Mardi Gras Audrey
Senior Member
So well rounded, I'm pointless...
Joined: Dec 25, 2010 18:49:31 GMT -5
Posts: 2,087
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Post by Mardi Gras Audrey on Jan 17, 2017 17:12:12 GMT -5
Because he is NOT under the ACA if he is receiving Medicare. If he was, then it is very likely that his policy would be lower because your dad is in one of the most expensive classes to insure. In reality, your dad is now paying more accurately, what it costs to insure him at this stage of life. Single payer would be what would benefit the most people and would be the cheapest. But, it won't ever go anywhere here sadly. I don't know that it would. Who would be the single payer? The Government? Medicare or Medicaid for everyone? If we do that, prepare for a large loss of providers. The government doesn't negotiate. They just say "This is what we are paying, period". A lot of providers (especially on the outpatient side) would take a loss on every patient because the reimbursements are so poor. We already have providers that won't take Medicare/Medicaid patients. The ones that do are kept afloat by private insured, who are essentially subsidizing their brothers with govt care. The govt rails against the "evil insurance companies" but they are the ones that are preventing the system from collapsing. Nice that the politicians create a system where the private insurers are paying more to prop their programs (Medicaid/-care) up and then villify them for needing to charge more to keep the system intact. Also, as far as paperwork goes, Medicaid and Medicare are by far the worst IMHO. I work in the medical field and work with govt payers, private payers, and cash pays. As far as bureaucracy, the Medicaid and Medicares take the most time up and have the most ridiculous rules. I'd rather deal with a United Health of BCBS any day. At least they 1. Answer the phone (Calling Medicaid in CA is a nice 30 minute phone tree from hell then they will answer only 3 questions (but won't tell you that is the limit). Some of the reps will lie to you/give you misinformation on questions 4+ because you "only get to ask 3". Yes, this has happened to me personally), 2. Make sense/their rules are more logical 3. Are responsive (Private insurers will tell us if something is covered in up to 72 hours, Medicaid or Medicare? yeah, good luck. We had one patient it took Medicaid 3 MONTHS to tell us if a treatment was covered, in the meantime the patient went without and was at greater risk for getting very ill. 4. Don't do weird clawbacks. Govt: Oh, we are cutting your reimbursement by 10% but not starting from here forward. We are starting from last summer so all the services you already provided and billed for? We want 10% back Or they will say something is covered and then deny it even though their electronic system already said you wer good to go. From an access side, having single payer would be horrible. Sure, everyone would have insurance but most people would have a horrible time finding care
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emma1420
Senior Member
Joined: Jan 28, 2011 15:35:45 GMT -5
Posts: 2,430
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Post by emma1420 on Jan 17, 2017 19:39:26 GMT -5
Single payer would be what would benefit the most people and would be the cheapest. But, it won't ever go anywhere here sadly. I don't know that it would. Who would be the single payer? The Government? Medicare or Medicaid for everyone? If we do that, prepare for a large loss of providers. The government doesn't negotiate. They just say "This is what we are paying, period". A lot of providers (especially on the outpatient side) would take a loss on every patient because the reimbursements are so poor. We already have providers that won't take Medicare/Medicaid patients. The ones that do are kept afloat by private insured, who are essentially subsidizing their brothers with govt care. The govt rails against the "evil insurance companies" but they are the ones that are preventing the system from collapsing. Nice that the politicians create a system where the private insurers are paying more to prop their programs (Medicaid/-care) up and then villify them for needing to charge more to keep the system intact. Also, as far as paperwork goes, Medicaid and Medicare are by far the worst IMHO. I work in the medical field and work with govt payers, private payers, and cash pays. As far as bureaucracy, the Medicaid and Medicares take the most time up and have the most ridiculous rules. I'd rather deal with a United Health of BCBS any day. At least they 1. Answer the phone (Calling Medicaid in CA is a nice 30 minute phone tree from hell then they will answer only 3 questions (but won't tell you that is the limit). Some of the reps will lie to you/give you misinformation on questions 4+ because you "only get to ask 3". Yes, this has happened to me personally), 2. Make sense/their rules are more logical 3. Are responsive (Private insurers will tell us if something is covered in up to 72 hours, Medicaid or Medicare? yeah, good luck. We had one patient it took Medicaid 3 MONTHS to tell us if a treatment was covered, in the meantime the patient went without and was at greater risk for getting very ill. 4. Don't do weird clawbacks. Govt: Oh, we are cutting your reimbursement by 10% but not starting from here forward. We are starting from last summer so all the services you already provided and billed for? We want 10% back Or they will say something is covered and then deny it even though their electronic system already said you wer good to go. From an access side, having single payer would be horrible. Sure, everyone would have insurance but most people would have a horrible time finding care I grew up with single payer. It worked fine, and while underfunded now, it still works well and there is a robust insurance industry that provides supplemental insurance to allow people to speed up their care for non-emergent and non-life threatening situations. However, I don't believe that we will ever have single payer here. And i hate United. I have them, and I find them to be one of the most frustrating insurance companies to deal with. And I want my care to be decided by my doctor. And I find that too often that the administrators at insurance companies are making decisions. At least if I'm dealing with the government, I'm not worried about a potential six figure bill at the end of the conversation.
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Mardi Gras Audrey
Senior Member
So well rounded, I'm pointless...
