clear rules about what would be paid w/o review and what would be denied w/o review, the hospital would follow certain guidelines (authorizations mainly). Both sides were able to save FTE cost in processing/administering claims (thus making healthcare costs reduce).

While that saves some cost - it's yet to be seen whether that model could work for all payers/providers (and if the money would be credited back to employers/subscribers).

Within a hospital, the actual process of correctly identifying/billing for goods/service is very archaic. We call it 'charge capture/entry'. The pricing models for hospitals, called a chargemaster, is basically a pre-contract rate guide. If consumers had more information (e.g., I could get an MRI at Hospital Y for $1000 OR for $850 at another facility), free market drivers would push the overall cost lower. Even sharing the chargemaster, though, will not fix the spiraling cost though (lots of factors play out here). Generally, the unknown for consumers, is that contracted payers are given a large adjustment for their members fee (so, my insurer would only have to pay like $450 for the MRI and I'd pay like $100 in coins). The 'cash factor' rate for many hospitals is razor thin (and follows reimbursement by Medicare). More to follow in the next point...

To points 2 and 3, as Congress attempts to manage the deficit, they often make guideline changes to Medicare. Hospitals/Payers will follow suite with actual reimbursement. States like California, Maine and Massachusetts have been leading the way in self-pay reform. Basically, if you don't have insurance in Cali but you make 3X's the guideline for poverty OR have 20% of your AGI as medical expenses, you get a discount that is the same as patients who have Medicaid.

Hospitals (non-profit) generally have to 'give back' 5% of gross revenue yearly to charity care in order to skip out on taxes. Years back, some hospitals were not great about following this rule (state/local driven). That all changed when a nationwide series of lawsuits nearly forced hospitals into a corner. In theory, that 5% is used for patients who really need charity - while the very old, young, and disabled are covered by the gov't and the rest by employers.

Hospitals can also improve internal access to care (efficiency in patient care processing in ER, OR and Inpatient stays). Reducing wait times or length of stay improves everyone's ability to use healthcare and lowers the cost.

There are lots of other things like mandating an electronic medical records, reforming frivolous medical lawsuits (and MD insurance), paying MDs by performance (quality), providing quality report cards on hospitals, looking at additional changes to HSAs/other high ded plans, and requiring large/medium sized employers (the WalMark scenario) to provide some form of insurance.

It's a combination of those above items, with an investment by everyone, that will change the cost/quality of care in the US.

Simply changing to a universal payer would not change the COST aspect or ACCESS aspect - but only how something gets PAID. Allowing the gov't to drive healthcare would be a huge mistake in my opinion. And all of those factor into the general state of the US system.

[PackerBlues]

To simplify things,


If you watch Moore's film, you get to listen to the tapes of Nixon discussing Kaiser Insurance, and how its all for profit. The less care you give people, the more profit you make. The next day, Nixon was on TV pushing the kaiser health plan.

There is nothing hard about this people. Our health care coverage.......our health insurance.......is run by people out to make a profit. Even if you have health insurance, just hope you never need to use it, because they are trying to make a profit, and if that means denying your claim.......they will come up with any reason they can to do so.

[packinpatland]

To simplify things,


If you watch Moore's film, you get to listen to the tapes of Nixon discussing Kaiser Insurance, and how its all for profit. The less care you give people, the more profit you make. The next day, Nixon was on TV pushing the kaiser health plan.

There is nothing hard about this people. Our health care coverage.......our health insurance.......is run by people out to make a profit. Even if you have health insurance, just hope you never need to use it, because they are trying to make a profit, and if that means denying your claim.......they will come up with any reason they can to do so.

I'd like to simplify things also. Can you name any business, any corporation that is not trying to make a profit? Even 'non profits' have employees to pay. Why would you be in buisness if not to make a profit?

Second, and I am not defending the insurance companies, but without the scams, the fraudulant claims, false charges($), maybe more claims would not get rejected initially. We have alot of dishonest folks out there.

Third, instead of trying to find a drug(s) to cure all that ails us, why don't we, meaning the U.S., try to become a healthier nation. Diabetes, skin cancer, high blood pressure, obesity etc................are a few of the 'controlables'. Why do we lead the word in obesity and all the ills associated with it? Why do we continue to lay in the sun?

Jamie Dukes was on NFL channel the other night complaining about how hard it is for a man of his 'size' to get health insurance. He weighs in excess of 300lbs! He's been out of the league since '95!, He and alot of people carry too much weight, and wonder why they pay so much for insurance.

[Fosco33]

Many non-profit hospitals make money - that is very true. But do you know their profit margin or what they plan to do with that cash? Do you know the future plans of that hospital for the community? Do you have hospitals in your area making new facilities, wings, buying new equipment and getting better clinicians? Do you know how much money hospitals never collect due to people not having insurance (or not even being citizens)?

