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I don't even want to read the previous posts on this as I am very passionate about health insurance, and I am now married to a doctor who has her own perspective.

I didn't have health insurance until I was 15 years old. But before that I broke my arm at 13 and my brother got pneumonia that same year. It almost bankrupted my family.

When I broke my back right before we had insurance, I chose to not tell my mother. I got NO treatment and let my back heal incorrectly. Now I have back problems galore, but I did finally tell my mother a few years ago (20+ years later).

It was my choice, however, not to tell my parents. At the time we were poor, both my parents worked just to get by, and they never saw me for most the week. I was able to hide from them a broken back.

I don't find this story the American feel-good one about our fabulous health care innovation. The lack of health care brought my family to the brink of bankruptcy, meant that I got improper (or no) care, and it was frankly one of the first times I lied to my parents -- just because I knew they couldn't afford the truth.

Fu<k the health care system.

k.
 
One of the main arguments of people against a universal health care system is that "Government is wasteful! The private sector will do it better." Here is a great quote from a NYT article on the subject:
The Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage. This is a near perfect &#8220;apples to apples&#8221; comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.

Article by Nobel Prize winner Paul Krugman:
http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/
 
johndoughy said:
As a lifelong uninsured person, I have to say that this sounds insane. How could a person financially justify paying out 6-10k a year? Do you really rack up MORE than that at medical institutions?!
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i slipped and fell on ice this past December. i landed in just the wrong way and broke my ankle, smashed my tibia, and cracked my fibula. the whole thing was billed at $62k (i had a long surgery and spent three days in the hospital, which accounted for a lot of it). i paid $18 out of pocket, plus about $250 in medicine and physical therapy copays. i work at a state university (and the hospital was the hospital the building i work in is attached to, which certainly was to my advantage), and have really fantastic insurance that i pay about $80 a month for (it's about $1000 in benefits monthly). even with the inevitable deals that are made in these situations (and the billed amount certainly isn't what was actually paid out), i certainly would have been happy to have paid $6-10k to avoid even half of that $62k, if i had known it was going to happen and didn't have insurance. there is a reason that accidents are called accidents. so yes, you can certainly rack up more than that at medical institutions.
 
EdipisReks said:
the whole thing was billed at $62k.
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The uninsured are the only people that pay the billed amount. It is the basis for calculating the discount for insurance providers. Each Insurer negotiates the discount for its network which is why some doctors don't accept certain insurance. It isn't unusual for Medicare to pay 10-20% for a given procedure, so you see a lot of doctors refusing to treat them. Reimbursement rates vary a lot for private insurers. I helped set up a billing system for a doctor once. It was unusual when anyone reimbursed over 50%.
 
so_sleepy said:
The uninsured are the only people that pay the billed amount. It is the basis for calculating the discount for insurance providers. Each Insurer negotiates the discount for its network which is why some doctors don't accept certain insurance. It isn't unusual for Medicare to pay 10-20% for a given procedure, so you see a lot of doctors refusing to treat them. Reimbursement rates vary a lot for private insurers. I helped set up a billing system for a doctor once. It was unusual when anyone reimbursed over 50%.
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Word. It's the insurance that made it 62k.

BTW, $80/mo insurance sounds great to me. The downside is that it isn't costing you $80/mo...because your boss could be paying YOU what he is paying the insurance company to cover you at $80/mo. And you are losing the money that is going to the pockets of every paid employee and business owner along the line. Your money and the money you aren't getting is paying for everything from advertisements for drugs that extend eyelashes during primetime to the food cost at a cafeteria in a nearby hospital. Essentially, you are carrying the burden of an entire culture and suffering under the weight of those who would game the system for profit.

Ask anyone who practices medicine charitably overseas--although it is a severe injury, it doesn't cost $62,000 to fix three broken bones.
 
johndoughy said:
Ask anyone who practices medicine charitably overseas--although it is a severe injury, it doesn't cost $62,000 to fix three broken bones.
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no, of course it doesn't. the whole thing was unbelievably ridiculous. and it certainly doesn't cost $10k a day for me to sit in a bed and not be given enough pain medication.
 
Andrew H said:
One of the main arguments of people against a universal health care system is that "Government is wasteful! The private sector will do it better." Here is a great quote from a NYT article on the subject:
The Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage. This is a near perfect “apples to apples” comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.

Article by Nobel Prize winner Paul Krugman:
http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/
Click to expand...

You forgot to add "Former ENRON economic advisor" to Krugman's tag line. He's not well regarded in most respected economic circles btw....
 
One thing that has not really entered into discussion is the cost of liability insurance for the docs/ hospitals. Litigation and liability insurance costs really have a big impact on health care costs in the US. (yeah, this is straying more from the OP, but heck, it's been that way for the last few days)
 
Kentucky Jeff said:
You forgot to add "Former ENRON economic advisor" to Krugman's tag line. He's not well regarded in most respected economic circles btw....
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It is true that economists generally see him now as a journalist and not so much of an economist, but when he won the John Bates Clark Medal in 1991 he was very well respected. That was 20 years ago though.

k.
 
