Healthcare Language

[btq96r]

In relation to better than nothing, yes. But why would you ruin potentially the best medical system for a large country? There are flaws for sure and I say all of them are caused by beuracracy.
Besides, if it were so good the smart people would sell it to us instead of deceiving us.

 

I'm not convinced we have the "best medical system for a large country."  Based on what I read, I like Germany's model (mix of about 75% public and 25% private).  And, as mentioned above, the UK version is pretty good.

 

I will concede that it's all speculative, and that the US may be too large in population, sub-division (50 states each having a stakeholder claim), and political influence to be any kind of apt comparison.  I just know our system isn't automatically the best.  Maybe we have the best specialists on something like heart surgery or any other complex operation, but day to day routine care....hard for me to think so.

 

As to the selling vs. deceiving argument, the HMO's and the healthcare industry at large do more than enough deceiving and lobbying on the hill as well.

Edited February 2, 2016 by btq96r

[peejman]

It works well enough in the United Kingdom.

 

 

I'm not convinced we have the "best medical system for a large country."  Based on what I read, I like Germany's model (mix of about 75% public and 25% private).  And, as mentioned above, the UK version is pretty good.

 

I will concede that it's all speculative, and that the US may be too large in population, sub-division (50 states each having a stakeholder claim), and political influence to be any kind of apt comparison.  I just know our system isn't automatically the best.  Maybe we have the best specialists on something like heart surgery or any other complex operation, but day to day routine care....hard for me to think so.

 

As to the selling vs. deceiving argument, the HMO's and the healthcare industry at large do more than enough deceiving and lobbying on the hill as well.

 

 

So what you're saying is you're good with roughly doubling your income tax to fund it?

[Ugly]

I know Germany has rationed healthcare. I have a good friend there and she runs out care before midyear. Seems like a great option huh?

HMOs and the like are trying to recover lost revenue from both freeloaders and beuracracy bs.
Fix that and we would have the best healthcare available for us.

[MrsMonkeyMan2500]

Pretty much my situation, except I have a $5,200 annual deductible across the board in-network, and the co-pay takes it up to $6,400 out of pocket. But it was the most affordable plan month to month for me. I'm not mad so much that I have to pay out of pocket for the (relatively) small stuff, it's that I can't get a straight answer from medical offices who are more compartmentalized than the CIA.

And we wonder why so many people are ready to embrace a single payer system and get rid of such a mess.

They're lying. Each time you visit there's a procedure code used according to the AMA. If you were just going for a consult, there's a code for that. Then all they have to do is pull your fee schedule from your insurance company or give you the procedure codes so you can.

Also, once you get your EOB from your insurance company, save it to make sure they adjusted your bill according to you insurance. Sometimes they count on people not paying attention.

[btq96r]

So what you're saying is you're good with roughly doubling your income tax to fund it?

 

Depending on what changes, I don't think income taxes would have to be doubled, but if there could be a public system that can deliver medical services at an acceptable level, then I think it's at least worth a cost benefit analysis of seeing how much taxes would have to go up. 

 

I'm going to spend over $2,300 in 2016 for an insurance plan that doesn't pick up a dime unless my medical bills accumulate past $5,400.  That's basically to avoid going bankrupt by medical bills if I get hit by a bus.  Any office visits, RX refills, special tests, ect.. are all costing me now in addition to that $5,400.  Plenty of people are paying a lot more, and pooling that money into a public option may yield better results.  So, yeah, I'd say why not look at the pros and cons.

 

Like I said, Germany has a setup worth studying.  They've had some form of government provided healthcare since Bismarck set up their first system in the 1880s.  I think we can borrow at least a few ideas that make sense from them.  The ACA tried it a bit, but it was still a giant blowjob to the insurance lobby (risk-corridors for insurance companies is the most glaring one).

http://www.commonwealthfund.org/topics/international-health-policy/countries/germany

http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

 

Letting the HMO's, who have a fiduciary duty to shareholders as priority #1 set the stakes hasn't been working very well, IMO.  We need to actively look at ways to find a happy medium between a private for profit industry bleeding us dry and an inefficient government run system that can't do anything right.

