OT: Healthcare

FormerBully

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Sep 2, 2022
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I do not want this to get locked, but I really would love some input. I had to take my wife and kids off my work insurance this year because the cost more than doubled. We were looking at around $15,000 a year if they stayed. I ended up finding a plan we pay out of pocket for around $550 a month. It was through the marketplace, and we got a discount because she stays at home. We are paying a little more for bills under their new insurance, but the issue is that people are starting to reject our insurance. We have been waiting for an appointment for my son for two months, which is today, but on Friday, they called to say they will no longer accept his insurance. Also, my daughter had an ER trip early this year in the middle of the night, and we have gotten crazy bills from five different people. Last year, with my insurance, we had the same issue when I was in the hospital, with getting sent bills from 8 different companies. We will save a little this year, but we will still be close to paying the same amount. How do we fix healthcare in this country, because I do not think good health insurance exists?

I know a good number of people who have lived in Canada and in England/Europe. I honestly think we would be better off with their system. I get people arguing against it because of wait times, but my wife had back issues, and we were required to do two months of rehab, plus two more months of waiting for a doctors appointment before she could get X-rays. Also, as I shared, my son has had to wait two months for his appointment.

As I stated at the start of this thread, I do not want this thread locked. I know this is a sports board, but we have a lot of people here who offer good advice. I just need to know if there is a better way, because I just got word that my healthcare costs are likely to go up again next year, and I am looking at a big pile of bills. I have even considered a part-time job on the side, plus my wife is looking to go back to work. What can we do?
 

DoggieDaddy13

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Dec 23, 2017
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I'm sorry, man. It is a mess and the care is so different depending on who you are paying and where you live. I have a small host of employees and providing health insurance for them is a joke. I am at a loss for why an employer has to in anyway be responsible for an individual and their families healthcare. But that is the system we live under.

And while we all foot the bill on some level, healthcare is one of the most profitable industries in the U.S. and the limited subsidy system we have only ensures that the industry stays profitable - good healthcare is a 17n luxury most of us cannot afford.

But hopefully the discussion will center around something more practical we can do other than the "communist plot" for universal healthcare.

LOCK IT!
 
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dorndawg

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Sep 10, 2012
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We shot ourselves in the foot when it comes to healthcare. The rent-seekers ran amok and now we have a huge percentage of our economy (it used to be about 1/6, not sure where that is today) tied up in it. Even if we switched to a better, cheaper, sane single-payer system today, the reverberations would be economically catastrophic. In short, we prioritize capital over humans.

I really feel for you OP and the millions of others who are getting ground up by this machine. I hope one day we will do better.
 

Maroon Eagle

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May 24, 2006
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If insurance is a dog, mine is a mutt…

Facilitated by PERS + Current Employer + Paid out of pocket by myself…
 

patdog

Heisman
May 28, 2007
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I'm sorry, man. It is a mess and the care is so different depending on who you are paying and where you live. I have a small host of employees and providing health insurance for them is a joke. I am at a loss for why an employer has to in anyway be responsible for an individual and their families healthcare. But that is the system we live under.

And while we all foot the bill on some level, healthcare is one of the most profitable industries in the U.S. and the limited subsidy system we have only ensures that the industry stays profitable - good healthcare is a 17n luxury most of us cannot afford.

But hopefully the discussion will center around something more practical we can do other than the "universal healthcare communist" plot.

LOCK IT!
Employer health insurance started because of wage freeze in WWII. Employers couldn't offer employees more money, but they could offer a health insurance fringe benefit. But yeah, it's ridiculous that your employer chooses your health insurance for you and pays for it (or at least part of it).
 

FormerBully

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Sep 2, 2022
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I'm sorry, man. It is a mess and the care is so different depending on who you are paying and where you live. I have a small host of employees and providing health insurance for them is a joke. I am at a loss for why an employer has to in anyway be responsible for an individual and their families healthcare. But that is the system we live under.

And while we all foot the bill on some level, healthcare is one of the most profitable industries in the U.S. and the limited subsidy system we have only ensures that the industry stays profitable - good healthcare is a 17n luxury most of us cannot afford.

But hopefully the discussion will center around something more practical we can do other than the "universal healthcare communist" plot.

