Healthcare rant

[bsjkki]

My family is semi-self employed. My husband has a partner that has used the same insurance for years so when we joined, we switched to this plan (needs 3 members) and pay out of pocket a $2000 a month premium for our family. We have ongoing health issues. I despise our new health insurance. We had to switch doctors. Not one of my daughters diabetic needs are considered formulary. The amount of time and hoops we have jumped through is ridiculous. She just joined her employers plan so we are lucky because after 6 months of  trying, our insurance still has not covered anything she needs. She is allergic to the preferred brand of insulin.  We have been using our stockpile. She is drawing insulin for her pump out of pen needles and needs to get in to see in endo in her new town which could take months. Being a type 1 diabetic is a nightmare. Insulin used in pumps is now well over $300 a vile. Obamacare drove all of our costs up. Our premiums doubled and our deductibles and out of pocket expenses have too. I hate that the insurance company dictates what drugs they like and which doctors to go to. I want a catastrophic plan and want to pick my doctor and choose which medical devices/procedures to use without the insurance dictatorship involved. I want competition across the board. I want prices listed for surgeries and for medical procedures before I agree to them. I want to know the price of each test, each drug and each procedure before it is done--kind of like the auto mechanic. I want to buy insulin from Canada. The government protects companies from competition but then doesn't regulate huge price hikes. This semi-capitalist system isn't working but I don't want more government involvement. I feel 3rd party insurance is what has driven the cost of healthcare up to these unreasonable levels. It has been a very frustrating day. I just want to go buy my blood pressure meds without having to go to a new doctor...I want to be able to have my husband get his medical procedure without having to go through a new doctor and new insurance required step  therapy we already tried. I am just tired.

Edited July 11, 2017 by bsjkki

[Calm]

Diabetic supplies are ridiculous.  We always max out on out insurance even with a high deductible.

We have found Contour strips great.  If you can't get insurance to pay for them,  buying them online is twice as cheap as Walmart and three times as cheap as Walgreens.

Edited July 11, 2017 by Calm

[bsjkki]

1 minute ago, Calm said:

Diabetic supplies are ridiculous.  We always max out on out insurance even with a high deductible.

We have found Contour strips great.  If you can't get insurance to pay for them,  buying them online is twice as cheap as Walmart and three times as cheap as Walgreens.

Thank you. She uses the omnipod (it changed her life) which requires freestyle test strips but may need to start using another tester and manually inputting her numbers.She is rationing...and not testing enough. If anyone knows of a good endocrinologist in the San Jose area...that is what she really needs to get everything started on her new insurance which is has much better coverage than mine.She is trying to do all this for herself since she is now a full blown, college graduated adult with a real job. 

[Storm Rider]

I had a liver transplant in 1999 due to a rare liver disease.  When I was diagnosed with the disease I joined an HMO.  Over some 20 years my premiums went from $175 per month for me alone to over $1100.  HOWEVER - i had a minimal prescription co-pay and a doctor appointment copay.  After that it paid 100% of my annual expenses.  With Obama care the HMO canceled my policy because it did not meet the new requirements i.e. my personal insurance policy did not pay for OBGYN, child dental, and I cannot remember what all.  

What has resulted is that my medical costs are not affordable.  I do not get the preventative testing that I used to get; I don't get the blood tests that I used to get; I have stopped taking some medications, and I have lost touch with my doctors.  

I can understand the benefit of providing coverage to a lot of other folks, but my coverage was destroyed by Obama care.  The insurance market today is ridiculous and not helpful.  I see no reason why we cannot purchase our drugs in Canada.  I want a single payer system where the prescription costs are negotiated for everyone.  The Health industry is a scam because of the government messing around with it.  The insurance market is a racket that wants a monopoly and wants to make exorbitant profits.  It never surprises me that insurance companies are found in some of the biggest and best buildings in every city.  They are not in business to help citizens, but to make as much money as they can in a marketplace that decides on the life of death of its customers.

