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Nimrod2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:06 AM
Original message
Our healthcare system vs. them Socialists'?
What is the exact complaint righties have against having healthcare coverage available to all people?

They always say you should see Canada's problems, have you tried to go to the doctor in France or Germany...etc.? you have to wait...etc.?

I happen to be sick today, fever, caugh...etc. So I went to the Doctor's office unannounced!!!

Waited 1 hour and 40 minutes to be told the doctor can't see me right away. So I told them I had to leave and they should call me for an appointment today, they have called twice, one time they gave me a time, then called few minutes later to say that while she was on the phone with me, someone else scheduled another person in that spot...etc.

My experience today is not unusual, the office is always full of people, ALL visits run more than the 15 minutes they allocate, so you're in there for hours no matter what...etc.

IT IS FOR PROFIT FOLKS, THEIR PROFITS, HOSPITALS' PROFITS & INSURANCE COMPANIES' PROFITS. Large hospital companies own and operate smaller doctor's offices, and I know they underpay the Docs too...

I have an outstanding insurance policy, I have money for copays, live in a good area...etc. But can't honestly say we have the best of the best!!! And I Pay serious bucks to have what I have!

I have family in more than one European country, I can't say we have it better than they do, and guess what? they never ever complain and it is always FREE for them!!!


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Astrad Donating Member (374 posts) Send PM | Profile | Ignore Mon Jul-10-06 10:12 AM
Response to Original message
1. It's not 'free' we pay for it through taxes. n/t
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unpossibles Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:14 AM
Response to Reply #1
2. but I think the point is that we both are paying for it
we pay through our insurance premiums and copays and whatnot - not only is it not cheap, but it's a huge headache to figure out what doctor is in your plan, etc.
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fordnut Donating Member (207 posts) Send PM | Profile | Ignore Mon Jul-10-06 01:07 PM
Response to Reply #2
20. Insurance
Insuance companies,drug companies and doctors Make huge proffits,so why would they want to change anything.
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leftofthedial Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:25 AM
Response to Reply #1
5. you pay much less
Americans pay much more for healthcare than any other country

and the quality of care, even for those with insurance, is atrocious and getting worse every day.

and 50 million or more of us have no insurance.
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lumberjack_jeff Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:25 AM
Response to Reply #1
6. Funny thing is we pay about the same through our taxes
Through medicare, medicaid and VA hospitals we pay about as much toward health care through taxes as europe.

In other words, get rid of insurance companies and we can provide medical care for what we're already paying.
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Nimrod2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:52 AM
Response to Reply #6
10. Bingo, YES!
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Nimrod2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:51 AM
Response to Reply #1
9. I know, I pay taxes here, then I pay from after tax wages for this crap!!!
That's exactly my point, can I trade what I have in for what you have?
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Dutch Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 01:25 PM
Response to Reply #1
30. And I for one am f*cking glad to do so!
(I live in the UK).
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rman Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 01:34 PM
Response to Reply #1
31. That way we share the cost evenly
Shared and collective responsibility for the well-being of the members of society. It's good for society, and by extension good for all its members.
Neat trick, ain't it.


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BuddyYoung Donating Member (455 posts) Send PM | Profile | Ignore Mon Jul-10-06 10:19 AM
Response to Original message
3. More competition throughout the healthcare industry/professions would
help a lot. Most rich people are extremely selfish, greedy, and anti-democracy. They obviously do not "believe" in even the most basic tenets of most religions. Their goal is more monetary "healthcare" for them, but paid by you and me, dispursed by their puppets in Congress.

It would help if there were more doctors, nurses, and so on.
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Sir Jeffrey Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:28 AM
Response to Reply #3
16. More competition is not the answer...
You will still have the free market deciding prices which is why we are at this breaking point now.

The answer is a single system throughout the US that covers everybody, is funded through taxes, and that eliminates the need for private insurance completely. Once you get the govt involved, you can control prices by either having the govt pay after delivery of care (single payer like Canada) or before delivery of care (NHS in the UK). Either system would work here and would operate at half the cost that our system works.

Introducing more free market principles into our situation will only make it worse. The "more competition/free market" effect would be the same as it has been up to now: drive competitiors to deny coverage whenever possible to cut costs.

