What is fair to expect from health care?

[steve09ru]

On 11/18/2017 at 7:27 PM, Springfield said:

Something like this:

$100,000-149,000 - $10,000 out of pocket

$150,000-199,000 - $17,000 out of pocket

$200,000+ $40,000 out of pocket

 

Is that a family basis or individual?  That could be crippling either way, especially for someone making $200k where $70k already goes into taxes

[LadySkinsFan]

Thanks for the advice twa. I'll make sure that I have numerous copies!

[Springfield]

1 hour ago, steve09ru said:

Is that a family basis or individual?  That could be crippling either way, especially for someone making $200k where $70k already goes into taxes

 

That would encourage the aforementioned coinsurance.

 

I think a big problem in all of this, is that these HUGE insurance companies are just going to be gone.  Poof.  A coinsurance model for the rich will allow them to stay in business to an extent.

[twa]

33 minutes ago, LadySkinsFan said:

Thanks for the advice twa. I'll make sure that I have numerous copies!

 

Not just copies, there is a separate form for EMS here.

[TheGreatBuzz]

19 hours ago, Sacks 'n' Stuff said:

How can prices soar? We're already paying for it in one way or another. Let's start by taking away the billions of dollars of profit that insurance companies are making. Eliminate all of the unnecessary prescriptions, procedures, supplies, etc that don't actually help people and you're going to put a gash in those costs. How about we don't let bloodsucking pharmaceutical companies  buy legislation that keeps Americans from getting safe & affordable drugs from overseas?

Same question I asked LSF.......Is that even legal?  

2 hours ago, bcl05 said:

I'm a doc at a major health center (Mayo Clinic).   I have strong feelings about this. 

 

I think a reasonable way to judge a civilization/culture is to look at how they care for and value the most vulnerable and helpless among them.  By that standard, we aren't doing a great job...

 

I think that health care should be a right in this country.  I think that everyone deserves lifelong care, with the costs spread amongst the entire population.  We are the richest country in the world.  Most of us don't have catastrophic health care costs, but some do (and those are often not predictable).  An individual can almost never cover catastrophic costs, but as a country, we easily could. 

 

Note that this does not mean that every patient gets whatever they want whenever they want.  There has to be mechanisms to make reasonable decisions (as there are now).  I have had multiple patients over the years who demand (or their families demand) excessive/unnecessary care and we have used hospital ethics boards and other mechanisms to do what is reasonable, not necessarily what is requested.  

 

A key piece of a rational health care system is a constant process of research and re-evaluation. We need to look at what works and what doesn't and adjust our practices accordingly.  We currently spend more than any other country (by far) and are not close to the healthiest by many measures.  Our goal should be to make our population healthier as a whole.  We all are rewarded by healthier neighbors and friends, and our national productivity will only improve as our health improves.  

 

I strongly feel that we need to change the incentives in the health care system.  Somehow, we need to reward docs/hospitals/systems that keep people healthier, not those that just do more stuff.  There are countless pressures on docs to see more patients (as long as they have the right insurance), do more tests, do more procedures, etc.  Administrators meet with me every month to go over numbers and finances, and none of the metrics have anything to do with health outcomes.  (note this has been true at every place I've worked, not just Mayo).

 

Overall, I think we, as a country, need to assume the care of our neighbors and work towards a better health care system.

 

(I have no hope that any of this is in any way politically feasible.)

Thank you for a very good post.

 

The bolded part is good to hear but I would have to know more about the criteria.  For example, Manson is in the news now because he just died.  Now I'm no doctor but from what it sounded like, he got a lot of care that a person like him shouldn't have gotten in my opinion.  Give him reasonable care but when things start failing, let them go.  I would also say the same about people with other medical issues.  Smoked for 30 years and now want us to drop a couple million to fix your lung cancer?  NO!  You should have read the labels.  Here are some painkillers to make you comfortable.  I think my biggest issue is we don't hold people responsible for their own decisions.

[Burgold]

Just now, TheGreatBuzz said:

 

 

The bolded part is good to hear but I would have to know more about the criteria.  For example, Manson is in the news now because he just died.  Now I'm no doctor but from what it sounded like, he got a lot of care that a person like him shouldn't have gotten in my opinion. 

It may surprise you, but I'm more or less on board with this. The idea of extraordinary care is one that I wrestle with not just for monsters like Manson, but all of us. I know my parents both put it in their living wills that they don't want to kept a living vegetable. I'm very glad to have that directive because if the moment ever came where it was my choice to pull the plug it'd be hard as hell on me and it would haunt me (both ways). It probably still will if that day ever happens, but to know what they want and to talk through what they want makes it easier.