LOCK IT!
I brought up England because my friend was a missionary there and broke his leg. He was treated the same day and never saw a bill. Also, he had a church member who was diagnosed with cancer. She never saw a bill and was treated well. She actually beat it by the grace of God. How is this worse than what we have here?
 

mstateglfr

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Feb 24, 2008
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I just need to know if there is a better way...
There isnt just one better way, there are multiple better ways.

Below are a couple clips about what are some of the problems, but they are by no means all of the problems.

- One big problem is 4 of 6 large insurance companies(video) also own pharmacies, own medical practices, are Pharmacy Benefit Managers, AND are publicly traded(duty to maximize shareholder value).
When 4 massive companies make money managing health insurance and influence pricing at the Dr office, pricing at the pharmacy, and have a duty to maximize shareholder profit...health insurance users are not the priority.

- And when there is 0 internal penalty or repercussion for denying claims that should be approved, there is 0 incentive to change and improve the system for users.

- Tethering health insurance to employment hurts worker movement, which has a negative side effect of suppressing wages and family wealth growth in some instances.

Again, I recognize these are just part of a very large and complex problem.

 
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FormerBully

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Sep 2, 2022
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There isnt just one better way, there are multiple better ways.

Below are a couple clips about what are some of the problems, but they are by no means all of the problems.

- One big problem- 4 of 6 of the largest insurance companies also own pharmacies, own medical practices, are Pharmacy Benefit Managers, AND are publicly traded(duty to maximize shareholder value).
When 4 massive companies make money managing health insurance and influence pricing at the Dr office, pricing at the pharmacy, and have a duty to maximize shareholder profit...health insurance users are not the priority.

- And when there is 0 internal penalty or repercussion for denying claims that should be approved, there is 0 incentive to change and improve the system for users.

Again, I recognize these are just part of a very large and complex problem.

I completely agree. Also, Obamacare has been a major issue, but not the only one. I am a libertarian for the most part, but healthcare is one area I struggle to see the right answer. Something that impacted me in a major way happened after the birth of my firstborn. My wife worked for the OBGYN clinic, and we basically had our first child for free. $1,500 for everything. I went to pay, and there was a guy I knew from my time at State who was also paying. He was in tears, and I walked over to check on him. he said, "Everyone is pro-life until the baby is born. I do not know how I am going to pay for my child." The guy worked hard at a good job, btw. That quote hit me hard, and I honestly think baby births should be free, but that is me.
 

stateu1

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Mar 21, 2016
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Talk to an independent insurance agent and look for a high deductible plan with Golden Rule or somebody. You will make up for the out of pocket with the premium savings. I got priced out of my group plan years ago and have come out way ahead.
ETA I have never been turned away.
 
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horshack.sixpack

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Oct 30, 2012
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I do not want this to get locked, but I really would love some input. I had to take my wife and kids off my work insurance this year because the cost more than doubled. We were looking at around $15,000 a year if they stayed. I ended up finding a plan we pay out of pocket for around $550 a month. It was through the marketplace, and we got a discount because she stays at home. We are paying a little more for bills under their new insurance, but the issue is that people are starting to reject our insurance. We have been waiting for an appointment for my son for two months, which is today, but on Friday, they called to say they will no longer accept his insurance. Also, my daughter had an ER trip early this year in the middle of the night, and we have gotten crazy bills from five different people. Last year, with my insurance, we had the same issue when I was in the hospital, with getting sent bills from 8 different companies. We will save a little this year, but we will still be close to paying the same amount. How do we fix healthcare in this country, because I do not think good health insurance exists?

I know a good number of people who have lived in Canada and in England/Europe. I honestly think we would be better off with their system. I get people arguing against it because of wait times, but my wife had back issues, and we were required to do two months of rehab, plus two more months of waiting for a doctors appointment before she could get X-rays. Also, as I shared, my son has had to wait two months for his appointment.

As I stated at the start of this thread, I do not want this thread locked. I know this is a sports board, but we have a lot of people here who offer good advice. I just need to know if there is a better way, because I just got word that my healthcare costs are likely to go up again next year, and I am looking at a big pile of bills. I have even considered a part-time job on the side, plus my wife is looking to go back to work. What can we do?
Our system is cooked but I don't think there are any easy answers. The fact that our healthcare is coupled to employment is problematic. Universal coverage is the norm in a lot of places and the taxes to support that are not politically feasible in the US. Germany has a pretty solid system where coverage is mandatory but employers and employees provide funding (not dissimilar to the US), BUT the coverage is tied to the individual, so when you change jobs, it follows.