I agree with you about the need for more doctors, nurses, etc. I think if we allowed students to go directly into med school without needing a bachelors that would solve a lot of the problems...but I haven't seen any data on that. I'm just speculating.
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BrownOak Donating Member (391 posts) Send PM | Profile | Ignore Mon Jul-10-06 05:17 PM
Response to Reply #16
23. A true free market would certainly work
But the problem is that under the existing structure there is no free market, regardless of how many insurance companies you bring into the mix. The truth is that the cost of healthcare is controlled primarily by the CUBA's - that's Cigna, United, Blue Cross/Blue Shield, and Aetna. Depending upon where you live one of those guys will be the big player in your market and has the ability to dictate their pay structure to the providers.

Looking at it from 30,000 feet, the cost of medical care comes down to two things; the cost of the services provided and the administrative overhead to deliver those services. The game that the CUBAs play is to use their size to dictate their prices for services from your local providers. Read your newspaper's health section and once every 6 months you'll come across an article talking about how one of the CUBAs in your area has been dropped as an approved carrier at one of the major hospitals in your area. That's when the negotiations have become nasty and one side (depending upon who made the press release first) is trying to use the public to influence the other side. If it's the hospital, they want the insurance participants to flood the carrier with frantic phone calls about needing to be able to see their doctor at Sisters of Whateverthehellthenameis. If it's from the carrier, they want the public to call the hospital and let them know just how big that carrier is.

At the end of the day what happens is the insurance company forces a number on the medical provider that they can live with, but just barely. The insurance company then takes and marks up the costs of their administrative services to the point where the premium that they charge isn't substantially different than what the lesser known carriers would be able to do. The difference is that those other carriers are charging a fourth to a half as much on the admin side but, lacking the bulk of the big boys, don't have as sweet a deal with the provider. So if the little guy looks at a group and calculates that with his discounts, the cost of the claims would be 1.8M and then calculates $200K for his admin services, he's looking at a total cost of $2.0M. Then the big carrier walks in, uses his PPO contract to get those same claims for $1.5M, and then charges $400K for his admin services. He sells a product that is more cost competitive and just adds to his size and ability to dictate prices further in the future.

The way it's set up now the system allows the big carriers to get bigger while at the same time increasing premiums and giving everyone the lovely side effect of sending you off to see doctors who now have no choice but to see patients as quickly as possible in order to stay afloat.

Fixing all of that is so simple it would take about 2 freakin' minutes. Eliminate the PPO arrangements out there. Let any hospital and provider set whatever price they want for their services with the understanding that the price the pick goes to everyone - uninsured, insured with a big carrier, insured with a small carrier, or insured through the government.

This puts everyone on the same field which means that the insurance companies are now competing on the actual service they provide - the administration of claims - rather than on how much they can strong arm providers.
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rman Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 01:43 PM
Response to Reply #23
32. If you mean "free" as in "unregulated",
Than "free" means only that it's officially allowed to do anything to improve the bottom line; there wouldn't be any laws to break. No oversight, no safety rules, no environmental regulations, etc - all those just obstruct the free market.

Aside from that, there's a paradox with competition:
Competition tends to eliminate competition, which leads to monopoly, which is the complete absence of competition; the opposite of competition.
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BrownOak Donating Member (391 posts) Send PM | Profile | Ignore Tue Jul-11-06 11:42 PM
Response to Reply #32
35. Obviously you would still need regulations regarding patient care
The free market we don't have right now is that providers have been strong armed into selling their services at barely profitable levels to the major carriers. It's not something they want to do, but walking away from 75%+ of the potential patients in a given market isn't something most providers are interested in doing.

The point here is that we have an oligopoly right now which is why the system is so flawed. The problem is that the people making the money in the system aren't the ones providing the service. Most physician practices have seen their margins erode even while the cost of treatment has increased. The disconnect in that scenario is account for by the fact that the major carriers can control the price of the service.