 

For most of us, I think it goes back to quality of life. Now, I've seen terminally ill people change their mind. I've seen them grasp on to life despite unbarable pain and no possible cure or chance of improvement. I won't argue with them about that choice. It's theirs to make. For me, I don't want to live like that... although it's a lot easier to say that being healthy than in the moment.

 

As for guys serving multiple life sentences or death row, extraordinary care seems wasteful to me. I don't necessarily need them to suffer. You can make their passing easier with painkillers, but giving them those extra days or weeks despite their condition and despite the understanding that they are incapable of contributing to society seems overboard. Let them go. Ethically, I can understand that this can be easier said than done. After all, figuring out what exactly is extraordinary can be tricky all by itself.

[skinsmarydu]

2 minutes ago, TheGreatBuzz said:

Same question I asked LSF.......Is that even legal?  

Thank you for a very good post.

 

The bolded part is good to hear but I would have to know more about the criteria.  For example, Manson is in the news now because he just died.  Now I'm no doctor but from what it sounded like, he got a lot of care that a person like him shouldn't have gotten in my opinion.  Give him reasonable care but when things start failing, let them go.  I would also say the same about people with other medical issues.  Smoked for 30 years and now want us to drop a couple million to fix your lung cancer?  NO!  You should have read the labels.  Here are some painkillers to make you comfortable.  I think my biggest issue is we don't hold people responsible for their own decisions.

I'm a 40-year smoker.  Doc says (she's Russian and sounds like Arianna Huffington)...'I shouldn't tell you dis, but your lungs sound great.  I really don't like telling you dat, but it's true. ' 

I just wanted to get my BP med renewed.  Just one.  I'm not on anything else. 

 

[TheGreatBuzz]

2 minutes ago, Burgold said:

 

For most of us, I think it goes back to quality of life. Now, I've seen terminally ill people change their mind.

Somewhat of a tangent here but in my limited it experience, it seems to be the religious people that want to hold onto every extra minute.  I would think it would be opposite.  Wouldn't you be ready to get to heaven assuming you haven't done something really horrible?  It is something that has always made me question the convictions of some religious people.

[PeterMP]

13 minutes ago, TheGreatBuzz said:

Same question I asked LSF.......Is that even legal?  

Obamacare has already capped their profits (as a function of their medically related expenses) by essentially making them spend 80-85% of their money on medical expenses.

 

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio.html

 

I generally don't think the issue is with insurance company profits (because of the cap), but I don't see if we can cap there why we couldn't cap even lower.

[skinsmarydu]

11 minutes ago, TheGreatBuzz said:

Somewhat of a tangent here but in my limited it experience, it seems to be the religious people that want to hold onto every extra minute.  I would think it would be opposite.  Wouldn't you be ready to get to heaven assuming you haven't done something really horrible?  It is something that has always made me question the convictions of some religious people.

With that statement alone, you have certified yourself as one smart as **** individual. 

[TheGreatBuzz]

14 minutes ago, PeterMP said:

Obamacare has already capped their profits (as a function of their medically related expenses) by essentially making them spend 80-85% of their money on medical expenses.

 

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio.html

 

I generally don't think the issue is with insurance company profits (because of the cap), but I don't see if we can cap there why we couldn't cap even lower.

Well LSF I believe was proposing more of a "require them to be non-profits" and that is more what I was referring to.  Wasn't there huge legal questions regarding the capped profits though?  And an agreement was reached because the insurance companies got other things they wanted?  

[Sacks 'n' Stuff]

2 hours ago, TheGreatBuzz said:

Same question I asked LSF.......Is that even legal?

Sure, why not? They can still exist just like private schools and toll roads. If they offer something better than the public option, people can still spend their money on them if they so desire.

[TheGreatBuzz]

19 minutes ago, Sacks 'n' Stuff said:

Sure, why not? 

Are you just saying this or do you have any basis for thinking so?

[Sacks 'n' Stuff]

10 minutes ago, TheGreatBuzz said:

Are you just saying this or do you have any basis for thinking so?

I think so but I was also asking why it wouldn't be in case I missed something. When I say, take out the profit, I didn't mean that the government is going to tell insurance companies they can't exist. That's why I said it would be like private schools or toll roads. There is a public, government funded option and there is a private, for-profit option  as well.

[LadySkinsFan]

That would be true competition, low cost insurance policies from the public option would force for profit companies to lower their prices to compete. And they would be caught out if they get aggressive in denying claims to keep higher profits. Then people could choose the lower priced public option. 