Edited February 2, 2016 by btq96r

[btq96r]

I know Germany has rationed healthcare. I have a good friend there and she runs out care before midyear. Seems like a great option huh?

 

Every system has "rationing" to some effect.  It's either an individual budget choice, an HMO saying what they will or won't cover, or a government doing the same.

[btq96r]

They're lying. Each time you visit there's a procedure code used according to the AMA. If you were just going for a consult, there's a code for that. Then all they have to do is pull your fee schedule from your insurance company or give you the procedure codes so you can.

Also, once you get your EOB from your insurance company, save it to make sure they adjusted your bill according to you insurance. Sometimes they count on people not paying attention.

 

I'd like to think it was simple ignorance, but I could believe lying too.  The "claim' is showing as pending online, but nothing is in yet.  So, I'll have to check it all when it hits.  Thanks.

[gjohnsoniv]

It might be too late now but United Healthcare has some pretty good plans out there compared to BCBS with equivalent price points.

[btq96r]

It might be too late now but United Healthcare has some pretty good plans out there compared to BCBS with equivalent price points.

 

They weren't as good as BCBS from what the marketplace showed me on comparison.  I may get away from the marketplace next year depending on my employment situation after I finish undergrad work in the fall, we'll see.  Right now a lot of my "everyday stuff" is taken care of since I can see the doctors on campus at student health services for free, and only end up paying for tests, shots, and RX's.  That's helped a lot.

 

One thing that sucked is my CPA finished my taxes for the year, and I missed getting out of the "Medicare Gap" by only a few thousand, so I wasn't able to get any tax credits for my healthcare plan.

[blewbayou]

I'd like to see the medical system set up similar to a Firestone or NTB. Walk in and there's a big board reading the cost of all the normal services. For those with no insurance, you know exactly what you'll pay. It would also let the general public really see how much money is spent on medical care and maybe then there might be a bit of an outrage about how expensive even just a consultation really is.

[peejman]

Depending on what changes, I don't think income taxes would have to be doubled, but if there could be a public system that can deliver medical services at an acceptable level, then I think it's at least worth a cost benefit analysis of seeing how much taxes would have to go up. 

 

I'm going to spend over $2,300 in 2016 for an insurance plan that doesn't pick up a dime unless my medical bills accumulate past $5,400.  That's basically to avoid going bankrupt by medical bills if I get hit by a bus.  Any office visits, RX refills, special tests, ect.. are all costing me now in addition to that $5,400.  Plenty of people are paying a lot more, and pooling that money into a public option may yield better results.  So, yeah, I'd say why not look at the pros and cons.

 

Like I said, Germany has a setup worth studying.  They've had some form of government provided healthcare since Bismarck set up their first system in the 1880s.  I think we can borrow at least a few ideas that make sense from them.  The ACA tried it a bit, but it was still a giant blowjob to the insurance lobby (risk-corridors for insurance companies is the most glaring one).

http://www.commonwealthfund.org/topics/international-health-policy/countries/germany

http://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/

 

Letting the HMO's, who have a fiduciary duty to shareholders as priority #1 set the stakes hasn't been working very well, IMO.  We need to actively look at ways to find a happy medium between a private for profit industry bleeding us dry and an inefficient government run system that can't do anything right.

 

 

Both the UK and Germany have tax rates of around 40% for the typical middle income earner.  That would be a pretty steep hit for millions of people here (including me).  You'd need an independent 3rd party to perform the CBA to get any sort of believable results as the healthcare folks would skew it their direction while .gov would certainly skew it their direction. 

 

 

 

It might be too late now but United Healthcare has some pretty good plans out there compared to BCBS with equivalent price points.

 

 

UHC.... ugh.  The plans may compare but the service isn't even close.  UHC hasn't been completely terrible, but I'd call them 3rd tier at best. 

[Oh Shoot]

Both the UK and Germany have tax rates of around 40% for the typical middle income earner.  ..

 

What's "middle" here?