Joined: Dec 25, 2010 18:49:31 GMT -5
Posts: 2,087
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Post by Mardi Gras Audrey on Jan 17, 2017 19:58:43 GMT -5
I grew up with single payer. It worked fine, and while underfunded now, it still works well and there is a robust insurance industry that provides supplemental insurance to allow people to speed up their care for non-emergent and non-life threatening situations. However, I don't believe that we will ever have single payer here. And i hate United. I have them, and I find them to be one of the most frustrating insurance companies to deal with. And I want my care to be decided by my doctor. And I find that too often that the administrators at insurance companies are making decisions. At least if I'm dealing with the government, I'm not worried about a potential six figure bill at the end of the conversation. I assume you grew up in the UK? How were providers paid? Aren't they govt employees? And my understanding is that they make significantly less than what providers here make. Why would any provider here agree to that? Why would providers want to give up their autonomy and work for the govt for less money? Most would just call it a day and find something else to do. There is also a huge difference in the costs associated with becoming a provider. Here, education is not free and malpractice insurance is expensive. If someone is entering practice with $200k in student loans, they aren't going to be okay with making $80k a year. Especially when you consider that they spent all of their 20s and a good part of their 30s (all wage earning years) in school or earning little as a resident. A good portion of your top talents will just go into other fields, where they will make more money commensurate with their hard work/education. There is the concept of risk vs reward in finances. This is true in career choices as well. If people are taking risks (Student loans, working for low wages for years while training, etc), they expect to make rewards at the end. No rewards? Why take the risk? As far as doctors making the call on care, do you think they really do if they are govt employees? Absolutely not. They make care choices based on what the govt/their employer will pay for and approves. Govt won't cover it? They don't do it. United Health may have problems but you have more avenues for appeals/coverage reviews. Medicare (govt) will just say No and that's the end of it. I tried getting a lab test covered for a Medicare pt and was told "it isn't covered and there is no way to ask for it to be covered. Period. Medicre just says no, this patient's circumstances aren't important.". This test was around $600 and would tell us if a particular $100k therapy would work for their condition. But let's not spend the $600 ("waste of money" per Medicare) and go ahead and spend $100k (and expose patient to therapy risks/side effects) to see if it works.
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milee
Senior Associate
Joined: Jan 17, 2012 13:20:00 GMT -5
Posts: 12,344
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Post by milee on Jan 17, 2017 19:59:00 GMT -5
I am ever the optimist. Just as the pendulum swings, so shall it swing back. This sentiment shows how complicated an issue this is - because I was saying the same thing a few years ago when the ACA was passed and would view repealing the ACA as the pendulum swinging back. It's not an easy issue, no easy answers and neither political party is equipped to deal with it either in theory or in practice.
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trimatty471
Established Member
Joined: Dec 21, 2010 3:59:02 GMT -5
Posts: 490
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Post by trimatty471 on Jan 20, 2017 13:45:45 GMT -5
I would at least want to get it checked and keep an eye on it. Lumps scare me now that is how my cancer started in my shoulder. Do not blow this off They scare me too, which is why I DON'T want to get it checked. I know I should. My gut says its just a cyst or something, but it kind of hurts. I had a lump on top of my foot. It was just a cyst. A few years prior to that, I had a lump in my breast. That was a cyst also. Please get it checked out. It may not be anything.
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trimatty471
Established Member
Joined: Dec 21, 2010 3:59:02 GMT -5
Posts: 490
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Post by trimatty471 on Jan 25, 2017 10:04:00 GMT -5
This is worrying to me. Health insurance was always a top priority, from military coverage to making sure each and every job EXH or I had offered coverage. Now I am going to be without if ACA goes. What were the rules to get individual coverage before the ACA, why couldn't people do that? Was it cost? I hear about pre existing could prevent coverage too? I never needed individual coverage so never looked into, so what were the barriers to calling BCBS (for example) and purchasing an individual healthcare policy. When I first left college and was a temp, in 1997, my mom acquired insurance for my brother and I. We went through Conseco. At the time it was $68 per month with a high deductible (I cannot remember how much). She went through a broker.
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Deleted
Joined: Oct 7, 2024 21:28:20 GMT -5
Posts: 0
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Post by Deleted on Jan 25, 2017 11:35:50 GMT -5
Who would be the single payer? The Government? Medicare or Medicaid for everyone? If we do that, prepare for a large loss of providers. The government doesn't negotiate. They just say "This is what we are paying, period". A lot of providers (especially on the outpatient side) would take a loss on every patient because the reimbursements are so poor. We already have providers that won't take Medicare/Medicaid patients. The ones that do are kept afloat by private insured, who are essentially subsidizing their brothers with govt care. <snip> From an access side, having single payer would be horrible. Sure, everyone would have insurance but most people would have a horrible time finding care. Amen. Doctors frequently go on strike in France because they're overworked and underpaid, and few new doctors are coming into the system for the same reason. In the UK, some employers provide their executives with supplemental policies that pay more to providers than the National Health service does, making it easier for them to get same-day appointments (heard this from London-based boss who had one). Others who have some money use "medical tourism" for non-emergency care- dental implants, knee replacements. Fly to Budapest or Bangkok (Look up Bumrungrad clinic- very highly regarded), skip the 6-month wait at home and play tourist while you recover. Competition is good. Oversight by State Insurance Commissioners (who have no authority over Medicare or Medicaid) is good. If you want a recalcitrant insurer to snap to attention, invoke the name of the State Insurance Commissioner. If they're trying to get away with something sleazy, they'll back down quickly.
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