Again, all that really needs to be done is to stop the providers from selling their services to one carrier at preferable rates - rates that the end user doesn't see because of the way the insurance game is played. If all insurance companies it forces them to compete on the services they actually provide rather than their ability to leverage the providers into contracts that hurt their ability to provide quality care.
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islandspirit Donating Member (28 posts) Send PM | Profile | Ignore Mon Jul-10-06 12:00 PM
Response to Reply #3
18. Healthcare is SO broken here
It truly is the market forces infrastructure that the US has versus all other western countries (except SAfrica). All versions of 'single payer' are in place everywhere else.
Americans are just not yet able to embrace the idea/concept/notion that everyone's on the same level playing field. People still want to have something that others can't have - one-upmanship?
Our family of 5 moved from Toronto 22 years ago - i made sure my husband's health insurance would be comparable to what we were leaving before i got on a plane with 3 young children. But today we pay our own (his job sent to India) $458 for bare bones coverage & high high dedubtible - if anything really happens to one of us, we move back to Canada. Our daughters in their 20's would never get coverage without an employer or being a student as they each have puny deniable problems according to Blue Cross & others.
Oh.........and yes the wait times in Canada - extremely long according to the insurance industry there. My father's hip replacement last year - he was on the list for a very long 3 weeks - he was 81.
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napi21 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:21 AM
Response to Original message
4. Many people from Canada have posted here on DU that the only
long waits are for elective surgery, and things that CAN wait. If there is some emergency, you're taken care of right away. Maybe some will even respond to this thread.

I believe it's the profits too! My son has been living and working in Sicily for 3 1/5 years. He told me doctors in Europe don't earn anywhere close to what they earn in the States. Taxes in Italy are much higher than they are in the US, BUT, there's no charge for health care, EVERYBODY gets a reasonably comfortable pension so they can retire before age 65 too, if I'm not mistaken, they also maintain their infrastructure much better than we do.

It's a trade off for sure. Depends on what the majority really want!
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Spazito Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:25 AM
Response to Reply #4
15. I have always been able to receive treatment in a timely manner
and I used to pay $56.00 a month for my health insurance. I recently moved to another province and my cost is now $49.00 a month.

I, too, believe the medical insurance companies control your congress through lobbyists/political contributions and that is why universal healthcare is always defeated at the discussion stage, never mind the legislative stage. It is very sad, imo.
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u4ic Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:55 AM
Response to Reply #15
46. Spazito -
did they have something akin to the Medicentres in BC? An alternative to emergency if you couldn't be fit in to your doc immediately; or when they are closed?

I should point out to others on the board that there are full and partial subsidies for those with low incomes. For example, I'm on disability, and I pay nothing for my health coverage. Minimum wage workers would at the very least have partial subsidy.

Also to point out, it's not just doctors and surgeries that are covered - here in Alberta, physiotherapists (mine does acupuncture, too) are fully covered up to a certain number of visits (if you need more visits and are low income, the physiotherapist makes a request, and is usually granted, an extension (again, for free).

It also includes partial subsidy for chiropractic appointments. Gov't pays $13 for every visit, and I pay $22; I think I get about 15 or 16 visits during the year at the subsidized rate.

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Tyler Durden Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:32 AM
Response to Reply #4
17. The majority wants what the assholes on TV TELL them
With no fairness doctrine to insure news isn't propaganda, with no public service requirement on network and cable channels, with people told that four "Friends" can work at coffee shops and live in what amounts to a $5000/month apartment...

Delusion is mass spoon-fed. Why does it shock anyone that delusional beliefs are closely held?
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LSK Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 11:46 PM
Response to Reply #4
37. trade off??? what exactly is the trade off???
Edited on Tue Jul-11-06 11:46 PM by LSK
What is bad about their system?? What is better about ours?
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Selatius Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 11:59 PM
Response to Reply #37
38. The trade-off is this:
Edited on Wed Jul-12-06 12:03 AM by Selatius
High tax, high service government vs. low tax, low service government

Don't want to pay any taxes? You get no roads, railroads, schools, the power grid, or anything built by taxpayer dollars. Willing to pay taxes? You get all of that and more if you want it. That's the trade-off. It's a decision each and every American must make with respect to where they want the government to go, and with respect to health care, most have already decided it's a trade-off that's worth the price in higher taxes, but folks like Dennis Kucinich say it could be done without raising taxes.