If you don't, it's probably best that you stop complaining about how much profit they are making.

You guys are right that we, as a nation - and as individuals, need to look at preventative medicine - the largest factor in the cost increases over the past decade is increased use of healthcare.

[Iron Mike]

You guys are right that we, as a nation - and as individuals, need to look at preventative medicine - the largest factor in the cost increases over the past decade is increased use of healthcare.

I'd also like to point out that there seems to be a misunderstanding about terms utilized here.

It seems to me that some of the posters here are making an invalid assumption, that being insurance company profit issues=healthcare crisis. That's comparing apples and oranges, IMO.

For example--I have automobile insurance on my vehicle. I understand that the reason I am insuring my vehicle is to protect my finances should something calamitous happen to my vehicle--e.g., were I to be involved in an accident where my vehicle is "totalled," I don't have to shoulder the financial burden of replacing my vehicle by purchasing a new one (irregardless if the previous one is payed off or not.) Also, were my vehicle to need repair, again I don't have to shoulder the whole financial burden of repair costs--by paying a certain portion of the costs--in terms of a "deductible" I cover a certain portion of the costs and the insurance company pays the rest of the costs. Now, I don't deny that the automobile insurance makes a huge profit. I'm guessing that the idea is that whatever I pay in premiums is probably greater than the amount I utilize in replacing vehicles that I wreck, or health care costs for people that I strike with my vehicle (ignore the sarcasm inherent here....I'm trying to make a point.) I'm guessing were that to happen, the insurance company would go out of business.

Now.......since I pay approximately $240 every three months for automobile insurance, does that mean that I should be able to go to a car lot and purchase a vehicle for a fraction of what a person without automobile insurance pays?? Really?

And since I pay for automobile insurance, shouldn't I also have to pay less for gas than someone without automobile insurance? You know...they pay $40 to fill up their 13-gallon tank, I pay $15 and insurance covers the other $25??? And if it's unfair for those without automobile insurance, can't they buy gas in Mexico, where it's cheaper??

What about those that drive and can't afford automobile insurance?? I'm sure there are more and more of those people, but is Michael Moore doing a documentary about the automobile insurance crisis? Do you realize that they can manufacture an automobile in Yugoslavia for about $3000.00 and the insurance is only about $.25/month??? Why are our vehicles so much more expensive???


The point I'm trying to make is that insurance companies and healthcare delivery systems are separate things. Inter-related yes, but very different systems with different ideologies and different value systems. An insurance company that is maximizing profits does not mean that the healthcare delivery system is broken.

Let me make one more observation. A previous poster stated that they took one of their children for a visit to the Emergency Department for a spider bite. Now I might not know all of the details, but since when is a spider bite an emergency??? OK, I worked in healthcare for over fifteen years. The Pediatrics Department in the clinic where I worked routinely had one physician available to take calls that came in that day, rather than scheduled appointments. That means were my child to have a spider bite, I would have the option to schedule an appointment with an available pediatrician.....or, take my child to a walk-in clinic.......or, take my child to the Emergency Department. Guess which one of these is most expensive???
Now, if I continue to utilize the most expensive options for my healthcare, can you guess what is going to happen to my insurance premiums??? And if I am part of a group which purchases insurance for the entire group, guess what will happen to ALL of our premiums??? Sometimes it's the insurance company and sometimes it's the healthcare choices we make.

Again, I pay for home insurance.......but that doesn't mean I should get natural gas, electricity, water and cable t.v. at a discounted rate for having it.

I pay for automobile insurance.....but that doen't mean I should get vehicles, gas, oil and car washes at a reduced rate because I have it.

Health insurance should be looked at upon in the same way, IMO. I'm guessing that was the original intent.....to prevent a financial burden upon a family (or, better worded--an employee) rather than make sure they can have a child delivered for a $50 co-pay.

[Freak Out]

Half of all personal bankruptcies in the US last year were because of illness or injury.

[Fosco33]

You guys are right that we, as a nation - and as individuals, need to look at preventative medicine - the largest factor in the cost increases over the past decade is increased use of healthcare.

I'd also like to point out that there seems to be a misunderstanding about terms utilized here.

It seems to me that some of the posters here are making an invalid assumption, that being insurance company profit issues=healthcare crisis. That's comparing apples and oranges, IMO.

I agree with your post for the most part. There's a lot more than cost when looking at evaluating healthcare in the US.

I mean - in the US - you could be walking in a park, driving your car or just sitting in your home and have a medical emergency. In a matter of minutes you have a fully trained team of urgent responders at your beckon call. They rush you straight to a local hospital (6,000+ in the US) where you get immediate treatment of your condition. If you have a form of sponsorship, you often actually pay for a 10th of the cost (or less) of that service.