[Tacenda]

49 minutes ago, Storm Rider said:

I had a liver transplant in 1999 due to a rare liver disease.  When I was diagnosed with the disease I joined an HMO.  Over some 20 years my premiums went from $175 per month for me alone to over $1100.  HOWEVER - i had a minimal prescription co-pay and a doctor appointment copay.  After that it paid 100% of my annual expenses.  With Obama care the HMO canceled my policy because it did not meet the new requirements i.e. my personal insurance policy did not pay for OBGYN, child dental, and I cannot remember what all.  

What has resulted is that my medical costs are not affordable.  I do not get the preventative testing that I used to get; I don't get the blood tests that I used to get; I have stopped taking some medications, and I have lost touch with my doctors.  

I can understand the benefit of providing coverage to a lot of other folks, but my coverage was destroyed by Obama care.  The insurance market today is ridiculous and not helpful.  I see no reason why we cannot purchase our drugs in Canada.  I want a single payer system where the prescription costs are negotiated for everyone.  The Health industry is a scam because of the government messing around with it.  The insurance market is a racket that wants a monopoly and wants to make exorbitant profits.  It never surprises me that insurance companies are found in some of the biggest and best buildings in every city.  They are not in business to help citizens, but to make as much money as they can in a marketplace that decides on the life of death of its customers.

This!!!

 

[The Nehor]

I am guessing the United States will be transitioning to a single-payer system within the next decade. The ACA proved that half-measures do not work. The AHCA is a tacit endorsement from the other side that we cannot go back to straight capitalism when they are not even considering it. People and politicians who thought it was extreme are now coming around to single-payer. Not sure if it will be good or bad but I think we are heading that way.

[bsjkki]

8 minutes ago, The Nehor said:

I am guessing the United States will be transitioning to a single-payer system within the next decade. The ACA proved that half-measures do not work. The AHCA is a tacit endorsement from the other side that we cannot go back to straight capitalism when they are not even considering it. People and politicians who thought it was extreme are now coming around to single-payer. Not sure if it will be good or bad but I think we are heading that way.

The only good thing about that is putting the insurance companies out of business. 😉 I hope your wrong though...more government will just screw things up more. I agree the half-measures are not working because the cost of care is the root problem but no one seems to be addressing this core issue. Currently you have people insured with Obamacare who can't afford to get healthcare because of high deductibles. 

I had to go read if the NHS covered my daughters prefered care products...it sounded like it depended where you lived.  One lady had to drive 200 miles to her assigned hospital. Most discussed very long approval processes. Same hassles and frustrations but maybe they aren't spending $30000 a year for a families medical needs.

 

[Storm Rider]

The most difficult thing for doctors and, more importantly, society is to define when is it time to stop providing care for someone.  As someone that had/has a disease that destroyed my liver - and without any action on my part that contributed to the disease - I feel it is necessary to understand that no society can pay exorbitant health costs for the unluckiest among us.  In reality, in a society that understand they cannot do all things for all people, I probably should have just been given palliative care and allowed to die.  It is not like death is such a terrible thing.  

When I had by transplant I recognized that every dollar spend on my care was impacting each and every other member of our HMO.  I received care, but at what price to others?  

This needs to be discussed and society and individuals need to understand that it is not possible to provide ongoing, expensive care for all of us.  In order for a healthy society to exist more easily then some of us who are really sick may need to be allowed to pass on by withholding care, that may be possible, but is just too expensive to deliver. Of course, the danger of this is that the poor and the weak will be targeted as being allowed to die and the rich and powerful will mysteriously be identified as being affordable to provide the care.

The impetus needs to be put into developing care that is inexpensive for all yet with an understanding that we have a limited supply of dollars to devote to healthcare.

Can the government actually be successful in providing a single payer system?  All I have to do is visit a DOL in any state and realize that is a daunting task that should terrify each of us.  Can you imagine going into a doctor's office and being treated like the DOL treats us?  Yet, what we have now is clearly not working for those who pay for the system to function.  

It is a very tough problem with zero easy answers. 