The pre-requisite is that you must have a competent civil service that is efficient and avoids bloat and that you have a very powerful mechanism to fight government corruption and incompetence and graft to avoid things like embezzlement of taxpayer funds.
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LSK Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:03 AM
Response to Reply #38
39. we have low taxes? how long will that last with our deficit???
In addition, what do we get for our taxes??? Not nearly what they get in other countries.
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Selatius Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:17 AM
Response to Reply #39
41. Yes, if you mean "we" as in corporations.
Edited on Wed Jul-12-06 12:21 AM by Selatius
You pay more percentage wise in taxes than most corporations do. I am almost certain of it after the GAO released its findings. Unless I am talking to one of several thousand immortal beings called corporations that enjoy many of the same rights that flesh-and-blood humans have, I can only assume you are a mere mortal like me.

http://www.boston.com/business/globe/articles/2004/04/11/most_us_firms_paid_no_income_taxes_in_90s/

You pay a lot of taxes, but you get none of that, which seems to contradict my post, doesn't it? Well, it doesn't because there are prerequisites I specifically listed, and one of them is a government free from corruption, incompetence, and graft.

We don't have that.
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Quantess Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:25 AM
Response to Reply #39
43. Do we have high taxes compared with other countries who get more?
I haven't heard that. However, dollar for dollar, I wouldn't be surprised if we're getting ripped off. Definitely, the spending priorities are misplaced.
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LSK Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:44 AM
Response to Reply #43
45. if we actually paid for what we spent, what would our taxes be??
Doesnt the EU have a restriction on how much of a deficit a country can have in a year?
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Quantess Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:17 AM
Response to Reply #38
40. I agree with Kucinich, it could be done without raising taxes.
Look how much of our tax dollars are funneled into the military-industrial complex (Defense).

Where has that gotten us? 2500+ dead soldiers, thousands more permanently injured, thousands of dead Iraqi civilians, increased terror, and practically the whole world hating us for our actions. That's where a huge Defense budget has gotten us!

Of course, the pharmaceutical industries are also heavy-hitters in politics.

(hmmm.... both the military-industrial complex, and pharmaceutical lobbyists are working against the best interests of the people, yet in different ways). just now finding my Sherlock cap
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Warpy Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:28 AM
Response to Original message
7. Well, the good news is that what you have is likely viral
and there's not much they can do for you anyway. Waiting a few days will tell them whether or not you've gotten a bacterial infection on top of it, and that's something they can treat.

Viral illnesses are horrid and may feel like an emergency, but most can be cured with rest, fluids, Tylenol and bad TV.

All medical practice has become a treadmill, an assembly line where human contact has largely been eliminated as being inefficient. We have a nursing shortage in this country because more than half the nurses have quit and gone on to something else because the working conditions in corporatized medicine are so bad. They're bad for the docs, too, and no amount of money will compensate for the working conditions. I'm afraid docs are going to start quitting, too, going on to administrative or educational careers. I've lost several good docs that way.

That is why the wait for treatment in corporatized medicine is going to increase and why even the rich aren't getting very good care in the hospitals.

However, your experience may have done you a favor, allowing you to avoid being medicated for soemthing you don't have yet by something you don't need.





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pinto Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:33 AM
Response to Original message
8. Many people forget that Medicare *is* socialized medicine. When
you see a Republican running around saying anything closely resembling "we want to save Medicare" don't believe it! They want to dismantle this bastion of Great Society "socialism". They just won't and can't tell the truth.
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rubberducky Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:04 AM
Response to Original message
11. Independant docs are scarce
Most docs (at least in my area) work for big corporate hospitals, so they are always sending you to a "specialist". I`m old enough to remember family docs, who seemed to handle everything. Back in the Dr. Welby days!!:)
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Nimrod2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:19 AM
Response to Reply #11
13. Same here....
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BuhByeChimp Donating Member (246 posts) Send PM | Profile | Ignore Mon Jul-10-06 11:07 AM
Response to Original message
12. Get a new doctors office or go to urgent care.
I've never waited that long before, especially at urgent care. I think I waited 15 minutes one time, I complained!!
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Nimrod2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:20 AM
Original message
Do you live in a big city? Where I go
you walk in with an apt. and you almost always stand for 10/15 minutes to let them know you are there for your prescheduled apt...
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ComerPerro Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 11:20 AM
Response to Original message
14. At least you can go to the doctor. I'm uninsurable
and can't even get coverage to buy seizure medication
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raccoon Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 12:06 PM
Response to Original message
19. People who are against a national health plan, IME, always
have group medical insurance through their employer, or Medicare and a Medicare supplement.