ETA: One thing that I believe is constant in the world is that when it comes to legal and healthcare situations, if you have money, you generally fare way better.
 

dorndawg

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Sep 10, 2012
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Our system is cooked but I don't think there are any easy answers. The fact that our healthcare is coupled to employment is problematic. Universal coverage is the norm in a lot of places and the taxes to support that are not politically feasible in the US. Germany has a pretty solid system where coverage is mandatory but employers and employees provide funding (not dissimilar to the US), BUT the coverage is tied to the individual, so when you change jobs, it follows.

ETA: One thing that I believe is constant in the world is that when it comes to legal and healthcare situations, if you have money, you generally fare way better.
I wonder how many people stay at jobs that hold them back, only for the healthcare?

I wonder how much that holds back entrepreneurship, growth, and freedom?
 

patdog

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May 28, 2007
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I completely agree. Also, Obamacare has been a major issue, but not the only one. I am a libertarian for the most part, but healthcare is one area I struggle to see the right answer. Something that impacted me in a major way happened after the birth of my firstborn. My wife worked for the OBGYN clinic, and we basically had our first child for free. $1,500 for everything. I went to pay, and there was a guy I knew from my time at State who was also paying. He was in tears, and I walked over to check on him. he said, "Everyone is pro-life until the baby is born. I do not know how I am going to pay for my child." The guy worked hard at a good job, btw. That quote hit me hard, and I honestly think baby births should be free, but that is me.
The one good thing Obamacare did was allow anyone to get health insurance. One of the bad things is it's usually sh*tty coverage with sky high deductible.
 

HailStout

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Jan 4, 2020
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You think you guys hate it? I spend all day fighting uphill with insurance companies who refuse to pay for my patient’s medications or needed studies. The system is broken. The problem is that capitalism and healthcare don’t mix. The other option is to give control to the federal government. That’s a hard no for me.

By far one of the biggest problems is the amount of money we spend in end of life care. And I mean literally end of life.
 

615dawg

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Jun 4, 2007
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I do not want this to get locked, but I really would love some input. I had to take my wife and kids off my work insurance this year because the cost more than doubled. We were looking at around $15,000 a year if they stayed. I ended up finding a plan we pay out of pocket for around $550 a month. It was through the marketplace, and we got a discount because she stays at home. We are paying a little more for bills under their new insurance, but the issue is that people are starting to reject our insurance. We have been waiting for an appointment for my son for two months, which is today, but on Friday, they called to say they will no longer accept his insurance. Also, my daughter had an ER trip early this year in the middle of the night, and we have gotten crazy bills from five different people. Last year, with my insurance, we had the same issue when I was in the hospital, with getting sent bills from 8 different companies. We will save a little this year, but we will still be close to paying the same amount. How do we fix healthcare in this country, because I do not think good health insurance exists?

I know a good number of people who have lived in Canada and in England/Europe. I honestly think we would be better off with their system. I get people arguing against it because of wait times, but my wife had back issues, and we were required to do two months of rehab, plus two more months of waiting for a doctors appointment before she could get X-rays. Also, as I shared, my son has had to wait two months for his appointment.

As I stated at the start of this thread, I do not want this thread locked. I know this is a sports board, but we have a lot of people here who offer good advice. I just need to know if there is a better way, because I just got word that my healthcare costs are likely to go up again next year, and I am looking at a big pile of bills. I have even considered a part-time job on the side, plus my wife is looking to go back to work. What can we do?
Oh goodness. I'm sorry for what you are going through. Pat and I share the same thoughts - the American healthcare system is a cluster17 and while socialized healthcare seems better, its not the answer. We need a complete and total overhaul.
 

patdog

Heisman
May 28, 2007
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Talk to an independent insurance agent and look for a high deductible plan with Golden Rule or somebody. You will make up for the out of pocket with the premium savings. I got priced out of my group plan years ago and have come out way ahead.
ETA I have never been turned away.
Be very careful with companies like Golden Rule. Cheap premiums, but good luck if you need them to pay a big claim.
 