 

For UK, I see 20% up to £42,000 counting standard deduction. Which is $60,500 USD. Higher, the 40% over that kicks in.

 

- OS

[btq96r]

Both the UK and Germany have tax rates of around 40% for the typical middle income earner.  That would be a pretty steep hit for millions of people here (including me).  You'd need an independent 3rd party to perform the CBA to get any sort of believable results as the healthcare folks would skew it their direction while .gov would certainly skew it their direction.

 

The money people are paying their HMO's every month would just be routed to taxes and not the monthly bill, so, after that amount, only the rest would be a net loss to someones disposable income. 

 

Also, there are differences in what levels of government can tax in other countries.  I think that only the federal government can tax income in Germany, with the Länder (their equivalent of our state level) having a small add on that gets collected (it amounts to only a few hundred euros difference based on location with this calculator).  Once the federal government is funded, the rest is then divided up on some kind of quota/apportionment system back to the states where they get to decide how to spend it.  Not sure how their VAT (sales tax) works. 

 

Then there are the differences in that the German/UK model is paying for a cradle to grave welfare state.  I'm not advocating for that, just better healthcare since I see it as a public interest.  People should still have to work a job for a living, and if they aren't willing to, screw them.  Either way you're looking at a different system with different taxes and services, so a direct what they pay vs. what we pay comparison is too simplistic, IMO.

 

 

Fully agree that an independent 3rd party would be needed to do any kind of CBA for all this.  Finding enough people that can do it, but don't have an agenda would be the hard part.  Both liberal and conservative think tanks would want to stack the deck on that one.

Edited February 2, 2016 by btq96r

[Sam1]

They're lying. Each time you visit there's a procedure code used according to the AMA. If you were just going for a consult, there's a code for that. Then all they have to do is pull your fee schedule from your insurance company or give you the procedure codes so you can.

Also, once you get your EOB from your insurance company, save it to make sure they adjusted your bill according to you insurance. Sometimes they count on people not paying attention.

 

+1 I couldn't tell you how many of the thousands of separate bills I've seen come through where they send the same charges on 3-4 different bills in different groups (to make it show a different total) so it looks like you owe them money.  UT hospital did this about 3-4 months after the initial accident (BCBS appointed a liaison to handle all the bills for 90 days since there were so many) and the liaison went away I paid somewhere between $500-$600 in stuff that had already been paid.  BCBS caught the discrepancy when I called to ask a question and UT refunded me the money after I called them.  Ever since then, I read every single bill, every single charge and sort the EOBs by dates of service to keep track of it.  If I wouldn't have called them out on it, they would have kept the money and not said a word.

What pisses me off is that after 5 years of dealing with this, it appears that some places do it on purpose, and I think about them ripping off people like our grandparents that don't know any better.

Worst one of all is Paige Prather (dentist) in Green Hills, thought she was great but she charged me a flat fee for work, then added more charges later, then more charges later and if I remember correctly, after everything was paid, her office sent my dental insurance the SAME EXACT bill 6 times over the course of a year after it had been paid and then told me I was responsible because the insurance never paid their part. (That's why I now go to GR8smiles on the board here.  Haven't had a single issue with his office)

[Sam1]

I'd like to see the medical system set up similar to a Firestone or NTB. Walk in and there's a big board reading the cost of all the normal services. For those with no insurance, you know exactly what you'll pay. It would also let the general public really see how much money is spent on medical care and maybe then there might be a bit of an outrage about how expensive even just a consultation really is.

 

 

You mean like Grace Pointe Healthcare? 

 

http://gracepointehealthcare.com/services/fees/

[Ugly]

Both the UK and Germany have tax rates of around 40% for the typical middle income earner. That would be a pretty steep hit for millions of people here (including me). You'd need an independent 3rd party to perform the CBA to get any sort of believable results as the healthcare folks would skew it their direction while .gov would certainly skew it their direction.





UHC.... ugh. The plans may compare but the service isn't even close. UHC hasn't been completely terrible, but I'd call them 3rd tier at best.