As I stated earlier, healthcare is somewhat of a privilege (and sometimes a right). That question needs to be answered by everyone prior to judging the payment aspect. The access and quality of care are huge facets of a successful delivery system.

The very old, young, poor and disabled are often covered by the gov't (taxes) to maintain a quality of life for society. While having auto insurance doesn't cover oil changes, car washes and maintenance, the gov't does cover the equivalent of these services for citizens in the above demographic. If you're poor/young/old, there are social services (welfare, social security, etc.) that is available with or without a component of healthcare coverage.

Insurance is a risk business. Most people are risk averse - meaning they'll pay money into coverage as a back-up plan and an increased peace of mind. Hospitals don't operate as a risk business - they are a service to the community and have a completely different mission. Most hospitals in the US are non-profit - and operate at about 3-4% margin.

The ideas above (elec med recs, elec RXs, pay for performance (MDs) and quality/cost report cards (hospitals)) will address the quality of care. The access question is also somewhat controllable by consumers as Iron Mike mentioned (going to the appropriate source) and hospitals (being more efficient).

[GrnBay007]

People get frustrated with all the loop holes the insurance companies seem to use. The constant questioning of any claim. I suppose it's understandable with all the fraud and lawsuits now.

A co-worker of mine is still trying to fight this unpaid medical bill: We generally have 2 or 3 insurance plans offered to us. A new one popped up 2 yrs ago in which the employee paid nothing per month toward the coverage. I was skeptical and didn't switch as I wanted to watch for a year or so to see the kind of coverage the people that did switch received. At least 3 people had serious problems in which the insurance company would not pay the cost and they all resulted in this type of situation: This plan had certain participating physicians you had to use. All 3 people went to the doctor for a problem...a participating physician, and all 3 ended up with a huge bill a month or so later. Seems even though they went to the proper physician for the initial visit, tests were order...blood work, etc and it seems the charges came from the doctor that read the test, a non-participating physician...in the same office, in one example. There were a couple other of that nature that were much more expensive. So here's a case that the 'insured" had absolutely no control what happened after that initial contact with the participating physician. They fought the bill until the threatening letters started to appear about sending it to collections and then paid it as they were building a home and didn't want to take the chance of having their credit damaged.

[swede]

I like the idea that there is a distinction between health care insurance and other kinds of insurances. In auto, home, life, etc. you simply do the math and find a trustworthy vendor.

I am one of those lucky enough to have good health insurance. Most of the people I work with have better coverage than I do because they are so desperately poor that most of their health care is free, and whatever costs they might incur will eventually be written off as uncollectable and passed on to those of us with insurance or the ability to pay.

The neighbor across the street is an administrator at the local clinic, a building that is as lavishly appointed as a five star hotel and is ever-expanding to add new offices and new centers for specific functions such as MRI scans and orthopedic injury rehabilitation. He was happily showing off his new Lake Michigan battle cruiser, a boat whose cost easily eclipsed my annual salary.

He is a good guy, a captain in the health care industry. But he doesn't do a thing to make people get better.

The health care in this country is just like the American people: amazing; excellent; constantly making nearly miraculous advances because of brilliant men and women.

But, health care systems in this country are also just like the American people: greedy; self-serving; dysfunctional; bloated and grotesque bureaucratic parasites that outgrew their function and now take a vicious skim from companies and workers alike.

I like my chiropractor. He charges me 25 bucks in cash. He gives me paperwork to submit directly to the insurance company. He encourages me to behave in a manner which will improve my health and wellness. He helps me feel better and live with less pain. He recommends medical attention from other sources whenever my health issues require it.

Our country would be better off if every time every one of us went to the doctor we paid the costs out of pocket. Competition for quality and cost would return to health care.

If you argue that such a thing would cost us too much money when it self-evident that it would cost less then we must all ask ourselves who is presently paying for Taj Mahal hospitals and clinics and the tens of thousands of employees in "health care" who never actually contribute to anyone's health or care.

Oh...and Michael Moore is still an asshat...I simply do think that the American health care systems are a mess while American health care rocks.

[PackerBlues]

Its kinda funny, the way some web-sites can post certain videos that you wouldnt think that they could legally post. However, one of my other favorite sites besides this one, "Spiked Humor", has a 6-part copy of the movie "Sicko". I dont think the movie has even been released in theaters yet.
Below is a link to the first of the six parts. You can also watch clips of all the talk shows that have done pieces on the film. Bill Mahr, Oprah, whatever, at the same site.

http://www.spikedhumor.com/articles/110903/Sicko.html

By the way, if you do go to this site to watch a clip, and it starts out with a stinkin ad that you dont want to watch........just hit your "refresh" button.