johnson86-1

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Aug 22, 2012
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I do not want this to get locked, but I really would love some input. I had to take my wife and kids off my work insurance this year because the cost more than doubled. We were looking at around $15,000 a year if they stayed. I ended up finding a plan we pay out of pocket for around $550 a month. It was through the marketplace, and we got a discount because she stays at home. We are paying a little more for bills under their new insurance, but the issue is that people are starting to reject our insurance. We have been waiting for an appointment for my son for two months, which is today, but on Friday, they called to say they will no longer accept his insurance. Also, my daughter had an ER trip early this year in the middle of the night, and we have gotten crazy bills from five different people. Last year, with my insurance, we had the same issue when I was in the hospital, with getting sent bills from 8 different companies. We will save a little this year, but we will still be close to paying the same amount. How do we fix healthcare in this country, because I do not think good health insurance exists?

I know a good number of people who have lived in Canada and in England/Europe. I honestly think we would be better off with their system. I get people arguing against it because of wait times, but my wife had back issues, and we were required to do two months of rehab, plus two more months of waiting for a doctors appointment before she could get X-rays. Also, as I shared, my son has had to wait two months for his appointment.

As I stated at the start of this thread, I do not want this thread locked. I know this is a sports board, but we have a lot of people here who offer good advice. I just need to know if there is a better way, because I just got word that my healthcare costs are likely to go up again next year, and I am looking at a big pile of bills. I have even considered a part-time job on the side, plus my wife is looking to go back to work. What can we do?
We would be better off with something approaching a free market in healthcare than what we have now. But we would probably be better off with socialized medicine than what we have now, even if we wouldn't be as well off as if we let the market work like it does for every other 17ing thing. I don't think most people would like the service they get with the equivalent of medicaid (which is what we'd end up with; we can't do medicare for everybody financially), which is basically what you're dealing with now. You've got insurance, but they apparently have put provider reimbursements so low, or created enough of a reputation for headache, that providers just won't deal with it. But, the relative simplicity if we just had medicaid for all would probably be better and it would allow for a market based healthcare beyond the basic medicaid level.


Some things we could do that would not help much in the short term but would help address the stranglehold we put on supply and put some downward pressure on costs over time (if we could overcome the lobbying by the special interests involved that is; this wouldn't necessarily be politically doable but would be easier than moving to socialized medicine or free markets):

- Fund way more residencies;
- Allow foreign doctors from 1st world countries to take boards and practice without having to go back through residencies
- Reduce medicare/medicaid reimbursements in states that don't allow nurse practitioners to practice without supervision


Some things that might not reduce costs but would help reduce frustrations: Billing must be consolidated through the healthcare facility. No receiving separate bills from the hospital, the contracted docctor's group, the contracted anesthesiology group, the contracted radiology group, lab company, etc. That's 17ing ridiculous. If you are getting service at a hospital, the hospital should bill for everything and everythign should either be in network or not.
 

horshack.sixpack

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I wonder how many people stay at jobs that hold them back, only for the healthcare?

I wonder how much that holds back entrepreneurship, growth, and freedom?
It is certainly a primary consideration. If we could get it decoupled from employers, it would certainly have an opportunity to benefit from scale and coverage. The insurance lobby is not going to go down easily even if a good idea is presented. At present they love the fact that the current system:

  • It artificially lowers the price of insurance vs. individual plans
  • Keeps millions of customers in private plans instead of public options
  • Creates a government-subsidized customer base without looking like a program
  • They can provide very crappy customer service, hiding behind a corporation
  • They can target businesses and substantially lower the cost of acquiring business because they don't have to deal directly with consumers. Think about how much margin they give up to agents for Auto/Home. They don't do that for healthcare. Get one big company, get hundreds/thousands of people auto-enrolled. Just look at what they spend marketing for auto/home, etc. (Cavemen, lizards, ostriches, etc.)
 
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BioChemDawg

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Nov 10, 2016
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You think you guys hate it? I spend all day fighting uphill with insurance companies who refuse to pay for my patient’s medications or needed studies. The system is broken. The problem is that capitalism and healthcare don’t mix. The other option is to give control to the federal government. That’s a hard no for me.

By far one of the biggest problems is the amount of money we spend in end of life care. And I mean literally end of life.
Was just thinking this. It’s miserable to deal with on the provider side as well.
 