Kentucky Jeff said:
You forgot to add "Former ENRON economic advisor" to Krugman's tag line. He's not well regarded in most respected economic circles btw....
Click to expand...

True, he was a former Enron adviser. Also true that he worked there for I think 9-10 months, and was on an advisory board that did nothing. I don't even know how you gauge respect in economic circles (is there a poll you know about that I don't?), but I do know that he writes an Op-Ed for arguably the most prestigious newspaper in the country.
 
SpikeC said:
The nation's five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).
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And that is after even their lowest level "executive" officers are paid well in excess of $200k/yr.
 
Oh good. This unpleasantness is behind us. Back to collecting knives.
 
In California, a "company" can have as little as two employees and qualify for group rates, the trick is both people have to be drawing a salary - so a family owned business can qualify by splitting the draw among two people - i'm not sure of the rule sin other states.

That having been said the subsidies in Obamacare are quite good for moderate income people and are worth looking into...
 
As a non US citizen,i find your health care system incomprehensible.Some of your stories i find shocking.If i was an elected representative of the people of one of the most wealthy countries in the world and failed to at least attempt to address this issue i would expect to live my remaining days in shame.
I am also not a Doctor but my understanding is that ,prior to obtaining ones licence to practice,the individual is required to swear to uphold the Hypocratic oath.Maybe this is a myth?-the lack of empathy and compassion to those in suffering and who do not possess a fat wallet from many (but i am sure not all)medical practitioners would suggest that the moral compass needs to be redressed.Perhaps Ethics is no longer taught in medical schools?
 
scotchef38 said:
As a non US citizen,i find your health care system incomprehensible.Some of your stories i find shocking.If i was an elected representative of the people of one of the most wealthy countries in the world and failed to at least attempt to address this issue i would expect to live my remaining days in shame.
I am also not a Doctor but my understanding is that ,prior to obtaining ones licence to practice,the individual is required to swear to uphold the Hypocratic oath.Maybe this is a myth?-the lack of empathy and compassion to those in suffering and who do not possess a fat wallet from many (but i am sure not all)medical practitioners would suggest that the moral compass needs to be redressed.Perhaps Ethics is no longer taught in medical schools?
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I can understand how foreigners find our system incomprehensible, but it is a bit more complicated than that and you may get some harsh comments in response. Don't get me wrong, I have experienced medical care in Europe and the US, I spent a good chunk of my life uninsured, I deplore the US system, and I am married to a doctor. But the Spanish flu, the advent of BlueCross in the 1920s selling insurance to Texas teachers, the great depression, and then the wage and price controls during WWII all worked together to create the rather contorted employer-based health care we have today. Add to that LBJ's addition of medicare and we have a big pile of something -- not sure what, just something. And that something just happens to take care of some really well and others not at all.

The only thing that will ever change it IMO is the next health catastrophe similar to the Spanish flu. Once that happens, private health insurers will go bankrupt just like the banks of the most recent 'catastrophe' and the government will have to bail them out. That event will probably change things drastically. But wt-f do I know really ;)

k.
 
scotchef38 said:
As a non US citizen,i find your health care system incomprehensible.Some of your stories i find shocking.If i was an elected representative of the people of one of the most wealthy countries in the world and failed to at least attempt to address this issue i would expect to live my remaining days in shame.
I am also not a Doctor but my understanding is that ,prior to obtaining ones licence to practice,the individual is required to swear to uphold the Hypocratic oath.Maybe this is a myth?-the lack of empathy and compassion to those in suffering and who do not possess a fat wallet from many (but i am sure not all)medical practitioners would suggest that the moral compass needs to be redressed.Perhaps Ethics is no longer taught in medical schools?
Click to expand...
Since you are not familiar with it, and have not used it, your comments really are just conjecture. You are attacking it based on hearing a few stories. Just as with anything else, no one publicizes when everything goes A-Okay, which is the vast majority of the time.
 
I talked to my insurance broker the other day. My rates have been going crazy.
Long story short, I was paying $1427 per month for my ex, daughter and myself. For a crappy plan with a high deductible.
Under Obamacare my monthly cost, for a better plan will be $213 limited providers or $306 unlimited providers. And it includes Mental health (A must have) which my other plan didn't cover. In all fairness I took a pay cut last year which helped the premium.

That's for me only. The ex will be about the same and daughter dirt cheap.
 
We pay close to $600/ mo now per employee for single person coverage under a decent preferred provider plan that has reasonable deductibles. A family plan with the same coverage is ~$1,500/ mo (we pay 100% of the single person coverage, anyone who needs to cover spouse/ family needs to pick up the difference). Probably better coverage that most younger workers need, but we had two people with serious health conditions over the last few years (one terminal pancreatic cancer) and the coverage resulted in them paying very little out-of-pocket. And also several people with sports-related injuries from flag football/ softball/ skiing, etc.
 