Edited July 11, 2017 by Storm Rider

[strappinglad]

There are several countries in the world that have figured out very good ways to provide health care. Some are single payer some are a combination of gov't and private. No real need to keep reinventing the wheel. Pick one and get at it.

I watched the HMO scam when I was dealing with the last years of my father-in-law's life .He switched HMOs a couple of times in the last 5 years and every time he switched, the hospital would do all of the standard tests that the previous hospital had done as recently as a month before, and then bill the HMO . Nobody trusted anybody's results and besides, there was big money to be made on the tests.

I recently had emergency surgery with a 4 day stay in hospital. Total cost to me??? nothing. My monthly health care premium excluding drugs ??? nothing. My monthly Blue cross which covers most of my drugs and part of dental etc.??? $85 . Had I lived in the US in my current circumstances, I would have had to declare bankruptcy and go on welfare. There are better ways folks. Look into them.

 

Edited July 12, 2017 by strappinglad

[Storm Rider]

1 hour ago, strappinglad said:

There are several countries in the world that have figured out very good ways to provide health care. Some are single payer some are a combination of gov't and private. No real need to keep reinventing the wheel. Pick one and get at it.

I watched the HMO scam when I was dealing with the last years of my father-in-law's life .He switched HMOs a couple of times in the last 5 years and every time he switched, the hospital would do all of the standard tests that the previous hospital had done as recently as a month before, and then bill the HMO . Nobody trusted anybody's results and besides, there was big money to be made on the tests.

I recently had emergency surgery with a 4 day stay in hospital. Total cost to me??? nothing. My monthly health care premium excluding drugs ??? nothing. My monthly Blue cross which covers most of my drugs and part of dental etc.??? $85 . Had I lived in the US in my current circumstances, I would have had to declare bankruptcy and go on welfare. There are better ways folks. Look into them.

 

I think Strappinglad has an excellent point.  The USA thinks they need to do original research to discover the answer for both healthcare and education.  I don't quite understand when other countries have excellent examples and all we need to is emulate their systems.  No blue ribbon panels, no consultants paid millions of dollars - just do it.  

Our government is a bit of a racket I think.  Every department defends its turf; they spend outlandishly for fear if they don't their budgets will be cut; and they think putting "consultant" in front of the name means you are getting the brightest and the best.  Sorry, children, it does not work that way.  I have met some extremely bright consultants in my lifetime.  However, in the Trust department of a major bank in which I worked early in my career I would not have given two wooden nickels for the product one of the biggest consulting firms in the nation put out.  I strongly suspect it is even worse in government. 

Strappinglad, do you know of an example of a national health care system that is not going broke or not a significant spender of the public purse?  Over the last 30 years I have read of a lot of complaints that these nations cannot support their then current social systems.  There is a balancing act when the public purse is not bottomless. 

Edited July 12, 2017 by Storm Rider

[Stargazer]

21 hours ago, The Nehor said:

I am guessing the United States will be transitioning to a single-payer system within the next decade. The ACA proved that half-measures do not work. The AHCA is a tacit endorsement from the other side that we cannot go back to straight capitalism when they are not even considering it. People and politicians who thought it was extreme are now coming around to single-payer. Not sure if it will be good or bad but I think we are heading that way.

Every time our government has meddled in healthcare it has caused more problems than it solved.  In my humble opinion, the ACA was designed from the start to fail miserably, and thus make a single payer system inevitable.  Which, as both Canada and the UK have discovered, can be a nightmare.  

There are plenty of people in both countries that think it's great, but there are also plenty who have discovered that a one-size fits all system has serious flaws in it.  My wife is a UK NHS nurse, I've recently spent time in the UK, and I have observed that there are serious problems with their system.  Because the government controls health care, and there is no charge to the patients or anything, there must be rationing, and long waiting periods for certain kinds of care.  My wife, for example, needs a knee replacement. She has been waiting for months just to find out whether or not they think she's bad enough off.  And after they decide she really needs it, it will take many more months until she even gets scheduled to have it done.  This is a cost control measure, by the way.  Of course, if she wants to jump the queue, she can, if she can afford to pay for the replacement all herself.  And by the way, she does make extra money doing surgical cases outside of normal working hours, for people who got too badly off to wait any longer AND who could afford to have procedures done on their own dime, and their own time.  I'll be immigrating there soon (they're considering my application as I write this), so I'll be able to report on the matter very much in first person.  But what I have seen so far leads me to believe that it would be a disaster for the United States.