If these folks lost their group insurance because they were downsized or their plant closed and went overseas, they would quickly change their minds about "commie socialized medicine."
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neverforget Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 02:51 PM
Response to Original message
21. Here's my tale of 2 surgeries 2 1/2 years apart with insurance
and hospital costs.

In October 2003, I had surgery on my right hand due to a genetic disease (dupytrens contracture). Since I'm young (33) and this is mostly an older persons disease, the doctor chose to be aggressive and operate now instead of letting it grow. My insurance, which I get through work, took care of all of it except for co-pays. The total for surgery, doctors, etc in 2003 was about $6500. I was paying for 3 people on my insurance and it cost about $200/month through my company.

Fast forward to this year, April 2006, I have surgery on the other hand. I still work for the same company and my insurance costs the same $200/month but now it doesn't cover 100% only 90%. I owe the hospital $321, the doctor $120, the anesthesoligist $58 and a yet undetermined amount for physical therapy (probably about $60). So in the space of 2 1/2 years, the costs of surgery go up, my insurance gets worse yet I still work for the same company and have received 14% increase in salary since the first surgery and I am now struggling to pay the costs not covered by insurance.

This is where I get pissed off. I call the insurance company and ask them about these charges on the bill and this credit to the hospital. The lady tells me they have a negotiated rate for the procedures so they pay X amount credit Y amount and I get the Z amount. So I ask her how they come up with these dollar amounts and she says it's what's negotiated. I then ask about a a specific charge and she said she had no idea what that was because they use numbers for items.

Me: "So how do you know what you are being billed?"
Insurance lady: "We don't know and we don't question we just pay."

I didn't know whether to laugh or cry. In other words, there is no auditing, just cutting the checks. Kinda sounds like Halliburton, etc.

I keep hearing about the evils of Canadian healthcare, etc but our system is corrupt, expensive and inefficient. I am all for a single-payer system. I would rather pay more taxes and know that EVERYONE is covered than pay for insurance that is covering less and less for my me and my family. Those of us who have insurance are getting the bill for those who don't have insurance but require care. I'm pissed that my insurance is helping to pay for those who don't have any, not because I'm selfish and don't want too, but because this is a NATIONAL problem that needs to be solved nationally. We're all paying for it now but the only ones benefiting from it are the healthcare, insurance and drug companies. It needs to be fixed and fixed soon.

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Nimrod2005 Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 03:45 PM
Response to Reply #21
22. My costs where I work have gone up 25% in the past 3 years, my raise?
$0.00, as in zero, synonymous with nothing or empty or shit!!!

Same situations as you, my copays are higher, my deductibles are higher, actual costs for treatment are higher, my premiums are higher, yet my pay has not changed. Factor in inflation, about 3% per year...My out of pocket costs for healthcare have gone up 50%, no raise!!!

I say trade it all in for a Canadian or French style healthcare.
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neverforget Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:38 PM
Response to Reply #22
26. I'm sorry you have not recieved a raise in 3 years. That really sucks!
My raises over the last 2 years while nice, still have not reached the median income for my field in Portland. Everything costs more and my raises are eaten up in energy costs. :grr: It's next to impossible to have any "extra" money anymore. At least the wealthy are doing great because they are that matters. We're just serfs here to serve our corporate masters.
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BrownOak Donating Member (391 posts) Send PM | Profile | Ignore Tue Jul-11-06 12:12 PM
Response to Reply #21
28. You're not as bad off as you think
Fast forward to this year, April 2006, I have surgery on the other hand. I still work for the same company and my insurance costs the same $200/month but now it doesn't cover 100% only 90%. I owe the hospital $321, the doctor $120, the anesthesoligist $58 and a yet undetermined amount for physical therapy (probably about $60). So in the space of 2 1/2 years, the costs of surgery go up, my insurance gets worse yet I still work for the same company and have received 14% increase in salary since the first surgery and I am now struggling to pay the costs not covered by insurance.