Germany's tax rate is stepped somehow I believe. My single neighbor was paying 69% when I left there 7 years ago.
Fed taxes here for a small business are at least 40.7%, that's if you don't make a lot of money, and it goes up incrementally.
The Aca doesn't address the problems, at all. It's a rape and pilfer scheme until it collapses.

[JRM]

I can't believe anyone believes the government can do healthcare better than any other program that they've tried. They're doing a bang up job at the VA

[blewbayou]

You mean like Grace Pointe Healthcare?

http://gracepointehealthcare.com/services/fees/

That's pretty much it. If all doctors were set up that way, one can call around and find the doctor with the best price; or most reasonable price they are willing to pay for whatever service they need. I guess the Kroger little clinic is the same idea with a very limited menu of options.

It brings competition to the medical industry. It's win win for everyone.

[peejman]

What's "middle" here?

 

For UK, I see 20% up to £42,000 counting standard deduction. Which is $60,500 USD. Higher, the 40% over that kicks in.

 

- OS

 

 

Your president seems to think that $500k is middle income....   But I would say that singles under $75k and families under $150k would be considered typical middle income these days. 

 

 

 

 

The money people are paying their HMO's every month would just be routed to taxes and not the monthly bill, so, after that amount, only the rest would be a net loss to someones disposable income. 

 

Also, there are differences in what levels of government can tax in other countries.  I think that only the federal government can tax income in Germany, with the Länder (their equivalent of our state level) having a small add on that gets collected (it amounts to only a few hundred euros difference based on location with this calculator).  Once the federal government is funded, the rest is then divided up on some kind of quota/apportionment system back to the states where they get to decide how to spend it.  Not sure how their VAT (sales tax) works. 

 

Then there are the differences in that the German/UK model is paying for a cradle to grave welfare state.  I'm not advocating for that, just better healthcare since I see it as a public interest.  People should still have to work a job for a living, and if they aren't willing to, screw them.  Either way you're looking at a different system with different taxes and services, so a direct what they pay vs. what we pay comparison is too simplistic, IMO.

 

 

Fully agree that an independent 3rd party would be needed to do any kind of CBA for all this.  Finding enough people that can do it, but don't have an agenda would be the hard part.  Both liberal and conservative think tanks would want to stack the deck on that one.

 

 

Simply re-routing healthcare premiums to taxes would be seen as a huge tax increase by most people, and thus be completely uncacceptable to everyone who's not a Bernie Sanders supporter.  They wouldn't get the idea that the money is simply going into a different bucket.

[gjohnsoniv]

Both the UK and Germany have tax rates of around 40% for the typical middle income earner. That would be a pretty steep hit for millions of people here (including me). You'd need an independent 3rd party to perform the CBA to get any sort of believable results as the healthcare folks would skew it their direction while .gov would certainly skew it their direction.





UHC.... ugh. The plans may compare but the service isn't even close. UHC hasn't been completely terrible, but I'd call them 3rd tier at best.

Ah, see I wasn't aware of that. I've been on BCBS for past 5 plus years at least. Just happened to be looking at all that the other day.

[peejman]

Ah, see I wasn't aware of that. I've been on BCBS for past 5 plus years at least. Just happened to be looking at all that the other day.

 

 

My employer switched to UHC from Aetna 4-5 years ago.  Aetna was actually pretty good.  When issues came up (typically with billing), people on the phone were generally very helpful and actually able to do what needed to be done.  UHC people, on the other hand, were typically clueless and had to be told, step by step, how to fix whatever the problem was.  They've gotten better over the past few years, but the improvement gets them to average at best.

 

The biggest issue I've had is billing cycles.  Most providers seem to be on a 30-45 day billing cycle, while UHC seems to be on a 60-90 day payment cycle.  So basically, I end up getting bills in the mail for stuff UHC is supposed to have paid weeks prior.  So you look up the claims on the web and UHC says they paid it.  So you call the provider and they say no they haven't.  Iterate ad nasuem.   At the end of the day, I basically just ignore any bill I get from a provider that doesn't say something like 3rd or final notice or have a big red PAST DUE stamp on it.  And I hate that.