FormerBully

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Some things that might not reduce costs but would help reduce frustrations: Billing must be consolidated through the healthcare facility. No receiving separate bills from the hospital, the contracted docctor's group, the contracted anesthesiology group, the contracted radiology group, lab company, etc. That's 17ing ridiculous. If you are getting service at a hospital, the hospital should bill for everything and everythign should either be in network or not.
This is a major issue. One reason care costs so much is the number of administrative staff we have. Five different bills means 20 to 30 more people that I am paying for.
 
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patdog

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You think you guys hate it? I spend all day fighting uphill with insurance companies who refuse to pay for my patient’s medications or needed studies. The system is broken. The problem is that capitalism and healthcare don’t mix. The other option is to give control to the federal government. That’s a hard no for me.

By far one of the biggest problems is the amount of money we spend in end of life care. And I mean literally end of life.
We can easily spend $500,000 to keep someone barely alive for 3 months.
 
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patdog

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My limited understanding is that they are not always regulated like other traditional insurances.
They're not. They structure their policies to be "short-term" insurance, which gets them out of most regulations. Like a lot of things you get what you pay for. And super cheap premiums is usually really bad insurance.
 
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thatsbaseball

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FWIW not complaining but as a reference point wife and I pay $972 / mo for Medicare and supplements . I can't remember what they are but deductibles are much cheaper than private insurance .
 

FormerBully

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Sep 2, 2022
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You think you guys hate it? I spend all day fighting uphill with insurance companies who refuse to pay for my patient’s medications or needed studies. The system is broken. The problem is that capitalism and healthcare don’t mix. The other option is to give control to the federal government. That’s a hard no for me.

By far one of the biggest problems is the amount of money we spend in end of life care. And I mean literally end of life.
End-of-life care is a major issue. I get that people want Granny to make it 5 more months, but she has been around 98 years. It is time to go.
 

Perd Hapley

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The only ultimate solution is to completely untether health care from profitability / capitalism. It’s a lot easier said than done.
It’s also important that I’m noting profitability / capitalism, and NOT the salary earned by highly trained and educated medical professionals. Caregivers should be paid competitively for their field. Where it gets bonkers is when you see basically educated individuals with a bachelor’s in general business administration that end up making $900k per year or more (legitimately more than many doctors) from medical / pharmaceutical sales. Products that essentially sell themselves.

Ultimately, it is my belief that the amount of government regulation and oversight needed for anything is directly proportional to the extent that people need the good or service. The greater the need, the more ripe for extortion the consumer is.

Everybody needs healthcare, at some point. Affordable health care at 21st century standard is a basic human right in any first world country. There is no greater need for the population.

I don’t know what the answer is, but there’s got to be cuts made elsewhere, and a lot of them, to support a transition to something that is either regulated or fully administered to the extent necessary to protect the health care consumers. There are also going to be a lot of people that need to check their pride and their historical idealogy to support a change. The problem has grown big enough that it absolutely is going to begin stifling growth in every other sector of the economy, very soon.
 

johnson86-1

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You think you guys hate it? I spend all day fighting uphill with insurance companies who refuse to pay for my patient’s medications or needed studies. The system is broken. The problem is that capitalism and healthcare don’t mix. The other option is to give control to the federal government. That’s a hard no for me.

We haven't really tried this in a long time. We restrict the hell out of supply and then subsidize demand. There are unique parts of healthcare that are probably required politically that we would have trouble addressing without some market distortion, but plenty of markets operate with a lot of government distortion. It just can't be to the extent that we do it now.

But generally Capitalism and healthcare is fine. Even within the 17ed up incentives of todays system, you can look at Oklahoma Surgery Center for an example of how it can work.

By far one of the biggest problems is the amount of money we spend in end of life care. And I mean literally end of life.
This is largely a problem with having a third party payment system and the politics involved. You wouldn't see 80 years olds run up high six figures of costs in the last month of their life if it meant that they didn't get to leave their house to their children. But if you saw elderly people essentially trading in their home in order to receive hundreds of thousands of dollars of care, people would lose their ****.
 
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horshack.sixpack

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We would be better off with something approaching a free market in healthcare than what we have now. But we would probably be better off with socialized medicine than what we have now, even if we wouldn't be as well off as if we let the market work like it does for every other 17ing thing. I don't think most people would like the service they get with the equivalent of medicaid (which is what we'd end up with; we can't do medicare for everybody financially), which is basically what you're dealing with now. You've got insurance, but they apparently have put provider reimbursements so low, or created enough of a reputation for headache, that providers just won't deal with it. But, the relative simplicity if we just had medicaid for all would probably be better and it would allow for a market based healthcare beyond the basic medicaid level.