 

[The Nehor]

1 hour ago, Stargazer said:

Every time our government has meddled in healthcare it has caused more problems than it solved.  In my humble opinion, the ACA was designed from the start to fail miserably, and thus make a single payer system inevitable.  Which, as both Canada and the UK have discovered, can be a nightmare.  

There are plenty of people in both countries that think it's great, but there are also plenty who have discovered that a one-size fits all system has serious flaws in it.  My wife is a UK NHS nurse, I've recently spent time in the UK, and I have observed that there are serious problems with their system.  Because the government controls health care, and there is no charge to the patients or anything, there must be rationing, and long waiting periods for certain kinds of care.  My wife, for example, needs a knee replacement. She has been waiting for months just to find out whether or not they think she's bad enough off.  And after they decide she really needs it, it will take many more months until she even gets scheduled to have it done.  This is a cost control measure, by the way.  Of course, if she wants to jump the queue, she can, if she can afford to pay for the replacement all herself.  And by the way, she does make extra money doing surgical cases outside of normal working hours, for people who got too badly off to wait any longer AND who could afford to have procedures done on their own dime, and their own time.  I'll be immigrating there soon (they're considering my application as I write this), so I'll be able to report on the matter very much in first person.  But what I have seen so far leads me to believe that it would be a disaster for the United States.

 

There are two Presidents in US history who made healthcare a major objective of their Presidency, Obama and LBJ.

LBJ created Medicare and Medicaid. I would not call them a failure. Without them many of the elderly and the impoverished sick would be crippled by medical debts or, worse, refused medical care. Obama's legislation was hampered by compromise. It is a system that needed tending to to be maintained and even when it was passed it was acknowledged that adjustments would need to be made. After the last election it was declared dead so of course the markets started to collapse. Saying it would self-destruct became a self-fulfilling prophecy. I am not a big fan of the ACA but its detractors ascribe to it all kinds of evil. I also do not believe for a second that Obama or the Congress that passed the ACA had a long-term plan for it to fail. That it has failed and even those who oppose it do not want to get rid of it and return to the old status quo but instead insist on some kind of similar replacement system is a tacit acknowledgement that they actually like some parts of it or they think the voters do.

I know European single-payer systems have problems, many of them. I am reasonably well-off and have good insurance. The ACA or a single-payer system would be bad for me. However I also know people barely financially holding on with terrible or no insurance who are one disease or accident away from bankruptcy and God help them if they need mental health assistance. We need something.

[strappinglad]

The problem with a single payer only system is, as has been mentioned, long wait times for some procedures, and rationing . There needs to be a way for people to have access to private additional insurance systems as well as public health care. There is a worry that all the good doctors/health care workers would gravitate to the private side for better pay etc. I think there are regulatory methods to minimize this. Where I live we already have a "2 tier " medical system,... One for the politicians and elite athletes , and one for the rest of us peons. Having said that, I have had no complaints with my interactions with the peon side. Always good treatment.

[Stargazer]

1 hour ago, The Nehor said:

There are two Presidents in US history who made healthcare a major objective of their Presidency, Obama and LBJ.

LBJ created Medicare and Medicaid. I would not call them a failure. Without them many of the elderly and the impoverished sick would be crippled by medical debts or, worse, refused medical care. Obama's legislation was hampered by compromise. It is a system that needed tending to to be maintained and even when it was passed it was acknowledged that adjustments would need to be made. After the last election it was declared dead so of course the markets started to collapse. Saying it would self-destruct became a self-fulfilling prophecy. I am not a big fan of the ACA but its detractors ascribe to it all kinds of evil. I also do not believe for a second that Obama or the Congress that passed the ACA had a long-term plan for it to fail. That it has failed and even those who oppose it do not want to get rid of it and return to the old status quo but instead insist on some kind of similar replacement system is a tacit acknowledgement that they actually like some parts of it or they think the voters do.