 

And because there would be a larger and larger pool of people in the public option, the policies could continue to lower. And there would be no need for mandatory enrollment penalties.

 

It's why the public option was anathema to Republicans and their donors I mean constituents.

[twa]

51 minutes ago, Sacks 'n' Stuff said:

I think so but I was also asking why it wouldn't be in case I missed something. When I say, take out the profit, I didn't mean that the government is going to tell insurance companies they can't exist. That's why I said it would be like private schools or toll roads. There is a public, government funded option and there is a private, for-profit option  as well.

 

Is the govt going to fine/tax you for not using the govt option?

[Sacks 'n' Stuff]

3 minutes ago, twa said:

Is the govt going to fine/tax you for not using the govt option?

No. They will use magic. Same way they get the money that pays for public roads, public schools, etc. Magic.

[LadySkinsFan]

Why not keep the mandate, kind of like uninsured motor vehicle fees, which would go into the public option pool.  Make it equal to the lowest premium price. 

[PeterMP]

17 hours ago, TheGreatBuzz said:

Well LSF I believe was proposing more of a "require them to be non-profits" and that is more what I was referring to.  Wasn't there huge legal questions regarding the capped profits though?  And an agreement was reached because the insurance companies got other things they wanted?  

 

Hospitals and insurance companies in this country were almost all non-profits based on state regulations before Nixon made HMOs legal and Reagan did things to add more for profit into the system.

 

I'm guessing a federal law requiring a certain non-profit for insurance companies would be legal and if nothing else, getting rid of federal laws that allow for profits to be legal would allow you to resort back to state laws.

 

(Though, the profit and non-profit thing is misleading, I think (partly because I think many non-profits have lost their way of what it means to be a non-profit to start with and CEOs and etc. make huge sums of money in non-profits).  Studies show that when you take into account the tax exemption of non-profits, they don't actually in general deliver cheaper health care.  So I think in general, what she is saying won't work.  But I suspect it is legal.)

[PeterMP]

The hope of lowering cost through a public option is not really about profit vs. not for profit.  It is based on a couple of things:

 

1.  Creating a national system with a high number of customers and therefore a high amount of bargaining power, especially if you couple it with Medicare, Medicaid, and the VA system (essentially push all of those people into a public option).  This potentially gives you a huge benefit over the current factured system in terms of negotiating with providers and health care facilities.

 

2.  Lower overhead costs,  but not in the context of profits really, but more in the context of advertising and customer acquisition (also though in the context of fraud where the federal government to a large extent in Medicare and Medicaid is "farming" out fraud investigations to things like the FBI for "free" and so does not show up as their "costs" so that is sort of dishonest when thinking about over head costs.  There is also things like the ability to acquire money where essentially nobody is able to borrow money at a lower cost than the federal government and therefore it makes them hard to compete with.)

[twa]

11 hours ago, LadySkinsFan said:

Why not keep the mandate, kind of like uninsured motor vehicle fees, which would go into the public option pool.  Make it equal to the lowest premium price. 

 

What are uninsured vehicle fees?

Here you can't get tags w/o liability ins( you will note liability is to cover damage to others)

[LadySkinsFan]

In Virginia, there's an uninsured motor vehicle fee where you can get tags by paying the fee and not have insurance. I think but am not sure that if you don't have insurance you are personally liable for any accident.

 

https://www.dmv.virginia.gov/vehicles/#uninsured_fee.asp

 

Good to know about the laws in Texas, although I will have insurance on my Tahoe and camper just as I do in Virginia.

[88Comrade2000]

 Read this about a public option:

 

Make Obamacare better with Medicare-X

[TheGreatBuzz]

5 hours ago, LadySkinsFan said:

In Virginia, there's an uninsured motor vehicle fee where you can get tags by paying the fee and not have insurance. I think but am not sure that if you don't have insurance you are personally liable for any accident.

 

https://www.dmv.virginia.gov/vehicles/#uninsured_fee.asp

 

 

Just looked that up.  That is the dumbest **** I have ever seen.  You should be required to have minimum $50k in an escrow if you refuse to get car insurance.

 

@PeterMP  Seems you know a lot more about the financial side of it than I do so I won't dispute any of that with you.  Getting a little closer to the topic, how much do you think we would save on cutting out some of the care for things that weren't even an issue a few years ago (ie. restless leg syndrome, sleep apnia)  and should we cut back on some of this crap?

[skinsmarydu]

I have restless leg syndrome of a sort.  It really does exist.  I've been on my feet for 37 years, and sometimes the nerves in my legs want to keep moving when all I want to do is relax.  I've never taken a medication for it tho, just "one of those things".