Some things we could do that would not help much in the short term but would help address the stranglehold we put on supply and put some downward pressure on costs over time (if we could overcome the lobbying by the special interests involved that is; this wouldn't necessarily be politically doable but would be easier than moving to socialized medicine or free markets):

- Fund way more residencies;
- Allow foreign doctors from 1st world countries to take boards and practice without having to go back through residencies
- Reduce medicare/medicaid reimbursements in states that don't allow nurse practitioners to practice without supervision


Some things that might not reduce costs but would help reduce frustrations: Billing must be consolidated through the healthcare facility. No receiving separate bills from the hospital, the contracted docctor's group, the contracted anesthesiology group, the contracted radiology group, lab company, etc. That's 17ing ridiculous. If you are getting service at a hospital, the hospital should bill for everything and everythign should either be in network or not.
Many people are staunchly against funding any social safety nets but change their tune when they realize how bad Medicare is and they are under it as a senior adult. Heck, even with "good" healthcare I had a foot issue that required I visit doc->xray->doc says we will need a MRI but before we can do that I have to do PT for 3 months->PT doesn't help->MRI finds tumor(benign thankfully). that could have gone sideways if it had been not been benign
 
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L4Dawg

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I brought up England because my friend was a missionary there and broke his leg. He was treated the same day and never saw a bill. Also, he had a church member who was diagnosed with cancer. She never saw a bill and was treated well. She actually beat it by the grace of God. How is this worse than what we have here?
It still has to be paid for, and rationed. They just do it different than we do. They do it by rationing slots for treatment. If you need non-emergency treatment you will wait, a LONG time in some cases. No country on earth does everything for everyone.
 

johnson86-1

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Many people are staunchly against funding any social safety nets but change their tune when they realize how bad Medicare is and they are under it as a senior adult. Heck, even with "good" healthcare I had a foot issue that required I visit doc->xray->doc says we will need a MRI but before we can do that I have to do PT for 3 months->PT doesn't help->MRI finds tumor(benign thankfully). that could have gone sideways if it had been not been benign
To what extent you want to fund a social safety net is separate from the question of whether you want to foul up the healthcare market by making 90%+ of funding get filtered through third party payments, whether you want to severely restrict supply, whether you want to subsidize demand, etc.. You could have a means tested social safety net and also have a functioning healthcare market.

Also not sure that medicare, which serves a lot of people that are richer than average, is a "social safety net".
 
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L4Dawg

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You think you guys hate it? I spend all day fighting uphill with insurance companies who refuse to pay for my patient’s medications or needed studies. The system is broken. The problem is that capitalism and healthcare don’t mix. The other option is to give control to the federal government. That’s a hard no for me.

By far one of the biggest problems is the amount of money we spend in end of life care. And I mean literally end of life.
Yep
 

L4Dawg

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If you follow any British local media, you will see articles periodically about how broken the NHS is. They struggle with many of the same issues we do, and they have their own. The real problem everywhere basically boils down to expectations vs reality. When it comes to healthcare, everyone wants everything at a cheap or non-existent price. That just isn't possible anywhere, nor will it ever be. State-of-the Art healthcare is EXPENSIVE. The start of any fix has to be a realistic and honest debate about what is possible vs what possible costs. We have NEVER done that in this country.
 
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HailStout

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If you follow any British local media, you will see articles periodically about how broken the NHS is. They struggle with many of the same issues we do, and they have their own. The real problem everywhere basically boils down to expectations vs reality. When it comes to healthcare, everyone wants everything at a cheap or non-existent price. That just isn't possible anywhere, nor will it ever be. State-of-the Art healthcare is EXPENSIVE. The start of any fix has to be a realistic and honest debate about what is possible vs what possible costs. We have NEVER done that in this country.
This. 100% this.
 
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615dawg

All-Conference
Jun 4, 2007
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Honestly, when that time comes for me, I want them to pull the plug so the damn Drs and hospitals don't wipe me out financially and I can leave something to my heirs.
I watched my in-laws drain everything they had coming to keep a parent alive for three more weeks. I have already told my wife and kids not to do that.
 
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