I know European single-payer systems have problems, many of them. I am reasonably well-off and have good insurance. The ACA or a single-payer system would be bad for me. However I also know people barely financially holding on with terrible or no insurance who are one disease or accident away from bankruptcy and God help them if they need mental health assistance. We need something.

Let me just say that both Medicare and Medicaid are both economically unsustainable over the long term.  Eventually, medicare taxes will have to go up drastically to continue to fund the system.  And as for medical expenses bankrupting seniors, you'll pardon me for saying that even under Medicare seniors can lose everything -- because it doesn't pay for everything.

But I got a good laugh out of your joke that the ACA was hampered by compromise.  The Democrats in Congress had an absolute mandate and steamrolled it into law without a single compromise with the Republicans.  And Nancy Pelosi's "We Have to Pass the Bill So That You Can Find Out What Is In It" is among the funniest lines of comedy ever uttered by a politician.  Almost as amusing as Obama's "If you like the plan you have, you can keep it.  If you like the doctor you have, you can keep your doctor, too.  The only change you’ll see are falling costs as our reforms take hold."  All three claims were as false as three dollar bills -- and Obama had to know it when he said it.  My family had personal experience with that.  One of my sons had a decent plan with my HMO, but when the ACA took hold his premiums went up 150% and he could no longer afford the plan -- so he went on Medicaid, and on the government's dime for his medical care.  

As for the rising cost of medical care in general, one only need examine the economics to see why it is such a reliable upward curve.  Economics 101 tells us that the more money that chases any good or service, the higher the price will go.  This can be seen easily when one compares luxury with non-luxury goods. Medical insurance companies are perceived to have lots of money to pay for medical procedures, and the providers are only too happy to negotiate higher maximums.  Because the insurers can afford it, can't they?  The customer-patients don't care what it costs, since they're not paying, and it's not under their control anyway.  And in many cases, if not most, when insurance is provided as part of an employee's compensation, there's no incentive for the employee to seek out only necessary care, or care that costs less.  So it does not pay for the medical people to compete with each other on the basis of price for their customer's business.  And then we tack on the costs of government regulation and reporting. Another source of rising prices is the artificial scarcity created by medical associations, such as the AMA.  These bodies require draconian regimens of education and training, so much so that only a dedicated few seek to become doctors.  And then the systems put into place make their lives as miserable as possible (long internships requiring long and hard hours of underpaid labor) before they can finally be allowed to practice medicine. You might argue that these requirements produce good doctors, and you may be right, but would the potential doctors who are driven away from the profession by this onerous path all be bad doctors?  It costs so much to become a doctor, and it is so hard to become one, that a doctor would be a fool to charge less than top dollar for his or her services.  And the artificial scarcity the system produces makes it unnecessary anyway.  Oh, and let's not forget malpractice insurance premiums!  How lovely it is for the lawyers when they can sue a doctor for a mistake (or even for an unlucky outcome) with awards in the millions of dollars!  Doctors in some professions have to pay enormous malpractice insurance premiums, and guess how these premiums get funded?  That's right, these are folded right into the fees charged and paid by medical insurance.  Tort reform, anyone?  Oh, no, we can't do that!  Those poor unfortunate lawyers who run the malpractice suits would starve!  Which is why the American Bar Association fights tooth and nail against any kind of reform.

Well, I could go on.  And going single payer would be out of the frying pan and into the fire.

[The Nehor]

7 hours ago, Stargazer said:

Let me just say that both Medicare and Medicaid are both economically unsustainable over the long term.  Eventually, medicare taxes will have to go up drastically to continue to fund the system.  And as for medical expenses bankrupting seniors, you'll pardon me for saying that even under Medicare seniors can lose everything -- because it doesn't pay for everything.