In the last two years medical trend has increased by around 14% each year which means the cost has gone up nearly 30%. Your premiums have stayed the same and you've only lost 10% on your coinsurance. As the cost of the medical services goes up somebody has to pay for them. My guess is your employer made the decision to keep premiums where they were and lower the level of coverage because that would impact fewer people than spending more money for the same level of coverage.




This is where I get pissed off. I call the insurance company and ask them about these charges on the bill and this credit to the hospital. The lady tells me they have a negotiated rate for the procedures so they pay X amount credit Y amount and I get the Z amount. So I ask her how they come up with these dollar amounts and she says it's what's negotiated. I then ask about a a specific charge and she said she had no idea what that was because they use numbers for items.

Me: "So how do you know what you are being billed?"
Insurance lady: "We don't know and we don't question we just pay."

I didn't know whether to laugh or cry. In other words, there is no auditing, just cutting the checks. Kinda sounds like Halliburton, etc.


The numbers that Insurance Lady is referring to are either ICD 9 or CPT codes. If you asked her how much it was for your hospital room for example, if she doesn't know the code for that service she would have no way of knowing what to look for. On a surgical bill with multiple items it would be hard for her to locate it. Those codes are tied to a provider in their claims system which generates the repriced bill for the system to pay. All the person you spoke with has to do is to verify that the codes on the claim are the same as those on the hospital bill.

That said, I would guarantee you that there are audits being done because, at that point any money the company saves goes directly into their bottom line. It's in their best interests to audit those bills. But most audits are being done by the system, looking for duplicate codes or codes that couldn't possibly be found on the same bill. It's inefficient for an individual to review each bill as it comes in, especially if you can program a computer to do most of the same thing.
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neverforget Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 12:54 PM
Response to Reply #28
29. Thanks for telling me I'm not as bad off as I think. Do you want to pay
my bills? Didn't think so.

As for the insurance codes: I asked for a breakdown of what they were charged and she said they don't have it but the hospital would. She also told me specifically that there are items billed that have no codes. I have that now and am trying to make sense of it comparing it to the insurance bill.

The hospitals have to make a profit so they throw everything at the insurance company to see what sticks. My bill also has a $525 credit from the insurace company to the hospital, for what specifically the lady could not tell me. Where did that come from? She didn't know.

My employer is a HUGE company that is very profitable but somehow, every year, my insurance gets worse and worse while their profits continue to increase. What's up with that? The shareholders demand more and more while the employees pay for it with worse insurance and smaller raises.
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BrownOak Donating Member (391 posts) Send PM | Profile | Ignore Tue Jul-11-06 11:25 PM
Response to Reply #29
33. No, I don't want to pay for your bills
But then, I won't ask you to pay for mine either.

The point is, you think your insurance has gotten worse and worse when you haven't seen a premium increase in 2 years. But during that 2 years the cost of medical care has gone up by at least 30%. I can guarantee you with a near certainty that the amount of money your employer contributes to the cost of your health insurance has increased during that 2-year span. You've been able to maintain your $200 monthly expense for family coverage because they made the decision to change the coinsurance from 100% to 90%. Would you have been happier with contributing $250 a month over the last 2 years but not having any of your current expenses? Would you feel the same way if you were not facing your current medical bills?

I empathize with your situation but feel your anger toward your employer is misplaced in this situation. I deal with this crap every day and know what your employer was going through when they made the changes to their plan. I have no idea what their profits have been over the last 2 years, but there are few employers who have enjoyed the kind of profit increases that keep pace with the cost of medical services and insurance.

As for your hospital bill and the insurance bill, without actually seeing what you're dealing with I'm not able to give you anything beyond a vague explanation. Again though, I know how the larger carriers work and feel pretty confident that since the dollars they're spending come from their bottom line, they don't just pay these things without any safeguards in place.

Now, if you want, I'll be happy to have one of the people in my office look at your hospital bill and your insurance EOB. I'm not saying that it's out of the realm of possibilities there's an error in there that hasn't been caught. I've seen plenty of sloppy billing from hospitals and other providers. A couple of weeks ago I saw an instance where a woman had a pacemaker put in and the hospital had marked up the price of the pacemaker about 800% which is bad enough but only got worse when we found that the patient didn't meet the criteria for the procedure and could have been treated with a less costly and less invasive treatment.