Hubby is eligible to retire in just over a year. We have pre-existing conditions, and didn't see any way for him to retire due to health insurance costs/availability. Even though he can get coverage through his employer after retirement, we were looking at over $2800/month for not-so-good health insurance--and getting insurance through someone else was next to impossible due to the pre-existing stuff. Once the exchange came out, we started shopping--a good HSA eligible policy is less than $800 for both of us, and the most expensive/cover everything policy is around $1400 for both. That's without any subsidies.

I might have to stop buying new knives, but he might be able to retire when he's eligible.
 
How about this: an acquaintance went into the hospital for major surgery; stayed 7days and received really good care.
Cost less than $400. Yeah, I got the zeros right.
So I have a really hard time buying that we can't do a similar thing in the US if we tried.
 
Then there are the ones who help drive up the cost. My sister's in the health care industry and does lab support for a hospital emergency room. Every month like clockwork, there's a woman who shows up in the middle of the night with her teenaged daughter, who has bad cramps. What she needs is a beer (best medicine ever for that sort of thing.) Instead the hospital has to run all sorts of expensive tests or risk a lawsuit.
 
Sadly I have good insurance, but my plan that covers the family costs about 26k a year.
 
My wife works for Wellpoint which owns BCBS and Anthem. We pay 5k a year to insure the two of us and have a 3k deductible and a 6k out of pocket per year. We hit our out of pocket every year because I have epilepsy and my medications run about 15k a year. We shell out 11k a year for health care premiums and health expenses but it's cheaper than paying for just my meds. You want to talk profits and milking the public look at big pharma.
 
Ok, I am going to say it because I have drunk just enough. Just enough, that is. Ok, maybe too much, but it is fun to rant isn't it?

The key (or one of the keys) to understanding health insurance costs is all about taxes. One of the main reasons we have high cost is because so many people are not covered by insurance. When someone walks into an emergency room without coverage, or when the family goes bankrupt due to health costs that their insurance doesn't cover, these are all costs that have to be absorbed (somewhere). Despite what many would like to believe, the government doesn't absorb these costs (unless it is directly through Medicare/Medicaid), but the private doctors, hospitals, clinics, non-profit hospitals etc -- they absorb the costs.

In turn, they raise the costs of everything to compensate for this, just as a convenience store incorporates theft into the cost of their retail items. Every hospital bed, doctor visit, and nursing hour you receive has built into it a cost that recuperates the loss of the uninsured and the unpaid bills. It is a private tax levied by independent organizations and private corporations that you will never see.

One can complain about taxes and health mandates, but the the reality is that every time we enter a medical institution in the USA now and in the past decades, we have been and are being taxed by a corporation. There are no voters, elected representative debates, transparency, electoral accountability, OMB audits, or anything. It is a hidden tax levied by boards of directors, financial analysts, and adjustors to recuperate losses from the uninsured and unpaid bills. This is built into every hospital visit. And even if someone tries to control it (i.e., the government), MONEY IS FUNGIBLE and costs will be shifted to other areas eventually.

Everybody pays for the uninsured whether you know it or not. You are being taxed for it right now whether you know it or not.

Now, just to be the devil's advocate and present another situation: If you let a city government tax like a health corporation with no debate, transparency, accountability, popular voting etc and the only people they answered to were a handful of majority municipal bond holders, what do you think would happen in that city? Do you think it would magically produce the best run city in the country with the most frugal budget and lowest cost increases?? No, it wouldn't.

The American health system is exactly what we want and expect it to be. We trust private corporations with stock holder oversight to tax us more than we trust the government with elected representative oversight to tax us. That is reality. We also believe we get the best care in the world, but until you have challenged the system with a life-threatening illness, you really can't say that for sure, and unless you have received primary care outside of the USA, you don't really have a comparison. Bankruptcies to INSURED families happen all the time; millions of American with insurance go bankrupt every year.

So that is my statement. I am married to a physician and for those who want to blame doctors, we have taken a 15% pay cut since Obamacare was enacted this last year. That's our tax as reimbursements have changed. Doctors have accepted the tax, have you??

k.
 
I love ya Drinky but it is much more than that. When you look at the profit margins of said corporations we are being more than just taxed by them to recover losses, we are being raped. There is a lot of greed priced in there too, and they do it because they can and call it what ever they want.
 
I don't think you can seriously talk about health insurance without going into politics, and that's not wanted here. So I will just ask one question? If you build a health care system on the values of capitalism and expect the pharma industry, the medical supply and technology industry, the insurance industry, the whole range of medical personel and staff, the pharmacists, the politicians who need to be lobbied and corrupted, and the lobbyists to profit - who the $)&& did you think would have to pay for all this?

Stefan
 
Mingooch said:
Sadly I have good insurance, but my plan that covers the family costs about 26k a year.
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26k is more than most people earn annually around here.

US having the best health care in the world?
My boss just recently died after half a dozen trips to 2 different hospitals.
Seems the doctors around here are unable to diagnose pneumonia. I thought even a school nurse could do that.
Sorry, but I am still upset.
 
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