But I got a good laugh out of your joke that the ACA was hampered by compromise.  The Democrats in Congress had an absolute mandate and steamrolled it into law without a single compromise with the Republicans.  And Nancy Pelosi's "We Have to Pass the Bill So That You Can Find Out What Is In It" is among the funniest lines of comedy ever uttered by a politician.  Almost as amusing as Obama's "If you like the plan you have, you can keep it.  If you like the doctor you have, you can keep your doctor, too.  The only change you’ll see are falling costs as our reforms take hold."  All three claims were as false as three dollar bills -- and Obama had to know it when he said it.  My family had personal experience with that.  One of my sons had a decent plan with my HMO, but when the ACA took hold his premiums went up 150% and he could no longer afford the plan -- so he went on Medicaid, and on the government's dime for his medical care.  

As for the rising cost of medical care in general, one only need examine the economics to see why it is such a reliable upward curve.  Economics 101 tells us that the more money that chases any good or service, the higher the price will go.  This can be seen easily when one compares luxury with non-luxury goods. Medical insurance companies are perceived to have lots of money to pay for medical procedures, and the providers are only too happy to negotiate higher maximums.  Because the insurers can afford it, can't they?  The customer-patients don't care what it costs, since they're not paying, and it's not under their control anyway.  And in many cases, if not most, when insurance is provided as part of an employee's compensation, there's no incentive for the employee to seek out only necessary care, or care that costs less.  So it does not pay for the medical people to compete with each other on the basis of price for their customer's business.  And then we tack on the costs of government regulation and reporting. Another source of rising prices is the artificial scarcity created by medical associations, such as the AMA.  These bodies require draconian regimens of education and training, so much so that only a dedicated few seek to become doctors.  And then the systems put into place make their lives as miserable as possible (long internships requiring long and hard hours of underpaid labor) before they can finally be allowed to practice medicine. You might argue that these requirements produce good doctors, and you may be right, but would the potential doctors who are driven away from the profession by this onerous path all be bad doctors?  It costs so much to become a doctor, and it is so hard to become one, that a doctor would be a fool to charge less than top dollar for his or her services.  And the artificial scarcity the system produces makes it unnecessary anyway.  Oh, and let's not forget malpractice insurance premiums!  How lovely it is for the lawyers when they can sue a doctor for a mistake (or even for an unlucky outcome) with awards in the millions of dollars!  Doctors in some professions have to pay enormous malpractice insurance premiums, and guess how these premiums get funded?  That's right, these are folded right into the fees charged and paid by medical insurance.  Tort reform, anyone?  Oh, no, we can't do that!  Those poor unfortunate lawyers who run the malpractice suits would starve!  Which is why the American Bar Association fights tooth and nail against any kind of reform.

Well, I could go on.  And going single payer would be out of the frying pan and into the fire.

After the year long fight to pass the ACA I thought we would never again hear that they snuck the bill through after the AHCA tried to get shoved through in a week with no one seeing it. Watching the same people who complained about this tactic defend an even more extreme version made for great political theater. Poor Paul Ryan looked like a total git.

And yes, there were compromises with Republicans to get the ACA passed before it went through the House where it passed unanimously (Yeah, every Republican present in the House voted Yes after their concerns were worked in). Then the Senate had an intense debate, modified it a bit, and sent it back, passing it on a near-party line vote. With political blood in the air after the Senate debate the Republicans in the House opposed as did many democrats and it passed by 7 votes. The Republicans in the House had a lot of input in the first version and were so happy with it they voted unanimously for it. If they were shut out and none of their suggestions were taken into account why did they do this? Of course it is basically a historical fact that Republicans did make suggestions that were incorporated into the bill that Obama and other Democrats did not like but were okay with to get the larger bill passed.

Paul Ryan and his ilk all whine about the ACA while conveniently forgetting they voted for the first version. Ah.....politics.