My offer is sincere and if you want an outside review just drop me a PM.

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conflictgirl Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 05:25 PM
Response to Original message
24. Yep, when I had health insurance, I couldn't even get into a doctor!
There was a time a couple years ago when we had very good insurance. I knew I had strep throat and needed antibiotics; I'd had it before and knew the symptoms very well. So I called my doctor telling them that I had strep and need antibiotics...they said they could get me in two weeks later! I ended up having to go to one of those walk-in urgent care kind of places and paying out of pocket. $140 for the visit and rapid strep test, if I remember correctly. So much for that good insurance!
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PA Democrat Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 05:42 PM
Response to Original message
25. Americans pay 53% more for health care than the next most expensive country
U.S. citizens paid $5,267 per person for health care in 2002, 53 percent more than any other industrialized country and $1,821 more than Switzerland, the nation with the second highest per-capita spending.

We pay for drugs, hospital stays, and doctor visits 2 to 2 1/2 times as much as other countries pay. Americans pay twice as much for prescription drugs than other countries.

While medical malpractice is a problem, its cost account for less than 1 percent of spending. And defensive medicine makes up no more than 9 percent of total spending.

Despite the belief that Americans make frequent use of some of the best medical care in the world, they see doctors less often and spend 20 percent fewer days in the hospital than most other countries.

http://hrblog.typepad.com/hrblog/2005/07/americans_pay_5.html
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Quantess Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Jul-10-06 10:51 PM
Response to Original message
27. Yet another tragic story:
I know a man who recently had a stroke, whose speech is greatly impaired, who is in desperate need of a speech-pathologist, but he hasn't gotten any speech treatment, at all, because he has no insurance.

Studies have shown that stroke victims benefit most from treatment given immediately after a stroke, or at least, as soon as possible. This is the critical time for him to be regaining his speech functions, but he isn't getting any treatment at all!

He is an accountant, about 50, and his speech and cognitive needs are being neglected because he has no insurance.
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Cleita Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 11:37 PM
Response to Original message
34. The for profit propaganda astroturf spreaders always say
Canada, France and Germany have problems, but they can't back it up. When you go to the sources that give you the stats, the truth is that we have a poor health care system that lumps us in with third world countries as far as infant mortality and deaths that could have been cured if those people would've had access to health care.
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Selatius Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:23 AM
Response to Reply #34
42. Hell, Cuba has lower infant mortality rates than we do. n/t
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Quantess Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 12:32 AM
Response to Reply #42
44. Here's your link for that
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Lydia Leftcoast Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 01:05 AM
Response to Reply #34
47. Yes, years ago when Harris Wofford ran for Senate on a health care
platform, I was talking about this issue in a group that included an American who had just returned from living in England for nine years.

One person present brought up a "horror story" article in the local paper about the UK health system, claiming that everybody had to wait months to see a doctor all the time.

The recently returned American had seen the article as well, and he informed us that it was copied from the London Sun, which sounds legit to someone who doesn't know better but is actually more like the National Enquirer.

I know a number of people here in the U.S. who have had hip replacements and knee replacements and other elective surgeries. All of them have had to schedule months in advance.
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LSK Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Jul-11-06 11:43 PM
Response to Original message
36. i had to wait 3 days to get an emergency root canal
And I have coverage and money to pay for it.

Their claims are a bunch of BULLSHIT like EVERY OTHER CLAIM THEY PUT FORTH.
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Lydia Leftcoast Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jul-12-06 01:11 AM
Response to Original message
48. The best deal I can get here in Minneapolis
Edited on Wed Jul-12-06 01:12 AM by Lydia Leftcoast
at my age is a 1000 dollar deductible with a 20% copay on top of that.

I have NEVER used up my deductible, because I'm basically healthy and mostly believe in letting the body heal itself.

However, my premiums went up $80 a month last year when I hit a major birthday and another $30 when I hit my most recent birthday--even though I have never cost the insurance company a cent.

Don't tell me to find another insurance company. The other two in town are even worse.

Don't tell me to get a Health Savings Account. That would give me the "privilege" of paying the same premium for a higher deductible AND the need to set aside an extra $200 a month.

Rrrright.

Owning a health insurance company is a license to print money.
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